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uworld > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Paediatric constipation complications

A
  • anal fissues
  • hemorrhoids
  • enuresis/ UTI
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2
Q

recurrent cystitis with suprapubic pain,dysuria, and bacteriuria with anal fissue - what is the cause of urinary infection

A
  • think chronic constipation

patient gets urinary stasis
(b/c constipation cause rectal distension which in turn compresses the bladder and prevents complete emptying

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3
Q

number one diagnostic choice for VUR

A

voiding cystoourethrogram

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4
Q

cause of conjugated hyperbilirinemia

A 
biliary atresia 
neonatal hepatitis 
TPN cholestasis 
Rubin johnson 
Rotor 
TOURCH
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5
Q

initial well appearing infant for 1-8 weeks THEN develops jaundice, pale stool or dark urine, hepatomegaly , high conjugated hyperbilirubinemia and mild elevation in transaminase

A

Biliary atresia

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6
Q

Treatment of biliary atresia

A

hepatoportoenterostomy

liver transplant

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7
Q

blood smear of sickle cell anemia

A

holly jolly bodies

sickle cell anemia gets functional asplenia

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8
Q

basophilic stippling

A

seen in thalssemias

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9
Q

heinz bodies and bite cells

A

Glucose 6 P dehydrogenase

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10
Q

Helmet cells

A

schistocytes - seen in MAHAS
- DIC,
HUS
, TTP

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11
Q

local papule with ipsilateral regional LAD in setting of cat exposure - think?

A

Bartonella henselae (gram negative bacilli)

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12
Q

cat or dog bite

A

think pasteruella multicoida - normal oral flow in dogs and cats can cause cellulitis and other safe tissue infections

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13
Q

whitish foreign body inside vaginal introits

A

think toilet paper and you want to irrigate it with warm fluids

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14
Q

ocular findings in Neurofibromatosis

A

Lisch nodules

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15
Q

cafe au lait macules, axillary freckling and monocular eue proptosis and vision changes

A

neurofibromatosis type 1 with optic glioma

15% of NF1 who are <6 will have optic pathway gliomas - decrease visual acuity, color vision , optic nerve atrophy and proptosis

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16
Q

Selective IgA deficiency

A
  • usually asymptomatic

Recurrent sinopulmonary and GI infections
Ass. w/ AI disorgers ( Celiac) and atrophy (asthma , eczema)
ANAPHYLAXIS during transfusion

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17
Q

breastfeeding failure jaundice vs. breast milk jaundice

A 
Failure 
- first week of life 
- decrease bilirubin elimination 
- increased enterohepatic circulation 
Clinical: signs of dehydration

BMJ

  • start at age 3-5 days , peak at 2 weeks
  • high levels B- glucuronidase in breast milk deconjugate intestinal bill and increase enterohepatic circulations
  • normal exam
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18
Q

brick - red rate crystals in diaper

A

breast milk failure jaundice

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19
Q

hypocellular marrow with decreased megakaryoctytes and precursor of erythroid and amyloid cell lines - what is Dx

A

Aplastic anemia

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20
Q

how does AML present

A 
lethargy ( anemia) 
fever unexplained (leucocytosis 
bleeding ( thrombocytopenia)
bone pain 
Limp
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21
Q

Diamond blacken anemia

A

congenital pure red cell aplasia - presents with poor feeding and pallor in first few months of life

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22
Q

Falcon anemia

A 
pancytopenia and congenital anomalies such as 
- hyperpigmentaition 
- neck and intertriginous area 
- cafe au lait 
upper limb anomalies 
hypogonadism 
skeletal anomalies
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23
Q

how do patients with homocystinuria present

A

they have marfanoid body habits
Fair hair and eyes
Developmental delay
Cerebrovascular accident (thromboembolic events)

Lab:
- increase homocysteine and methionine level - vit B6 , folate and vit B12 to lower homocysteine levels

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24
Q

treatment of homocystinuria

A

vit B6 , folate, vit B12 - lower homocysteine levels

Antiplatlets - to prevent stroke, CHD, VTE

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25
Q

scoliosis, joint laxity and hyper elasticity

A

Ehlers Danlos

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26
Q

Marphanoid pictures PLUS Thromboembolic event

A

homocystinuria

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27
Q

big baby after delivery - crepitus over clavicle, asymmetric moro reflex and pain with passive motion of the affected extremely - how to treat?

A 
clavicle fracture 
Tx 
- reassurance 
- gental handling 
- analgesics 
- place affected arm in long sleeved garnet and put sleeve to check with elbow flexed at 90 degrees

Sx is NOT need b/c these fractures heel very quickly in neonates

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28
Q

c/i rotavirus

A
  1. anaphylaxis to ingredients
  2. history of intussusception
  3. hx of uncorrected congenital malformation of GI tract ( deckle’s diverticulum)
  4. severe combined immunodeficiency
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29
Q

peripheral smear shows anisocytosis, spherocytes and polychromatophilia - what is Dx

A

Dx - hereditary sphercopcytosis

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30
Q

Clinical for hereditary spherocytosis

A

HA , Jaundice and splenomegaly

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31
Q

Labs for hereditary spherocytosis

A

HIGH MCV
Spherocytes
Negative Coombs test
Increase osmotic facility test on acidified glycerol lysis test
Abnormal eosin - 5 - meleimide binding test

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32
Q

Treatment for hereditary spherocytosis

A

folic acid supplementation
blood transfusion
splenomegaly

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33
Q

what is Dx by erythrocyte CD55 and CD59 testing

A

PNH - paroxysmal nocturnal hemoglobinuria

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34
Q

low Hg, reticulocytosis and positive Coombs test

A

warm agglutinin autoimmune hemolytic anemia

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35
Q

viral CSF vs TB CSF

A

VIRAL - glucose normal
- protein > 100

TB

  • low glucose
  • protein > 250
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36
Q

hemolytic anemia, thrombocytopenia, AKI - what is Dx

A 
HUS 
- the triad 
(HA - schistocytes, HIGH bili) 
Thombocytopenia 
AKI (high BUN, high Cr)
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37
Q

