Pediatric Conditions

Question 1

What is the treatment for asthma in children 0-4 y.o.?

Answer 1

Step 1: SABA prn
Step 2: SABA prn + low dose ICS
Step 3: SABA prn + med. dose ICS
Step 4: SABA prn + med. dose ICS + LABA or montelukast
Step 5: SABA prn + high dose ICS + LABA or montelukast
Step 6: SABA prn + high dose ICS + LABA or montelukast + oral glucocorticoids

Question 2

What is the treatment for asthma in children > 5 y.o.?

Answer 2

Step 1: SABA prn
Step 2: SABA prn + low dose ICS
Step 3: SABA prn + EITHER
low dose ICS + LABA, LTRA or Theophylline OR
med. dose ICS
Step 4: SABA prn + med. dose ICS + LABA or LTRA or Theophylline
Step 5: SABA prn + high dose ICS + LABA or LTRA or Theophylline
Step 6: SABA prn + high dose ICS + LABA or LTRA or Theophylline + oral glucocorticoids

• Check inhaler technique

Question 3

What is the most common cause of bronchiolitis?

Answer 3

RSV

Question 4

What test confirms cystic fibrosis?

Answer 4

Sweat chloride test (60 mmol/L or greater)

Question 5

What are the respiratory symptoms of cystic fibrosis?

Answer 5

Persistent productive cough, increased sputum production, hyperinflation of lung fields on x ray, repeated bronchitis inf. that eventually turn into bronchiectasis

Question 6

What are the non-respiratory symptoms of cystic fibrosis?

Answer 6

Male infertility, pancreatic dx, greasy stools, sinus dx, reduced bone mineral density, weight loss

Question 7

First line treatment for pneumonia in children? If unimmunized? PCN allergy?

Answer 7

Amoxicillin 90 mg/kg/day BID for 10 days
Augmentin
Clindamycin, erythroycin, azithromycin

• < 6 months, send to ER

Question 8

How long can a pertussis cough last?

Answer 8

Typically 1 month but can last up to 3-4 months

Question 9

Hallmark signs of croup? Treatment?

Answer 9

Barking cough, Steeple sign (tapering of trachea) on x-ray
Decadron 0.6 mg/kg may be given or prednisolone

• Avoid causing distress as this may worsen symptoms

Question 10

Symptoms of coarcation of aorta?

Answer 10

High SBP in upper extremities and diminished or unobtainable BP in lower extremities

Question 11

Most common leukemia in children?

Answer 11

Acute lymphoblastic leukemia

Question 12

Signs and symptoms of ALL?

Answer 12

Hepatomegaly, splenomegaly, lymphadenopathy, anorexia, fever, bleeding (platelet count < 100, 000), petechiae, musculoskeletal pain, may present w/ a limp

Question 13

In what condition is an olive-shaped mass palpable in the RUQ?

Answer 13

Pyloric stenosis
(dx using U/S)

Question 14

In an infant suspected of GER, what can be trialed in order to improve symptoms?

Answer 14

Removing cow’s milk to r/o cow’s milk protein intolerance.
SS: occult blood in stool, eczema, poor weight gain, family hx of atopy increases risk

• GER typically resolves after first year of life. Not concerning as long as infant is eating well and gaining weight and is otherwise healthy

Question 15

What are the signs and symptoms of intussusception?

Answer 15

Inconsolable crying
Abdo pain
May draw legs towards abdomen
“Currant jelly stools”
Vomiting as obstruction worsens

Question 16

In what condition can a sausage-shaped mass be palpated on the right side of abdomen?

Answer 16

Intussusception

Question 17

Most common cause of viral gastroenteritis in children?

Answer 17

Rotavirus

• Pedialyte

Question 18

When does a hydrocele need a referral?

Answer 18

Refer if not resolved by 1 year

Question 19

When does cryptorchidism need a referral?

Answer 19

If testes are not descended by 4 months

• Increases risk for testicular cancer in the future

Question 20

What is the most common renal malignancy in children?

Answer 20

Wilms tumour (most commonly occurs b/f 5 y.o.)

• Do not palpate if suspected

Question 21

What are the signs and symptoms of a Wilms tumour?

Answer 21

May be asymptomatic; abdo pain, htn, hematuria

Question 22

What is the definition of scoliosis?

Answer 22

Lateral curvature of the spine; > 10 degrees on the Cobb angle

Question 23

How is the diagnosis of scoliosis confirmed?

Answer 23

PA and lateral views of the full spine (long view)

Question 24

What causes milia?

Answer 24

Trapped keratin and sebaceous materials

Question 25

What are the 3 Ds of epiglottitis?

Answer 25

Drooling, dysphagia, distress

Question 26

What are the indications for antibiotics for acute otitis media?

Answer 26

< 6 month old
Bilateral involvement
Otorrhea
Severe symptoms - ear pain > 48 hours, temp > 39

Question 27

Most common organisms that cause otitis media?

Answer 27

S. pneum
H. inf
M. catarrhalis

Question 28

Treatment for otitis media if PCN allergy?

Answer 28

Azithro
Clarithro
Clinda

Question 29

What is the first line management of constipation in children < 6 months?

Answer 29

100% undiluted prune, pear or Apple juice (if > 4 months) - start with 2 tbsp and increase to 8 tbsp as needed

• Second line: lactulose + glycerin supp prn

Aim for soft stools. Wean after 1-2 months

Question 30

How is constipation managed in infants > 6 months?

Answer 30

PEG 3350 po 1-1.5 g/kg/d X 3-6 days (add oral stimulant i.e. bisacodyl, senna if ineffective)

Reduce to PEG 0.5-1 g/kg/d