Pedi 13

Question 1

Pathogenesis of refeeding syndrome?

Answer 1

High insulin–Increase cellular uptake of K/Mg/P and thiamin–Low serum k/Mg/P and thiamine
High insulin also increases Na and Water retention

Question 2

Manifestation?

Answer 2

Arrhythmia and CHF
CNS(Seizure, Treamour..)
Wernicke encephalopathy
MSK(rhabdomyolysis and weakness)
GI(diarrhea and elevated TA)

Question 3

RTA type?

Answer 3

1–distal
2-proximal
4-aldosterone related
D/T based on urine PH and electrolyte(PH is >5.5 in 1 and <5.5 in 2 and 4), serum K high in 4, and low-normal in 1 and 2

Question 4

CM of RTA?

Answer 4

Growth failure
Low bicarbonate
High serum chlorine(help to D/T from MA from Gi causea)
Non Anion GAP metabolic acidosis

Question 5

T1RTA Cxs?

Answer 5

Poor H secretion in the distal nephron
High urine PH
Low-Normal serum K
Medication disorder
AID(SS and RA)
Family Hx of nephrolithiasis

Question 6

T2RTA?

Answer 6

Defect in proximal Bicarb absorbition
Low urine PH
Low-Normal serum K
Fanconi syndrome(Glucoseuria,Posphaturia and aminoaciduria)

Question 7

T4RTA?

Answer 7

Aldostrone resistant/defect in k/Na antiporte in DCT
Urine Ph <5.5
High serum K
CAH and Obstructive uropathy

Question 8

DPT component?

Answer 8

Diphtheria Toxoid
Tetanus Toxoid
Conjugated/acellular pertussis

Question 9

Schedule?

Answer 9

6 dose
2,4,6 month
15-18 month
4-6 year

Question 10

C/I?

Answer 10

in Px dose
EncephalopathyIAMS, Prolonged seizure, comma…)
Anaphylaxis
Unstable neurologic sign(uncontrolled seizure and infantile spasm)

Question 11

Reactive attachment disorder (RAD) CM?

Answer 11

Occur in children with Hx of neglect/abuse/prolonged institutionalization and inconsistent care
Seldom need comfort
Do not respond to confrontation
Lack of social responsiveness
Lack of positive emotion
Unexpected irritability and sadness to non-treatning situation

Question 12

What about PTSD?

Answer 12

No emotional stunning

No lake of response to the caregiver

Question 13

Risk factor for methemoglobinemia?

Answer 13

Nitrates
Dapsone
Topical/Local anesthetic

Question 14

CM?

Answer 14

Cyanosis
Dark checolate blood
Pulsosimetry–85%

Question 15

LAB?

Answer 15

Normal Po2

>5% d/c in saturation by pulse oximetry and ABG

Question 16

pathophysiology?

Answer 16

Oxidizing agents—Change Fe2+ to Fe 3+–Low O2 affinity and Deacrese 02 release from periphery–Hypoxia/Blood colour and cyanosis did not respond to 100 02 but ABG read normal o2

Question 17

management?

Answer 17

Methylene blue(reduce MetHb to Hb)
Vit C if MB not available or C/I(G6PDD)

Question 18

Viral meningitis Cxs?

Answer 18

Viral predoom
Meningeal sign
CSF(WBC(10-500),G(40-70,I.e N) and P(40-150)
Focal NS less likely
MCC is Enterovirus

Question 19

Enterovirus

Answer 19

part of picorena (NE,IS,SS,RNA)
Poliovirus
Echovirus,
Coxsackievirus 
can cause  aseptic (viral) meningitis

Question 20

management?

Answer 20

Supportive

Question 21

Important Hx in monoarteritis?

Answer 21

Hx of rash(LD, SS, SJA–all three have a rash)

SS and SJA will have a rash

Question 22

Cxs of streaptococal perianal dermatitis?

Answer 22

School-age
Sharpley demarcated perianal erythematous lesion
Pruritis and perianal pain
Fissure--Blood on stooling
Constipation due to pain
Personal or contact pharyngitis

Question 23

Management?

Answer 23

Oral antibiotic

Question 24

what about PW(EV)?

Answer 24

No significant perianal pain
Night pruritis
No sharp demarcated lesion

Question 25

MA(RKHS) d/t with AIS?

Answer 25

AIS Male with female external genitalia Absent axillary/pubic hair development

Question 26

CF complication in females?

Answer 26

Delay puberty due to malnutrition | Infertility due to cervical mucus thickening

Question 27

Hereditary angioedema pathophysiology?

