Minimal Q's for peds Flashcards
Imaging modality of choice when evaluating a child for infantile hypertrophic pyloric
stenosis:
ultrasonography.
Typical age of intussusception in infants:
3 months - 3 years.
Standard imaging modality of polytraumatized patients
acute CT.
Most common cause of acute abdomen in children:
appendicitis
Which is the most common cause of strangulation ileus?
Incarcerated hernia
The most common cause of transfusion-requiring hematochezia, without abdominal pain and without
diarrhea
Meckel’s diverticulum.
You find a high GGT in a patient with ulcerative colitis, what should you think about?
Sclerosing
cholangitis
What are the two typical anamnestic features of acute appendicitis? F
First epigastric and periumbilical
pain, later the pain is localized in the right lower abdominal quadrant.
What are the typical characteristics of perianal fissures in Crohn’s disease?
Not in the midline, deep, not
painful
What is the first therapeutic choice in Crohn’s disease?
Exclusive enteral nutrition.
What are the two most frequent chest deformities?
Pectus excavatum and pectus carinatum
What are the 4 most important indications of adenoidectomy? R
Recurrent infections of the upper respiratory tract,
recurrent otitis media
inhibition of nasal breathing,
obstructive sleep apnea.
The most frequent pathogen of sinusitis and otitis media?
Str. pneumoniae
In which cases of middle-ear inflammatory disease should we suggest tympanostomy tubes (Grommet)?
Chronic serous otitis media and/or chronic dysfunction of the Eustachian tube
What is the most frequent pathogen in urinary tract infections?
E. coli.
What are typical signs of bacterial otitis externa?
Pain and/or tenderness of the tragus
What are the typical abnormalities in urine analysis in glomerulonephritis?
Red blood cells and red blood
cell cylinders. Proteinuria can also appear
What is the most frequent cause of hypertension before the adolescent age?
Kidney disease.
Which is the most frequent glomerulonephritis type?
IgA nephropathy.
What is the prognosis of West-syndrome or infantile spasm?
Usually poor.
Which bacterium is the most frequent cause of childhood pneumonia?
Str. pneumoniae.
What are the two main components of the treatment of pseudocroup?
Rectal steroid, inhalation of
adrenaline
What is the most common cause of new onset cough?
Viral infection.
What is the Holzknecht sign characteristic for?
Airway foreign body aspiration.
What is the most common cause of a cough ongoing since birth which always presents during feeding?
tracheoesophageal fistula.
What percentage of the mortality is caused by accidents in Hungary in children older than 1 year?
36-
40%, this is the main cause of death in children older than 1 year.
what is the prognosis of juvenile absence epilepsy?
Usually favorable
What can prevent coronary artery disease (aneurysm) in Kawasaki syndrome?
IVIG
What is the most serious complication of juvenile idiopathic arthritis?
Macrophage activation syndrome
(MAS).
Which muscles are affected in juvenile polymyositis?
Proximal muscles of the limbs.
what is the typical feature of stool in biliary atresia?
Clay-colored (acholic) stool.
What kind of diseases are included in atopic march and in which order
Atopic dermatitis
Food allergy -
Asthma bronchiale
Allergic rhinitis
How is food allergy diagnosed? What is the reliability of IgE testing?
IgE testing is not reliable. The
diagnosis should be based on double blind oral food challenge
In which case serological testing is not informative in celiac disease.
In IgA deficiency
What is the diagnostic basis of endocarditis?
Blood culture and echocardiography.
What are the upper airway infections that should be treated with antibiotics?
Streptococcus angina, acute
otitis media and acute bacterial sinusitis.
What is the diagnostic basis of erythema migrans?
The fact of tick bite and the clinical picture:
growing erythema which is more than 5 cm in diameter
What is the ideal age for closing the soft palate defect?
Between 9 and 18 months.
What is the most likely diagnosis in the following case: patient with polyuria, polydipsia with positive urine
glucose and acetone test?
Diabetes mellitus.
patient with typical diabetes symptoms has a 18.2 mmol/l blood sugar level in the afternoon. What is to be
done?
Refer the child to a pediatric diabetic center immediately.