B1 deficiency

A

THIAMINE

beriberi ( peripheral neuropathy , heart failure )
Wernicke - Korsakoff syndrome

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38
Q

B2 deficiency

A

RIBOFLAVIN

angular cheilosis, stomatitis, glossitis

normocytic anemia

seborrheic dermatitis

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39
Q

B3 deficiency

A

Niacin

  • Pellagra ( dermatitis, diarrhea, delusions/ dementia, glossitis)
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40
Q

B6 deficiency

A

PYRIDOXINE

  • cheilosis, stomatitis, glossitis
  • irritability , confusion, depression
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41
Q

B9 deficiency

A

FOLATE , FOLIC ACID

  • megaloblastic anemia
    Neuro déficits ( confusion , paresthesias, ataxia)
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42
Q

C ( ascorbic acid)

A

SCURVY

- punctate hemorrhage, gingivitis, corkscrew hair

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43
Q

reticulocytes and platelets in patients with sickle cell anemia

A

Increase reticulocytes

decrease platelets

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44
Q

colonization of bacteria in patients with CF by age

A

Age 2-20 - S. AURES

Age 20 - 45 - Pseudomonas

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45
Q

what is the most common type of brain tumour in children

A

ASTRYOCYTMOA

  • supratentorial tumour - presents with seizure, weakness, sensory changes
  • increase ICP signs - morningn headache , vomitting , papilledema
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46
Q

Craniopharyngiomas

A

arises in the sella trice

  • cystic structure with calcifications on imaging
  • visual field defects and hormonal deficiencies ( GH due to compression of surrounding structures - optic chasm, pituitary stalk
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47
Q

ependymomas

A

glial cell tumours - arise in the ependymal cell lining of the ventricle with calcifications on imaging

Symptoms: visual field defects, hormonal deficiencies

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48
Q

medulloblastoma

A

second most common tumour of the posterior fossa in children
- infratentorial tumours - arise from cerebellar vermis and present with vomitting, headache and ataxia

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49
Q

worried about an animal bit and patient has neurological signs

A

think rabies - rat bit

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50
Q

neuroblastoma

A

raise from neural breast cell

  • most common cancer in paediatric population ( after leukaemia and CNS tumour)

Most common site - abdomen

  • calcifications and hemorrhage on plain x-ray and high levels of HVA and VMA
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51
Q

refeeding syndrome

A

carbohydrate intake stimulates insulin activity –> which promotes cellular uptake of phosphorus, potassium and magnesium

Clinical: arrhythmia, cardiopulmonary failure

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52
Q

classic findings of retropharyngeal abscess on x-ray

A

increase width of pre vertebral soft tissue ( greater than half the width of corresponding vertebral body

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53
Q

treatment of heamangiomas

A

b-blockers (nadolol, propanolol)

Others: 
- systemic steroids 
laser ablation 
interferon therapy 
embolization 
surgical excision
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54
Q

treatment of chickenpox

A

supportive in healthy children
if immunocompromised , give acyclovir, VZIg
+/- vaccination depending on immunization status

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55
Q

perinatal chicken pox in mom

A

treat mom - immediate postpartum period with VZIG (if mom gets infection 5 days before delivery OR 2 days after )

Treat baby with IV acyclovir - if it develops varicella

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56
Q

treatment of measles

A

vit A and supportive

CONSIDER post exposure prophylaxis ( vaccine and immunoglobulin)

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57
Q

treatment of candidas diaper rash

A

stallite lesions with flexure sites involvement

tx - 1% hydrocortisone cream in clotrimazole cream tid

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58
Q

Aspiration of knee joint yeilds yellow colored, translucent fluid with a leukocyte count of 20 000 ( 50% neurtrophils)
NO organism on Gram stain

Hx. Trip to Main with migratory arthralgias

A

Migratory arthralgia

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59
Q

imaginary friends

A

normal from age 3-6
healthy development
will not affect the childs social relationship

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60
Q

peripheral precocious puberty
irregular cafe au lait macules
polyostotic fibrous dysplasia (ex recurrent fractures)

A

McCune Albright Syndrome

abnormal scar-like (fibrous) tissue in their bones, a condition called polyostotic fibrous dysplasia
scoliosis
cafe au lait
pernicious puberty

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61
Q

previous
Edit Flashcard
Premature puberty (pubic hair , axillary hair, acne, body odor )
NO BREAST DEVELOPMENT

A

ADRENAL TUMOUR

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62
Q

all vacines should be given accroding to

A

chronological age rather than gestational age

EXCEPTION - weight should be > 2kg ( 4 lb 6 oz) before the first hepatitis B vaccine

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63
Q

Preseptal cellulitis vs. Orbital cellulitis

A

Pre-septal cellulities

  • eyelide erythema and swelling
  • chemosis

Trreatment: oral antibiotics

Orbital cellulitis 
- eyelid erythema, swelling , chemosis 
PLUS 
- pain with EOM , protosis, ophthalmoplegia with diplopia 
Tx: IV antibiotics +/- surgery
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64
Q

clinical allergic conjunctivities

A

usually b/l conjunctivites
clear discharge
ocular itching

No erythema pre-orbital or fever seen

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65
Q

carvenous sinus thrombosis symp

A

headahce
opthaloplegia
vision loss
papilledema

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66
Q

anterior uvitits

optic neuritis

A

anterior uvitits - red eye, eye pain, blurry vision with history of autoimmune disease

optic neuritis - ass. w/ MS - acute vision loss and pupillary defects
NOT eyelid redness or swelling

