Pediatric Misc. Flashcards

1
Q

Both Prader-Willi and Angelman syndrome are due to a mutation or deletion of genes on chromosome […].

A

Both Prader-Willi and Angelman syndrome are due to a mutation or deletion of genes on chromosome 15.

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2
Q

Duchenne muscular dystrophy classically presents with the […] sign, in which a patient uses their upper extremities to help stand up.

A

Duchenne muscular dystrophy classically presents with the Gower sign, in which a patient uses their upper extremities to help stand up.

may also be seen in other muscular dystrophies and inflammatory myopathies (e.g. polymyositis)

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3
Q

Duchenne muscular dystrophy classically presents with […] of calf muscles.

A

Duchenne muscular dystrophy classically presents with pseudohypertrophy of calf muscles.

due to fibrofatty replacement of muscle

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4
Q

Duchenne muscular dystrophy is associated with increased serum creatine kinase and […].

A

Duchenne muscular dystrophy is associated with increased serum creatine kinase and aldolase.

useful for screening for muscular dystrophies, but not specific for DMD; typically elevated before weakness begins

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5
Q

Edwards syndrome is associated with intellectual disability, rocker-bottom feet, low-set ears, and a small […].

A

Edwards syndrome is associated with intellectual disability, rocker-bottom feet, low-set ears, and a small jaw (micrognathia).

also may present with clenched hands with overlapping fingers, prominent occiput, and congenital heart disease

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6
Q

In Angelman syndrome, the […] gene is imprinted and the […] gene is mutated/deleted.

A

In Angelman syndrome, the paternal gene is imprinted and the maternal gene is mutated/deleted.

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7
Q

In Prader-Willi syndrome, the […] gene is imprinted and the […] gene is mutated/deleted.

A

In Prader-Willi syndrome, the maternal gene is imprinted and the paternal gene is mutated/deleted.

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8
Q

Prominent J waves on ECG are typically indicative of […].

A

Prominent J waves on ECG are typically indicative of hypothermia.

also known as an Osborn wave

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9
Q

The symptoms of myotonic dystrophy may be remembered with the mnemonic “CTG”:

C: […]

T: Toupee (early balding in men)

G: Gonadal atrophy

A

The symptoms of myotonic dystrophy may be remembered with the mnemonic “CTG”:

C: Cataracts

T: Toupee (early balding in men)

G: Gonadal atrophy

other symptoms include myotonia, muscle wasting, and arryhthmias

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10
Q

The symptoms of myotonic dystrophy may be remembered with the mnemonic “CTG”:

C: Cataracts

T: […]

G: Gonadal atrophy

A

The symptoms of myotonic dystrophy may be remembered with the mnemonic “CTG”:

C: Cataracts

T: Toupee (early balding in men)

G: Gonadal atrophy

other symptoms include myotonia, muscle wasting, and arryhthmias

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11
Q

The symptoms of myotonic dystrophy may be remembered with the mnemonic “CTG”:

C: Cataracts

T: Toupee (early balding in men)

G: […]

A

The symptoms of myotonic dystrophy may be remembered with the mnemonic “CTG”:

C: Cataracts

T: Toupee (early balding in men)

G: Gonadal atrophy

other symptoms include myotonia, muscle wasting, and arryhthmias

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12
Q

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: […]

G: Gout

P: Pissed off (aggression, self-mutilation)

R: Retardation (intellectual disability)

T: dysTonia

A

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: Gout

P: Pissed off (aggression, self-mutilation)

R: Retardation (intellectual disability)

T: dysTonia

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13
Q

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: […]

P: Pissed off (aggression, self-mutilation)

R: Retardation (intellectual disability)

T: dysTonia

A

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: Gout

P: Pissed off (aggression, self-mutilation)

R: Retardation (intellectual disability)

T: dysTonia

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14
Q

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: Gout

P: […]

R: Retardation (intellectual disability)

T: dysTonia

A

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: Gout

P: Pissed off (aggression, self-mutilation)

R: Retardation (intellectual disability)

T: dysTonia

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15
Q

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: Gout

P: Pissed off (aggression, self-mutilation)

R: […]

T: dysTonia

A

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: Gout

P: Pissed off (aggression, self-mutilation)

R: Retardation (intellectual disability)

T: dysTonia

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16
Q

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: Gout

P: Pissed off (aggression, self-mutilation)

R: Retardation (intellectual disability)

T: […]

A

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: Gout

P: Pissed off (aggression, self-mutilation)

R: Retardation (intellectual disability)

T: dysTonia

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17
Q

The symptoms of […] may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: Gout

P: Pissed off (aggression, self-mutilation)

R: Retardation (intellectual disability)

T: dysTonia

A

The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic “HGPRT”:

H: Hyperuricemia

G: Gout

P: Pissed off (aggression, self-mutilation)

R: Retardation (intellectual disability)

T: dysTonia

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18
Q

What chromosomal abnormality is associated with intellectual disability, prominent epicanthal folds, and a single palmar crease?

