Peadiatrics

Question 1

What is the only contraindication for a newborn to not receive Hep B vaccine at birth? and when is it appropriate to give?

Answer 1

Because the production of protective anti-HBs antibodies in infants with low birth weight is weakened, infants < 2000 g should not receive their first dose until they are 1 month of age (regardless of birth weight) or discharged from the hospital.

Question 2

What are the 2 preferred initial treatments of intermittent strabismus?

Answer 2

1. Eye patch - Cover the unaffected eye using a patch (occlusion) → training of the weaker eye
2. Cyclopentolate eye drops- apply cyclopentolate drops to the unaffected eye → blurs vision → encourages monocular use of the affected eye

Question 3

What is a rare cardiac deformity associated with DiGeorge syndrome

Answer 3

Truncus arteriosus (single overriding vessel)

Question 4

FMD (Fibromuscular dysplasia) affects boys and girls equally in the pediatric population true or false?

Answer 4

True

Question 5

What are the indications for laparoscopic varicocelectomy?

Answer 5

1. Adolescents with testicular atrophy or delayed growth of the affected testicle
2. Painful varicocele
3. Infertile men (confirmed with an abnormal sperm analysis)

Question 6

single or multiple osteolytic lesions that cause bone pain and swelling in the skull + anemia in young child. Dx?

Answer 6

Langerhans cell histiocytosis (LCH)

Question 7

Characteristic laboratory findings of systemic JIA (juvenile idiopathic arthritis)

Answer 7

Leukocytosis, thrombocytosis and elevated inflammatory markers such as ESR and CRP as well as anemia from chronic inflammation and/or iron def.

Question 8

Systemic JIA treatment

Answer 8

NSAIDs and Biologic agents

Question 9

Liver biopsy in a patient with Reye syndrome will present with what finding

Answer 9

Microvesicular fatty infiltration (steatosis)

Question 10

A unique characteristic of Leukocyte adhesion deficiency type 1 infection

Answer 10

Absence of pus with infection.

other features include poor wound healing with large skin ulcers, severe periodontitis/gingivitis

Question 11

Patients should be started on empirical antibiotic therapy immediately if meningitis is suspected and any of the following features are present

Answer 11

immunocompromise, focal neurological deficits, abnormal level of consciousness, seizure at initial presentation, and a history of CNS disease

Question 12

indirect hyperbilirubinemia and moderate jaundice in an otherwise healthy infant about 2 weeks after birth.

Answer 12

Breast milk jaundice

Question 13

neonatal jaundice within the first week of life and typically presents with hypovolemia

Answer 13

Breastfeeding failure jaundice

Question 14

Granulosa cell tumor features in girls

Answer 14

1. high level of estrogen
2. GnRH production is suppressed and there is no LH response to GnRH.
3. bone age in these patients is typically above their chronological age

Question 15

Low birth weight, microcephaly (head circumference at the 2nd percentile), microphthalmia, polydactyly, cleft lip and palate, and rocker-bottom feet (convex foot deformity with prominent heel)

Answer 15

trisomy 13 (Patau syndrome).

Question 16

What is chorioretinitis

Answer 16

A type of posterior uveitis characterized by inflammation of the choroid (vascular layer of the eye) and retina

Question 17

Children with a history of seizure disorder are at increased risk of having a seizure with the administration if what vaccine

Answer 17

pertussis vaccine.

Question 18

Increased nuchal translucency, decreased levels of PAPP-A, shortened femur length, shortened fifth digits with clinodactyly, and a small nasal bone in a fetus with a 47, XX karyotype

Answer 18

trisomy 21 (i.e., Down syndrome).

Question 19

The eruption of multiple, nontender, and nonpruritic white macules with fine scaling after traveling to a warm, humid climate

Answer 19

tinea versicolor.

Question 20

Complications of pertussis and why?

Answer 20

scleral hemorrhages, epistaxis, abdominal hernias, and pneumothorax (due to the increased intrathoracic and intra-abdominal pressure)

Question 21

most common congenital heart defects in patients with Down syndrome

Answer 21

Atrioventricular septal defects (AVSD; also referred to as endocardial cushion defects)

Question 22

chronic anterior uveitis (anterior chamber flare with signs of iris inflammation bilaterally) and the asymmetric joint involvement of ≤ 4 joints for > 6 weeks.

