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Pediatric Exam Questions Flashcards

1
Q

What is the moro reflex and at what age does it disappear?

A

Extension of upper extremities in response to controlled drop of patient’s head.
Disappears at 6 months.

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2
Q

An infant turning in the direction of it’s cheek being touched is what reflex?

A

Rooting reflex

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3
Q

Which reflex has the earliest onset?

A

Grasp reflex (20 weeks gestation)

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4
Q

What are milia?

A

Small yellow-white papules caused by retained sebum. They are transient and not a serious concern.

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5
Q

What is the difference between cephalhematoma and caput succedaneum?

A

A cephalhematoma is a unilateral swelling on the scalp caused by sub-periosteal hemorrhage.

Caput succedaneum is a swelling on the scalp that extends beyond the suture lines and is caused by the pressure of labor and delivery.

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6
Q

What can decreased femoral pulses indicate in the newborn?

A

Coarctation of the aorta

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7
Q

What is the normal liver edge in a newborn?

A

1-2 cm below Right costal margin

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8
Q

What is the importance of the red reflex in the newborn exam?

A

Rules out lens opacities and retinoblastoma

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9
Q

What vitamin must all newborn receive within one hour of birth?

A

Vitamin K1 oxide to prevent vitamin K dependence hemorrhages.

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10
Q

What vaccine should be given at birth?

A

Hepatitis B

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11
Q

Differentiate between Erb and Klumpky palsies.

A

Both occur secondary to birth trauma.
Erb palsy is an injury to C5-C6 nerve roots.
Klumpky palsy is an injury to roots C7-T2

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12
Q

How many times a day should an infant eat in the first three months?

A

6-8 times daily

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13
Q

At what age can a child switch to cow’s milk?

A

9-12 months

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14
Q

At what age should solid foods be introduced?

A

4-6 months

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15
Q

How much weight should an infant gain per day in the first two months?
When do they double and triple their birth-weight?

A

15-30 grams per day.

They should double their birthweight in five months and triple it in a year.

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16
Q

What are the signs and symptoms of Reye’s syndrome?

A

Stage 1: Vomiting, lethargy, liver disfunction
State 2: Disorientation, combativeness, delirium, hyperventilation, increased DTRs, fever, tachycardia, sweating.
Stage 3: Coma, decorticate rigidity
Stage 4. Coma, decerebrate posturing, no ocular reflexes, loss of corneal reflexes
Stage 5: Loss of DTRs, seizures, flaccidity, respiratory arrest, 95% mortality.

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17
Q

What is the treatment for Reyes Syndrome?

A

Stages 1 and 2: Supportive
Stages 3-5: ICP must be managed with elevation of the head of the bed, paralysis, intubation, furosemide, mannitol, dexamethasone, and pentobarbital.

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18
Q

What are the Wessel Criteria for infantile colic?

A

Crying or irritability lasting longer than 3 hours a day, 3 days a week, or 3 weeks total in an infant under 3 months.

It usually subsides after three months.

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19
Q

When does physiological jaundice occur in newborns?

A

2-4 days after birth.

Bilirubin levels may rise to 5-6 mg/dL

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20
Q

What are some causes of jaundice in the first day of life?

A
  1. Sepsis
  2. Congenital infections
  3. ABO/Rh incompatibility
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21
Q

When does jaundice caused by breast feeding occur?

A

By the 7th day of life.

Bilirubin levels may reach 25 mg/dL

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22
Q

At what level of total serum bilirubin will scleral and facial jaundice be visible in the newborn?
Shoulders?
Lower extremities?

A

Face/sclera 6-8 mg/dL
Shoulders/trunk: 8-10
Lower extremities: 10-12

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23
Q

What are some extra-hepatic causes of direct hyperbilirubinemia with obstructive jaundice in the infant?

A 
Biliary atresia
Common duct stenosis/stone
Obstructive tumor
Bile or mucous plug
Choledochal cyst
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24
Q

What are some intra-hepatic causes of direct hyperbilirubinemia with obstructive jaundice in the infant?

A

Cytomegalovirus, toxoplasmosis, rubella, coxsackie virus, syphilis, HepB, UTI, CF, alpha 1 anti-tripsin deficiency, Zellweger syndrome.

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25
Q

What are the most common causes of persistent direct hyper-bilirubinemia in the neonate?

A

Neonatal hepatitis and biliary atresia

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26
Q

Wat is the treatment for biliary atresia?

A

Surgery.

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27
Q

What type of jaundice causes the highest levels of bilirubin elevation?

A

A-O incompatibility.

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28
Q

What is kernicterus?

A

A complex of neurological symptoms caused by very high levels of unconjugated bilirubin. This occurs when free bilirubin crosses the blood brain barrier. (Can occur when Total Bilirubin is over 25)

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29
Q

What are some signs and symptoms of hydrops fetalis?

A

Ascites, CHF, anasarca, pleural effusions, hepatosplenomegaly, pallor

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30
Q

SIDS has a bimodal distribution. At what ages to the peaks occur?

A

2.5 and four months

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31
Q

In what season is SIDS incidence higher?