) What kind of hormonal changes are seen in the salt wasting form of congenital adrenal hyperplasia
due to deficiency of 21-hydroxylase?
Insufficient glucocorticoid and mineralocorticoid
secretion, excessive androgen secretion.
How does the mother’s iodine deficiency influence the newborn’s thyroid function?
It results in temporary
primary hypothyroidism.
Which is the most common adrenocortical enzyme defect?
The defect of the 21-hydroxylase enzyme.
what are the most typical histologic findings in ulcerative colitis?
Crypt abscesses.
name at least 5 extraintestinal abnormalities in celiac disease:
: hepatitis, osteoporosis, arthritis, isolated
iron deficiency, Duhring-disease (dermatitis herpetiformis).
What is the definition of “graft versus leukemia”?
Immunologic attack of the donor cells against the
patient’s leukaemic cells after allogeneic bone marrow transplantation.
what is a haploidentical transplant? H
Half matched HLA antigen stem cell transplant (from usually a
family member).
What does allogeneic stem cell transplant mean?
The patient (recipient) gets hematopoietic stem cells
from another person (donor)
What glucose levels are diagnostic for diabetes mellitus?
Fasting blood glucose level higher than 7
mmol/l, or more than 11.1 mmol/l at any time or at any point during an oral glucose tolerance
test (OGTT)
Which are the 4 presenting symptoms of diabetes mellitus? P
Polyuria, polydipsia, weight loss with
good appetite, fatigue-weakness.
What are the diseases most commonly associated with type 1 diabetes mellitus?
Celiac disease and
Hashimoto thyroiditis.
What is the most modern therapeutic method of type-one diabetes?
? Insulin pump with an integrated
glucose sensor.
How much insulin should be given in diabetic ketoacidosis?
0.05-0.1 U/kg/h.
Since the introduction of expanded screening, how many congenital metabolic diseases are screened
routinely in Hungary?
27 and SMA screening is also available.
The final therapy of biliary atresia is liver transplantation. There is a surgical bridging therapy before
transplantation. What is the name of this operation?
Kasai porto-enterostomy.
How often should a baby be breastfed?
On-demand.
When is it suggested to introduce cow’s milk for children?
After 12 months of age.
How does the breast milk’s protein content relate to the cow’s milk protein content?
One third.
What are the most important diseases which can be easily diagnosed and followed up by cranial
ultrasound
Brain hemorrhage and hydrocephalus.
for how long can we see the shadow of the thymus on the thoracic X-ray?
Until 3 years of age.
What radiological examinations can be done to diagnose VUR? (Name three!)
MCU (Micturating cystourethrogram)
Sono-cystography
Dynamic kidney-scintigraphy.
How can you diagnose perforation in a critically ill baby with necrotizing enterocolitis if you cannot move
them in the incubator?
Horizontal X-ray from side position while the baby is lying on the back.
In which part of the bone does osteomyelitis start?
In the metaphysis.
How long to wait after surgery before bathing?
7-8 days
What is chicken pox (varicella) reactivation called?
Herpes zoster.
What is the sixth disease?
Exanthema subitum, roseola infantum.
Which is the contagious disease that causes severe fetal injuries in 80 percent of its cases?
Rubella.
Name at least five examples when pulse oximetry is not informative!
! Carbon-dioxide intoxication,
methemoglobinemia, severe anemia, cardiac failure, cold extremities.
Define paradoxical breathing! T
The chest moves inward and the abdomen moves outward during
inhalation, and vice versa
How do we give oxygen to a conscious patient in an emergency situation who is breathing spontaneously?
Through a face mask with a reservoir, with high flow oxygen (10-15 l/min).
How does the concentration of protein and glucose of CSF change in bacterial meningitis? P
Protein
concentration is increased, glucose concentration is decreased.
Name of the two most common pathogens of newborn meningitis!
Streptococcus agalactiae, E. col
What affects the sensitivity of blood culture? T
The amount of blood drawn within 24 hours after the fever.
Name the condition of infants associated with abdominal pain in which bowel movements are preceded by
tension and crying lasting for about 10 minutes?