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67
Q

Laryngomalacia

Pathophysiology

Clinical

Dx

tx

A

Pathophysiology - increase laxity of supraglottic structures

Clinical
- inspiratory stirdor worsens when supine
peaks age 4-8

Dx

  • usually clinical
  • confirmation by flexible laryngoscopy for moderate/ severe cases

Tx

  • reassurance for most cases
  • supraglottioplasty if severe symptoms
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68
Q

infants with inspiratory stiador that worsens in supine and improves when patinet is prone

A

Laryngomalacia
- use laryngoscopy to look for collapse of the supraglottic structures during inspiration

NORMALLY resolves by age 18

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69
Q

diffenrece b/w absence vs. focal seziure

A

Absent sezirue - generalized seziure
NO postictal period , normally reproduced with hyperventilations

Focal seziuer - abnormal neuronal discharges orginating in a single hemisphere can present with motor ( head turning) , sensory ( paresthesias) or autonomic ( sweating)

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70
Q

Osteoid osteoma

A
  • scleroitic cortical lesion on imaging with central nidus of lucency
    typically causes pain that is wrose at night and unrelated to activity
    pain relieved by NSAIDS
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71
Q

treatment of hypovolemix HYPERnatremia

A

normal saline - isotonic solution

b/c half normal saline should NEVER BE USED for inital resusitation measurees

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72
Q

what cynotic heart disease will have a single loud S2

A

transposition of great vessels
tricuspid atresia
truncus arteriosus

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73
Q

difference b/w TTN and RDS

A

TTN
- inadequate alveolar fluid clearance at birth results in mid pulmonary edema
Clinical:
- tachypnea begins shortly after birth and resolves by day 2 of life
X-ray - bilateral perihilar linear streaking

RDS
- surfactant deficiency resulting in alveolar collapse and diffuse atelectasis
- severe resp distress and cyanosis after premature birth
X-ray - diffuse reticulogranular (ground glass) appearance, air bronchograms , low lung volumes

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74
Q

X-ray - diffuse reticulogranular (ground glass) appearance, air bronchograms , low lung volumes

A

RDS

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75
Q

X-ray - bilateral perihilar linear streaking

A

TTN

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76
Q

what finding for burns indicate abuse

A

sparing of flexor surfaces
unifrom burn depth
sharp lines of demarcation

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77
Q

d

maintaince treatment of sickle cell anemia

A

vaccination
penicillin
folic acid supplement
hydroxyurea ( if recurrent vaso-occlusive disorder)

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78
Q

difference b/w hirschspring and meconium ileus disease

ass. disorder
level of obsturction
meconium consistency
squirt sign * forceful expulsion of stool after rectal exam

A 
Hirschsprung 
ass. w/ DOWN SYNDROME  
rectosignmoid 
normal meconium
positive squirt sign 
Meconium ileus 
- ass/ w CYSTIC FIRBOSIS 
ileum 
inspissated 
negative squirt sign
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79
Q

narrowing of ileum on laparotomy

A

meconium ileus

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80
Q

right and left cheecks swollen
b/l swelling and tenderness anterior to ears extending into the mandible

what complication is patient greatest risk of development

A

think MUMPS

risk - aseptic meningitis and ochitis

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81
Q

schapoid diagphram

number 1 treatment

A

think congential diaphramatic hernia

  • develop pulmonary hypoplasia

therefore need emergency incubation
THEN nasal or orgastric tube - connected to continuous suction to prevent bowl distention against the lungs

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82
Q

x-ray finding for retropharyngeal abscess

A

widened per vertebral space

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83
Q

GERD in 2 month old

A

provide reassurance
frequent small volume feeds
hold infant upright 20-30 minutes after feeds

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84
Q

GERD + FTT treatment

A

this is more severe

  • thicken feeds 9 adding oatmeal)
  • antacid Tx (PPI)
  • excessive weight gain and PPI increase risk for pneumonia and diarrhea

PPI = unnecessary in physiologic GERD

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85
Q

complications of prematurity

A
  1. RDS
  2. PDA
  3. Bronchopulmonary dysplasia
  4. NEC
  5. Retinopathy of prematurity
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86
Q

dandy walker malformation

A

congenital brain malformations that cause non communicating hydrocephalus due to the obstruction of CSF flow in

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87
Q

treatment of SCFE

A

surgical pinning of femoral head (helps to prevent the risk of AVN when it heals )

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88
Q

radiopaque tables of 3 year old boys

A

THINK pre-natal vitamins - these are radio-opaque tablets that are seen on x-ray and cause
IRON POISONING

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89
Q

clinical presentation of iron poisoning

A 
pain 
hematemesis 
hypovolemic shock 
metabolic acidosis 
low bicarb hypotension 
cool extremities
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90
Q

treatment of iron poisoning

A

IV deferoxamine ( antidote for iron poisoning)

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91
Q

umbilical cord cut with pair of sizer knife

A

tetanus

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92
Q

infant difficulty with feeding , truisms, spasms and hypertonicity , clenched hands , dorsiflexed feet

A

tetanus

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93
Q

difference b/w botulism and tetanus presentation

A

botulism

  • weakness
  • constipation
  • poor feeding
  • HYPOtonia

tetanus

  • HYPERtonia
  • spasms
  • poor feeding
  • trismus
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94
Q

most common cause of nephrotic syndrome in children <10

A

minimal change disease

- normal findings on light microscopy

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95
Q

1 treatment for septic arthritis in children

A

arthrocentesis , blood and fungal cultures THEN empirical antibiotics

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96
Q

what is the gold standard investigation to diagnose duchenne muscular dystrophy

A

GENETIC testing

dystrophin gene Xp21

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97
Q

fever, tonsilitis , pharyngitis , cervical LAD, fatigue , HSM , rash after amoxicillin