A

Winter

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32
Q

What is suggested by an infant with cyanotic spells and difficult breathing, especially during feeding? What is the treatment?

A

Choanal atresia

Treat with surgery; the septum between the nose and pharynx is removed.

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33
Q

What commonly precipitates an aplastic crisis in a sickle cell child?

A

Viral infections

Most commonly human parvovirus B19.

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34
Q

What does parvovirus B19 cause?

A

Erythema Infectiosum

“Slapped cheek disease”

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35
Q

What organism is most commonly implicated in childhood sickle cell infections?

A

Strep. Pneumo (60%)

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36
Q

Which organs are most commonly damaged in sickle cell patients?

A 
Spleen
Lung
Liver
Kidney
Skeleton
Skin
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37
Q

What is acute chest syndrome?

What causes acute chest syndrome?

How is ACS treated?

A

Chest pain, hypoxemia and/or infiltrates on chest x-ray in a patient with sickle cell disease.

Caused by pneumonia or pulmonary infarct secondary to vaso-occlusion.

Tx: Blood transfusion, hydration, 02, analgesics, antibiotics.

38
Q

An hour-old premature infant presents with tachypnea, grunting, chest wall retractions, nasal flaring, and cyanosis. What is a possible dx?

A

Hyaline membrane disease, AKA respiratory distress syndrome of the newborn. These patients have atelectasis, intrapulmonary shunting hypoxemia, and cyanosis.
The lungs are poorly compliant due to lack of surfactant. These are generally preterm and have not developed mature lungs.
Xray would show atelectasis with diffuse, fine, granular densities.

39
Q

What is the most common trigger for asthma in infants?

A

Viral infection

40
Q

How is asthma diagnosed in a small child?

A

Clinically.

PFTs are not useful until age 6

41
Q

Is extrinsic or intrinsic asthma more common in children?

Which immunoglobulin is involved?

A

Extrinsic

IgE

42
Q

What is the most common cause of bronchiolitis?

A

RSV.

Other causes are parainfluenza, influenza, mumps, echovirus, rhinovirus, mycoplasma, and adenoviruses.

43
Q

What is the most common cause of stridor in neonates?

A

Congenital abnormalities.

Especially laryngotracheomalacia

44
Q

What is the clinical difference between inspiratory and expiratory stridor?

A

Inspiratory: obstruction above vocal folds.
Expiratory: obstruction below vocal folds.

45
Q

An 8 month old is brought to the office. The mother states that he suddenly developed difficulty breathing. The patient is afebrile and has no other symptoms. What is the first thing to rule out?

A

Foreign body

46
Q

What is the most common cause of pneumonia in school age children?

A

Mycoplasma

Other causes include S. pneumo, parainfluenza, and influenza

47
Q

A 3day old infant has a high fever and is coughing, grunting, and really working hard to breathe. Chest xray shows reticulogranular pattern. Birth history is unremarkable. What is the probably dx?
What is the treatment?

A

Group A strep. pneumonia.
The infant most likely contracted this while passing through an infected birth canal. Mortality can be as hight as 40% so early treatment with penicillin G is important.

48
Q

What is the most common pneumonia in children under five?

A

RSV.

Patients present with nonproductive cough, rhonchi, rales, wheezing, and possible fever/chills.

49
Q

What is the most common bacterial pneumonia in pediatric patients?
What is the presentation?

A

Streptococcal

Presentation is productive cough, pleurisy, dyspnea, fever, and chills.

50
Q

What is the most common bacterial cause of pharyngitis in pediatric patients older than 3?

A

Group A hemolytic strep

51
Q

How long should a school age child receive penicillin for GABHS before returning to school?

A

One day.

The patient is no longer infectious three hours after initiation of treatment.

52
Q

Rheumatic fever is preventable if abx therapy is initiated prior to how many days after the start of GABHS pharyngitis?

A

9 days

53
Q

Is abx therapy preventative for post streptococcal glomerulonephritis associated with GABHS?

A

No, it is not prevented by abx therapy.

54
Q

What is the most common cause of tonsillitis?

A

Viral infection

55
Q

What does hot potato voice suggest in the presence of a sore throat?

A

A peritonsilar abscess

56
Q

What is the clinical presentation of mono?

A

Malaise, fever, HA, fatigue, sore throat, lymphadenopathy, splenomegaly.

57
Q

What antibiotic should not be given for mono?

What is the treatment?

A

Ampicillin: it will cause a rash

Treat with rest. Avoid contact sports.

58
Q

What would you expect the serum chloride, sodium, bicarb, and pH of a patient with CF to be?

A

Sodium and chloride levels will be low, representing renal compensation for the increased salt losses in the sweat. Bicarb and pH are usually elevated.

59
Q

What is the most common vasculitis in the pediatric population?
What is the presentation?

A

Henoch-Schonlein Purpura (HSP), which is a temporary allergic disorder of the blood vessels. Patients present with bruises over the lower extremities, abdomen, and buttocks. Bleeding from the GI and GU tract are also common. Associated arthritis occurs in 75% of cases.

60
Q

What is the typical rash of HSP?

