Natsumi Pediatric Flashcards

Question 1

Q

Children younger than 5, averaging 18 months old.
Myoclonic jerk extremities, chaotic eye movements in all directions, hypertension, palpitations, diarrhea.

PE: palpable abdominal mass, diastolic hypertension, increased urine VMA and HVA

What do you suspect? Investigation? Tx?

Answer

A

Neuroblastoma - adrenal medulla cancer

Test:
Tumor biopsy
CT or MRI of chest, abdomen, pelvis
bone scan to look for lytic lesions

Tx: usual cancer tx

Prognosis: 40% survival rate, but children 1 yo have a 90% cure rate

Question 2

Q

This condition has point mutation that inactives RB Leukocoria, strabismus are associated with?

Answer

A

Encephalitis

Question 3

Q

Inestivestigtion

Answer

A

MRI is best

Question 4

Q

This childhood condition Slapped cheek appearance and exanthema. lasts 2-4 days with headache fever, sore throat, pruritus, arthralgia. Erythematous maculopapular rash extends to the trunk and proximal extemitites.

Answer

A

Erythema infectiosum

ELISA increased IgM , PCR, clinci l

Self limiting -can use NSAID

Question 5

Q

Parovirus B19 is associated with which dz

Answer

A

Erythema infectiosum

Question 6

Q

Coxsackievirus

Answer

A

Hand-foot-mouth disease

fecal oral route or skin lesion contact or oral contact t

Question 7

Q

Mcular lesion on buccoal mucosa, tongue that may be painful. Lesion vesicular that erode and become surround by erythematous halol

hands, feet, butt, genital

Fever of 38-39 C within the first 24-48 hours

Answer

A

Hand-foot-mouth disease

clinical dx, self limiting

Question 8

Q

Coxsackievirus

Answer

A

Hand-foot-mouth disease

Fecal-oral route or skin lesion contact or oral contact t

Question 9

Q

Macular lesion on the buccal mucosa, the tongue that may be painful. They can erode and become surrounded by an erythematous halo.
Skin lesions are erythematous, tender macules or vesicles on hands, feet, butt, genital
Fever of 38-39 C within the first 24-48 hours

Answer

A

Hand-foot-mouth disease (Coxsackievirus)

clinical dx, self-limiting

Question 10

Q

coxsackievirus A16 and enterovirus 71

Answer

A

Herpangina

Question 11

Q

Most are asymptomatic
Fever 101-104 F
Multiple vesicles or ulcers on soft palate and pharyn surrounded by erythema
Gray papulovesicular with erythematous base
Sore throat upon swallowing
Incubation period: 4-14 days

What do you suspect? Investigation? Tx?

Answer

A

Herpangina - due to enterovirus infection (fecal-oral, respiratory route, fomites)

Diagnosed clinically

Self-limiting

Question 12

Q

Fever, nuchal rigidity/stiff neck, headache, seizures, altered level of consciousness, n/s

Lab differences: (bacterial vs. viral)

Increased CSF protein
Increased total CSF leukocytes
Normal CSF glucose
Grain stain negative

or

Increased CSF protein
Increased total CSF leukocytes
Decreased CSF glucose
Grain stain positive, positive culture

Answer

A

Meningitis - pia mater inflammation

ER!!! MONITOR VITALS & AIRWAY

Question 13

Q

Most are asymptomatic
Fever 101-104 F
Multiple vesicles or ulcers on soft palate and pharyn surrounded by erythema
Gray papulovesicular with erythematous base
Sore throat upon swallowing
Incubation period: 4-14 days

What do you suspect? Investigation? Tx?

Answer

A

Herpangina - due to enterovirus infection (fecal-oral, respiratory route, fomites)

Diagnosed clinically

Self-limiting

Question 14

Q

Paramyxovirus

Question 15

Q

Paramyxovirus

Answer

A

Mumps, Rubeola

Question 16

Q

Incubation 12-25 days transmitted via droplets
Fever, HA, BL parotitis with increased serum amylase, ears are displaced laterally and superiorly, myalgia, malaise

What do you suspect? Investigation? Tx? Complications?