A

EBV infection

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98
Q

COMPLICAtiON of supracondylar humeral fracture

A

COMPARTMENT SYNDROME

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99
Q

long term complication of undescended testes

A

sub fertility

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100
Q

clinical and treatment for SCID

A
  • recent severe viral fungal or opportunistic infections
  • failure to thrive
  • chronic diarrhea
    ( think no T or B cell function)
    treatment
  • Stem cell transplant
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101
Q

what maneuvers increase murmur in hypertrophic cardiomyopathy

A

VALSALVA, abrupt standing and maul nitrate administration

ALLL of these will decrease LV cavity size by decreasing preload cause LV outflow tract obstruction and increases intensity of murmur

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102
Q

what maneuver decrease intensity of hypertrophic cardiomyopathy

A

squatting , leg raise and hand gripping

increase LV cavity by increase preload
this will decrease outflow obstruction decrease intensity of murmur

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103
Q

primary amenorrea - what investigations should be done

A

FSH

Then MRI pituitary - if FSH is decreased
Then karyotypicing if FSH increase

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104
Q

what do you order to evaluate pernicious anemia

A

gnRH

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105
Q

Cause , clinical dx and treatment of scarlet fever

A

cause : STREPTOCOCCUS PYROGEN

CLINICAL:
- fever and pharyngitis 
tonissilar erythema 
strawberry tongue 
 tender anterior cervical nodes 
sandpaper rash

Dx:

  • rapid streptoccal antibodies
  • throat culture

Treatment;
- penicillin ( amoxicillin)

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106
Q

difference b/w KD and SF

A

SF

  • fever and pharyngitis
  • tonsillar erythema
  • strawberry tongue
  • tender anterior cervical nodes
  • sandpaper rash

KD

  • 5 days of fever
  • > /= 4 of the following
    1. >1.5ccm cervical node
    2. POLYmophous rash - truck and extremities
    3. edema of hands and feet
    4. conjunctivitis - non exudative
    4. mucosal changes ( strawberry tough, dry crackled lips )
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107
Q

what is KD patient at risk for?

A

CAA - coronary artery aneurysm

MI - myocardial infarction

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108
Q

hemophilia A and B - what is the most likely cause of joint pain

A

heamosiderin deposition and fibroses

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109
Q

ddx of laryngomalacia and vascular ring

A

laryngomalacia - inspiratory stridor most prominent in infant

  • worse when supine
  • improve prone

Vascular ring

  • presents infants
  • biphasic stridor that IMPROVES with neck extension
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110
Q

vascular rings

A

results from abnormal development of aortic arch causing tracheal bronchial and or esophageal compression

  • age <1 , respiratory ( stridor, wheezing , coughing) and or esophageal ( dysphagia , vomitting , difficulty feeding
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111
Q
  • distress ( tripod position , sniffing position, stridor )
  • dysphagia
  • drooling
  • ## high fever
A

epiglottitis

-

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112
Q

epiglottis x-ray , treatment and prevention

A

X-ray - thumbprint sign
manamgent - endotracheal incubation and antibiotics
prevention - immunization

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113
Q

turner syndrome - what is the cause of its edema

A

the cause is congenital lymphedema due to abnormal development of lymphatic system

114
Q

loud S2 with harsh crescendo decrescendo systolic murmur - what is fx

A

ToF

115
Q

infant failure to thrive , b/l cataracts , jaundice , hypoglycaemia - what enzyme is deficient

A

patient most likely has a metabolic disorder ( galactosemia) caused by galactose 1 phosphate uridyl transferase deficiency

116
Q

clinical if patient has galactokinase deficiency

A

cataracts ONLY

117
Q

breath holding spells

A

cyanosis - crying followed by breath holding cyanosis and loss of consciousness

Pallid - timor trauma follow by breath holding, allow, diaphoresis an d LOC

118
Q

are breath holding spells normal

A

yes

119
Q

wiskott aldrich syndrome

A

x-linked recessive defect in WAS preteen gene

- impaired cytoskeleton changes in leucocytes , platelets

120
Q

eczema

ircothrombocytopenia ( small platelets , low platelet count , recurrent infection

A

weskott aldrich syndrome

121
Q

treatment of wiskott aldrich syndrome

A

stem cell transplant

122
Q

cause of acute rheumatic fever

A
  • strep pyrogens
123
Q

Prader Willi syndrome

A

deletion of paternal 15q11 q13

124
Q

nocturnal headaches and morning vomitting

A

think IC pathology - get a CT first

125
Q

best investigation for meconium ileus

A

contrast edema

126
Q

reye syndrome - what type of liver disae

A

microvascular fatty infiltrate
- high AST and ALT
high PT , INR , PTT
high NH3

127
Q

Clinical Reyes

A

acute liver disease and encephalopathy

128
Q

otoscope shows intact left tympanic membrane with peripheral graduation and some skin debris

A

cholesteatoma

129
Q

cholesteatoma

A

acquired or congenital

Congenital < 5 years old
Acquired - secondary to chronic mid ear disease

new onset hearing loss OR chronic ear drainage despite antibiotic treatment are typically presenting symptoms of cholestatomas and granulation tissue and skin debris within retraction pockets of tympanic membrane on otoscope

130
Q

difference b/w cholesteatoma and otosclerosis

A

otosclerosis - bony overgrowth of the stapes footplate that results in conductive hearing loss - NO ear drainage

Cholestatomas - chronic midd ear disease , new onset hearing loss or chronic ear drainage despite antibiotics - granulation tissue and skin debris on otoscope

