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PED COMAT Flashcards

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1
Q

What effects on the fetus is associated with maternal use of heroin/opiates during pregnancy?what should these children be monitored for?

A

increase risk of:fetal growth restrictionplacental abruptionfetal deathpreterm laborintrauterine passage of meconiuminfants should be monitored for NEONATAL ABSTINENCE SYNDROME (uncoordinated sucking reflex = poor feeding, irritability, high pitched cry)

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2
Q

what is the cause: 3 day old infantlarge bump on headscleral icterus, abdominal jaundiceswelling over parietal bone - does not cross suture lines

A

Cephalohematoma

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3
Q

what is the best tx for osgood-schlatter disease?

A

ibuprofen

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4
Q

What is the caloric requirement for most 1. healthy babies2. preterm babies3. VLBW (very low birth weight) infants = <1500gin the first 1 to 2 months of life?

A
  1. 100 cal/kg/day2. 115 to 130 cal/kg/day3. 150 cal/kg/day
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5
Q

when does a child double their birth length?

A

4 years of age

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6
Q

what is the Ballard Assessment tool?

A

uses signs of neurologic and physical maturity to estimate gestational age

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7
Q

For a 18 month old child what are the milestones for:1. gross motor2. fine motor3. language4. social/adaptive

A
  1. walks alone, may climb stairs/runs, can help undress2. drinks from cup/spoon, make tower of 2 cubes3. 6 words in vocabulary4. points to show what he wants, shakes head no
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8
Q

What is the disease:5 year old with newly discovered cardiac murmur. elfin facies, mild retardationwhat kind of cardiac defect?

A

Williams-Beuren syndrome - also HTN, short statusBicuspid Aortic Valve–aortic regurg–aortic stenosis develops 40s-50s

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9
Q

For a 6 month old child what are the milestones for:1. gross motor2. fine motor3. language4. social/adaptive

A
  1. rolls over, sits unsupported, no head lag when pulled to sit from supine2. reaches for objects, looks for dropped items3. turns to voice, babbles4. feeds self, demonstrates stranger recognition (prelude to stranger anxiety)
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10
Q

What is the most likely inborn error of metabolism in a 2 day old infant with severe metabolic acidosis?

A

Glutathione synthetase deficiency–severe metabolic acidosis+ jaundice+ hemolytic anemia

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11
Q

what is the infective agent:7 year old w low grade fever, headache, pruritic rash. Rash began on cheeks, spread to trunk and extremities. Physical exam shows maculopapular rash w lacy, reticulated appearance

A

Erythema infectiosum - parvovirus B19

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12
Q

cal/mL for 20 cal formula?

A

0.67 cal/mL

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13
Q

Neonate IV fluids +/- feeds

A

Increase 20-30 mL/kg/day until 150-160 mL/kg/dayDay 1: 60-80 mL/kg/dayDay 2: 80-100 mL/kg/dayDay 3: …etc…60+(20day)= max limit

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14
Q

What is dz and defect?Tall 10 year old, arachnodactyly, ligamentous laxity, pectus excavatum

A

Marfan syndrome - fibrillin

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15
Q

what is the etiology:infant born w part of small bowel protruding from abdomen to the right of the umbilicus.

A

Gastroschisis—involution of the second umbilical vein

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16
Q

how old is the child:Child says “mama” and “dada” w meaning, follows one-step commands, shows objects to parents to share interest.plays interactive games (peekaboo, waves bye bye). points to desired object

A

12 months

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17
Q

What electrolyte abnormalities is most often seen in infants of diabetic mothers?

A

hypoglycemiahypocalcemiahypomagnesemia

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18
Q

what is the dx?1 month old with head circumference > 100th percentile. mother had no prenatal care. Macrocephaly w no other dysmorphic features. Transillumination of the head is positive.

A

hydranencephaly

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19
Q

cal/mL for 24 cal formula?

A

0.80 cal/mL

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20
Q

What will a coin appear like in an AP CXR if in the 1. esophagus2. trachea

A
  1. Round – The coin will face you2. Linear – You are looking at the coins edge. A Sagital CXR needed to see the front/back of the coin.
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21
Q

Identify the pathogen:12 day old infant w bilateral eye discharge. conjunctival injection, lid swelling, scant mucopurulent discharge. no rashes

A

chlamydia trachomatis

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22
Q

What are the two most prevalent causes of acute otitis media?

