Pediatric Board Review

Question 1

What are signs and symptoms of a central cause of hypotonia

Answer 1

Axial hypotonia, normal-to-slightly decreased weakness, normal DTR, no muscle fasciculation, normal muscle bulk, normal sensation

Question 2

What is the difference between a brown recluse spider bite and a black widow spider bite?

Answer 2

A brown recluse spider bite will cause localized necrosis and skin break down (redness, itching, hemorrhagic ulcer). Black widow spider bike will cause GI s/s (nausea, pain, parathesias) and more systemic signs and symptoms for acetylcholine and NE release at nerve endings. Typical story will be cleaning an attic or garage

Question 3

Provide examples of hydrocarbons and how to treat ingestions

Answer 3

Hydrocarbons = lamp oil, nail polish, pine oil, gasolene, lighter fluid, paints, solvents. They can cause MODS (encephalopathy, myocardial dysfunction, arrhythmias, resp distress, liver injury, ATN). Even if they have exposure but no s/s, observe for 6 hrs. Very common to have aspiration event that leads to chemical pneumonitis and should be treated with oxygen and bronchodilator

Question 4

What are signs and symptoms of hyperventilation syndrome and how do we confirm the diagnosis?

Answer 4

S/s: recent emotional trigger with hyperventilation. This causes metabolic alkalosis which causes decreased ionized calcium (albumin binds the calcium d/t alkalosis decreasing free calcium), and this causes parasthesias. You confirm diagnosis with capillary blood gas.

Question 5

How do you work-up and evaluate a thyroid nodule?

Answer 5

All get a thyroid US and Thyroid studies. If > 1 cm obtain a fine needle aspiration if they are solid, or if there are other suspicious features: (hypoechogenicity, irregular margins, increased intranodular blood flow, microcalcifications, abnormal cervical lymph nodes)

Question 6

Describe the differences between ETEC and Entamoeba histolytica.

Answer 6

ETEC - usually starts 1-3 days after exposure, lasts 3-4 days, low grade fever, non-bloody diarrhea.
E. h. more severe, bloody diarrhea, tenesmus, wt loos, high fever, crampy abdominal pain. most common cause worldwide, transmission by fecal-oral route. Both can happen with travelling. Treatment of amoebic colitis is with intravenous (or oral) metronidazole (35-50 mg/kg per day every 8 hours) or oral tinidazole (age ≥3 years: 50 mg/kg, max 2 g orally, once daily for 5 days).

Question 7

what is the first line antibiotics for acute bacterial lymphadenitis? and what organisms do you suspect?

Answer 7

Unasyn -The most common bacteria isolated in these infections are Staphylococcus aureus, Streptococcus pyogenes, other Streptococcus species, and anaerobes. Ampicillin/sulbactam or clindamycin

Question 8

What does the AAP recommend for toilet training?

Answer 8

The AAP recommends avoiding: 1) pressure or negative reinforcement, and 2) initiation during times of transition, such as a new school, moving, new caregivers, or new siblings, and 3) keeping toddlers in wet or soiled diapers. The child-directed approach recommends that children should: 1) be encouraged to use the toilet when feeling the urge to go rather than at scheduled times; 2) have a safe, comfortable toilet-training environment, including an accessible toilet or chair at the appropriate size, and 3) use training paints as a transition from diapers to underwear.

Question 9

How is PPROM managed?

Answer 9

all are hospitalized. If < 32 weeks, expectant management. If 32-39 weeks, fetal lung maturity testing with lecithin/sphingomyelin ratio, phophatidylglycerol level, etc. All get antibiotics if go into labor. If in labor > 48 hrs give GBS ABX for 48 hrs

Question 10

What is Bloom Syndrome

Answer 10

Blood syndrome is an AR disorder, also called congenital telangiectatic erythema, causes sun-exposed rashes, telangictasias, increased risk for cancer, hypogonadism. Face is long and narrow, prominent ears. Long extremities. Decreased serum IgG, IgM, and IgA. Mutation in BLM causes altered function of DNA helicase activity

Question 11

What is the newborn test for SCID?

