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UWorld > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Normal age at which children should be walking?

A

9-16 mo

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2
Q

How does Turner’s Syndrome impact intelligence?

A

Normal intelligence (with normal developmental milestones), but increased risk of learning difficulties

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3
Q

MSK presentation of Turner’s Syndrome?

A

Lymphedema of hands + feet

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4
Q

Inheritance pattern of Turner’s Syndrome?

A

Sporadic

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5
Q

Genetic cause of Turner’s Syndrome?

A

Nondisjunction

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6
Q

Genotype of Turner’s Syndrome?

A

45 XO

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7
Q

When is flu vaccine recommended for babies-children-adults?

A

September-April

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8
Q

Is egg allergy a contraindication to flu vaccine?

A

No

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9
Q

Influenza is a type of ___ vaccine

A

Inactivated

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10
Q

Is mild URI illness a contraindication to flu vaccine?

A

No

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11
Q

Clinical presentation of Food Protein-Induced Allergic Proctocolitis (FPIAP)?

A

Painless bloody stools in well appearing infant

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12
Q

Epidemiology of Food Protein-Induced Allergic Proctocolitis (FPIAP)?

A

Infants < 6 mo

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13
Q

2 qualities of blood-streaked stools in Food Protein-Induced Allergic Proctocolitis (FPIAP)?

A

Absence of anal fissure; Presence of mucus in stool

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14
Q

Pathophysiology of Food Protein-Induced Allergic Proctocolitis (FPIAP)?

A

Non-IgE mediated allergic reaction

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15
Q

Allergic reaction in Food Protein-Induced Allergic Proctocolitis (FPIAP) is most commonly caused by …

A

Cow’s milk protein

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16
Q

Best treatment for Food Protein-Induced Allergic Proctocolitis (FPIAP) in a breastfeeding infant?

A

Elimination of dairy from maternal diet

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17
Q

Clinical course of Food Protein-Induced Allergic Proctocolitis (FPIAP)?

A

Benign, self-limited; No associated long-term complications

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18
Q

What accounts for neonatal breast hypertrophy?

A

High levels of maternal estrogen crossing the placenta during the 3rd trimester, then decreasing in infant’s blood after delivery

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19
Q

Which hormone is responsible for neonatal breast hypertrophy?

A

Prolactin

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20
Q

How does prolactin result in neonatal breast hypertrophy?

A

Decrease in estrogen in fetal blood after delivery stimulates the pituitary to produce prolactin

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21
Q

Prognosis for neonatal breast hypertrophy?

A

Self-limited resolution within 6 months

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22
Q

3 additional effects of maternal estrogen in newborn females?

A

Uterine bleeding, labial swelling, leukorrhea

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23
Q

When would confidentiality of an adolescent’s medical conditions be condition?

A

When the adolescent poses danger to self or others

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24
Q

Initial step of workup for 6 yo male with nocturnal enuresis?

A

UA

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25
Q

Role of UA in evaluation of nocturnal enuresis?

A

Differentiate primary vs. secondary nocturnal enuresis … UA would identify diabetes, UTI

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26
Q

Normal UA in a 6 yo male with nocturnal enuresis suggests which diagnosis?

A

Primary nocturnal enuresis

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27
Q

6 yo male presents to receive flu vaccine; Parents report HX of egg allergy (urticaria) – Should patient still receive flu vaccine?

A

Yes – patient is fine to get flu vaccine

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28
Q

Should patient who has severe egg allergy (angioedema, anaphylaxis) receive the flu vaccine?

A

Yes … but in a supervised healthcare setting

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29
Q

What is the ONLY contraindication to flu vaccine?

A

Severe allergic reaction (angioedema, anaphylaxis) to the flu vaccine itself

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30
Q

Which type of flu vaccine should be administered to all patients?

A

Inactivated IM injection

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31
Q

3 risk factors for pediatric dental caries?

A

Diet, Nighttime bottle feedings, Inadequate fluoride

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32
Q

3 aspects of clinical presentation for pediatric dental caries?

A

Visible plaques, White enamel defects, Brown discoloration

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33
Q

When should dental screenings by pediatrician begin?

A

5-8 mo … when first teeth erupt

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34
Q

When should dental screenings by dentists begin?