Answer

A

Mumps

Test: ELISA immunoglobulin titer

Tx: MMR vaccine

Complications: pancreatitis, orchitis, epididymitis, infertility, encephalitis, myocarditis, arthritis

Question 17

Q

Bordetella pertussi bacterial infection

Answer

A

Pertussis

Tx: Azithro

Question 18

Q

3 stages

Catarrhea stage (1-2 weeks): mild cough, coryza, cyanosis
Paroxysmal stage (2-4 weeks): paroxysmal bouts of 10-30 coughs, interrupted by 'whoops" to get air. Vomiting with coughing spells
Convalescent stage (1-2 weeks): decreased frequency and severity yhst van last up to 6 months

Answer

A

Pertussis

Question 19

Q

High fever that lasts 3-5 days which

after an abrupt loss of fever → pink, non-pruritis macules and maculopapular that starts at neck and trunk → face and extremities (lasts 2 days)

Answer

A

Roseola Infantum

Complications
Febrile seiuares
enxephalitis

Question 20

Q

HSV 6

Answer

A

Roseola Infantum

Question 21

Q

RNA togavirus (

Answer

A

Rubella (3 day measle)

Question 22

Q

Forcheimer’s spot

Answer

A

red sports that develop on posterior soft/hard palate that develop at the onset of rash

Question 23

Q

Rash that is ITCHY, starts at hairline → rapidly spreads to neck trunk and tst of the body

Answer

A

Rubella

ELISA

Question 24

Q

Rash that is ITCHY, starts at hairline → rapidly spreads to neck trunk and tst of the body

Answer

A

Rubella

ELISA

Question 25

Q

Morbilliform rash starts at hairline → spreads to neck/face/trunk, desquamates
Enanthem: koplik spots (grey/white papules on buccal mucosa)
Prodrome: Cough, coryza, conjunctivitis

What do you suspect? Investigation? Tx? Complications?

Answer

A

Rubeola

desquamates = no palm or sole involvement

Test: Clinical

Complication: otitis media, pneumonia, encephalitis, SJS, glomerular nephritis, myocarditits/pericarditis

Vitamin A, immunoglobulin, MMR vaccine

Question 26

Q

Caused by toxin-producing group A beta-hemolytic streptococci (GABS)
Children aged 5-15 years
Acute onset of fever, sore throat
24-48 hours after pharyngitis, erythematous rash develops on the face and neck before spreading to
other parts of the body
Sandpaper quality, non-pruritic, non-painful
Spares the mouth, but tongue has white exudate that is studded with prominent red papillae
Rash fades after 6 days and peeling begins that can last up to 10 days
White exudate on tongue disappears leaving it to be beefy red which is termed, ‘strawberry tongue’

What do you suspect? Investigation? Tx? Complications?

Answer

A

Scarlet Fever

Investigation: rapid strep test, throat culture

Tx: Penicillin, amoxicillin

Question 27

Q

Group A streptococci infection (GABHS)
Commonly occurs in school
Children aged 5-10 years, uncommon children <3 years old

Clinical Features
• Mclssac Criteria
• No cough
• Age 3-14 years old
- Tender anterior cervical lymphadenopathy
• Erythematous tonsils
- Fever >38°C

Assign 1 point for each feature

• 0-1: no culture, no antibiotics
- 2-3: Culture, treat if positive
- 4: Antibiotic 
Investigations
• Culture, Rapid Strep antigen test
• If Rapid strep test is negative (50-90% sensitivity), throat swab for culture as it is the gold
standard (90-95% sensitivity)

Answer

A

Streo Pharyngitis

Investigations
• Culture, Rapid Strep antigen test
• If Rapid strep test is negative (50-90% sensitivity), throat swab for culture as it is the gold
standard (90-95% sensitivity)
Treatment

• If Mclsaac score is >1, treat with Penicillin or Amoxicillin, but must be treated with 9-10 days to
prevent rheumatic fever
• Acetaminophen for discomfort

complications
• If untreated, it can lead to complications such as otitis media, sinusitis, pneumonia, mastoiditis,
peritonsillar abscess, scarlet fever, rheumatic fever
• If infection is invasive, prescribe clindamycin antibiotic

Question 28

Q

This condition is investigated using psudohyphae and gram-positive yeast seen on gram stain or with KOH stain