Answer 11

T-cell Receptor Excision Circles (surrogate measure for Naive T-cells)

Question 12

Differentiate the different types of E.coli infection (ETEC vs STEC vs EPEC vs entero-invasive Ecoli

Answer 12

Reference screen shot

Question 13

What is bathrocephaly

Answer 13

Prominent occiput with no frontal bossy. It is causes be persisent mendosal suture (that typically disappears in utero). Often confused with sagittal synostosis, but this causes frontal bossing, narrowing of biparietal diameter. Sagittal synostosis should be referred for NSG proc, bathrocephaly is reassurance.

Question 14

Describe erythema multiforme

Answer 14

Typically triggered by infection (like HSV, EBV, mycoplasma, etc). Dusky center, surrounding pallor, ring of erythema. Involves drunk, extremities, palms. Meds can also trigger (NSAIDs, anit-epileptics, etc)

Question 15

Describe ectodermal dysplasia

Answer 15

Many different forms, most common is X-linked. Has to effect 2 of the following: hair, teeth, nails, and sweat glands. Common to have hypodontia, hypohidrosis, hypotrichosis (little hair). It is critical to avoid overheating if they do not sweat, remainder is supportive care for body systems involved

Question 16

What are the indications for ABX ppx for dental procedures?

Answer 16

• prosthetic cardiac valve or prosthetic material used in cardiac valve repair
• previous hx of endocarditis
• Specific congenital heart disease (CHD)
  1. Unrepaired cyanotic cardiac lesions, including palliative shunts or conduits
  2. Completely repaired CHD (via surgical or interventional procedure) with prosthetic material/device for the first 6 months after the procedure
  3. Repaired CHD with residual defects at or adjacent to the site of prosthetic material which would present endothelialization
• A history of cardiac transplantation with valvulopathy

Question 17

What is the best screening test for HIV?

Answer 17

HIV-1/HIV-2 antibody/antigen combination assay. Screen at least once between the ages of 13-64, and annually for those w/ high risk

Question 18

What sports should be limited in those w/ 1 functional eye? What precautions do they need to take?

Answer 18

• Definition is vision worse than 20/40 corrected
• should wear protective eye wear in all sports, and they should not participate in sports where they cannot wear protective eye wear (i.e. wrestling, boxing, martial arts). Basketball and baseball are high-risk sports for eye-injury, but you can wear protective eye wear

Question 19

What is spasmus nutans?

Answer 19

A form of fine, horizontal, pendular nystagmus found between 6-24 months that usually resolves with time (months to years). They have a normal brain MRI and development. It is associated with torticollis and slow head nodding

Question 20

What is Job Syndrome?

Answer 20

Job syndrome is AKA Hyper-IgE syndrome and presents with eczema, eosionphillia, recurrent skin abscesses, lung infections

Question 21

What is Wisckot-Aldrich Syndrome?

Answer 21

Combination of thrombocytopenia, eczema, and recurrent infections. May have log IgM and elevated IgG and IgE. Can treat w/ IV-IG + platelet transfusions or HSCT in severe cases

Question 22

What are the diagnostic criteria of Benign Paroxysmal Vertigo in childhood?

Answer 22

1. Brief episodes of nausea, vomiting, nystagmus, dizziness, ataxia fearfullness. 2. Normal neuro exam in between episodes 3. symptom free intervals 4. non-attributable to othe disorders. Typically in children age 2-12 yrs, may go on to develop migraines. Middle ear pathology is most common cause of vertigo, so consider this for ddx. Long-term prognosis good, remits by adolescence. Treat with anti-emitics or anti-histamines if long-lasting s/s

Question 23

Describe characteristics of toxocariasis infections?

Answer 23

s/s: Wheeing, hepatomegaly, anemia, FTT/poor weight gain, pica, eosinophilia
Exposure to dogs or cats (visceral larva migrans)
Dx by Serum IgG to Toxocara
albendazole is the treatment
It is a tissue roundworm infection

Question 24

Describe cohort vs case-control vs cross-sectional

Answer 24

Cohort: a cohort is observed over time for the development of the outcome of interest.
Case-control: You have “cases” and “controls” and you look for exposures/risk factors. Good for rare diseases
Cross-sectional: looks at exposures and outcomes in a single point in time, not followed longitudinally

Question 25

Describe indications for antibiotics in a neonate.