A

Trisomy 21 (Down syndrome)

other features include flat facies, upslanting palpebral fissures, a gap between the first two toes, and Brushfield spots (whitish-gray spots on the periphery of the iris)

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19
Q

What chromosomal abnormality is associated with intellectual disability, rocker-bottom feet, cleft lip/palate, and small eyes?

A

Trisomy 13 (Patau syndrome)

other features include midline defects (e.g. holoprosencephaly, omphalocele), polydactyly, congenital heart disease, and cutis aplasia

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20
Q

What chromosomal abnormality presents with clenched hands with overlapping fingers?

A

Trisomy 18 (Edwards syndrome)

other important features are rocker-bottom feet, low-set ears, and micrognathia

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21
Q

What gene is defective in X-linked muscular dystrophy (e.g. Duchenne, Becker)?

A

Dystrophin (DMD) gene

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22
Q

What genetic pathology is associated with “elfin” facies, intellectual disability, and extreme friendliness with strangers?

A

Williams syndrome

due to microdeletion of chromosome 7q; also may have cardiovascular problems and hypercalcemia (due to increased sensitivity to vitamin D)

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23
Q

What genetic pathology is associated with microcephaly, intellectual disability, and a high-pitched cry?

A

Cri-du-chat syndrome

due to microdeletion of chromosome 5p; also may have a protruding metopic suture, epicanthal folds and cardiac abnormalities (VSD)

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24
Q

What genetic pathology is characterized by inappropriate laughter, seizures, ataxia, and severe intellectual disability?

A

Angelman syndrome (“happy puppet syndrome”)

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25
Q

What genetic pathology is characterized by insatiable appetite (hyperphagia), obesity, intellectual disability, and hypogonadism?

A

Prader-Willi syndrome

also may result in hypotonia

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26
Q

What is a common cause of death in Duchenne muscular dystrophy?

A

Dilated cardiomyopathy

death usually results from cardiac or respiratory failure

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27
Q

What is the gold standard for diagnosis of Duchenne muscular dystrophy?

A

Genetic studies

reveals a deletion of the dystrophin gene on the Xp21 chromosome

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28
Q

What is the likely diagnosis in a child that experiences sudden transient episodes of loss of consciousness with paleness prior to the attack and flushing after? The child is fully alert upon awakening.

A

Adams-Stokes syndrome

due to cardiac dysrhythmia; ECG may show asystole, AV block, or ventricular fibrillation during the attacks

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29
Q

What is the likely diagnosis in a patient with scoliosis, long fingers and toes, and upwards lens dislocation?

A

Marfan syndrome

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30
Q

What is the mode of inheritance of Duchenne and Becker muscular dystrophy?

A

X-linked recessive

hence referred to as “X-linked muscular dystrophy”

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31
Q

What is the mode of inheritance of myotonic dystrophy?

A

Autosomal dominant

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32
Q

What is the most common cause of death in Marfan syndrome patients?

A

Aortic dissection

secondary to aortic root dilation and cystic medial degeneration of the aorta

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33
Q

What MSK pathology is characterized by impaired relaxation after a single muscle contraction?

A

Myotonic dystrophy

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34
Q

What protein is defective in Marfan syndrome?

A

Fibrillin (scaffold for elastin)

due to mutations of the fibrillin-1 gene

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35
Q

X-linked muscular dystrophy is characterized by muscle wasting and replacement of skeletal muscle by […] tissue.

A

X-linked muscular dystrophy is characterized by muscle wasting and replacement of skeletal muscle by adipose tissue.

e.g. Duchenne and Becker muscular dystrophy

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36
Q

[…] muscular dystrophy is typically due to a non-frameshift deletion, resulting in a partially functional dystrophin protein.

A

Becker muscular dystrophy is typically due to a non-frameshift deletion, resulting in a partially functional dystrophin protein.

therefore dystrophin is mutated but NOT deleted (vs. Duchenne)

37
Q

[…] muscular dystrophy typically presents in adolescence or early adulthood.

A

Becker muscular dystrophy typically presents in adolescence or early adulthood.

presents as a milder form of Duchenne muscular dystrophy

38
Q

[…] muscular dystrophy is typically due to frameshift or non-sense mutations, resulting in a truncated or absent dystrophin protein.