A

Streptococcus pneumoniaeHaemophilus influenzae, nontypeable

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23
Q

Fluid management for neonate

A

Based on weight until day 7Feeding q 3 hours

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24
Q

What is the definition of Small of Gestational age?

A

Less than 10% for Birth WeightAt Term = <2500gAt 37 wk = <2000gAt 34 wk = <1500gAt 31 wk = <1000gAt 24 wk = <500g

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25
Q

What are the components of the HEADS adolescent screen?

A

H-homeE-education/employment/eating disorderA-activities/alcoholD-drugs/depressionS-safety/sex/suicide

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26
Q

What are the components of an APGAR score?

A

Appearance (skin color)Pulse (heart rate)Grimace (reflex irritability)Activity (muscle tone)Respiration

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27
Q

What congenital heart defect results in a biscuspid aortic valve and patent ductus arteriosus? neonate has recurrent epistaxis

A

Coarctation of the aortaa/w–bicuspid aortic valve–persistent ductus arteriosus–ventricular septal defect

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28
Q

What is the current guideline for intrapartum antimicrobial prophylaxis against Group B Strep?

A

If the mother is in labor with ruptured membranes and one of the following is present:G – Gone – Unknown StatusB – Before – Prev infant infected w/ invasive GBSS – Soon – During pregnancy: + bacteriuria, + vag-rec cultureDuring Labor: Premature delivery, ROM >18hrs, +GBS PCR, Maternal Fever

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29
Q

cal/mL for D10 formula?

A

0.34 cal/mL

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30
Q

Neonate “feeds only” amount per day

A

Increase 30 mL/kg/day until 150-160 mL/kg/dayDay 1: 30 mL/kg/dayDay 2: 60 mL/kg/dayDay 3: …etc…30day=max limit

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31
Q

What effect on the fetus can occur from a mother on anticonvulsants?

A

Cardiac defectsMicrocephaly, dysmorphic craniofacial featureshypoplastic nails, distal phalangesIUGRMental retardationrare: methemoglobinuria

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32
Q

what is the cranial nerve affected:1 month old presents w poor feeding, suckling difficulty. she had this problem since birth. pt has a cranial dysfunction

A

CN IX – glossopharyngeal

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33
Q

What supplement is recommended for exclusively breastfed infants younger than 6 months?

A

Vitamin D

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34
Q

What are 3 risk factors an infant is susceptible to who is small for gestational age?

A

HypoglycemiaHypothermiaPolycythemia

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35
Q

What 3 medications are routinely given to newborns?

A
  1. Intramuscular Vit K2. Hepatitis vaccine (HBIG if mother is + for HbsAg)3. Erythromycin, tetracycline, silver nitrate - for gonococcal conjunctivitis
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36
Q

How old is the child:uses more than 50 words, follows two-step commands, engages in parallel play, stacks 5-6 blocks, turn pages in book, throw ball overhand, refer to themselves as “me” or “I”

A

2 years old-uses two word phrases

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37
Q

A 7cm mass is palpated on the right side that does not cross the midline in a 5 month old. The child was born large for gestational age with macrocephaly, macroglossia, hypospadias.what is the etiology?

A

Wilms Tumor - associated with Beckwith-Wiedemann syndrome = a genetic overgrowth syndromea/w omphalocoele, hemihypertrophy, hypoglycemia, large for gestational age, other dysmorphic features.

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38
Q

A 2 year old with 102.6F fever has a seizure. what should you tell the parents?

A

Simple Febrile Seizure = reassure parents

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39
Q

cal/mL for 22 cal formula?

A

0.73 cal/mL

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40
Q

Pounds to grams conversion

A

1 lb. = 453.59 g

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41
Q

What congenital heart condition results in a cleft anterior mitral valve leaflet?

A

ostium primum atrial septal defect–clefts in anterior leaflet of the mitral valve–a/w anomalies of the AV valves–possible defects on the ventricular septum

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42
Q

A child born to a diabetic mother has an absent Moro reflex on the left. left SCM appears to be in spasm. what is the cause?

A

clavicle fracture = absent moro reflex on affected side + spasm of SCM

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43
Q

What type of congenital heart defect:neonate is born and initial physical exam is unremarkable. holosytolic murmur is heard on day 5 of life

A

Perimembranous VSD–upper ventricular septum close to aortic/mitral valve–left to right shunt occurs several days after birth when pulmonary vascular resistance decreases

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44
Q

What does it mean to have a term pregnancy?

A

born at >37 weeks gestation

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45
Q

What are 3 side effects of stimulant medication in a child with ADHD?

