Pediatric

Question 1

Croup facts

Answer 1

Croup

• subglottic inflammatory disorder
• most commonly caused by PARAINFLUENZA virus types 1-3 in children 6-36 months of age.

•Hallmarks
-sudden onset of cough and stridor without wheezing.

•Treatment
- is dependent on the severity of presentation, but even mild cases benefit from the administration of oral corticosteroids and nebulization of epinephrine.

•Hospitalization should be considered when there is failure to control symptoms with standard therapy or if the child develops hypoxia, cyanosis, extreme agitation, retractions or lethargy.

Question 2

Chronic hypertension in pregnancy

Answer 2

Chronic hypertension in pregnancy

• is hypertension without proteinuria
• that is diagnosed prior to 20 weeks estimated gestational age (EGA) or hypertension requiring medication prior to pregnancy.

Question 3

Gestational hypertension or pregnancy induced hypertension

Answer 3

hypertension in a pregnant woman after 20 weeks gestation without presence of protein in the urine or other signs of pre-eclampsia

Question 4

Group B Strep (GBS)

- antibiotic of choice
- which pregnant women should be treated and at what gestational age

Answer 4

Penicillin G is the antibiotic of choice for GBS antibiotic prophylaxis.

• Women with a positive GBS culture at 35 weeks should be treated with intrapartum antibiotics.
• Women with unknown GBS status in labor should be treated using a risk-based approach.

Question 5

Women with unknown GBS status at the time of labor (cultures not done or results not available) are managed according to a risk-based approach.
When should antibiotic prophylaxis be given

Answer 5

Antibiotic prophylaxis should be given for (1) gestation <37 weeks, (2) membrane rupture 18 hours or (3) a temperature >100.4° F

Question 6

Fast Facts – Chlamydia in the Newborn

Answer 6

Chlamydial ophthalmia neonatorum usually presents 5-14 days after delivery. Silver nitrate and antibiotic ointments given prophylactically after birth do not prevent its development.

• Chlamydia pneumonia usually appears between 4 and 12 weeks of age. Fever, if present, is usually low grade; wheezing is rare.
• Treatment of chlamydia conjunctivitis and pneumonia is with ORAL ERYTHROMYCIN

Question 7

Hyperphosphatemia can be caused by …

Answer 7

Excess phosphate ingestion or phosphate-containing enemas can cause hyperphosphatemia

Impaired renal function is the most common cause

Question 8

differentiator for croup versus acute epiglottitis

Answer 8

• cough for croup and

- drooling for epiglottitis are key differentiators

Question 9

Acute epiglottitis in children is still most commonly caused by

Answer 9

H. influenza type B (HiB)

Question 10

Criteria for Lower-Risk BRUE

Answer 10

• age > 60 days
• born at gestational age > or equal to 32 weeks and corrected gestational age > 45 weeks
• First BRUE
• Duration of event < one minute
• No CPR by a trained medical professional needed

Question 11

Undecended testicle is more common in …

Answer 11

Premature infants

Question 12

When in pregnancy can the HELLP syndrome occur?

Answer 12

HELLP may develop during pregnancy or in the postpartum period.

Question 13

What medication is effective for prevention of preeclampsia

HIGH -risk pregnancies (chronic hypertension and history of preeclampsia/HELLP)

Answer 13

Low-dose aspirin

Question 14

What is the best way to make the diagnosis of Listeria in pregnancy?

Answer 14

Blood, spinal fluid or placental cultures

Question 15

Oral steroid use in an asthmatic pregnant patient is associated with an increased risk of …?

Answer 15

And increased incidence of preeclampsia and prematurity

Question 16

Periodic fever with abscess ulcer pharyngitis and Adenitis

(PFAPA)

Answer 16

• is the most common periodic fever syndrome.
• it occurs primarily in children and usually resolves before puberty.
• Response to oral corticosteroids is rapid and considered by some to mission, but some individuals will have a current despite surgery.
• Tonsillectomy may induce remission but not cure

Question 17

Pregnant women should receive a dose of _________ vaccine optimally between _________ weeks of gestation, regardless of when they last received it.

Answer 17

Pregnant women should receive a dose of Tdap, optimally between 27 and 36 weeks of gestation, regardless of when they last received it.

Question 18

Question: 3
A 7-year-old male is brought to your office with a 2-day history of rash. He developed two itchy spots on his legs yesterday and today he has multiple purple, slightly painful lesions on his legs. A few days ago he was ill with cold-like symptoms, stomach pain, and a fever up to 101.2°F. He complained of leg pain at the time and his left ankle is now swollen. His fever resolved 2 days ago and he now feels fine but limps when he walks. On examination he is afebrile with a normal blood pressure and pulse rate. He is active in the examination room. His physical examination is normal except for purpuric lesions on his legs and buttocks and edema and mild pain of the left ankle. A urinalysis is negative. Which one of the following would be most appropriate in the management of this patient?

Acetaminophen

Answer 18

patient meets the clinical criteria for Henoch-Schönlein purpura (HSP), an immune-mediated vasculitis found commonly in children under the age of 10. The clinical triad of purpura, abdominal pain, and arthritis is classic. Almost 95% of children with HSP spontaneously improve, so supportive therapy is the main intervention. Acetaminophen or ibuprofen can be used for the arthritic pain. However, ibuprofen should be avoided in those with abdominal pain or known renal involvement. Prednisone has been found to help in those with renal involvement or other complications of the disease such as significant abdominal pain, scrotal swelling, or severe joint pains (SOR B). However, it is not effective for preventing renal disease or reducing the severity of renal involvement, as was once thought (SOR A). Immunosuppressants such as cyclophosphamide and cyclosporine have been suggested for treating patients with severe renal involvement, but there is insufficient evidence to support their use. Amoxicillin is appropriate for patients with a bacterial infection, such as streptococcal pharyngitis, which has led to HSP. In this patient, however, there is no indication of pharyngitis or another bacterial focus. Patients with renal involvement and resultant hypertension with HSP should be treated with calcium channel blockers such as amlodipine