131
Q

Friedreich ataxia - most common cause of death

A

cardiomegaly

132
Q

Friedrich ataxia

A

AR disorder
Gait ataxia, frequent falling and dysarthria
Cardiomegaly , DM , skeletal deformities ( scoliosis and hammer toes)

133
Q

von Gierke disase

A

deficient glucose 6 phosphate (found in liver, kidney and intestinal mucosa) - impaired conversion of glycogen to glucose leading to glycogen accumulation in affected organs
3-4 months of hypoglycaemia ( often seizure) and lactic acidosis

134
Q

doll like face, thin extremities, protuberant abdomen ( HM ) and short stature

A

glucose 6 phosphate deficiency ( von gierke disease)

135
Q

what coag factor is affected if you have a prolonged PT

A

factor 7

136
Q

localized abode pain, hematuria, high reticulocytes, low hct

A

sickle cell disease

137
Q

what vaccine should patients with sickle cell disease receive

A

vaccination with a conjugated polysaccharide - b/c patients with SS are susceptible to encapsulated organisms (s. pneuma, H. influenza, N. meningitides)

138
Q

causes of nephrotic vs. nephritic syndrome

A

Nephrotic - MCD, FSGS, Membrane nephropathy, MPGN

Nephrotic - PSGN, HUS, IgA nephropathy, MPGN, crescentic glomerular nephritis

139
Q

treatment of lyme disease in patient < 8

A

amoxicillin in children < 8 years of age

Doxycycline is often used but C/I in patients <8

140
Q

complication of patients with sickle cell trait

A

hematuria

141
Q

difference b/w sickle cell disease and sickle cell trait

A

Trait: 50-60% HgA, 35-45% hg S , <2% hgF

Disease 0% HgA, 95%hgS, 5-15% hgF

NormalL 99% hgA, ,1% hgF

142
Q

Spondylolisthesis

A

forward slip of vertebrae ( usually L5, S1) , preadolescent children

Clinical: clinical scenario, back pain ,neurological dysfunction - ex: urinary incontinence and a palpable step off at the lumbrosarcal area

143
Q

management if child < 2 with febrile UTI

A

first 1-2 weeks antibiotics

  1. bladder and renal ultrasound
  2. voiding cystourethrogram - not indicated for first febrile UTI
144
Q

traid: pain, jaundice, palpable mass in RUQ think?

A

biliary cyst

145
Q

DX of biliRY cyst

A

VISUALIZATION ON US

ERCP

146
Q

Treatment of binary cyst

A

surgical resection to relieve obstruction and prevent malignant transformation

147
Q

ALL vs aml

A 
ALL - leukemia 
age 2-10 
infections 
LAD 
Splenomegaly 
Investigation: Lymphocyte , postive PAS

AML - aurer rides seen

148
Q

cause of aplastic anemia

A

Drugs: NSAIDS , sulphonamides

Toxic: benzene glue

Idiopathic

Viral infections HIV, EBV

Immune disorders

Thymoma

149
Q

features of a BENIGN murmur

A
  1. early or mid systolic
  2. grade 1 or 2 intensity that decreases on standing and valsalva maneuver
  3. low pitches musical pure or squeaky tone at LLSB ( still’s murmur ) or high pitched at LUSB ( pulmonary flow murmur)
150
Q

chromosomal makeup for Kallmans

A

46XX - female

46 XY - male

no gnRH - no smell

151
Q

FSH LOW, LH low and low GNRH

A

Kallmans syndrome

152
Q

potter sequence

A

urinary tract anomaly
anuria/ oliguria in utero
oligohydraminios

Pulmonary hypoplasia, flat facies, limb deformities

153
Q

cause of potter sequence

A

posterior urethral valve

154
Q

webbed neck, cleft lip, shielded chest , triphalangeal thumb , pale mucous membrane and conjunctive

A

diamond blacken anemia

155
Q

pan systolic murmur that is loudest at the lower left sternal boarder and a diastolic rumble at the apex

A

LARGE vid

not ToF

156
Q

murmur for ToF

A

ejection murmur over the upper sternal boarder from the pulmonary stenosis
loud S2

157
Q

Beckwith Weidemann syndrome

A
  • deregulation of imprinted gene expression in chromosome 11p15

Fetal macrosomia, rapid growth, until late childhood, Macroglossia, hemihyperplasia

Complications: wilms tumour , heaptoblastoma

Surveillance - serum alpha feta protein
abdo / renal US

158
Q

for androgen insensitivity syndrome - when do you gonadectomy

A

AFTER puberty (helps maintain adult height) and decrease risk of gonadal malignancy

159
Q

heart condition in Down syndrome

A

CAVSD

  • loud S2 due to pulm HTN
  • systolic ejection murmur from increase flow across pulm valve
  • holosystolic murmur of VSD that may be soft or absent if defect is large
160
Q

most common posterior fossa tour in children

A
  1. astrocytoma

2. meduloblastoma

161
Q

meduloblastoma clinical findings

A
  1. truncal or gait instability
  2. fine motor dysfunction
  3. dysdiadochokinesia
  4. obstructive hydrocephalus (due to proximation of 4th ventricle)
  5. high ICP - headache, vomitting
162
Q

hair pulling disorder

A

trichotillomania

163
Q

Parinaud Syndrome

A

limited upward gaze
upper eyelid retraction ( Coller sign)
Pupils non reactive to light
active to accommodation

164
Q

Obstructive hydrocephalus

A

papilledema
headache vomitting
ataxia

165
Q

multiple 1mm vesicles on anterior tonsillar pillars with greyish ulcerated lesions

A

coxackie virus

166
Q

tine capita

A

most common in African American children

scaly erythematous patch with hair loss on scalp , blacks dots in affected area, tender lymphadenopathy