A
  1. decreased appetite2. insomnia3. decreased growth velocity
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46
Q

How old is the child:says “mama”, ball”, “yes”, “no”, “hi”turn pages in a bookgreet people, show empathylisten to story, drink from a cup

A

15 months

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47
Q

What are the contraindications for a child against receiving a DTaP vaccination?

A
  1. serious allergic reaction/anaphylaxis after a previous dose2. encephalopathy within 7 days after dose
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48
Q

3 yo M w/ 3 day hx of fever, fussiness, stiff neck, decreased oral intake. Hx shows Upper resp infection one week ago. throat gram stain gram-positive organisms.Confirm w/ lateral neck radiography… Dx?

A

Retropharyngeal Abscess–hx of upper respiratory, throat/ear infection–may present w torticollis–S. pyogenes, S. aureus

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49
Q

2-day old male w/ numerous small papular, and pustular lesions w/ surrounding erythema on the anterior chest and abdomen. Multiple eosinophils w/o microbial organisms on Bx… Dx?

A

erythema toxicum neonatorum

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50
Q

Age?10-25 words, names one picture on demand. engages in pretend play (feeding doll), laughs in response to others, walk up steps, run, stack 2-3 blocks, use spoon/cup

A

18 months

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51
Q

what are 5 alarming symptoms following vaccination?

A

FUCSA1. fever > 104F2. unresponsiveness of infant3. crying > 3 hours within 48 hrs4. seizure within 3 days 5. allergic reaction

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52
Q

what is the dx:6 year old male w painful oral lesions. had similar episode one year ago. multiple round, clearly defined, small buccal ulcerations w a grayish base that are tender to palpation. lips are normal without lesions. oropharynx is clear w/o erythema, exudate or tonsilar enlargement

A

aphthous stomatitis (canker sores)

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53
Q

What are the 3 circumstances that “Failure To Thrive” describes?

A
  1. Weight falls below the 3rd percentile2. Weight for height/length falls below the 3rd percentile3. Rate of weight gain slows compared to previous growth (growth chart crosses two or more major percentiles)
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54
Q

What are the screening guidelines for diabetes?when do you start screening? frequency?

A

Overweight (>85% weight + height or >120% weight for ideal height) +2 Risk factors:1. fam Hx2. race = NA, AA, Hispanic, Asian3. signs of insulin resistance4. maternal Hx of diabetes/gestational diabetes

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55
Q

what are 5 alarming symptoms following vaccination?

A
  1. fever > 104F2. persistent crying > 3 hours within 48 hrs3. seizure within 3 days 4. unresponsiveness of infant5. signs of severe allergic reaction
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56
Q

dx:4 year old w fever, respiratory distress. toxic appearing, drooling, sitting upright, holding neck in hyperextension. pt rapidly develops stridor and cyanosis

A

Epiglottitis–lateral neck x-ray = thumb sign

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57
Q

What is the most likely inborn error of metabolism in a 2 year old that develops severe cutaneous photosensitivity?

A

Hartnup disease - decreased availability (transport) of tryptophan for niacin synthesis

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58
Q

What effect on the fetus/pregnancy can Cocaine and other stimulants cause?

A

Vasoconstriction = placental insufficiency and low birth weight

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59
Q

when does an infant1. double2. tripletheir birth weight?

A
  1. 5 months2. 12 months
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60
Q

What immunologic abnormalities are found in ataxia-telangiectasia?

A

undetectable IgA levelselevated IgMnormal IgG

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61
Q

what is the pathogen:5 year old w axillary lymphadenopathy. small wound on palmar surface of the third digit adjacent to the distal interphalangeal joint. Cultures are obtained resulting in growth on Warthin-Starry stain.

A

Bartonella henselae

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62
Q

how does depression in adults differ than depression in adolescents?

A

Adult depression often includes early morning waking with difficulty sleeping at night

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63
Q

5 year old female with blood in underwear-multiple pathological fractures-tanner stage 2 breast development-multiple hyperpigmented irregularly shaped cutaneous macules

A

McCune-Albright syndrome–GNAS geneGnRH independent, peripheral precocious puberty from ovarian hyperfunction and cyst formation, episodic estrogen secretion–unpredictable vaginal bleeding–breast development w/o growth of pubic hair–bone lesions - polyostotic fibrous dysplasia

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64
Q

6 year old with sore throat, painful swallowing-no cough-febrile-bilateral tonsillar hyperemia, edema-lymph node enlargement in the anterior cervical chain-diffuse, pimply sandpaper-type rash on trunk and extremities

A

Scarlatina = rash that appears w group A streptococcal infection1. fever2. tonsillar exudates3. cervical adenopathy4. absence of cough

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65
Q

What congenital heart condition results in a persistent left superior vena cava

A

Total anomalous pulmonary venous connection–cyanotic–four pulmonary veins fails to make normal connection in left atrium and drain into systemic venous circulation

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66
Q

what is the most appropriate step after suspecting intussusception?