Limited in infants, antibiotics/steroid use/ immunocompromised group

Answer

A

Thrush

Tx: Nystatin or fluconazole

Question 29

Q

• Varicella-zoster virus
• Affects those who are <10 years of age, usually occurs in the spring months
• Incubation of 2-3 weeks; patient is highly infectious 1 week before rash begins and until vesicles have
crusted over
• Transmitted through respiratory secretions and vesicular fluid
• Maternal infection in the first trimester can cause a small chance (0.4 - 2.0%) that the baby could be
born with birth defects known as “congenital varicella syndrome”. Also 10-20% of pregnant women may
develop pneumonia, with the chance of death as high as 40% if infected in the first trimester.
Clinical Features
• 1-3 days of fever and respiratory symptoms
• Pruritic rash progresses from macules, to vesicles to pustules that burst and lesions crust over
• Involves trunk, face, scalp, conjunctivae, oral mucosa, extremities including palms and soles
• If scratched, vesicles can bleed• Maternal infection in the first trimester can cause a small chance (0.4 - 2.0%) that the baby could be
born with birth defects known as “congenital varicella syndrome”. Also 10-20% of pregnant women may
develop pneumonia, with the chance of death as high as 40% if infected in the first trimester.
Clinical Features
• 1-3 days of fever and respiratory symptoms
• Pruritic rash progresses from macules, to vesicles to pustules that burst and lesions crust over
• Involves trunk, face, scalp, conjunctivae, oral mucosa, extremities including palms and soles
• If scratched, vesicles can bleed

Investigations
• Tzanck smear test (Sensitivity of 60%)
• Confirmation with culture of vesicular fluidComplications
• Secondary bacterial infection with Group A streptococci
• Impetigo, abscesses, cellulitis, necrotizing fasciitis, sepsis
• Cerebellar ataxia, pneumonia
• Life-threatening in immunocompromised patients
• Neonates who were born from mothers who developed varicella 5 days before, or 2 days after
delivery are considered high risk
• Must begin Varicella zoster immune globulin (VariZIG) treatment ideally with 4 days (10 days
the latest)
• Virus becomes latent in sensory ganglia and reappears later as herpes zoster (shingles)
- Increased incidence in immunocompromised individuals

Answer

A

Varicella

Treatment
• Acyclovir antiviral medication
• Proper hygiene, do not scratch to prevent spread of infection to others
• Do not prescribe aspirin (ASA) in children due to risk of Reye’s syndrome
• Avoid contact with others until lesions have crusted over and no new lesions appear

Question 30

Q

6 months to 4 years
Prainfluenza (type 1,2,3)
Adenovirus

Clinical Features
• Begins with nonspecific respiratory symptoms such as rhinorrhea, sore throat and cough
• Low grade fever
• Within 1-2 days,
• Hoarse voice, barking cough
• Inspiratory stridor
© Symptoms worse at night as it is difficult to breathe while sleeping that can send the
child to the ER
• Symptoms resolve within 3-7 days but can last up to 2 weeks

Answer

A

Croup

Tests: Clinical diagnosis
- AP X-ray → Steeple sign with subglotting narrowing

Tx:

Humidified O2
Dexamethasone, prednisone
Epinephrine
Intubation, hospitalization if not better in 4 hours

Question 31

Q

Steeple sign on X-ray

Question 32

Q

Autosomal recessive, chromosome 7
Primarily affects Caucasions (>98%)
Usually diagnosed at 5 months of age with a median survival age of 30 years

Clinical Features
• Nasal polyps
• Heat exhaustion from the loss of sodium in the sweat from the skin
• Recurring respiratory infections
• Pseudomonas aeruginosa, Staph. aureus
- Cor Pulmonale commonly occurs
• Wheezing or chronic cough
• Malabsorption
- Chronic pancreatitis
- rales, rhonchi, clubbing of fingers, anemia, hypoproteinemia, hyponatermia

Type 1 diabetes mellitus from chronic pancreatitis
Meconium ileus
Gallstones (>50%)
Distal intestinal obstruction syndrome, rectal prolapse
Clubbing of fingers

Answer

A

Cy stic fibrosis

Test:

Sweat chloride test (> 60 mmol/L in children, >80 mmol/L in adults)
Clinical

Treatment
• Bronchodilators (e.g Albuterol/Salbutamol)
• Antibiotics depending sputum (e.g ciprofloxacin, cephalosporin)
• Corticosteroids
• High calorie diet
• Fat soluble vitamin supplements
• Pancreatic enzyme replacement
• Refer to Pulmonologist

Question 33

Q

In this condition, vocal cords are not involved, HiB vaccine is usually administered to avoid this dz.