A

palpable purpura measuring 1-2 mm in diameter, symmetrically distributed generally located on the buttocks and thighs. The rash lasts 4-6 weeks.

61
Q

How can Henoch-Scholein purpura be distinguished from idiopathic thrombocytopenic purpura?

A

The platelet count is normal in HSP. In HSP the immune complex reacts with blood vessel walls causing capillary leaking. In ITP, IgG anti-platelet antibodies develop and fix to normal platelets with are then destroyed.

62
Q

What is the most common thrombocytopenia in childhood?

How is the dx confirmed?

A

ITP
Platelet count and marrow examination will confirm the dx. Acute ITP generally follows an acute infection. 85% resolve within two months. It is most common in children 2-8 years old.

63
Q

What is the treatment for ITP?

A

Prednisone and IV gammaglobulin.

Splenectomy is used in refractory cases.

64
Q

What is the most common cause of acquired acute renal failure in children?

A

hemolytic uremic syndrome

65
Q

What is the classic triad of HUS?

A

Microangiopathic hemolytic anemia
Thrombocytopenia
Acute renal failure

66
Q

What is the most common bacterial infection associated with HUS?

A

E. Coli 0157: H7

67
Q

What is the most common cause of anemia in children?

A 
Iron deficiency (usually caused by inadequate intake)
Rapid growth spurts deplete iron stores.
68
Q

What is the most common cause of cellulitis in the pediatric patient?

A

S. aureus.

69
Q

What is the most common cause of croup?

A

Viruses

Parainfluenza is the most common.

70
Q

What is the most common causative organism in epiglottitis?

A

Group A strep

This is due to prevalence of the HIB vaccine

71
Q

What is the treatment for epiglottitis?

A

Oxygen, IV abx (ampicillin and cefotaxime), and intubation in the case of airway compromise.

72
Q

What bone is most commonly fractured in newborns?

A

clavicle

73
Q

What congenital foot abnormality is associated with spina bifida or arthrogryposis?

A

Congenital convex pes valgus
(congenital vertical talus)
Foot has tightened heel chord with “rocker bottom” appearance.

74
Q

A newborn baby you are examining has kidney-shaped soles and a medial deviation of his heels. You are not able to dorsiflex his feet. What is the diagnosis?

A 
Talipes Equinovarus
(Club Foot)
75
Q

What is the most common primary malignant bone tumor in the pediatric population?

A

Osteogenic Sarcoma

76
Q

Where do osteomas most frequently occur?

A

At the metaphyseal ends of long bones. Most common in the distal femur followed by proximal tibia, proximal humerus, and proximal femur.

77
Q

A three year old girl is holding her right arm flexed at the elbow with her forearm pronated. She will not let you near it. What it the probable diagnosis?
What is the treatment?

A

Subluxation of the radial head
“Nursemaid’s Elbow”

Tx: Hold the arm in extension and supination.
Slowly flex the elbow while pulling gentle traction.

78
Q

A mother brings in her 200 lb 14 year old son who is complaining of kneed pain and has been limping for two weeks. What is your initial suspicion?

A

Slipped capital femoral epiphysis.
Hip pain is often radiated to the medial knee.
Patient may also display abduction and external rotation.

79
Q

What is the most serious complication of SCFE (Slipped capitol femoral epiphysis)?

A

Vascular necrosis of the femoral head.

80
Q

What is the treatment of SCFE?

A

Minor cases may be corrected with traction and internal rotation but surgical pinning and immobilization are generally indicated.

81
Q

What is the classic profile of a patient with SCFE?

A

Obese males age 10-16 at the peak of their growth spurt.

82
Q

What is the most common site for osteochondritis dissecans?

A

Lateral aspect of the medial femoral condyle. Other sites include the patella or the lateral condyle of the femur.
This occurs when a segment of articular or sub-chondral bone is separated from the surrounding bone.

83
Q

A five year old is limping and complaining of hip pain. Upon examination, his quadriceps appear atrophied on the right side, his right leg is shorter than his left, and he has decreased motion of the hip joint, especially noted on internal rotation and abduction. What is the probable diagnosis?

A

Legg-Calve-Perthes disease.
Idiopathic aseptic necrosis of the femoral head.
Most common in 4-8 year old boys.
Believed to be caused by disruption in blood flow to the femoral epiphyses.

84
Q

When is the peak incidence for scoliosis?

A

early adolescence

females more commonly affected than males.

85
Q

Bowed legs, thinning of the skull, thickening of the costochondral junction, and prominences on the wrists and knees is suggestive of what disease?

A

Rickets

86
Q

What will an x-ray of a child with rickets show?

A

Widened space between the mataphysis and epiphysis and the ends of the metaphysis will be cupped and irregular.

87
Q

Rickets can be due to a lack of or abnormal metabolism of which vitamin?

A

D

88
Q

Benign intracranial hypertension in the pediatric patient can be caused by an excess of what vitamin?

A

A

89
Q

What are the most common complaints of children with Ewings Sarcoma?

A

Pain and swelling at site.

Systemic symptoms may or may not exist.

90
Q

Where are you most likely to see osteogenic sarcoma?

A

In the knees (50% of cases)

Most often metastasis is to the lungs

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