Answer 27

Low C1 inhibitor protein --excessive C1 esterase activation--High bradykinin/Kalerkine activation--Low C4 level

Question 28

CM?

Answer 28

``` Edema(Face, genitalia, and extremity) Laryngeal edema Nu urticaria or pruritis Abd pain, Vomiting, and diarrhea Episode Occur in stress, dental procedure, or trauma ```

Question 29

Management?

Answer 29

C1 concentrate | AntiBradykinin (icatibant) and ant Kallerkine(ecallantide)

Question 30

Avascular necrosis etiology?

Answer 30

``` steroid Alcohol SLE Hemoglinopphaty(SSD) APS Infection(osteomyelitis,HIV) Renal transplant Decompression sickness ```

Question 31

Pathophysiology of laryngomalacia?

Answer 31

Delayed maturation and NMD Redundant supraglottic tissue Recurrent inflammation(reflex)

Question 32

Management?

Answer 32

Normally resolve by 18 month Reassurance +/- GERD therapy Surgery in severe case

Question 33

Diagnosis?

Answer 33

Laryngoscopy Omega shaped epiglottis The collapse of the larynx during inspiration

Question 34

Newborn boy with potter sequence(flat face, deformed foot, and pul. Hypoplasia)

Answer 34

Posterior urethral valve

Question 35

transient tachypnea of the newborn?

Answer 35

Due to retained intrauterine fluid in neonate's lung | transient RD and cyanosis

Question 36

cause of Trendelenburg sign?

Answer 36

``` contralateral Gluteus medius and minimus lesion Cause NM disorder Trauma and impediment of SGN Inflammatory myopathy ```

Question 37

Lesch-Nyhan-syndrome genetics?

Answer 37

X-L-R Deficiency of HGPRT enzyme Accumulation of Hypoxanthine and Uric acid

Question 38

CM?

Answer 38

Delay in milestone and hypotonia in infancy Early childhood --Intellectual D --Extrapyramidal Sx(e.g dystonia and choria) --Pyramidal Sx (e.g hyperreflexia and spasticity) --Self-mutilation Gouty arthritis in late, untreated disease

Question 39

What to do inpatient with suspect of lead poisoning?

Answer 39

Capillary blood lead level If >5ng/dl do venous sampling B/C CBLL have a high FP rate If venous sampling >45 ng/dl--chelation X-Ray--For GI symptomatic patient(constipation,abd pain, and diarrhea)--we see an opaque lesion

Question 40

Cong.Hypothyroidism sx?

Answer 40

``` neonate normal during early infancy Hypotonia Protruding tongue Umbilical hernia weakness/sluggish movt Jaundice Hypothermia Refractory Macrocytic anemia Respiratory difficulty and noisy breath ```

Question 41

Management?

Answer 41

All neonates should be screened with T4 and TSH dysgenesis(Aplasia, ectopia, and hypoplasia) MCC Levothyroxine 10 mcg/kg and titrate based on need

Question 42

What to do in a child if parents refuse life-saving therapy like chemotherapy?

Answer 42

Seek court order | Hospital EC/RMG and social worker can assist in parent convincing

Question 43

HD sign help to d/t from MI?

Answer 43

High rectal tone Squirt sign Colonic dilation

Question 44

When will the germinal matrix be involute?

Answer 44

At 32 week | I.e the reason why prematurity is the main risk for IVH

Question 45

Aproch in wommen with primery amenoria?

Answer 45

Pelvic u/s 1--If uterus present--Do FSH(if high karyotype and if low cranial MRI) 2--If uterus absent---Do karyotype(XX--MA and if XY AIS)

Question 46

But when we consider observation?

Answer 46

age 13-15 with development of other SSC(Breast)

Question 47

Why do turner patients will have adrenarche?

Answer 47

B/C TS doesn't affect the Adrenal gland i.e patient will have normal axillary/pubic hair development.

Question 48

Lyme disease prophylaxis Indication?

Answer 48

``` Deer thick identified Thich attached for more than 36 hr Px started before 72 hr of removal Local LD PV is high>20% No Doxycycline C/I ```

Question 49

what to do??

Answer 49

Detach Bug by forceps w/o twist | Doxycycline one dose

Question 50

Infantile butulinism CM?

Answer 50

Constipation, poor feeding, and hypotonia Oculobulbar pulsy (absent gag reflex and ptosis) Symmetric descending paralysis Aut.Dsfn(dec,salivation and fluctuant Hr/RR