A

Duchenne muscular dystrophy is typically due to frameshift or non-sense mutations, resulting in a truncated or absent dystrophin protein.

“Duchenne = Deleted Dystrophin” (vs. Becker, where dystrophin is mutated)

39
Q

[…] muscular dystrophy typically presents before 5 years of age.

A

Duchenne muscular dystrophy typically presents before 5 years of age.

40
Q

[…] is due to CTG trinucleotide repeat expansion in the DMPK gene.

A

Myotonic dystrophy (type 1) is due to CTG trinucleotide repeat expansion in the DMPK gene.

41
Q

Beckwith-Wiedemann syndrome typically manifests as a combination of Wilms tumor, macroglossia, muscular […], hypo-glycemia, and/or organomegal.

A

Beckwith-Wiedemann syndrome typically manifests as a combination of Wilms tumor, macroglossia, muscular hemihyperplasia, hypo-glycemia, and/or organomegaly.

42
Q

Beckwith-Wiedemann syndrome typically manifests as a combination of Wilms tumor, macroglossia, muscular hemihyperplasia, […]-glycemia, and/or organomegaly.

A

Beckwith-Wiedemann syndrome typically manifests as a combination of Wilms tumor, macroglossia, muscular hemihyperplasia, hypo-glycemia, and/or organomegaly.

43
Q

Chediak-Higashi syndrome is caused by a defect in the lysosomal trafficking regulator (LYST) gene, resulting in impaired […] formation.

A

Chediak-Higashi syndrome is caused by a defect in the lysosomal trafficking regulator (LYST) gene, resulting in impaired phagolysosome formation.

LYST defect results in impaired protein trafficking

44
Q

Congenital diaphragmatic hernias occur due a defect in the […].

A

Congenital diaphragmatic hernias occur due a defect in the pleuroperitoneal membrane.

45
Q
A
46
Q

Diaphragmatic hernias typically occur on the […] side. (left or right)

A

Diaphragmatic hernias typically occur on the left side. (left or right)

due to protection of right hemidaphragm by the liver

47
Q

Early Fabry disease presents with a triad of peripheral neuropathy, […], and hypohidrosis.

A

Early Fabry disease presents with a triad of peripheral neuropathy, angiokeratomas, and hypohidrosis.

48
Q

In physiologic jaundice of the newborn, unconjugated bilirubin may deposit in the brain, especially in the […] (kernicterus).

A

In physiologic jaundice of the newborn, unconjugated bilirubin may deposit in the brain, especially in the basal ganglia (kernicterus).

49
Q

Kartagener syndrome is characterized by immotile cilia due to a […] defect.

A

Kartagener syndrome is characterized by immotile cilia due to a dynein arm defect.

also known as primary ciliary dyskinesia

50
Q

Marfan syndrome typically presents with subluxation of the lenses […] and […]. (direction)

A

Marfan syndrome typically presents with subluxation of the lenses upward and temporally. (direction)

versus homocystinuria which is usually downward and inward

51
Q

Osteogenesis imperfecta may present with […] due to abnormal ossicles.

A

Osteogenesis imperfecta may present with hearing loss due to abnormal ossicles.

bones of the middle ear fracture easily

52
Q

Osteoid osteoma typically arises in the cortex of the […] of long bones (typically the proximal femur).

A

Osteoid osteoma typically arises in the cortex of the diaphysis of long bones (typically the proximal femur).

important distinguishing feature from osteoblastoma, which typically arises in the vertebrae

53
Q

Osteomalacia/rickets is characterized by […] serum Ca2+ and PO43- .

A

Osteomalacia/rickets is characterized by decreased serum Ca2+ and PO43- .

important distinguishing feature from osteoporosis

54
Q

Osteomalacia/rickets is characterized by […] serum PTH and alkaline phosphatase.

A

Osteomalacia/rickets is characterized by increased serum PTH and alkaline phosphatase.

important distinguishing feature from osteoporosis

55
Q

Risk factors of sudden infant death syndrome include sleeping on the […] and exposure to […].

A

Risk factors of sudden infant death syndrome include sleeping on the stomach and exposure to cigarette smoke.

thus infants should sleep on their back and avoid second-hand smoke exposure

56
Q

Some forms of osteogenesis imperfecta have tooth abnormalities, including opalescent teeth that wear easily due to lack of […].