Answer 22

Oligoarticular juvenile idiopathic arthritis (JIA)

Question 23

The combination of maternal fever, tachycardia, uterine tenderness, malodorous and purulent amniotic fluid, vaginal discharge, and fetal tachycardia

Answer 23

chorioamnionitis

Question 24

a seizure that begins in a limited area of one hemisphere of the brain and progresses to involve both hemispheres.

Answer 24

focal to bilateral tonic-clonic seizure

Question 25

chickenpox in immunocompromised patients next best step

Answer 25

Acyclovir within 24hrs of onset

Question 26

Patient is a 5 year old girl from Tunisia comes in with right eye hyperaemia, follicles and papillae on the upper tarsal conjuctiva. slit lamp shows follicles in limbic region and bulbar conjuctiva. there is also corneal haziness with neovascularization

Answer 26

Trachoma conjunctivitis, which is caused by Chlamydia trachomatis serotypes A–C.

Question 27

Treatment of choice for management of Prader Willi syndrome

Answer 27

Growth hormone and testosterone

Question 28

Most common type of Oesophageal atresia

Answer 28

Esophageal atresia with tracheoesophageal fistula to the distal esophageal segment is the most common type of esophageal atresia, accounting for > 75% of cases.

Question 29

Patient presents with tachypnea, tachycardia, poor feeding, spasms, seizures, and decreased calcium and PTH levels within first 48 hrs of birth.. Whats the underlying cause

Answer 29

Maternal familial hypocalciuric hypercalcemia (maternal hypercalcemia results in hypercalcemia in the fetus and suppresses the fetal parathyroid glands).

Question 30

Most appropriate initial test to assess potential fetal-maternal hemorrhage involving Rh-positive fetal RBCs.

Answer 30

The rosette test- It is a qualitative test that detects fetal whole blood in maternal circulation.

Question 31

What test is used to distinguish between central and peripheral precocious puberty in a obese children

Answer 31

Leuprolide test - (an increase in LH = Central)

Question 32

How does Constipation increase risk for lower UTIs.

Answer 32

Prolonged fecal retention leads to bladder dysfunction and urinary stasis, which in turn promotes bacterial overgrowth.

Question 33

Next best step after confirming achondroplasia

Answer 33

CT scan of the head
Narrowing of the foramen magnum commonly occurs in achondroplasia due to increased growth of the head compared to the torso ..can lead to subsequent muscular hypotonia/quadriparesis, apnea/hypopnea, and sudden infant death

Question 34

What are the mechanisms that cause physiologic jaundice

Answer 34

1. High RBC turnover
2. decreased hepatic bilirubin clearance (UGT takes 2 weeks to become active)
3. enterohepatic recycling is increases (low gut flora)

Question 35

When does physiologic jaundice present

Answer 35

2-4 days of life

Question 36

Treatment of moderate to severe dehydration of children

Answer 36

IV bolus isotonic fluid (normal saline)

Question 37

Classic signs of a biliary cyst

Answer 37

Abd pain, jaundice and a palpable mass

Question 38

1st line treatment of scabies

Answer 38

topical 5% permethrin OR oral ivermectin

Question 39

Clinical presentation of Methemoglobinemia

Answer 39

Cyanosis, pulse Ox 85% and dark chocolate blood

normal PaO2

Question 40

Etiology of Methemoglobinemia

Answer 40

Exposure to oxidising substances (dapsone, nitrites and topical/local anaesthetics)

Question 41

Difference between patellar tendinitis vs Osgood-Schlatter

Answer 41

Pain happens over the tibial tuberosity in Osgood whilst in patellar tendinitis there’s in point tenderness at the inferior pole of the patellar

Question 42

Etiology of Abnormal uterine bleeding in adolescences

Answer 42

Immature hypothalamic-pituitary-ovarian axis –> anovulation and heavy, irregular bleeding

Question 43

Treatment of Abonormal uterine bleeding

Answer 43

IV estrogen or High dose oral estrange/progestin contraceptive pills

Question 44

Transmission of CMV among healthy children and adults

Answer 44

Infected bodily fluids (e.g. saliva, urine)

Question 45

The most common pathogenic organism in CF patients in the setting of concurrent influenza infection and treatment

Answer 45

Stap A. - treat with Vancomycin

Question 46

This child presents with acute onset cough and shortness of breath and has unilateral wheezing and reduced air entry along with hyperlucency of the lung fields

Answer 46

Foreign Body Aspiration