Answer 25

If mother meets criteria for intra-amniotic infection (F > 39 + 1 of following: leukocytosis, purulent discharge from cervix, fetal tachycardia) then ABX are recommended in these situations: Signs of sepsis, gestational age < 37 W, maternal PROM, inadequate tx GBS colonization, evidence of maternal chorioamnionitis

Question 26

What are the Rome IV clinical diagnostic criteria for colic

Answer 26

- younger than 5 months at the start and end of symptoms - Crying > 3 hrs/day for at least 3 days/week - No evidence of underlying medical problem

Question 27

Describe typical characteristics of juvenile polyposis syndrome?

Answer 27

- age 2-6 typically - Painless hematochezia - Most polyps are pedunculated w/ narrow stalk - Tx if removal of polpy, no repeat colonoscopy is needed - Most common syndromes w/ several polyposis: FAP, JPS, Peutz-Jeghers, hamartoma syndrome (should be suspected when have 5 or more)

Question 28

Describe the gram stain of shigella vs E coli

Answer 28

Gram-negative rod that is non-lactose fermenting, oxidase negative, and non-hydrogen sulfide producing. Only needs a small amount of organisms for infection vs Gram neg rod, ferments lactose Salmonella produces hydrogen sulfide (red-black center)

Question 29

What are the birth defects you can see in fetuses exposed to carbamazepine, valproate, and phenytoin?

Answer 29

Carbamazepine and Valproate: spina bifda vs NTD (increased risk in later of 2) Phenytoin: Fetal hydrantoin syndrome: Growth restriction, delays, craniofacial anomalies, microcephaly, hypoplastic fingers/nails

Question 29

What are the differences between von Willebrand Disease type 2B and Type 1

Answer 29

Type 2B: can be associated w/ neonatal thrombocytopenia. Tx w/ antihemophilic factor/vWF complex or another factor VIII/vWF concentrate. DO NOT use desmopressin as it can cause a transient decrease in platelets (this is a qualitative defect) Type 1: Can use desmopression as this increase in factor VIII activity, von Willebrand antigen, and ristocetin cofactor activity. Tx can cause hyponatermia so restric fluids (this is the only type of vWD that can be treated with this, as it is a quantitative defect) - most common type

Question 30

What is Blau Syndrome?

Answer 30

Familial form of scarcoidosis presents w/ uveitis, "boggy arthritis" and rash

Question 31

What diseases cause amyloid deposition?

Answer 31

SLE, Bechet disease, Familial Mediterranean Fever, IBD, TB, chronic osteomyelitis. Kidney disease is the most common and serious manifestation of amyloid deposition

Question 32

Differentiate Type A vs Type As vs Type Ad vs Type B vs Type C tympanograms (reference screen shot pdf for visual)

Answer 32

Type A: normal Type As: shallwo peak, normal position but low ocmpliance, seen ww/ ossicular fixation, TM scarring or otosclerosis. Type Ad: (disarticulation) normal peak pressure but highly compliant TM seen w/ ossicular chain discontinuity Type B: peak that is absent or poorly defined. Poorly mobile TM seen w/ middle ear effusion or perforated ear drums Type c: Clear peak, but peak shifted to left, indicating negative pressure in middle ear, seen with Eustachian tube dysfunction

Question 33

What is validity? Internal vs External Validity?

Answer 33

validity evaluates the extent to which a measurement or finding is accurate or true. Internal validity examines the ability of a tool to accurately measure the intended condition. External validity or generalizability measure the extent to which the tool can be used in the broader population

Question 34

What are the 2 types of internal validity

Answer 34

Convergent validity: When you use 2 different tests looking at the same outcome to see if the produce the same results. Predictive validity: evaluates the accuracy of a tool to measure a future event or outcome

Question 35

What are the types of reliability?

Answer 35

Test-retest reliability: measures the ability of an instrument or tool to produce the same results w/ repeated measurements. Interrelator reliability: measures the ability of 2 individuals to independently produce the same results Internal consistency reliability: is a measure of how consistent the items within a single instrument are with each other

Question 36

A patient has a sub-mucosal cleft palate, long narrow face with widely spaced eyes, what syndrome could this be and describe it?