Clinical Features
• Occurs at any age, particularly between the ages of 1 to 4 years old
• Rapid onset
• Cyanotic, inspiratory stridor, slow breathing, drooling
• Sore throat
• Dysphagia (difficulty swallowing)
• Restlessness

Answer

A

Epiglottitis

Investigations
• Physical exam can lead to complete obstruction, therefore they are contraindicated

Question 34

Q

SUDDEN INFANT DEATH SYNDROMEEpidemiology
• Leading cause of death of infants in the 12 months
• Approximately 60-70% of SIDS deaths occur in males
• More common in children who are placed in prone position
• Most deaths occur between midnight and 8 AM
Risk Factors
• Smoking in the household
• Bed-sharing may lead to compromise of an infant’s airway, especially before the age of 3-4 months
• Breastfeeding reduced the risk of SIDS by approximately 50% at all ages throughout infancy
• Pacifier (dummy) use may reduce the risk of SIDS
• Covering the infant’s head with bedding or bed clothing is a risk factor for SIDS
• Overbundling of infants during sleep should be avoided
Prevention
• Place infant on back, NOT in prone position when sleeping
• Avoid overheating and overdressing
• Observe for presence of toys, pillows, or other objects that may cause asphyxiation
• Firm mattress, no loose bedding
• Avoid smoking
Risk Factors
• Smoking in the household
• Bed-sharing may lead to compromise of an infant’s airway, especially before the age of 3-4 months
• Breastfeeding reduced the risk of SIDS by approximately 50% at all ages throughout infancy
• Pacifier (dummy) use may reduce the risk of SIDS
• Covering the infant’s head with bedding or bed clothing is a risk factor for SIDS
• Overbundling of infants during sleep should be avoided
Prevention
• Place infant on back, NOT in prone position when sleeping
• Avoid overheating and overdressing
• Observe for presence of toys, pillows, or other objects that may cause asphyxiation
• Firm mattress, no loose bedding
• Avoid smoking

Answer

A

Suddwn infant death syndrom

Question 35

Q

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants and
young children and manifests as bronchiolitis
• See Bronchiolitis in Respirology
Baby bronchitis dearth

Risk Factors
• Childcare attendance
• Overcrowding and lower socioeconomic status
• Exposure to environmental pollutants
• Minimal breastfeeding
• Multiple birth sets (triplets or more)

Clinical Features
• Low grade fever
• Cough
• Wheezing
• Cyanosis
• Tachypnea
• Rales or crackles
• Sepsis or toxic-like appearance

Answer

A

Respiratory Syncytial Virus

Investigations
• Viral culture for RSV (Molecular probe is the most sensitive) by swabbing nasopharynx
• X-ray shows hyperinflated lung fields with a diffuse increase in interstitial markings• On autopsy, histological findings of mononuclear cell and neutrophil infiltration of the peribronchiolar
areas

Question 36

Q

CONGENITAL HEART DISORDERS
ATRIAL SEPTAL DEFECT (ASD)
• Patent foramen ovale (opening between right and left atriums)
Epidemiology
• 6-8 % of congenital heart lesions
• 80-100% spontaneously close if the ASD is <8 mm
• Most common adult AD, congestive heart failure and pulmonary hypertension can develop in adults
while asymptomatic in childhoodPhysical Exam
• Blood flow across the AS does not create a murmur at the site of the shunt because there is no
pressure gradient between the atria. But, an AD with a moderate to large left-to-right shunt results in a
increased right ventricular stroke volume leading to a crescendo-decrescendo systolic ejection murmur
heard at the 2nd intercostal space at the upper left sternal border
• Patients with large left-to-right shunts often have a rumbling mid-diastolic murmur at the lower left
sternal border because of increased flow across the tricuspid valve; and fixed splitting of S2

