Pediatric Board Study #2 10/2020

Question 1

What are the milestones in regards to ability to use the staircase?

Answer 1

18 mos: walk up stairs with one hand held

2 years: walk down stairs holding the rail (takes more coordination to walk down)

3 years: walks up stairs alternating feet (more coordination to alternate feet vs both feet on each step)

4 years: balances on one foot for few seconds (balancing on one foot is like alternating feet, but being able to maintain balance longer)

Question 2

5 year old milestones?

Answer 2

TIP: All correlate with getting ready to go to school

Ties knots - like shoes
Print letters

Question 3

Rules of 3 for infantile colic?

Answer 3

3 weeks to 3 months of age

3+ hours of crying / day

> 3 days / wk

Question 4

Normal, but strange, physical behaviors in children that don’t require interventions

Answer 4

Headbanging: normal 8 months to 4 years
Thumb-sucking: up to 4 years of age
Biting: normal up to 3 years of age

Question 5

At what age is enuresis considered pathologic?

Answer 5

5

TIP: By 5 years of age, a kindergartener, should be potty-trained

Question 6

What is considered secondary enuresis?

Answer 6

Having been dry for 6 months, then start to have enuresis

TIP: “6 months” “S”econdary enuresis

Question 7

Diurnal enuresis cannot be diagnosed under what age?

Answer 7

3 years old

Question 8

What age should infants sleep THROUGHOUT the night?

Answer 8

4 months

Question 9

What age can sleep training begin?

Answer 9

4-6 months

Question 10

Vitamin D2 and Vitamin D3, what are the generic formulations of each?

Answer 10

Vitamin D2 has 2 C’s: ErgoCalCiferol

Vitamin D3 has 3 C’s: CholeCalCiferol

Question 11

What is the difference between Calcidiol and Calcitriol?

Answer 11

Calcidiol is 25 OH Vit D, storage form synthesized in the liver

Calcitriol is 1,25 OH Vit D, active form synthesized in the kidney

TIP: “DI” means 2, hence 2 numbers, 2 and 5; “TRI” means 3, hence 3 numbers, 1 2 and 5

Question 12

What is the most common presentation of milk protein allergy? And what age?

Answer 12

First month of life

• Cutaneous - urticaria, oral pruritus, and/or atopic dermatitis
• Gastrointestinal - vomiting and/or diarrhea
• Respiratory - oropharyngeal angioedema, rhinoconjunctivitis, rhinorrhea, and/or stridor or wheezing (reported to occur in 15% of patients)

TIP: Anaphylaxis organs

Question 13

What vaccines in childhood require at least 4 shots?

Answer 13

IPV

PCV

Hib

DTaP

TIP: of the 6 vaccines given betwen2-6 mos of age, the vast majority require 4 shots

Question 14

What vaccines are given at 12 mos?

Answer 14

BIG MONTH

TIP: other than 2, 4 and 6 mos, 12 mos is the only other time to receive 6 SHOTS

Hib
PCV
MMR
Varicella
Hep A
Influenza

Question 15

What are the list of live vaccines?

Answer 15

The live, attenuated viral vaccines currently available and routinely recommended in the United States are:

• MMR
• varicella
• zoster (which contains the same virus as varicella vaccine but in a much higher amount)
• rotavirus
• influenza (intranasal).

Other non-routinely recommended live vaccines include adenovirus vaccine (used by the military), typhoid vaccine (Ty21a), and Calmette-Guerin (BCG).

Question 16

Patient with egg allergy leading anaphylaxis. Influenza vaccine? Yellow fever vaccine? Rabies vaccine?

Answer 16

Yes to influenza, but monitor in office

No to yellow fever; allergy testing first regardless of how minor the reaction to egg
- TIP: YELLOW = egg

Yes to Rabies vaccine; only 1 of the formulations is grown in chick fibroblasts and has PICOgrams of egg

Question 17

Difference between early onset vs late onset sepsis in newborn?

Answer 17

EOS: Within 7 days of life

LOS: Up to 6 months! (Talk about LATE)

Question 18

Definition of SGA vs LGA?

Answer 18

SGA: BW < 10%ile OR < 2500gm

LGA: BW > 90%ile OR > 3900 gm

Question 19

How to calculate a baby’s corrected (or adjusted) age?

Answer 19

Chronological age - # of weeks premature

Example:

• Chronological age: 1 year old
• Baby born: 2 months early, AKA 32 weeks
• Corrected age: 1 year old - 2 months = 8 months corrected

Question 20

Child comes in with suspected abuse, but skeletal survey is negative. What additional test can be obtained that may demonstrate fractures due to child abuse?

Answer 20

Systematic review and Meta-analysis 2020
- low to very low quality evidence

Bone scintigraphy

Results:
-The summary detection rate of skeletal injury with RSS alone was 52% (95% CI 37 to 68). The summary absolute increase in detection rate with add-on BS was 10 percentage points (95% CI 6 to 15)

• the summary number of children with a negative RSS who needed to undergo a BS to detect one additional child with skeletal injury (number needed to test) was 3 (95% CI 2 to 7)

Conclusion:
From the available evidence, add-on BS in young children suspected of physical abuse with a negative RSS might allow for a clinically significant improvement of the detection rate of children with skeletal injury, for a limited number of BS procedures required

Blangis F, Taylor M, Adamsbaum C, et al. Add-on bone scintigraphy after negative radiological skeletal survey for the diagnosis of skeletal injury in children suspected of physical abuse: a systematic review and meta-analysis. Arch Dis Child. 2020 Sep 30. pii: archdischild-2020-319065. doi: 10.1136/archdischild-2020-319065.