Answer 36

Loeys-Dietz syndrome (LDS). AD condition w/ characteristic vascular findings (aortic aneurysms, arterial tortuosity), craniofacial findings (hypertelorism, bifid uvula, cleft palate, craniosynostosis), and musculoskeletal findings (pectus excavatum or carinatum, arachnodactyly, joint laxity). The diagnosis of LDS is made when the characteristic clinical features are present and/or genetic testing. Loeys-Dietz syndrome is associated with pathologic variants in the TGFBR1, TGFBR2, SMAD3, and TGFB2 genes. Individuals with suspected LDS should be screened for aortic root dilatation and monitored for progression and development of aortic dissection. Contact sports and isometric exercises should be restricted due to the risk of increasing systemic vascular resistance.

Question 37

How does a cryptosporidium infection present? What is the treatment for this?

Answer 37

Cryptosporidium causes watery diarrhea after drinking contaminated water or hanging out at recreational water parks. Treat only w/ severe s/s (>10 episodes/day or s/s > 2 weeks) treat w/ nitazoxanide In a child with HIV infection, prompt initiation of antiretroviral therapy (eg, dolutegravir, emtricitabine, and tenofovir combination) to improve the CD4 cell count results in resolution of diarrheal symptoms.

Question 38

What are the diagnostic criteria for bacterial vaginosis

Answer 38

1. Homogeneous, thin vaginal discharge that smoothly coats the vaginal walls 2. Clue cells (vaginal epithelial cells covered with adherent bacteria) on microscopic examination (Item C234A) 3. pH of vaginal fluid >4.5 (normal vaginal pH is 3.8 to 4.3) 4. Fishy odor of vaginal discharge before or after addition of 10% potassium hydroxide (KOH; ie, the whiff test)

Question 39

Describe Spondylosis vs Spondylolisthesis, diagnosis and treatment

Answer 39

Spondylosis is a fracture of the vertebral pars interarticularis. Spondylolisthesis is a fracture with anterior displacement of the vertebral bodies. Diagnoses by plain radiography. Treat w/ NSAIDs, rest for 6 weeks, and strength exercises. They may require bracing or spinal fusion if significant displacement and/or neurological symptoms are present.

Question 39

What is the treatment for congenital idiopathic talipes equinovarus? What is on the ddx?

Answer 39

Ponseti method - serial casting. Must be down by orthopedic surgeon Metatarsus adductus: forefoot points inward, but the hindfoot is normal. The ankle can easily dorsiflex past neutral, and the subtalar joint moves normally.

Question 39

What are the 3 types of clavicle fractures? Which is the most common? Which is the least worrisome? Which is the most worrisome? When do you need to refer for orthopedic consultation, internal reduction and fixation?

Answer 39

Class 1: middle third (most common), class 2: distal end (heal w/ rest, ice, NSAID), Class 3: proximal (least common, most likely to require referral) Urgent orthopedic consultation should be obtained for open fractures, sternoclavicular dislocation, distal displaced fractures, tenting of the skin over the clavicle, or evidence of neurovascular compromise

Question 40

Describe indications for statin therapy.

Answer 40

Statin therapy (eg, atorvastatin) is recommended for those aged 10 years and older whose LDL cholesterol level remains above goal after lifestyle modification. For those with a family history of cardiovascular disease, 1 high-level risk factor, or 2 or more moderate-level risk factors, the threshold for starting statin therapy is an LDL cholesterol level ≥160 mg/dL (4.1 mmol/L). The treatment goal is an LDL level <130 mg/dL (3.4 mmol/L). For those at higher risk, the threshold for statin treatment is an LDL level ≥130 mg/dL (3.4 mmol/L). The treatment goal is an LDL level <100 mg/dL (2.6 mmol/L).

Question 41

Describe the work-up of a sub-acute or chronic lymphadenopathy?

Answer 41

Sub-acute is 2-6 weeks, chronic is > 6 weeks. Most common cause is infectious so work-up should be targeted towards this (CBC, EBV + CMV + bartonella serology/titers). If this negative, then thick of non-TB mycobacterim and FNA can dx this (vs surgical exicision). US may be helpful with general work-up but doesn't give you an exact diagnosis.

Question 42

How long do you treat HSV that is in the eye, skin, mouth vs CNS?

Answer 42

14 vs 21 (21 days for disseminated as well)

Question 43

Which populations should you consider giving varicella-zoster IG?