Answer

A

Atrial septal defect

Investigations
• ECG
• Chest X-ray show cardiomegaly because of dilatation of the right atrium and right ventricular
chamber.
• Doppler echocardiography may be helpful in demonstrating flow across the atrial septum

Tx: surgery to close ASD through catheterization

Question 37

Q

•
• Associated with Turner’s syndrome
Physical Exam
• Increased upper extremity blood pressure
• Increased cerebral blood flow
• Decreased blood pressure in the lower extremity
• Leg claudication (pain in calf when walking) with weak or absent pulses in lower extremities
• Decreased renal blood flow leading to an activation of renin-angiotensin-aldosterone system causing
hypertension

Answer

A

Coarctation of the aorta - Narrowing of aorta almost always at the level of the ductus arteriosus and left subclavian artery

Test: Chest X-ray, MRI

Treatment
• Surgery to remove coarctation

Question 38

Q

•
• In PDA, it produces a left-to-right shunt causing blood from systemic circulation to pulmonary
circulation, leading to pulmonary hypertension
• Produces a pink upper body and cyanotic lower body (because ductus ateriorosus occurs after
the left subclavian artery)

Physical Exam
• Tachycardia
• Heavy “machinery” murmur heard during systole and diastole
• Wide pulse pressure
• The peripheral pulses are bounding because of high left ventricular stroke volume to compensate for
the PDA, and with low diastolic pressure in systemic circulation

Investigations
• ECG
• Chest X-ray may show normal to mildly enlarged heart
• Doppler echocardiography to identify the abnormality

Answer

A

Patent Ductus Arteriosus (PDA) - In PDA, ductus arteriosus remains open (vessel connection between descending aorta and left
pulmonary artery)

Tx: Surgery to close PDA

Question 39

Q

Right-to-left shunt causing cyanosis, shortness of breath and fatigue,
severe= seizure

Physical Exam:
• Systolic murmur heard along the left sternal border
• Systolic thrill along the left sternal border
• Harsh systolic ejection murmur is heard over the pulmonic area and left sternal border
• Loud S2 heard due to pulmonary stenosis

Answer

A

Tetraology of Fallot

• Combination of conditions:
- Ventral septal defect
- Right ventricular outflow tract obstruction
- Overriding aortic root
- Right ventricular hypertrophy
Treatment: Surgical repair preferably before the 2nd year of life

Investigations
• Doppler echocardiography
• Chest X-ray shows a classic boot-shaped heart
• ECG

Tx: Surgical repair before 2 yo

Question 40

Q

Most common congenital heart disease in children
Opening in ventricle septum allowing blood to flow between ventricles
Left-to-right shunting

Clinical Features
• Shortness of breath, exercise intolerance
• Lethargy, delayed growth and development
• Recurrent upper respiratory tract infections
• Congestive heart failure

Physical exam
• Holosystolic murmur at lower left sternal border with thrill
• Mid-diastolic rumble at apex

Answer

A

Ventricular Septal Defect (VSD)

Investigations
• Doppler echocardiography can be used to determine the size and location of VSDs
• Chest X-ray

small VSD - most close spontaneously

Question 41

Q

Most common congenital heart disease children

Question 42

Q

Name of the following condition:

Risk Factors
- Associated with malformations of the anorectal, vertebral or genitourinary structures

Clinical Features

Persistent straining, ribbon stools
Fecal impaction, distention

Answer

A

Anal Stenosis - congenital narrowing of the anal canal

Tx: surgical dilation

Question 43

Q

What is Encopresis

Seen more in M or F

Definition
• Fecal incontinence in a child >4 years old, occurring at least once per month for 3 months
• M:F = 6:1 in school-aged children
Risk Factors
• Chronic constipation
• Difficulty with bowel training
• Hypothyroidism

Evaluation
• Clinical diagnosis
• Physical exam may show anal fissure from painful stooling
• Emotional history could present a social and emotional stress between child and parent
• Child develops constipation through withholding bowel movement leading to fecal impaction and
seepage of soft or liquid stool
• Lack of toilet training or motivation to learn
• May show oppositional behavior

Answer

A

Child develops constipation through withholding bowel movement leading to fecal impaction and seepage of soft or liquid stools. Social and emotional stress.