A

Some forms of osteogenesis imperfecta have tooth abnormalities, including opalescent teeth that wear easily due to lack of dentin.

this is known as dentinogenesis imperfecta

57
Q

The features of DiGeorge syndrome (22q11 microdeletion syndrome) may be remembered with the mnemonic “CATCH 22”:

C: […]

A: Abnormal facies

T: Thymic aplasia

C: Cardiac abnormalities (truncus arteriosus, tetralogy of Fallot)

H: Hypocalcemia (lack of parathyroids)

A

The features of DiGeorge syndrome (22q11 microdeletion syndrome) may be remembered with the mnemonic “CATCH 22”:

C: Cleft palate

A: Abnormal facies

T: Thymic aplasia

C: Cardiac abnormalities (truncus arteriosus, tetralogy of Fallot)

H: Hypocalcemia (lack of parathyroids)

58
Q

The features of DiGeorge syndrome (22q11 microdeletion syndrome) may be remembered with the mnemonic “CATCH 22”:

C: Cleft palate

A: […]

T: Thymic aplasia

C: Cardiac abnormalities (truncus arteriosus, tetralogy of Fallot)

H: Hypocalcemia (lack of parathyroids)

A

The features of DiGeorge syndrome (22q11 microdeletion syndrome) may be remembered with the mnemonic “CATCH 22”:

C: Cleft palate

A: Abnormal facies

T: Thymic aplasia

C: Cardiac abnormalities (truncus arteriosus, tetralogy of Fallot)

H: Hypocalcemia (lack of parathyroids)

59
Q

The features of DiGeorge syndrome (22q11 microdeletion syndrome) may be remembered with the mnemonic “CATCH 22”:

C: Cleft palate

A: Abnormal facies

T: […]

C: Cardiac abnormalities (truncus arteriosus, tetralogy of Fallot)

H: Hypocalcemia (lack of parathyroids)

A

The features of DiGeorge syndrome (22q11 microdeletion syndrome) may be remembered with the mnemonic “CATCH 22”:

C: Cleft palate

A: Abnormal facies

T: Thymic aplasia

C: Cardiac abnormalities (truncus arteriosus, tetralogy of Fallot)

H: Hypocalcemia (lack of parathyroids)

60
Q

The features of DiGeorge syndrome (22q11 microdeletion syndrome) may be remembered with the mnemonic “CATCH 22”:

C: Cleft palate

A: Abnormal facies

T: Thymic aplasia

C: […]

H: Hypocalcemia (lack of parathyroids)

A

The features of DiGeorge syndrome (22q11 microdeletion syndrome) may be remembered with the mnemonic “CATCH 22”:

C: Cleft palate

A: Abnormal facies

T: Thymic aplasia

C: Cardiac abnormalities (truncus arteriosus, tetralogy of Fallot)

H: Hypocalcemia (lack of parathyroids)

61
Q

The features of DiGeorge syndrome (22q11 microdeletion syndrome) may be remembered with the mnemonic “CATCH 22”:

C: Cleft palate

A: Abnormal facies

T: Thymic aplasia

C: Cardiac abnormalities (truncus arteriosus, tetralogy of Fallot)

H: […]

A

The features of DiGeorge syndrome (22q11 microdeletion syndrome) may be remembered with the mnemonic “CATCH 22”:

C: Cleft palate

A: Abnormal facies

T: Thymic aplasia

C: Cardiac abnormalities (truncus arteriosus, tetralogy of Fallot)

H: Hypocalcemia (lack of parathyroids)

62
Q

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: […]

R: Rash (polymorphous -> desquamating)

A: Adenopathy (cervical lymph nodes)

S: Strawberry tongue (oral mucositis)

H: Hand-foot erythema and edema

&

Burn: Fever (for > 5 days)

A

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: Rash (polymorphous -> desquamating)

A: Adenopathy (cervical lymph nodes)

S: Strawberry tongue (oral mucositis)

H: Hand-foot erythema and edema

&

Burn: Fever (for > 5 days)

diagnosis requires fever for > 5 days with at least 4 of the 5 “CRASH” findings

63
Q

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: […]

A: Adenopathy (cervical lymph nodes)

S: Strawberry tongue (oral mucositis)

H: Hand-foot erythema and edema

&

Burn: Fever (for > 5 days)

A

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: Rash (polymorphous -> desquamating)

A: Adenopathy (cervical lymph nodes)

S: Strawberry tongue (oral mucositis)

H: Hand-foot erythema and edema

&

Burn: Fever (for > 5 days)

diagnosis requires fever for > 5 days with at least 4 of the 5 “CRASH” findings

64
Q

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: Rash (polymorphous -> desquamating)

A: […]

S: Strawberry tongue (oral mucositis)

H: Hand-foot erythema and edema

&

Burn: Fever (for > 5 days)

A

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: Rash (polymorphous -> desquamating)

A: Adenopathy (cervical lymph nodes)

S: Strawberry tongue (oral mucositis)