Answer 43

1. children w/ immunocompromised 2. Pregnant females 3. newborns whose mothers had variclla from 5 days before to 48 hrs after delivery. Hospitalized preterm infants >/= to 28 weeks if born to varicella antibody-negative mothers 4. Hospitalized PReM infants < 28 w of gestation or < 1000 G regardless of varicella status of mother

Question 44

Describe the infection from human herpesvirus 6 infection

Answer 44

AKA 6th disease or Roseola. Presents w/ fever for 3-5 days, abrupst cessation of fever and then appearance of a macular-to-macularpapular rash. Rash beings on trunk, spreads to extremities, sparing face

Question 45

Describe an older child w/ Rubella infection. What are the oral spots called.

Answer 45

Typical s/s are fever, headache, sore thorat, cough, mild coryza, mailase. Spots are Forchhiemer spots (sm red spots that appear on soft palate)

Question 46

What differentiates the oral lesions of herpangina from those w/ HSV?

Answer 46

Herpangina: tiny vesicles or punched out ulcers on uvula, posterior oropharynx, or tonsilas. HSV: front part of moth, extends onto lips

Question 47

Within what time frame after exposure should rabies vaccine be given, and in how many doses?

Answer 47

Give vaccine w/in 1st day of exposure (Day 0) and repeat doses on days 3, 7, and 14. A 5th dose is recommend in individuals w/ immunocompromise.

Question 48

Describe the rash of erythema infectiosum? What virus causes it and what are the s/s?

Answer 48

Caused by parvovirus B19, causes "slapped cheek" appearance with circumoral pallor, lattice- or lace-like, becomes more prominent in sun or warm baths. Can cause arthritis/arthralgias, aplastic anemia. Pregnant females should not be excluded from work w/ community infections (common virus, low risk for fetal infection)

Question 49

Which HPV virus strains put you at risk for genital warts? Cervical Cancer?

Answer 49

HPV serotypes 6 and 11 - waters HPV types 16, 18, and 31 - cervical cancer

Question 50

What is the diagnosis for fever, tachypnea w/ crackles on lung exam, purulent conjunctivitis, oral mucositis, and Target rash

Answer 50

Mycoplasma pneumoniae–induced rash and mucositis (MIRM). Approximately 10% of individuals develop a nonspecific maculopapular rash. Also causes other distinct mucocutaneous eruptions including erythema multiforme, Stevens-Johnson syndrome, and MIRM. Treatment = azithromycin + steroid therapy may shorten the clinical course of MIRM

Question 51

Describe developmental milestones of a 5 year old

Answer 51

Developmental milestones expected of a 5-year-old include the ability to balance on one foot for about 8 seconds and hop about 15 times. Children at age 5 years can copy a triangle, draw a person with 8 to 10 body parts, self-dress, count to 10, name 10 colors, and remember their phone number and address. Parents should instruct their children to memorize their telephone number for safety purposes. Language and communication skills at age 5 years should include a more than 2,000-word vocabulary and use of complete sentences to tell stories with a beginning, middle, and end. Five-year-old children have groups of friends, are able to apologize for mistakes, enjoy rhyming words, and understand adjectives. Imagination, fantasy, and creativity emerge at this age.

Question 52

Describe developmental milestones of a 6 year old

Answer 52

Copying a flag and tying shoe laces are milestones typical of a 6-year-old child. In addition, 6-year-olds are able to tandem walk, look both ways before crossing the street, draw a diamond, and write their first and last name. Six-year-old children are able to understand seasons, know the days of the week, and count to 20. They are able to distinguish fantasy from reality and make meaningful relationships with their peers including wanting to please them.

Question 53

A person has numerous pale, bluish 0.5-to-1 cm macules around the lower abdomen, proximal thighs, and buttocks. What do you suspect?

Answer 53

Pediculosis - pubic lice (fr anticoagulant activity after injection of saliva during feed) Tx w/ topical permerthrin 1%)

Question 54

Describe noonan syndrome

Answer 54

Heart murmur: Pulmonic stenosis: ejection click heard loudest w/ inspiration over LUSB, triangular face, webbed neck, down slanting palpebral fissures, short stature, joint laxity, pectus deformity, bleeding diatheses (most common factor 11 deficiency)

Question 55

What conditions are associated w/ nasal polyps? What is the mainstay of treatment?

Answer 55

Diagnosis: allergic rhinitis, asthma, chronic sinusitis, certain drug sensitivities (ASA) and CF Tx w/ nasal steroids

Question 56

What rash can be associated w/ reactive arthritis?