Question 44

Q

HIRSCHSPRUNG DISEASE
• Absence of ganglion cells in Meissner’s submucosal plexus and Auerbach’ myenteric plexus in distal
colon, causing localized constant contraction without relaxation, resulting in obstruction

Clinical Features
• No meconium within the first 48 hours
• Palpable stool on abdominal exam with empty rectum on digital rectal exam
• Bowel movement only with rectal stimulation
• Alternating signs of diarrhea and constipation
• Abdominal distention, vomiting, failure to thrive

Answer

A

Hirschsprung Disease

Investigations
• Diagnose with rectal biopsy (lack ganglion cells)
• Barium enema shows dilated proximal segment and narrow distal segment

Treatment
• Surgical resection of affected segment (colostomy)
• Increase fiber and fluid intake if it is a short segment

Complications
• Enterocolitis of dilated bowel, leading to perforation which is the most common cause of death

Question 45

Q

• 90% idiopathic
• Children with cystic fibrosis are significantly at risk
• Telescoping of the intestine into itself into distal segment leading to mechanical obstruction and
bowel perforation
• Usual site is the ileocecal junction; jejunum in children
Clinical Features
• Sudden onset of recurrent, paroxysmal and severe periumbilical pain with pain-free intervals
• Palpable sausage-shaped mass in the right lower quadrant (Dance sign)
•
“Red currant jelly” stools (10-15% of patients)
• Shock and dehydration
• Later vomiting and rectal bleeding

Answer

A

Intussusception

Tests: U/S, contrast enema (barium or air)

SEND TO ER!!!
Air enema can reduce intussusception in 75% of cases

Question 46

Q

MECONIUM ILEUS
• Meconium is the first stool of a newborn which is very thick and sticky
• Meconium ileus is a bowel obstruction that occurs from impaction of even thicker and tenacious
meconium than normal meconium
• Distal intestinal obstruction results from the impaction of thick, tenacious meconium in the distal
small bowel
• 90% of patients who have meconium ileus have cystic fibrosis
• Rare condition that affects 1 in 25,000 newborns
Clinical Features
• Abdominal distention
• Bilious (green) vomit and no passage of meconium

Answer

A

Meconium ileus

Test: abdominal x-ray

SEND TO ER!! IV hydration

Question 47

Q

Positive Ortolani’s test
Short leg (s)
Usually asymptomatic

What do you suspect? Investigation? Tx?

Answer

A

Congenital hip location

Test:

US & X-ray is not sensitive enough until >4 months old
Positive Ortolani’s test

Tx: PT, surgery

Question 48

Q

Inward twisting of tibia
Tibial torsion test (+)
How’s the progonisis

Answer

A

Internal tibial torsion

Prognosis is good, resolves with time usually between ages 5-8

Surgery if severe

Question 49

Q

Inward twisting of femur

• Inward twisting of the femur causing knees and feet to turn inward and have a
“pigeon-toed”
appearance
• Appears between the ages of 2-4, prominent at age 5-6
Epidemiology
• Congenital or acquired
• M:F = 1:2
• Ligamentous laxity
Clinical Features
• Child appears to have toes turned in toward midline
• Unsteady balance
• Legs appear to bow to give the patient more stability when standing

Answer

A

Femoral Anteversion

Clinical Dx, CT to measure degree or torsion

Prognosis is good, resolves with time usually between ages 5-8

can give braces, PT

urgery if severe

Question 50

Q

What is the primary method imaging for the diagnosis and follow-up eval for Juvenile rheumatoid arthritis?

Question 51

Q

What is the primary method imaging for the diagnosis and follow-up eval for Juvenile rheumatoid arthritis?

Question 52

Q

Tx for Juvenile Rheumatoid Arthritis?