A

1 yo, with follow-up every 6 months

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35
Q

Inheritance pattern of Marfan Syndrome?

A

AD

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36
Q

Etiology of Marfan Syndrome?

A

Mutation in fibrillin-1 protein

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37
Q

Clinical presentation of Marfan Syndrome?

A

Tall structure, myopia, increased arm-span:height ratio

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38
Q

Main cause of mortality in Marfan Syndrome?

A

Aortic root disease … causing aortic dissection, aortic aneurysm, AR murmur

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39
Q

Important step of pre-participation sports physical in patient with suspected Marfan Syndrome?

A

ECHO

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40
Q

5 diagnostic criteria for Kawasaki disease?

A

Fever > 105° for > 5 days, Mucositis, Conjunctivitis, Rash, Extremity lymphedema

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41
Q

Best management of patient who meets 3/5 diagnostic criteria for Kawasaki disease?

A

Order ESR/CRP, ibuprofen … Follow-up in 1 day

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42
Q

Best management of patient who meets 4/5 diagnostic criteria for Kawasaki disease?

A

Treat with IVIG + high-dose ASA

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43
Q

Complication of Kawasaki disease?

A

Coronary artery aneurysms

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44
Q

Additional step of workup for all children with Kawasaki disease?

A

ECHO to evaluate Coronary artery aneurysm

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45
Q

When should ECHO be performed for children with Kawasaki disease?

A

At time of diagnosis; 2 weeks after treatment completion; 6 weeks after treatment completion

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46
Q

How does administration of IVIG change routine healthcare for children with Kawasaki disease?

A

IVIG interferes with immune system response to live-attenuated vaccinations … Need to postpone administration of routine vaccinations until 11 months after IVIG treatment

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47
Q

Which live-attenuated vaccines are administered at 4 yo?

A

MMR, Varicella

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48
Q

2 yo male presents with father after swallowing a coin; Pt is asymptomatic; PE shows normal vitals; Abdominal XR shows coin located in stomach – best management of this patient?

A

Observation + repeat abdominal XR in 1 week

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49
Q

2 yo male presents with father after swallowing a coin; Pt is asymptomatic; PE shows normal vitals; Abdominal XR shows coin located in stomach – if repeat abdominal XR in 1 week shows no progression of coin, what is the next step in management?

A

Endoscopic removal of FB

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50
Q

Best management of child who swallows a high-risk object (button battery, sharp object, magnet)?

A

Immediate endoscopic removal of FB … to prevent necrosis/perforation of GI tract

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51
Q

Definition of chronic cough in children?

A

Cough lasting 4+ weeks

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52
Q

2 aspects of initial evaluation for chronic cough in children?

A

Spirometry + CXR

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53
Q

2 factors that determine management of adolescent scoliosis?

A

Risk of progression, Cobb angle

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54
Q

Risk of progression for adolescent scoliosis is determined by …

A

Skeletal maturity

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55
Q

How can you determine Skeletal maturity in a patient with adolescent scoliosis?

A

Pubertal status (Tanner stage)

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56
Q

Cobb angle at which surgical evaluation is required for severe scoliosis?

A

Cobb angle > 40°

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57
Q

Best management for adolescent scoliosis in a patient who has reached full skeletal maturity (Tanner Stage 5)?

A

No additional follow-up required

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58
Q

Sleep terrors are a type of ___ sleep disorder

A

NREM

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59
Q

Prognosis for sleep terrors?

A

Benign, self-limiting

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60
Q

Best management for sleep terrors?

A

Reassurance

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61
Q

4 “red-flag” symptoms in setting of scoliosis?

A

Back pain, Neurologic symptoms, Rapidly-progressing angle curvature, Vertebral anomalies on XR

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62
Q

Red-flag symptoms in setting of scoliosis are concerning for …

A

Spinal cord tumors

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63
Q

Gold standard test to assess spinal anatomy in scoliosis with red-flag symptoms?

A

Spine MRI

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64
Q

Definition of macrocephaly in infants?

A

Infants with head circumference > 98th percentile

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65
Q

3 characteristics of macrocephaly in infants, that warrants neuroimaging to evaluate pathologic intracranial process?