Answer 56

oral ulcers, genital ulcers, balnitis, and papular skin lesions (keratderma blennorrhagicum on palms and soles)

Question 57

What disease is associated w/ Pathergy?

Answer 57

Behcets (sterile neutrophilic infiltration of sites of injury)

Question 58

What does squatting and valsalva due to the heart?

Answer 58

squatting increases venous return, valsalva decreases venous return to heart

Question 59

What is Sotos Syndrome?

Answer 59

Overgrowth syndrome, born large for age and grow fast until 5 then have high-normal adult predicted high. They have hypertelorism, low IQ (65) w/ behavior problems (OCD, ADHD, emotional outbursts), increased risk for cancer, seizures

Question 60

What are the different types of Salter Harris fractures? Vs GreenStick Fracture?

Answer 60

For Salter Harris fractures, reference Screenshot. A greenstick fracture occurs when a bone bends and cracks on one side, but doesn't break all the way through. The name comes from the way a green branch of a tree breaks when bent.

Question 61

What is the typical care of a tooth avulsion?

Answer 61

1. Clean with sterile water 2. Put back in mouth or transport in alkaline solution (like milk) 3. Wash w/ chlorhexidine solution BID and doxy (or amox) BID for 7 days after

Question 62

What is the correct dose of epinephrine for anaphylaxis?

Answer 62

Epi 0.01 mg/kg of 1:1000 epi. For epi-pens: 0.15 mg for children < 30 kg or .3 mg for children > 30 kg (for epi pens)

Question 63

Immunodeficiency w/ recurrent infections in the first year of life, male, Low IgA, IgG, IgM

Answer 63

X-linked Agammaglobulinemia (Brutons) Tx w/ Immunoglobulins and ppx abx. Presents after 3 mo of life. B-cell problems

Question 64

Describe a Brue and low risk criteria?

Answer 64

BRUE = < 1 min - cyanosis or pallor - altered breathing (irregular or stopped) - hyper or hypotonia - Altered level of responsiveness Low risk: > 60 days, born > 32 weeks, normal physical exam, nothing concerning in hx, 1st even, no CPR given by medical professional

Question 65

What is the difference between distal patellar apophysitis vs osgood-Schlatters vs patella-femoral pain syndrome vs patellar tendonitis vs patellar instability.

Answer 65

distal patellar apophysitis: pain over distal patella, atraumatic pain over distal pole, happens with jumping or running. pain reproduce with extension and patella pressure Osgood-Schlatters: pain over tibial tubercles, most common knee pain patella-femoral pain syndrome : "Joggers knee": progressive anterior pain with increased activity patellar tendonitis: "jumping knee" : Pain along patella tendon with jumping sports patellar instability: most common is lateral patella instability w/ medial pain, presents w/ patellar subluxation or dislocation

Question 66

Differentiate 5-alpha-reductase vs mixed gonadal dysgenesis vs androgen insensitivity sydnrome

Answer 66

Androgen insensitivity syndrome (or partial) is when there is a lack of receptors with normal hormones 5-alpha-reductase is when there is decreased conversion of testosterone to DHT (more potent hormone that creates external male structures of penis and scrotum), so will have very high testosterone and low DHT. Mixed gonadal dysgenesis: 45X/45XY: streak on one side with ovary/testes on other side Pathophy: Need SRY gene to make male parts, absence makes female parts. Anti-mullerian hormone results in regression of mullerian structures (uterus, fallopian tubes, proximal vagina). Testosterone makes Wolfian ducts (epididymis, vas deferens, semineforous tubules)

Question 67

What is the NPO rule for sedation?

Answer 67

2 hrs clears 4 hrs breast mild 6 hrs non-human milk or solid food

Question 68

What is Mayer-Rokitansy-Kuster-Hauser Syndrome?

Answer 68

lack of development of the mullerian structures (uterus, fallopian tubes, proximal vagina)

Question 69

When are urine organic acids useful? vs Plasma acylcarnitines? vs Plasma amino acids?