Answer

A

Exercise
PT, OT, eye doc, rheumatologist
DMARDs, NSAID, corticosteroid

Question 53

Q

Clinical Features
• Hip pain and a limp, progressing to knee pain
• Pain resulting from necrosis of the involved bone
• Limited internal rotation and abduction of hip
• Atrophy of quadriceps muscles, hip many develop adduction flexion contraction
- Limited internal rotation and abduction of hip
- BL 20% of the time
- Mostly in boys 3 to 10 years of age

Family history
Avascular necrosis of the proximal femoral epiphysis, causing abnormal growth and remodeling of regeneated bone

Answer

A

Legg-Calve-Perthes Disease - Avascular necrosis of femoral head ossification center

X-ray, MRI or bone scan if x-ray is inconclusive

Complications
• Eventually, collapse of the femoral head may occur, increase in the width of the neck, and
demineralization of the femoral head
• Early onset of arthritis and decreased range of motionTreatment
• Consultation with an orthopedist
• Eliminate hip irritability
• Restore and maintain good range of motion in the hip
• Prevent femoral epiphyseal collapse
• Attain a spherical femoral head when the hip heals
• Bracing
• Surgery on femoral head or hip (osteotomy)

Question 54

Q

Mechanism
• Repetitive quadriceps contraction through the patellar tendon at its insertion that has a skeletally
immature tibial tubercle, eventually leading to fragmentation of the tibial tubercle
Epidemiology
• Very common cause of knee pain in athletic children (jumping sports) aged 10-15 years,
Clinical Features
• Knee pain, occurs during activities such as jumping, squatting, running
• Pain on resisted leg extension
• Pain is relieved with rest

Answer

A

Osgood-Schlatter Disease

Investigations
• Knee X-ray shows fragmentation of tibial tubercle (with or without ossicles in patellar tendon)
Treatment
• Benign, self-limited condition
• Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief and reduction of local
inflammation
• Restrict movement such as jumping, squatting, running etc.
• Stretching of the quadriceps to decrease tension on the tubercle and also stretching of the hamstrings
• Surgery is rarely indicated

Question 55

Q

Clinical Features
• Anxious child who is protective of the affected arm, supported with the other hand
• Tenderness at the head of the radius
• Patient resists all ranges of motion
Investigations
• Assume there is a fracture and send to ER for X-ray
• E doctors will manipulate radial head back into annular ligament through axial compression at the
wrist while supinating the forearm and flexing the elbow
- Snap will be heard to confirm radial head is back into anatomical position with the annular
ligament

Answer

A

Subluxation of Radial Head/ Nursemaid’s elbow

Question 56

Q

What is cryptorchidism? Tx and complications

Answer

A

Tx: orchiopexy

Complications

Question 57

Q

Failure to thrive definition
Investigation
Tx

Answer

A

Counseling, supplemental nutrition, observe feeding habits, diet

Question 58

Q

Hypospadias/Epispadias - ventral or dorsal? Tx

Question 59

Q

Tx more ADD

Answer

A

Methylphenidate

Question 60

Q

Tourette’s syndrome tx?

Answer

A

Clonidine

onset at 5-18 yp

Question 61

Q

Polyuria, polydipsia, bouts of dehydration
Muscle weakness, constipation, sudden death
bone deformities
imapred growth
acidosis

No rsrobtion of glucose, phosphate, amino afid, URI acid, bicarconaonate

Answer

A

Fanconi syndrome

Tx:

Replace substance lost in urine
Hydration to correct polyuria
Metabolic acidosis due to the loss of Picard via sodium bicarbonate
Phosphate and vitamin D sup,entation are also necessary

Question 62

Q

Hemangioma

Answer

A

surgical excision

Question 63

Q

• Lead poisoning
• Lead comes from lead paint, pipes, window blinds, toys that get ingested causing permanent CNS
toxicity, chronic liver failure, gout, seizures, leading to death
Clinical Features
• Weakness, irritability
• Weight loss
• Vomiting, abdominal colic
• Personality changes
• Wrist and foot drop
Investigations
• Basophilic stippling of RBCs
• Hypochromic microcytic anemia (sideroblastic)
• Lead lines on gingivae and epiphyses of long bones on x-ray
• Increased serum lead (serum lead is more sensitive than hair analysis of lead)

Answer

A

Plumbism - lead poisoning

EDTA chelation

Brainscape's Knowledge GenomeTM

Natsumi Pediatric Flashcards

Brainscape's Knowledge Genome^TM