A

Rapidly expanding head circumference, Neurologic abnormalities, Developmental delay

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66
Q

Neuroimaging study of choice for macrocephaly in infants?

A

Head US

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67
Q

Next step of workup for infant with macrocephaly, but NML head US?

A

Reassurance

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68
Q

Ocular complication associated with Marfan Syndrome?

A

Superior + Lateral lens subluxation

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69
Q

Relationship between vacuum-assisted delivery and jaundice?

A

Vacuum-assisted delivery increases risk of cephalohematoma … Cephalohematoma causes increased RBC turnover … Increased hemolysis leads to indirect hyperbilirubinemia

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70
Q

What is the danger of extreme indirect hyperbilirubinemia?

A

Kernicterus … bilirubin encephalopathy

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71
Q

How does phototherapy treat indirect hyperbilirubinemia?

A

Converts unconjugated bilirubin into water-soluble form, which can be excreted in urine

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72
Q

Best management of newborn with indirect hyperbilirubinemia ~15?

A

Phototherapy until bilirubin levels begin to normalize

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73
Q

Best management of newborn with indirect hyperbilirubinemia ~20-25?

A

Exchange transfusion … this is a toxic level of indirect hyperbilirubinemia

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74
Q

Prognosis for ADHD diagnosed during childhood?

A

33-67% will experience persistent symptoms during adulthood

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75
Q

Relationship between stimulant therapy (for ADHD) and substance abuse?

A

No increased risk

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76
Q

Weight loss expected during newborn phase?

A

10% weight loss is expected during 1st week

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77
Q

When should a newborn’s weight return to birth weight?

A

Age 2 weeks

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78
Q

How often should infants with weight loss be monitored in office?

A

Seen every 2-3 days

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79
Q

1 mo infant presents with mother for concerns about breathing; Mother reports that infant will stop breathing, then take lots of quick breaths; No signs of cyanosis or respiratory distress … several times during day – diagnosis?

A

Periodic breathing

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80
Q

Best management for periodic breathing?

A

Reassurance

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81
Q

Prognosis for periodic breathing?

A

Benign

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82
Q

Etiology of periodic breathing?

A

Immaturity of infant’s nervous system

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83
Q

When do patients receive childhood tetanus vaccines?

A

2 mo, 4 mo, 6 mo, 4 years

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84
Q

In setting of animal bite – for patient who has received 3+ tetanus toxoid vaccines, when is a booster dose indicated?

A

If last tetanus dose was 10+ years ago (clean wound); If last tetanus dose was 5+ years ago (dirty wound)

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85
Q

In setting of animal bite – best management of patient who is incompletely immunized, with clean wound?

A

Tetanus toxoid booster

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86
Q

In setting of animal bite – best management of patient who is incompletely immunized, with dirty wound?

A

Tetanus toxoid booster + Tetanus Ig

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87
Q

Inheritance pattern for cleft lip?

A

Multifactorial

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88
Q

Best management of cleft lip in an infant?

A

Surgical reconstruction at 10 weeks, 10g hemoglobin, 10 lbs weight

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89
Q

Pregnancy exposure associated with development of cleft lip?

A

ETOH

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90
Q

6 characteristics of intentional immersion injury seen in cases of suspected child abuse?

A

Burns to back + buttocks, uniform erythema, clear line of demarcation, lack of splash marks, zebra pattern (flexural creases are spared), center of buttocks spared

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91
Q

1st step of workup for cases of suspected child abuse?

A

Hospitalization; Report the case to child protective services

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92
Q

Description of kyphosis?

A

Forward convexity of T-spine

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93
Q

Difference between postural kyphosis vs. structural kyphosis?

A

Postural kyphosis = corrected by voluntary back extension; Structural kyphosis = does not self-correct

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94
Q

Etiology of postural kyphosis?

A

Slouching

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95
Q

Prognosis for postural kyphosis?

A

Deformity is not permanent; No treatment required, proper posture is corrective

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96
Q

Clinical presentation of Erb-Duchenne palsy?

A

Adduction, IR of upper extremity with pronated forearm

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97
Q

Which reflex is typically affected by Erb-Duchenne palsy?

A

Moro

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98
Q

Risk factor for Erb-Duchenne palsy in newborn?

A

Macrosomia, shoulder dystocia

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99
Q

Image of the moro reflex?