Answer 69

Urine organic acids: useful for dx of organic acidemias such as isovaleric acidemia (encephalopathy, metabolic acidosis w/ ketosis, sweaty feat), propionic acidemia (severe ketoacidosis +/- hyperammonemia), and methylmalonic acidemia (ketoacids, hyperammonemia, thrombocytopenia). Plasma acylcarnitines: fatty acid oxidation defects Plasma amino acids: problems with amino acid metabolism (PKU, MSUD, tyrosinemia)

Question 70

What infection should you suspect when physical exam shows punctate petechial lesions overlying an erythematous vaginal mucosa on the cervix?

Answer 70

Multiple motile trichomonads on wet mount. Often complain of profuse, foul-smelling, water, or yellowish-grey vaginal discharge, pruritus Tx w/ metronidazolex7 day and treat men x1 day

Question 71

What are symptoms of Late Lyme Disease (stage 3) vs Early disseminated Lyme disease (stage 2)

Answer 71

Late = arthritis (months to years after untreated infection), involves lg joints. Tx for 28 days Early disseminate: aseptic meningitis, uveitis, cranial nerve palsies, carditis. Tx for facial palsy is doxy x14 days, all others IV CTX 14-21 days. Can tx early lyme w/ doxyx10 days or amox/cefuroxim x14 d

Question 72

Describe an infection w/ German measles (Rubella)

Answer 72

mild fever, prominent postauricular and suboccipital lymphadenopathy, rash = fine, discrete, irregular, pinkish-red macules located on the face and trunk - usually lasts 3 days, also see Forchheimer spots. Adolescents may have arthralgias

Question 73

Differentiate ingestion of LSD vs huffing vs MDMA (ecstasy) vs Ketamine vs Bath Salts

Answer 73

LSD: distortions of sensory perception: dilated pupils, hyperthermia, tachycardia, and "seeing smells" Huffing: slurred speech, lacrimation, salivation, stupor MDMA: clenching/grinding teeth, hyperthermia, muscle rigidity, anxiety ketamine: excessive salivation, involuntary tongue and limb movements, anxiety, laryngospasms Bath Salts: Hallucinations, paranoia, seizures

Question 74

Within what time frame prior to administration of IV-IG would you need to repeat a vaccination? How long do you need to wait to administer a live vaccine after IV-IG?

Answer 74

If vaccine is administered within the 2 weeks preceding IV-IG - should re-dose Need to wait 3-11 months depending on dose/indication for IV-IG. For Kawasaki, you should wait 11 months

Question 75

What is chorea? Differentiate Syndenham Chorea vs Childhood-onset hereditary chorea.

Answer 75

Chorea = hyperkinetic, irregular, involuntary movement, dance-like, continuous flow of random muscle contractions Sydenham chorea = most common form of acquired chorea in childhood. Happens 1-8 mo after GAS infection Childhood-onset chorea: AD NKX2-1 chorea starts in infancy w/ hypotonia--> chorea. ADCY-5 related dyskinesia--> Infancy or early childhood w/ fluctuating hyperkinetic movements

Question 76

When do you screen for perinatal Hep C exposure and with what test?

Answer 76

> 18 mo, screen w/ anti-HCV antibody testing OR HCV-RNA testing after 2 mo

Question 77

What are the 3 treatments for SMA?

Answer 77

SMA type 1 most severe Screen for SMA on newborn state screen 3 disease-modifying therapies: onasemnogene abeparvovec, nusinersen (started after 2 yrs) and risdiplam.

Question 78

What work-up should you do for someone who has concern for pericarditis?

Answer 78

Even if vitals are reassuring, you should eval for myocarditis component w/ troponin and echo, and admit if elevated troponin.

Question 79

What is the treatment for congenital CMV?

Answer 79

6 mo of oral valganciclovir and should monitor CBCs for cytopenias

Question 80

When do you start metformin vs insulin in type 2 diabetes as initial treatment?

Answer 80

Start metformin if no signs of acidosis, HbA1C < 8.5%, and fasting glucose < 250 Start insulin when HbA1C is > 8.5%, serum glucose > 250 w/ symptoms, or ketosis/ketoacidosis is present

Question 81

When do you start pneumocystis pneumonia prophylaxis and with what?

Answer 81

Start when undergoing treatment for cancer, cell-mediated immunodeficiencies, immunosuppression after organ transplant, and HIV w/ CD4 count < 200 cells/microL Tx w/ Bactrim (ABX of choice) 3 cons days. Atovaquone and Dapsone (avoid if hx of SJS, TEN w/ bactrim) are safe alternatives. Aerosolized pentam reserved for kids who can't tolerate other agents

Question 82

What are oxygen targets at 1 min - 10 min for newborns? What initial FiO2 should you use if needed?