Infantile dyschezia
The pathogen causing neonatal infection that can be identified by maternal vaginal secretion screening.
Streptococcus agalactiae (group B Streptococcus, GBS).
The amount of a single fluid bolus required to treat septic shock:
10 ml/kg
The most common endocrine disorder causing growth retardation:
Thyroid dysfunction –
hypothyroidism
What does precocious puberty mean in the case of girls?
If the secondary sexual characteristics appears
before the age of 8 years.
What changes can we see in the urine sediment in typical pyelonephritis?
Leukocytes and bacteria.
in which chromosomal abnormality is duodenal atresia common? T
Trisomy 21 (Down syndrome).
What is the radiological sign of duodenal atresia?
Double-bubble” sign.
What are the B-symptoms in lymphoma?
Fever, night sweats, weight loss
What to do in case of neutropenic fever?
Broad spectrum empiric antibiotic therapy after taking blood
cultures
What are the serum electrolyte disturbances in case of tumor lysis syndrome?
Elevated
potassium, phosphate and uric acid, decreased calcium.
What are the alarming signs of retinoblastoma? What examinations are required?
Strabism, leukocoria -
ophthalmoscopic examination.
At what platelet count is there major risk of bleeding?
Below 10-20 G/l.
What is the most common type of malignancy in childhood?
ALL.
What are the symptoms of increased intracranial pressure?
Headache, vomiting in the morning,
nuchal rigidity, setting-sun sign, focal neurological signs, bradycardia, high blood pressure,
irritability, bulging fontanelle.
What are the physical symptoms of anemia?
? Fatigue, paleness, tachycardia, systolic heart murmurs
How does the total iron binding capacity change in case of anemia and inflammation?
Increased in
anemia, decreased in inflammation.
) What is the treatment of immune thrombocytopenia (first- and second-line treatment.)?
IVIG, corticosteroid.
List the signs of increased work of breathing!
Use of respiratory accessory muscles, intercostal
retraction, jugular retraction, nasal flaring, paradoxical breathing, grunting.
At what age do the fontanelles close at the latest?
Posterior fontanelle: by 3 months, anterior fontanelle:
by 18 months.
What are the symptoms and laboratory signs of nephrotic syndrome?
Proteinuria, hypoalbuminemia,
hyperlipidemia, oedema
What are the symptoms and laboratory signs of nephritic syndrome?
Hematuria
oedema
hypertension
uraemia + oliguria (kidney failure is correct instead of the latter two).
What factors are included in the APGAR score?
Heart rate, respiratory rate, skin color,
reflex irritability, muscle tone.
Age limits of puberty?
Boys: 9-14 years. Girls: 8-13 years.
What are the direct and indirect signs of appendicitis?
Direct sign: tenderness at the McBurney point.
Indirect signs: Blumberg, Rovsing, Obturator, Psoas signs.
How can we estimate the body weight between the ages of 2-8 years?
(2 x years) + 8.
What does autologous stem cell transplantation mean?
A procedure in which a patient’s healthy stem
cells are collected from the blood or bone marrow before high dose chemotherapy, stored, and then
given back to the patient after treatment.
What is the heart rate and respiratory rate of a healthy newborn?
Respiratory rate: 50-60/min, Heart rate:
120-160/min.
Which cultured pathogen from throat swabs warrants antibiotic treatment?
str. pyogenes
103) In case of maternal GBS positivity, up to what age can this bacteria cause disease in the baby?
up to 6 months of age
What is the recommended empiric treatment of neonates with suspected sepsis?
ampicillin + gentamicin
What factors are included in the croup score?
Sound of inhalation, stridor, cough, signs of dyspnea
(nasal flaring, retractions), cyanosis.
In case of pain localized to one point in the bone, when should we order an X-ray if the pain does not
stop?
1 week
What is the choice of imaging modality if acute osteomyelitis is suspected?
MRI.
What is the most common presentation of cow’s milk protein allergy in infants?
Bloody stool.
Which disease should be suspected in case of bloody stool and vomiting in neonates?
Volvulus.
110) Which disease should be suspected in case of neonates with distended abdomen and severe
constipation?
Hirschsprung-diseas