A
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100
Q

___ refers to isolated pubic hair development in male < 9 yo, female < 8 yo

A

Idiopathic premature pubarche

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101
Q

3 aspects of clinical presentation for McCune-Albright Syndrome?

A

Cafe au lait spots, Precocious puberty, Fibrous dysplasia

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102
Q

Etiology of indirect inguinal hernia in newborns?

A

Failed obiteration of processus vaginalis

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103
Q

4 risk factors for development of indirect inguinal hernia in newborns?

A

Prematurity, Increased abdominal pressure (prune belly syndrome), Cryptoorchidism, Hypospadias

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104
Q

3 complications of indirect inguinal hernia in newborns?

A

Incarcerated hernia + bowel ischemia + impaired fertility

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105
Q

Best management of indirect inguinal hernia in newborns?

A

Elective surgery 1-2 weeks after diagnosis in newborned without incarceration

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106
Q

Best management of pediatric obstructive sleep apnea?

A

Tonsillectomy + adenoidectomy

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107
Q

Etiology of pediatric obstructive sleep apnea?

A

Adenotonsillar hypertrophy

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108
Q

Clinical presentation of pediatric obstructive sleep apnea?

A

Snoring

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109
Q

Clinical presentation of neurofibromatosis 2?

A

Hypopigmented spots, Bilateral deafness

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110
Q

What accounts for Bilateral deafness seen in neurofibromatosis 2?

A

Bilateral acoustic neuromas

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111
Q

Red flag feature for a case of suspected SIDS?

A

Age > 6 months

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112
Q

Age definition of SIDS?

A

Age < 12 months … but uncommon after 6 mo

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113
Q

Clinical presentation of salicylate poisoning?

A

Tachycardia, tachypnea, dizziness, nausea, vomiting

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114
Q

Metabolic changes seen in salicylate poisoning?

A

Anion gap metabolic acidosis (lactic acidosis) + Respiratory alkalosis

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115
Q

Best initial management of salicylate poisoning?

A

Sodium bicarbonate

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116
Q

3 additional aspects of treatment for salicylate poisoning?

A

Glucose, dialysis, activated charcoal

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117
Q

Indication for dialysis in salicylate poisoning?

A

Pulmonary edema, fluid overload

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118
Q

Lead poisoning is concerning in homes built before …

A

1978

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119
Q

Best screening test for lead poisoning in children?

A

Finger-stick capillary blood testing

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120
Q

Next step of workup for a child with a (+) Finger-stick capillary blood testing for lead poisoning?

A

Venous lead level confirmation

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121
Q

Best management for lead poisoning > 45?

A

Chelation therapy

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122
Q

Complication of lead poisoning in children?

A

Cognitive impairment + behavioral problems

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123
Q

Location of caput succedaneum?

A

Above the periosteum

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124
Q

Best management of caput succedaneum?

A

Benign … observation

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125
Q

Does caput succedaneum cross suture lines?

A

Yes … (caput crosses)

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126
Q

Location of subgaleal hematoma?

A

Between scalp and periosteum

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127
Q

Best management of subgaleal hematoma?

A

ICU placement … continuous monitoring, volume replacement, blood count, coagulation studies

128
Q

Does subgaleal hematoma cross suture lines?

A

Yes … (gallo crosses)

129
Q

Location of cephalohematoma?

A

Subperiosteal

130
Q

Prognosis of cephalohematoma?

A

May calcify and lead to skull deformation

131
Q

Does cephalohematoma cross suture lines?

A

No

132
Q

Best management for a child who appears chronically-malnourished and dehydrated (dry MM)?

A

Oral rehydration solution

133
Q

Risk of IV rehydration in a child who appears chronically-malnourished and dehydrated (dry MM)?

A

Heart failure

134
Q

14 yo male presents with cough, SOB, fever; Cough is worse at night; HX of kidney transplant 3 months ago; PE shows T 100.8, RR 31, O2 82% on RA – diagnosis?

A

PCP pneumonia … (asthma won’t cause fever)

135
Q

PCP pneumonia is seen in patients with ___ immunodeficiency

A

Cell-mediated

136
Q

Medication that can prevent development of PCP pneumonia in child with kidney transplant 3 months ago?