167
Q

treatment of tinea wapitis

A

oral griseofulvin or terbinafine

168
Q

difference b/w absence seizure and inattentive staring spells

A

absence seizure

  • occurrence during all activities
  • length < 20 seconds
  • lack of response to vocal or tactile stimulation
  • presence of automatisms

Inattentive staring spell

  • occurrence primary during boring activities
  • length >1
  • response to vocal or tactile stimulation
  • lack of automatisms
169
Q

automatisms

A

eye lid fluttering

lip smacking

170
Q

metatarsus adducts and congenital clubfoot

A 
metatarsus adducts 
- flexible positioning
- medial deviation of forefoot 
- neutral position of hind foot 
Tx: reassurance

Congenital clubfoot
- rigid positioning
- medial / upward deviation of forefoot and hind foot
- hyper plantar flexion of foot
Tx; serial manipulations and casting , surgery if refractory cases

171
Q

myotonic dystrophy inheritance

A

AD

172
Q

presence of exudates , edema , palatal pmetchiae and absence of viral symptoms - what is your next step?

A

rapid antigen test
Negative - throat culture

Postive- Strep Pharyngitis (oral amoxicillin)
Negative - viral

173
Q

Caustive agent - initial test

A

airway
breathing
circulations

THEN discontamination - remove of contaminated clothing and visible chemicals

CXR

Endoscopy within 24 hours

174
Q

what should be tested at every well child check

A

VISION
- evaluated by checking fixation and tracking
(cover uncover test - to assess from strabismus
(visual acuity test - age 3 )

175
Q

normal age limit for bedwetting

A

Age 5

176
Q

complication of HSP

A

INTUSECEPTION ( due to intestinal bleeding and edema 0

177
Q

normal vs. abnormal lymph nodes

A

normal:
- soft
- mobile
- <2cm
- no systemic symptoms

Abnormal:

  • firm and hard
  • immobile
  • > 2cm
  • systemic simp ( fever, night sweats, WL)
178
Q

pathophysiology of coarctation of aorta

A

thickening of tunica media in aortic arch

179
Q

oestrogenesis imperfecta

A
  • CT disorder
  • AD mutation

Osteopenia
blue sclerae
recurrent fractures - easy nursing , hypotonia , hearing loss
opalescent blue gray to yellow brown discolouration caused by disclosed dentin shining through the translucent and weak enamel

180
Q

putussis post exposure prophylaxis

A

macrolides antibiotics to all household contacts

181
Q

gradual onset hemiplegia , aphasia , neck pain and thunderclap headache in 5 year old - what do you think

A

carotid artery dissection

182
Q

hypersensitivity reactions type 1

A

IgE mediated
Anaphylaxis
Urticaria

183
Q

Hypersentivitiy reaction type 2

A

autoimmune hemolytic anemia

good pasture syndrome

184
Q

type 3 hypersensitivity reaction

A

antigen complex
serum sickness
PSGN
Lupus nephritis

185
Q

Type 4 hypersensitivity reaction

A

T cell and macrophage mediated

  • contact dermatitis
  • tuberculin skin test
186
Q

risk factor for intussusception

A
  • recent viral illness or rotavirus
  • Mockers diverticulum
  • HSP
  • Celiac disease
  • intestinal tumor
  • polyps
187
Q

PJP , failure to thrive , chronic diarrhea , LAD

A

HIV in infancy

188
Q

clinical presentation of methemoglobinemia

A

Hx: exposure of oxidizing substances ( dispose, nitrites, topical / local anesthetic)

Clinical:

  • cyanosis
  • O2 sats - 85%
  • dark chocolate coloured blood

Lab: Sat gap > 5% b/w O2 sats on ABG vs. pulse ox
- normal PaO2

Tx: methylene blue

189
Q

lead overdose tx

A

dimercaprol

190
Q

ethylene glycol or methanol injection

A

fomepizole

191
Q

leech nyhan syndrome

A

deficiency of hypoxanthine guanine phophoribosyl transferase ( HPRT)

  • compulsive self injury - bitting extremity
  • uric acid excess - gouty arthritis , typhus formation and obstructive nephropathy

Tx: intake of fluid, allopurinol

192
Q

massive hematuria with episode that is mild and resolves spontaneously

A

think: sickle cell trait –> papillary necrosis

193
Q

comorbidities with absent seizure

A

ADHD

Anxiety

194
Q

clinical features of necrotizing enterocolitis

A

systemic: vital sign instability , lethargy
GI: vomitting, bloody stools, abode distension, tenderness

195
Q

RF for necrotizing enterocolitis

A
  1. prematurity
  2. hypotension
  3. congenital heart disease
196
Q

hyper IGM syndrome

A

Recurrent or severe sinopulmonary infections with viruses and encapsulated bacteria

Normal B cells
LOW IgG and IgA
HIGH IgM

197
Q

CVID

A

recurrent sinopulmonary infections with viruses and encapsulated bacteria

normal B cells
low IG levels

198
Q

X-linked agammaglobulinemia ( Brutons )

A

Recurrent sinopulmonary infections with viruses and encapsulated bacteria

Low or absent B cells
low IgG

199
Q

management of parapneumonic effusion

A

small effusion and no rest distress –> oral antibiotics, close monitoring

Moderate effusion OR resp distress OR hypoxia –> US, Iv antibiotics, draining

200
Q

most common cardiac issue in edwards syndrome

A

VSD

201
Q

neonatal polycytemia

A

hematocrit > 65% in term infants

Cause:

  • increase EPO from intrauterine hypoxia, smoking, HTN , IUGR
  • Delayed cord clamping
  • Genetic / metabolic disease - hypothyroidism , trisomy ( 13,18,21)
202
Q

if capillary blood shows high lead - what do you do?