A

air contrast enema

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67
Q

What congenital heart defect causes a redundant tricuspid valve leaflet

A

Ebsteins anomaly–hypoplastic right ventricle–enlarged right atrium–most patients also have an ASD

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68
Q

when should tympanostomy tube placement be considered?

A

Otitis media w effusion (OEM) for 4 months+hearing loss/documented language/developmental delay

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69
Q

What effect on the fetus can tobacco use cause?

A

Low birth weight

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70
Q

what is the cause: lethargic newbornlump on scalp that is slowly growingfirm, fluctuant mass overlying the occiput which crosses over to the left parietal skull

A

subgaleal hemorrhage

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71
Q

What are the four criteria in the diagnosis of diabetes?

A
  1. HbA1c > 6.52. fasting glucose >126mg/dL3. 2 hour fasting glucose > 200 mg/dL4. random plasma glucose > 200 mg/dL
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72
Q

Neonate caloric intake goal

A

100-110 cal/kg/day

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73
Q

Pathological Jaundice HPI

A

Onset: <24 HrsBilirubin Involved: Direct/Conjugated, >2 or >20% TotalRise: >5/day or >0.2/HrResolve: 14 days+

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74
Q

Pathological Jaundice HPI

A

Onset: <24 HrsBilirubin Involved: Direct/Conjugated, >2 or >20% TotalRise: >5/day or >0.2/HrResolve: 14 days +

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75
Q

Physiological Jaundice HPI

A

Onset: <7 daysBilirubin Involved: Indirect/Unconjugated, <10% TotalRise:<5/day or <0.2/HrResolve: w/n 10 days

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76
Q

Caffeine Citrate is used for…

A

Obstructive/Mixed/Central Apnea in Preterm Neonates <35wks

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77
Q

Methylxanthine is used in the NICU for…

A

Apnea control, precursor for caffeine

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78
Q

Central Apnea is …

A

lack of inspiratory effort

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79
Q

Mixed Apnea is …

A

Upper airway obstruction w/ inspiration that follows/precedes Central Apnea

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80
Q

Sx of Neonatal Abstinence Syndrome

A

High Pitched CryIrritablePoor FeedingPoor Coordinated Suckle

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81
Q

Obstructive Apnea is …

A

Inspiratory effort present but ineffective d/t upper airway obstruction

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82
Q

A newborn male child has a flat facial profile, upslanted palpebral fissures, epicanthal folds, a small mouth with a protruding tongue, small genitalia, and simian creases on his hands. What of the following chromosomal disorders is most likely in this child?

A

Tri 21

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83
Q

Sign/Sx of congenital hypothyroidism

A

Cretinism – severely stunted physical and mental growth

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84
Q

Sign/Sx of congenital hypothyroidism

A

Cretinism

85
Q

Deficiency that causes: Night blindness, xerophthalmia, Bitot spots, follicular hyperkeratosis; immune defects

A

Vitamin A

86
Q

Deficiency that causes: reduced bone mineralization

A

Vitamin D

87
Q

Deficiency that causes: Hemolysis in preterm infants; areflexia, ataxia, ophthalmoplegia

A

Vitamin E

88
Q

Deficiency that causes: Prolonged prothrombin time; hemorrhage

A

Vitamin K

89
Q

Deficiency common w/ Malabsorption; breastfed infants

A

Vitamin D

90
Q

Deficiency common with protein-calorie malnutrition; malabsorption

A

Vitamin A

91
Q

Sx: Pitting Edema, Hypo-albumin, normal weight, muscle atrophy, abdomen is distended, bowel sounds hypoactive. moon facies

A

Kwashiorkor – Protein malnutritionAfrican child

92
Q

Sx: Muscle and adipose wasting, hair and skin is dry and thin, bradycardia, hypothermia

A

Marasmus – Complete MalnutritionConcentration camp

93
Q

Drugs/Intoxications that cause hypoglycemia

A

SAD Q-TIP PA ValSalicylatesAlcoholDiabetic MedicationQuinineTMP-SMXInsulinPropanololPentamidineAckee FruitValproic Acid

94
Q

Hypoglycemia without ketonuria suggests…

A

hyperinsulinism or a defect in fatty acid oxidation.