A

TMP-SMX

137
Q

What is best strategy for stopping nosebleeding that is unresponsive to pressure applied to nares?

A

Place cotton pledget with topical vasoconstrictor

138
Q

Most epistaxis originates from ___ nasal septal mucosa

A

Anterior

139
Q

Why does most epistaxis originate from the anterior nasal septal mucosa?

A

Keisselbach plexus

140
Q

3 arteries that make up Keisselbach plexus?

A

Sphenopalatine, greater palatine, anterior ethmoid

141
Q

What is the topical vasoconstrictor used to stop nosebleeds in children?

A

Oxymetazoline

142
Q

6 yo male presents with several “dark spots” on trunk, which seem to be spreading and increasing in number; Paternal history is unknown; PE reveals macules on trunk, UE, LE, R thigh, BL inguinal creases - diagnosis?

A

NF-1

143
Q

Inheritance pattern of NF-1?

A

AD

144
Q

Clinical presentation of NF-1?

A

Multiple cafe-au-lait spots with axillary and inguinal freckling

145
Q

What is next step of workup in patient with suspected NF-1?

A

Ophthalamic screening for optic glioma

146
Q

24 yo male presents for WCC; Mother is concerned about launguage development in bilingual household; Patient can speak 5-8 words in Spanish; PE shows 2 cafe-au-lait spots on lower back - next step?

A

Hearing evaluation

147
Q

Normal vocabulary for a 18 mo child?

A

10-25

148
Q

Normal vocabulary for a 2 yo child?

A

50, with 2-word phrases

149
Q

Language delay in any child warrants …

A

Hearing evaluation

150
Q

70 yo AA male presents with his fracture; HX of cigarette smoking; Maternal history of vertebral fracture - what is most important risk factor for patient’s condition?

A

Age

151
Q

55 yo female presents to hospital for NV; treated with metoclopramide, ondansetron; Later that night, develops torticollis - what is DOC?

A

Diphenhydramine, Benztropine

152
Q

55 yo female presents to hospital for NV; treated with metoclopramide, ondansetron; Later that night, develops torticollis - diagnosis?

A

Metoclopramide-induced acute dystonia

153
Q

56 yo male presents with fatigue, BL knee and ankle pain, L-sided CP; Also reports waking with sweating for several nights; HX of cardiomyopathy with EF < 20%; AICD placed 6 months ago; Current meds include carvedilol, hydralazine, isosorbide dinitrate, furosemide, spironolactone; PE reveals small effusion in R knee; CXR shows cardiomegaly, small L pleural effusion - diagnosis?

A

Drug0induced SLE

154
Q

56 yo male presents with fatigue, BL knee and ankle pain, L-sided CP; Also reports waking with sweating for several nights; HX of cardiomyopathy with EF < 20%; AICD placed 6 months ago; Current meds include carvedilol, hydralazine, isosorbide dinitrate, furosemide, spironolactone; PE reveals small effusion in R knee; CXR shows cardiomegaly, small L pleural effusion - best next step?

A

ANA screening

155
Q

5 drugs associated with SLE?

A

Procainamide, hydralazine, anti-TNF (infliximab, etanercept), minocycline

156
Q

3 do male presents to nursery for V - green, non-projectile; Mother reports abdominal distension, no other passage of stool since small amount of meconium; PE reveals abdomen that is distended with hypoactive bowel sounds; Abdominal XR shows distended, gas-filled loops of small bowel, “ground-glass” mass in R abdomen - diagnosis?

A

Cystic fibrosis

157
Q

___ refers to intestinal obstruction in distal ileum

A

Meconium ileus

158
Q

4 aspects of clinical presentation for cystic fibrosis?

A

Recurrent sinopulmonary infections, intestinal obstruction (meconium ileus), pancreatic insufficiency + DM, male infertility

159
Q

35 yo male deemed brain dead, but organ donor; What is best approach to organ donation at this time?

A

Ensure adequate volume resuscitation, continued ventilation, and pressor support if necessary

160
Q

3 types of hormone therapy that should be administered to patients in preparation of organ donation?

A

Vasopressin, thyroid hormone, methylprednisolone

161
Q

68 yo male presents for episodes of recurrent dizziness; Orthostatic vitals are (+); Current meds include ASA, ACEI, statin, glyburide, metformin, isosorbide dinitrate - what is best step of management?