A

VENOUS BLOOD for lead levels

  • this will determine if patient requires treatment
203
Q

treatment for lead toxicity

A

Mild: 5- 44 - no meds, repeat level in one month

Moderate 45-69 : dimercaptosuccinic acid ( DMSA)

Severe > 70 - dimercaprol PLUS EDTA

204
Q

how do you prevent gonococcal conjunctivitis

A

give erythromycin ophthalmic ointment

205
Q

most common cause of congenital hypothyroidism

A

thyroid dysgenesis

206
Q

seborrheic dermatitis

A

peaks in infancy and adulthood

erythematous plaques + yellow , greasy scales

Located on scalp, face , umbilicus and diaper area

207
Q

excess cow milk consumption

A

> 24 onces 700ml per day
- results in iron deficiency anemia

Fe deficiency anemia can be differentiated by thalassemia with ELEVATED RCDW

208
Q

ONLY intention and repeated fire setting behaviour

A

Pyromania

differs from conduct - b/c conduct will also have lying, theft, cruelty etc

209
Q

if you suspect DDH - what do you do?

A

GET ULtRASOUND of the hip

  • not an x-ray of hip
210
Q

proteinuria in a child - what do you do next?

A

repeat dipstick testing on two subsequent occasions

b/c may just be an incidental or transient proteinuria - which can occur with excerise streets or change in position, volume depletion

211
Q

GBS - how do you evaluate respiratory invovlemtn

A

do serial measurements of FVC - spirometry

212
Q

bone pain with SCD - what is the cause

A

microvascular occlusion

213
Q

dactylics

A

early manifestation of faso-occlusive disease in SCD - presents with acute onset of bilateral hand and foot swelling and tenderness

214
Q

if you suspect their child has autism - what do you say to the parents

A

explain the spectrum of development disorders and recommend further evaluations

215
Q

treatment of hydrocele

A

observations and rasurrance

  • normally resolves by age 1
216
Q

patients with SCD are at increase risk of what

A

OSTEONECROSIS OF PROXIMAL FEMUR

avascular necrosis

217
Q

Asians with elevation of UCB - what is cause

A

decrease hepatic uridine diphosphogluconurate glucuronosyltransferase

218
Q

hypothermic neonate

A

think sepsis

- do blood cultures and start antibiotics

219
Q

when does chlamydial conjunctivitis occur

A

day 5- 14

Treat with ORAL macrocodes - since topical treatment are not affected

220
Q

what is topical eyrhtomycin used for?

A

prophylaxis for

gonococcal conjunctivitis

221
Q

treatment of gonococcal conjunctivitis

A

Prophylaxis : topical erythromycin

Treatment: IM 3rd gen cephalosporin

222
Q

CVID Dx

A

LOW LOW LOW IgG
Low IgA/ IgM
No response with vaccines

223
Q

CVID - treatment

A

IVIg replacement

224
Q

suspect heamarthrosis in child - what test do you do?

A

want to do CBC and coag testing

225
Q

acute onset of joint effusion - is concerning for what?

A

HEMARTHOSIS - bleeding disorger

226
Q

patient falls out of bed and found unconscious on the floor with blue discolouration of his lips, resolves in a few seconds but consciousness takes a few minutes and patient is sleepier than normal after, does not remember event

A

think generalized seizure

episode of Unconsciousness and feeling sleepy after

227
Q

potential serious S/e of infective mononucleosis

A

Acute airway obstruction

228
Q

potential d/e of cellulitis of the sublingual or submandibular

A

ludwig angina

229
Q

isolated thrombocytopenia after viral infection

  • what is it?
  • what do you do?
A

probably immune thrombocytopenia
- children usually recover spontaneously within 6 months and require ONLY observations regarding their platlet count

If bleeding - want to give ivIg or glucocosteroids

230
Q

cyanosis in infant and turns pink with crying - what do they have

A

choanal atresia

231
Q

what happens to the murmur in ToF when squatting

A

if child squats - increase murmur but cyanosis improves

232
Q

Complication of sickle cell trait

A

Hematuria and Papillary nervous
Hyposthenuria
Splenic infraction , VTE , priapism
Exceptional rhabdomyolysis

233
Q

most common cause of osteomyelitis in children

A

s. aures

234
Q

Early secondary sexual characteristics with advanced bone age - what do you do next

A

check LH

If low LH
- GnRh stimulating test
- if low LH still - peripheral precocious puberty ( do adrenal CT)
If high Lh - central precocious puberty

If high LH
- due to central precocious puberty ( do MRI brain)

235
Q

early secondary sexual characteristics with normal bone age

A

isolated breast development - premature thelarche

isolated pubic hair development - premature adrenarche

236
Q

low LH and Low FSH - with secondary premature sexual characteristics and advanced bone growth

A

think peripheral precocious puberty

- do adrenal CT

237
Q

if high LH, early Secondary premature sexual characteristics and advanced bone growth

A

think central precocious puberty

- do MRI

238
Q

treatment for cat bites

A

copious irrigation and cleaning
prophylactic amocillin and calvulanate
tentanus booster - if indicated
avoid closure

239
Q

treatment of tourette

A 
1st: alpha 2 against 
       antispcyhotic agents ( risperidone) - better s/e

2nd gen - clozapine

240
Q

Diagnosis of aDd requires several symptoms and for them to be present before what age

A

age 12

241
Q

congenital toxoplasmosis

A

diffuse intracerebrale calcifications and ventriculomegly
macrocephaly

Cause
- car feces or undercook meet

242
Q

pika virus - transmission and se to baby

A

transmission - mosquito or sexual transmission

Causes: MICRCEPHALY

243
Q

dental caries or abscess particularly in maxillary teeth should predispose to what

A

orbital cellulitis

244
Q

multiple episodes of gastroenteritis - increase risk for what ?