95
Q

Scalp swelling that extends across the midline, and contains serosanguinous, subcutaneous, extraperiosteal. Involves bleeding below the scalp and above the periosteum

A

Caput Succendaneum

96
Q

Bleeding between the skull and the periosteum, does not cross suture lines.

A

Cephlahematoma

97
Q

A narrow pulse pressure is seen with…

A

pericardial tamponade, aortic stenosis, and heart failure

98
Q

A wide pulse pressure may be seen with…

A

PDA, truncus arteriosus, AV malformations, aortic insufficiency, anemia, vasodilation with fever or sepsis.

99
Q

LLSB or between LLSB and apexVibratory, musical Systolic ejection murmur decreases in upright position

A

Still/Vibratory/Flow/Innocent Murmur

100
Q

Balloon septostomy is…

A

the widening of a foramen ovale, patent foramen ovale, or atrial septal defect via cardiac catheterization to allow flow of oxygenated blood in the presence of CHD, to prepare for, or sustain until corrective heart surgery.

101
Q

Down Syndrome heart defects

A

VSDAVSDCushion defects

102
Q

Cyanotic CHD

A

Right to Left Shunt1. Truncus Arteriosus2. Transposition of the Great Vessels3. Tricuspid Atresia4. TOF5. TAPVR6. Hypoplastic Left Heart

103
Q

Acyanotic CHD

A

Left to Right Shunt – “Holy” ChildASDVSDPDACoA

104
Q

Mid-systolic click indicates…

A

Mitral valve prolapse

105
Q

Turner Syn heart defects

A

Bicuspid AortaCoarctation of the Aorta

106
Q

Trisomy 18 Heart Defects

A

ASDVSDPDABicuspid Aortic/Pulmonary ValveCoA

107
Q

Trisomy 13 Heart Defects

A

ASDVSDPDABicuspid Aortic/Pulmonary ValveCoA

108
Q

Hyperpigmentation w/ Vitiigo and Hypoglycemia, Hyopnatremia, Hyperkalemia

A

Addison Disease, get ACTH stimulation test

109
Q

Pt presents w/Floppy BabySmall HeadBulbous noseCleft PalateForked UvelaTOFInterrupted Aortic ArchTruncus ArteriosusLong, tapered fingers… Dx?

A

Velocardialfascial syndrome

110
Q

Fluid Maintenance Therapy Guideline

A

4-2-14 ml/kg/hr for the first 10 kg2 ml/kg/hr for the next 10 kg1 ml/kg/hr for remaining kgOver 20 kg: Wt in kg + 40 = Maintenance ml/kg/hr

111
Q

Painful Buccal/Lip/Gum Ulcers along w/ GU Ulcers that scar and Uveitis…Dx?Other findings?

A

Bechet DzRed papule following skin prick, skin lesions, vasculitis

112
Q

IV Flow Rate Calculation

A

Vol (Drops per min)/time in min

113
Q

Drop rates for:BloodRegularMicrodrop

A

Blood = 10/mlRegular = 15/mlMicrodrop = 60/ml

114
Q

Fxn abdominal pain or HA that has no constitutional Sx…Dx?

A

New life stress

115
Q

Swollen knees/anklesAbdominal painPurpuric rash on feet/legs/buttocksRenal pathology

A

Henoch-Scholein Purpura

116
Q

Infant presents w/ severe cough, resp failure, apnea. What vaccine was missed by the older sibling.

A

Tdap

117
Q

First line tx for acute OM

A

High Dose Amoxicillin

118
Q

FeverAchy jointsHTNEdemaCoughDyspneaHemoptysisDiffuse alveolar hemorrhageRenal Sx

A

Goodpasture Syn

119
Q

Cardiac finding in Marfan

A

Mitral prolapse

120
Q

Long Thin FaceHyperflexiblePectus ExcavatumHigh arch palateDental OvercrowdingScoliosisDx?

A

Fragile-X

121
Q

Follow up management on UTI

A

Renal ultrasound &raquo_space; all Males &raquo_space; all Females <5 yo &raquo_space; Females >5 yo w/ more that two UTI

122
Q

Small EyesFlattened nasal bridgeThin lipMid-fascial hypoplasiaCardiac septal defectDx?

A

Fetal Alcohol Syn

123
Q

Asx infant w/ possible drain cleaner ingestion. PE unremarkable, next step….