Answer 82

1 min - 60-65% 2 min - 65-70% 3 min - 70-75% 4 min - 75-80% 5 min - 80-85% 10 min - 85-95% If > 35 weeks - 21% If < 35 weeks - 21-30%

Question 84

What are the alternatives for Bite wounds? For GAS? (for amox allergies)

Answer 84

Bite wounds: extended-spectrum cephalosporin or Bactrim + Clinda GAS: Clinda for 10 days or Azithro for 5 days

Question 85

What are contraindications for DTaP vaccine?

Answer 85

anaphylactic reaction or severe neurologic sequelae/encephalopathy w/in 7 days of vaccine Also, if have Guillain-Barre syndrome should wait at least 6 weeks before receiving next DTaP vaccine

Question 86

What levels in newborns are lower or higher compared to older children?

Answer 86

Potassium - higher (up to 5.9) Bicarbonate - lower (18-22) Phosphorus - Higher (up to 7.5) Creatinine can take up to 1 week representative of mothers Cr

Question 87

What is the treatment for invasive fungal infection?

Answer 87

Echinocandin (caspofungin or micafungin). Voriconazole and liposomal amphotericin could be use, but ampho causes more risk, and with vori would need to confirm it's a susceptible species of candida first (i.e. candida albicans), but is not good as empiric treatment.

Question 88

What babies need RoP screening?

Answer 88

all infants with birth weight < 1500 g or GA < 30 weeks infants w/ weights 1500-2000 g or GA > 30 w/ risk (hx of hypotension requiring meds, O2 supplementation more than a few days)

Question 89

What are the X-ray findings of Congenital syphilis vs Infantile cortical hyperostosis vs osteogenesis imperfecta Type 2 vs rickets d/t Vit D def vs Fanconi syndrome

Answer 89

Syphilis: osteochondritis and periostitis, involving metaphysis and diaphysis of long bones. Appear as irregular bands of decreased mineralization or focal circumscribed areas of bony destruction Infantile cortical hyperostosis: significant cortical thickening (often mandible) and periosteal reaction with normal mineralized bone Osteogenesis imperfecta Type 2: extreme undermineralization of entire skeleton, vertebral flattening, hypoplastic beaded ribs, broad telescoped long bones Rickets d/t Vit D def: widening of epiphysis, metaphyseal cupping and fraying, cortical thinning, periosteal reaction Fanconi syndrome: rickets and osteomalacia

Question 89

What screening test should you do in a child w/ intelectual disability who is non-syndrome w/out a significant family history? What percent of patients will you find something?

Answer 89

15-20% of patients you will find something Screen w/ chromosomal microarray analysis, consider Fragile X.

Question 90

What is the rule for body parts and guessing a child's age?

Answer 90

For every body part they draw (2 eyes, 2 ears, mouth, nose, 2 legs, 2 arms, 2 hands, 2 feet, neck and a trunk) they get 1/4 additional age added to a base of 3

Question 91

What is the appropriate weight gain and length gain over the 1st couple years of life?

Answer 91

Weight gain: 30 g/d x3 month, then 15 g/d until 6 months, then 10 g/day up until 1 year. Length: increases by 25 cm Head Circumference about 13 cm (about 0.5 cm/week for first 2 months) Another rule of thumb: Birth length increases by 50% by 1 year of age, double by 4, and triples by 13 For weight: Regain birth weight by 2 weeks, double wt by 4 mo, triple wt by 12 months, quadruple by 24 mo

Question 92

What percentage of BSA is included in SJS vs TEN? What specialist should you consult to help w/ assessment?

Answer 92

SJS is < 10%, > 30% is TEN Must c/s an ophthalmologist for eye examintation

Question 93

What are indications for referral to a burn center? What is the rule of 9s? What is the Parkland formula?

Answer 93

See screen shot

Question 94

What is the antidote for benzodiazepine toxicity? Iron toxicity? Lead Toxicity? Tyelnol?

Answer 94

Benzo - flumazenil Iron - Deferoxamine - consider whole bowel irrigation if stable Lead- Dimercaprol Tylenol - NAC