A

so gastroenteritis is thought to cause hypertrophy of the peter patches in lymphoid rich terminal ileum - which as a nidus for telescoping - increase risk of intussception

245
Q

pyloric stenosis treatment

A

always make sure you replace fluid loss and potassium before surgery ( pyloromyotomy) - b.c this will decrease risk of posop apnea

246
Q

chronic VUR symptoms and complications

A

recurrent or chronic pyelonephritis

Complications

  • scarring
  • HTN
  • renal insufficiency
247
Q

primary dysmenorrhea

A

is pelvic cramping in the first few days of menses in the context of a normal physical exam - caused by increase prostaglandin release from endometrial sloughing during menses

248
Q

suspect hydrocephalus in infant what test do you do ?

A

CT brain

249
Q

asymptomatic abdominal mass that is find accidentally by the caretaker or physician - what is the most likely diagnosis

A

wilms tumor

  • usually Dx age 2-5
  • affects single kindey
250
Q

mass in abdomen , HTN, hematuria and fever - what is Dx

A

wilms tumor

  • it is the most common primary renal neoplasm in children - usually Dx 2-5 years of age
  • affects single kindly
251
Q

treatment of impetigo

A

topical mupirocin

252
Q

painful clear vesicles over retyematous skin and both cheeks as well as a few scattered lesions overlying the dark red crusting - submandibular LAD - what is cause?

A

this patient most likely has a HSV infection

due to a complication of atopic dermatitis = eczema herpeticum

253
Q

short vagina, no uterus normal ovaries

A

mullarin genesis

254
Q

absent uterus and upper vagina , cryptorchid testes

A

androgen insensitivity syndrome

255
Q

sexually active women < 24 should get what screenig

A

chlamydia trachoma’s testing

256
Q

what rash spares the palms and soles

A

rubella

257
Q

disseminated gonococcal infection - what kind of rash

A

usually vesiculopustular and rarely involves the face

258
Q

how does hydroxyurea help SCD patients

A

it increases the amount of HbF in circulations which dilutes the number of sickled cells and reduces vasooclussive episodes

259
Q

sudden LOC, loss of postural tone and delayed return to baseline - should raise suspicion for

A

seizure

- look for tongue lacerations

260
Q

well appearing neonate with painless bloody stools - dx?

A

milk- soy protein proctocolitis
( milk protein induced enterocolitis )

    • rectal bleeding should stop in 2 weeks once eliminating material dairy and soy protein products or switching to hydrolyzed formula
261
Q

risk factor for cerebral palsy

A 
prematurity 
IUGR 
intrauterine infection 
Antepartum haemorrhage
 placental pathology 
maternal alcohol consumption 
maternal tabacco
262
Q

suspect constipation in child - what should you do?

A

start ORAL laxative regime

don’t have to confirm with x-rya

263
Q

what ovarian timor can secrete estrogen and cause premature puberty

A

granulose cell timor of the ovary
- child: pernicious puberty

Dx:
- increase estrogen and mass on ovary

264
Q

sertoli leydig cell tumour causes what

A

this timor produces androgen and therefore masculinization features

265
Q

most common cause of meningitis if 3 months - 10 years oldd

A

n. meningitiis
s. prnumonia

(>11 - think neisseria
(< 3 months - GBS, ecoli

266
Q

define aplastic crisis compared to splenic sequestrating crises

A

Aplastic crisis:
DECREASE reticulocytes
- transient arrest o ferytropoiesis , secondary to parovrius B 19)

Splenic sequestration crisis

  • INCREASE reticulocyte
  • splenic vaso-oclussive –> rapidly enlarging spleen
  • occurs in chid with autosplenectomy
267
Q

acute chest syndrome define

A

it is pulmonary vas occlusion or infection and is characterized by fever, chet pain and a new infiltration of chest radiography

  • fever, cough , chest pain, and findings on chest auscultations
268
Q

trachoma

A

child conjunctival injection, tarsal inflammation and pale follicles

269
Q

neonatal absteigende syndrome - due to exposure of what

A

HEROIN, metadone , opiods

not cocacine - withdrawal symptoms are not as sever with cocaine

270
Q

patient presents like measles but has had the vaccine 2 weeks ago - what do you do?

A

reassurance - b/c small precent of patients may develop fever and mild rash 1-3 weeks after immunization - resolves without treatment

271
Q

musty odor- what is it and how do you dx

A

think PKU
- quantitative amino acid analysis

AR mutation 
Clinical 
- severe ID 
- musty body odour 
hypo pigmentation skin eyes and hair and brain nuclei
  • treat with restriction of phenalyanine
272
Q

what protects you from malaria

A

sickle cell trait

273
Q

first line management for epiglottis

A

endotracheal intubation in a controlled setting

if failed then you can consider emergent tracheostomy

274
Q

tay sachs patology

A

b- hexosaminidase A deficiency

275
Q

difference b/w tay sachs disease and neimann pick disease

A
  • neiman picks - HSM

Both will have hypotonia , loss of motor milestones, hypotonia and feeding difficulties and cheery red macula

276
Q

patients with referring syndrome - why do they get hypokalemia

A

Carbohydrates stimulate INSULIN activity and this promotes cellular uptake of K+, phosphorus , and Mg

patients will develop arrhythmia and Cardiopulmonary failure

277
Q

patients who get cardiac surgery are at increase risk post op

A

pericardial effusions

- distant heart sounds , hypotension and distended jugular veins

278
Q

patients with bronchiolitis are at increase risk of what

A

apnea

resp failue

279
Q

treatment of androgen insensitivity syndrome

A

do a gonadectomy - BUT WAIT TILL AFTER PUBERTY ( helps maintain height)

280
Q

vicious meconium - what does this suggest

A

meconium ileus

uworld (11 decks)

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