A

Admit for possible esophageal endoscopy

124
Q

Diffuse rales and wheezingHyper inflated LungsFlat diaphragmPatchy atelectasisHypoxiaCoughReduced appetite

A

RSV Bronchiolitis

125
Q

Newborn Reflexes

A

BDRMSTGMoroDanceRootSuckTonic NeckBabinskiGrasp

126
Q

CF pt w/ pancreatic dysfxn presents w/ hemolytic anemia. Why?

A

Deficient in Vit ADEK d/t decreased lipase. Extensive Vit E deficiency may lead to hemolytic anemia.

127
Q

Children w/ high milk and low meat intake are at of …

A

iron deficiency anemia

128
Q

Fever, weight loss, painless nodes… next step?

A

CXR

129
Q

Easy bruising, hypermobile, hyperelastic skin, slow wound healing… Dx?

A

EDS

130
Q

Full testicle with twisted mass, non-tender, positive cremaster

A

Vericocele

131
Q

DKA pt present w/ acidosis, hyponatremia, hypokalemia. IV NS bolus given next step?

A

IV NS w/ potassiumThe hyponatremia is dilutional

132
Q

Physical Nadir of a newborn

A

Infant 6-12 weeks has a drop in Hgb to 9-11.Normal occurrence, no intervention needed.

133
Q

Infant has increased renin levels, other vitals/labs normal. Most likely causes (3)

A

Renal Thrombosis CoACongenital Renal Abnormality (Stenosis, Parenchymal Disease, Wilms Tumor)

134
Q

Aniridia presents w/…

A

absence of pupil

135
Q

Infant presents w/:DysuriaHematuriau/l painless abdominal massHTNFeverConstipationAniridia

A

Nephroblastoma: Wilms Tumor

136
Q

A 2-year-old girl is brought to the emergency room after her mother discovers a mass in the girl’s abdomen while bathing. The girl occasionally cries when urinating, but is otherwise asymptomatic, without any abdominal pain. On exam, she is found to be hypertensive. There is a palpable, non-tender mass on the right side, which does not cross the midline. A chest radiograph is ordered to assess for lung involvement.

A

Wilms Tumor

137
Q

Toddler w/:Chest painDyspneaShort PRWide QRSNormal Sinus Rhythm

A

WPW

138
Q

6 mo w/ nl birth, no PMH presents w/ neuro delay, exaggerated startle response, and no organomegaly…Dx?

A

Tay-sachs

139
Q

15 mo old w/ nl birth, no PMH presents w/ gargoyle facies, clouded corneas, heart dz, skeletal deformity, hepatomegaly, development delay… Dx?

A

Hurler syn

140
Q

3 mo w/ nl birth, no PMH presents w/ hepatomegaly, FTT, Resp Tract infxn, irritable.Progresses to hypotonia, develop delay, spastic, rigid, and introversion… Dx?

A

Neimann-Pick Dz

141
Q

3 yo w/ nl birth, no PMH presents w/ course facies, short for age, hepatosplenomegaly, Skeletal abnormality, vision loss, hearing loss, retardation… Dx?

A

Hunter Syn

142
Q

Tx for Digoxin toxicity

A

Digoxin Immune Fab

143
Q

Testicular cancer suspected. Initial work up includes…

A

U/SAFPBeta-hCG

144
Q

6 mo girl w/ nl birth, no PMH presents w/ rapid decline in motor skills, hypotonia, hand-wringing, introversion, FTT…Dx?

A

Rett Syn, X-Linked Dominant

145
Q

1 wk old w/ nl birth, no PMH presents w/ a 2 cm raised well circumscribed non-fluid lesion over the lumbar spine. Next step?

A

U/S to r/o spina bifida

146
Q

9 mo old w/ nl birth, no PMH presents diarrhea, abdominal pain, distention, flatulence, delay tooth eruption, aphthous stomatitis, growth delay, tympanic abdomen… Dx?

A

Celiac Sprue

147
Q

2 yo prev healthy child presents with black maxillary teeth and nl mandible teeth… Dx?

A

Bottle Feeding Caries

148
Q

Ig _ crosses the placenta and transfers some imunity

A

IgG

149
Q

Cyanotic one day old presents w/ grade 1 gallop, hepatomegaly, diminished pulses, RVH…Dx?

A

TAPVR

150
Q

Asx toddler turns blue and faints following a tantrum…Dx?