H: Hand-foot erythema and edema

&

Burn: Fever (for > 5 days)

diagnosis requires fever for > 5 days with at least 4 of the 5 “CRASH” findings

65
Q

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: Rash (polymorphous -> desquamating)

A: Adenopathy (cervical lymph nodes)

S: […]

H: Hand-foot erythema and edema

&

Burn: Fever (for > 5 days)

A

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: Rash (polymorphous -> desquamating)

A: Adenopathy (cervical lymph nodes)

S: Strawberry tongue (oral mucositis)

H: Hand-foot erythema and edema

&

Burn: Fever (for > 5 days)

diagnosis requires fever for > 5 days with at least 4 of the 5 “CRASH” findings

66
Q

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: Rash (polymorphous -> desquamating)

A: Adenopathy (cervical lymph nodes)

S: Strawberry tongue (oral mucositis)

H: […]

&

Burn: Fever (for > 5 days)

A

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: Rash (polymorphous -> desquamating)

A: Adenopathy (cervical lymph nodes)

S: Strawberry tongue (oral mucositis)

H: Hand-foot erythema and edema

&

Burn: Fever (for > 5 days)

diagnosis requires fever for > 5 days with at least 4 of the 5 “CRASH” findings

67
Q

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: Rash (polymorphous -> desquamating)

A: Adenopathy (cervical lymph nodes)

S: Strawberry tongue (oral mucositis)

H: Hand-foot erythema and edema

&

Burn: […]

A

The symptoms of Kawasaki disease may be remembered with the mnemonic “CRASH and burn”:

C: Conjunctivitis

R: Rash (polymorphous -> desquamating)

A: Adenopathy (cervical lymph nodes)

S: Strawberry tongue (oral mucositis)

H: Hand-foot erythema and edema

&

Burn: Fever (for > 5 days)

diagnosis requires fever for > 5 days with at least 4 of the 5 “CRASH” findings

68
Q

Treatment of Von Gierke disease includes avoidance of […] and […].

A

Treatment of Von Gierke disease includes avoidance of fructose and galactose.

fructose and galactose both lead to increased glucose-6-phosphate, which increases G6P accumulation in the liver

69
Q

Treatment of von Gierke disease includes frequent oral […] or cornstarch.

A

Treatment of von Gierke disease includes frequent oral glucose or cornstarch.

70
Q

What chromosomal deletion is associated with DiGeorge syndrome?

A

22q11 microdeletion

71
Q

What class of drugs are contraindicated in C1 esterase deficiency?

A

ACE inhibitors

72
Q

What congenital heart defect is associated with lithium exposure in utero?

A

Ebstein anomaly

73
Q

What demographic is classically effected by Kawasaki disease?

A

Asian children < 5 years old

74
Q

What is the mode of inheritance of Fabry disease?

A

X-linked recessive

75
Q

What is the mode of inheritance of Wiskott-Aldrich syndrome?

A

X-linked recessive

76
Q

What lysosomal storage disease presents with optic atrophy?

A

Krabbe disease

77
Q
A
78
Q

Which complement protein is decreased in all forms C1 esterase inhibitor deficiency?

A

C4

79
Q

Which lysosomal storage disease is associated with osteoporosis, bone crises, avascular necrosis, and pancytopenia?

A

Gaucher disease

pancytopenia secondary to increased blood cell consumption by enlarged spleen; bone pathologies due to lysosomal proteolytic enzymes and inflammatory mediators that are destructive to bone

80
Q

Which lysosomal storage disease is caused by deficiency of galactocerebrosidase?

A

Krabbe disease

81
Q

Which lysosomal storage disease is caused by deficiency of glucocerebrosidase (β-glucosidase)?

A

Gaucher disease

82
Q

Which lysosomal storage disease is characterized by “foam cells” (lipid-laden macrophages)?

A

Niemann Pick disease

83
Q

Which lysosomal storage disease is characterized by an “onion skin” lysosome?

A

Tay-Sachs disease

84
Q

Which lysosomal storage disease is characterized by deficiency of α-galactosidase A?

A

Fabry disease

85
Q

Which lysosomal storage disease is characterized by macrophages resembling crumpled tissue paper?

A

Gaucher disease

86
Q

Which lysosomal storage disease may present with progressive renal failure and cardiovascular disease?

A

Fabry disease (late)

87
Q

Which lysosomal storage diseases (2) have an X-linked recessive inheritance?

A

Fabry disease, Hunter syndrome

the rest are autosomal recessive

88
Q

[…] disease may also be referred to as mucocutaneous lymph node syndrome.

A

Kawasaki disease may also be referred to as mucocutaneous lymph node syndrome.