A

Breath-holding

151
Q

Two week old presents with a painless mastoid mass and head tilted/flexed to the same side.

A

Congenital Torticollis

152
Q

16 yo w/ Fever, HA, Sore Throat, Abdominal Pain…Dx?

A

Strep Pharyngitis

153
Q

Tongue coated in white w/ prominent red papilla

A

Strawberry Tongue

154
Q

Low back pain that decreases throughout the day, fatigue, pain in achilles/plantar fascia…next step?

A

X-ray of the spine

155
Q

Causes for fractures in infants other than abuse…

A

Rickets (Secondary Hyperparathyroid)Osteo imperfecta

156
Q

Neonate presents w/:Irregular port wine stain on face that follows CNVHamartoma of eye/skin/CNSSeizures Mental retardationAmblyopia…Dx?

A

Sturge-Weber Syn

157
Q

Infant presents w/:Posterior Fossa AbnormalityHemangiomaArterial AbnormalityCardiac DefectEye Abnormality… Dx?

A

PHACE Syn

158
Q

Child presents w/6+ cafe au lait spots >5mmADHDAxillary FrecklesFamHx of seizures…Dx?

A

NF1

159
Q

Reasons not to breastfeed…

A

Varicella 5 days prior/2 days after birthIllicit drug useActive, untreated TBChemoHIVActive HSVInfant w/ galactosemiaRadiation

160
Q

Tx for labial fusion…

A

Estrogen Cream

161
Q

Newborn presents w/Large hands and feetHypoplastic concave nailsDiminished pulse in legsRedundant neck folds… Dx?

A

Turner Syndrome

162
Q

Fever, rash, splenomegaly, sore throat that follows an ampicillin tx…

A

Mononucleosis

163
Q

Newborn presents w/MicrocephalyRetardationThrombocytopeniaBlindnessHearing lossJaundiceAnemiaScattered calcification throughout cortex… Dx?

A

Toxoplasmosis

164
Q

Prev healthy 3 yo presents w/ hoarseness, PE unremarkable…Dx?

A

Vertical HPV in resp tree

165
Q

Flu like Sx with tender adenopathy along w/ vesicles on GU and cervix… Dx?

A

HSV

166
Q

Short child w/ recurrent skin infections, abscess formation, osteomyelitis and PNA w/ a likely immunodeficiency… Dx?

A

Chronic Granulomatous Dz

167
Q

Pseudo albinismOcular albinismFrequent infections…Dx?

A

Chediak-Higashi Syndrome

168
Q

Every 21 days (-ish) pt presents w/:Oral ulcersFeverStomatitisPharyngitis… Dx?

A

Cyclic Neutropenia

169
Q

Neonate presents w/ Poor ToneProlonged JaundiceEnlarged fontanelleExcessive sleepHoarse cryFTTCoarse faciesConstipation… Dx?

A

Hypothyroid

170
Q

Infant presents w/ VomitingMusty smellEczemaSeizuresSelf-mutilation… Dx?

A

PKU

171
Q

Infant presents w/ JaundiceIrritableHepatomegalySmells of boiled cabbage… Dx?

A

Tyrosinemia

172
Q

Infant presents w/ Projectile vomitLethargicSmells of sweaty feet… Dx?

A

Isovaleric Acidemia

173
Q

Greasy, scaly plaque that causes hair loss…

A

Seborrheic Dermatitis

174
Q

Uniformly broken hairs, black dots on scalp, circle lesion…

A

Tinea Captitis

175
Q

Permethrin is used to tx …

A

Lice and scabies

176
Q

Pneumococcal pneumonia classically presents as…

A

Sudden onset of high feverRespiratory distressLobar consolidationElevated white blood count with left shift

177
Q

GBS presents as …

A

Sudden onset of respiratory symptoms HypothermiaRespiratory failureDiffuse bilateral granular infiltratesNeutropenia with marked left shift

178
Q

Causes of PNA in neonate…

A

GBSE. ColiListeria

179
Q

Patient between 5 to 20 years of age with a several day or week history of cough and low gradefever who has evidence of pneumonia likely has …

A

MycoplasmaTx w/ macrolide

180
Q

Age?Uses dada or mama specific to each parentUses simple gestures (waving bye) and copy gesturesRespond to simple requests and pull up to stand.

A

12 months

181
Q

Age?Puts on clothingWashes and dries handsCombines two different wordsName a picture, and can throw a ball overhand

A

24 months

182
Q

Age?Dress with supervisionCopy a crossDraw a man of three partsKnows first and last nameUse plurals.

A

48 months

183
Q

Nenonate presents w/FeverDecreased FeedingSunken FontenelleNormal - High Urine outputHypernatremiaDilute Urine…Dx?

A

DI

184
Q

Electrolyte disturbances in hyperthermia

A 
Elevated	
* Creatine Kinase	
* Hyperphosphatemia	
* Hyperuricemia	
* Cardiac Troponin I	
* Hyperkalemia
Depressed	
* Hypoalbuminemia	
* Hypocalcemia
185
Q

Infant has high white count and recurrent infections w/o pus. Sig PMHx include delayed cord seperation at birth…Dx? Transmission?

A

LADAutosomal Recessive

186
Q

4 wk M presents w/ vomiting, dehydration, hyponatremia, hyperkalemia.Dx?

A

CAH, most likely 21-hydroxylase-deficency

187
Q

Excessive circulating thyroid stimulating IgDx?

A

Graves Dz

188
Q

Mom has fever, sore throat, headache, tender posterior auricular and suboccipital lymphadenopathy, and a diffuse rose-pink colored maculopapular rash…neonate most likelt to present w/…

A

Rubella Congenital Defects:1. Hearing Loss2. Cataracts/Glaucoma3. PDA/Aortic Stenosis4. Blueberry Rash

189
Q

A child who develops intermittent excess gas and diarrhea suggests …

A

an infectious agent or food intolerance

190
Q

Teenager w/ fever, joint pain, weight loss, pallor, and joint edema. Evaluate for …

A

ANA, SLE

191
Q

Topical benzocaine has recently been identified as a cause of …

A

methemoglobinemia

192
Q

Tx for OE

A

Topical steroids and oral Abx

193
Q

Howell Jolly bodies indicate …

A

Asplenia/Hyposplenia

194
Q

Tx w/ phenytoin can cause … anemia, … will be seen on blood smear

A

Folate DeficentHypersegmented PMN

195
Q

Micro Anemia + Basophilic Stippling…Dx?

A

Lead Intoxication

196
Q

The only reasons not to give a vaccines…

A
  • Anaphylactic allergy
  • Live vaccines in severely immunocompromised
  • Encephalopathy within seven day
  • MMR or varicella in the pregnant patient
197
Q

Emperic Tx for PID

A

CeftriaxoneDoxycyclineMetronidazole

198
Q

First meningococcal vaccine given at ___ yo.2nd at ___ yo>

A

1116

199
Q

Premature infant being started on enteral feeds presents w/temperature instability, abdominal distension, increased feeding residuals,apnea, and bradycardia.Imaging shows dilated loops, abnormal gas pattern, and bowel wall edema…Dx?

A

Necrotizing Enterocolitis

200
Q

3­ to 4­ mo w/ “doll’s face”presents with seizures,hypoglycemia, hepatomegaly, lactic acidosis, massive hyperlipidemia, and hyperuricemia.

A

Von Gierke disease

201
Q

2 mo presents w/ hypotonia, macroglossia, hepatomegaly, and profound cardiomegalyDeath w/n first yeard/t cardiorespiratory failure

A

Pompe disease

202
Q

Newborn presents w/ bulging, thin membrane over the introitus… Dx?… Next step?

A

Imperforate hymenU/S

203
Q

Yellow fever is a mosquito­borne virus infection endemic in parts of northern South America and in central Africa. The classic description is of Child w/ recent travel presents w/sudden onset of fever, headache, myalgia, lumbosacral pain, nausea, and vomiting,flushing of the face, conjunctivitis, and red tongue. Sx improve for a few days, but then a recurrence of the fever, gastrointestinal symptoms, jaundice, renal failure, seizures, and coma ensue…. Dx?… Tx?

A

Yellow FeverSupportive

204
Q

Asoft, short, medium­ pitched systolic ejection click at the apex of the heart that does not change with Valsalva maneuver suggests a …

A

bicuspid aortic valve

205
Q

Pt w/ sickle cell andhistory of fever, cough, and increased work of breathing suggests …

A

pneumonia or chest syndrome

206
Q

Appy is suspected, next step?

A

U/S

207
Q

Sickle cell pt has osteomylitis, most common bug?

A

Salmonella

208
Q

An afebrile child with a recent upper respiratory infection who has groin and thigh pain, and mild limp is suspicious for having …

A

toxic (transient) synovitis

209
Q

HTN is more prevelant in babies that spend time in …

A

rhe NICU

COMLEX Level 2 (8 decks)

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