A

Stop isosorbide dinitrate

162
Q

3 medications that should be stopped in setting of orthostatic hypotension?

A

Alpha blockers, diuretics, nitrates

163
Q

15 yo male presents for concerns about pubertal development; PE shows height in 3rd percentile; Testes are Tanner stage 1; Bone age score is 13 - diagnosis?

A

Constitutional pubertal delay

164
Q

In constitutional pubertal delay, bone age is …

A

Delayed (when compared to chronologic age)

165
Q

2 aspects of clinical presentation for Constitutional pubertal delay?

A

“Late bloomers” … delayed bone age, short stature

166
Q

3 yo female presents for evaluation of legs; PE reveals symmetric genu valgus, legs that swing outward during ambulation, small gap between ankles - what is best management?

A

Reassurance

167
Q

Prognosis of symmetric genu valgus in childhood?

A

Spontaneous reassurance

168
Q

Most common age for symmetric genu valgus?

A

2-5 yo

169
Q

14 yo female presents for lack of pubertal changes; PE shows facial acnes, breast development Tanner stage 3, pubic hair development Tanner stage 2 - what is next step in management?

A

Reassurance … lack of menarche is fine if secondary sex characteristics are present

170
Q

Earliest event in puberty for females?

A

Breast development

171
Q

Last event in puberty for females?

A

Menarche

172
Q

Should you administer varicella vaccine to patient who has sister with recent kidney transplant? What about vaccination for sister?

A

Yes to vaccine for patient

173
Q

When is varicella vaccine administered?

A

12-15 mo; 4-6 yo

174
Q

4 absolute contraindications to varicella vaccine?

A

Anaphylaxis to neomycin; Anaphylaxis to gelatin; Pregnancy, Immunodeficiency

175
Q

3 yo male presents for bloody stool, crampy abdominal pain; T100.5; Recently attended birthday party, where other family members also became sick; PE shows generalized abdominal TTP - what is next step in exam?

A

Oral electrolyte solution

176
Q

13 mo male presents for a well-child visit; Mother reports that patient drinks 30oz of cow’s milk daily; Labs show HGB 9.2 - which complication is patient at risk for?

A

Developmental delay … psychomotor, or neurocognitive

177
Q

4 mo female passes away from SIDS - what is greatest risk factor that lead to this outcome?

A

Prematurity

178
Q

3 non-modifiable risk factors for SIDS?

A

Prematurity, Low BW, Maternal age < 20

179
Q

10 mo male presents for abnormal gait and feet; Just began pulling himself to stand; PE shows plantar flexion, adduction, inversion of feet - diagnosis?

A

Congenital clubfoot

180
Q

Etiology of Congenital clubfoot?

A

Deformity of talus bone

181
Q

10 mo male presents for abnormal gait and feet; Just began pulling himself to stand; PE shows plantar flexion, adduction, inversion of feet - prognosis?

A

Can be corrected by applying molding casts to feet

182
Q

Positioning of foot in congenital clubfoot?

A

Plantarflexed, adducted, inverted

183
Q

7 yo female presents for short stature; PE shows multiple nuchal folds; Diagnosed with Turner syndrome - what should be included in patient’s initial workup?

A

ECHO

184
Q

4 cardiac abnormalities associated with Turner’s Syndrome?

A

Coarctation of aorta, Bicuspid aortic valve, MVP, Hypoplastic heart

185
Q

Peak age at which SIDS occurs?

A

2-4 months

186
Q

3 major risk factors for SIDS?

A

Smoke exposure (pre- or post-natal), prematurity, prone sleep position)

187
Q

13 mo female presents with grandmother; Concern that patient is not yet walking; Delivered at 39 weeks in breech position; PE shows legs of equal length, outward bend of tibia/fibula, with gap between knees - what is best next step?

A

Reassurance

188
Q

13 mo female presents with grandmother; Concern that patient is not yet walking; Delivered at 39 weeks in breech position; PE shows legs of equal length, outward bend of tibia/fibula, with gap between knees - diagnosis?

A

Genu varum

189
Q

Genu varum is considered physiologic between years …

A

0-2

190
Q

Typical presentation of adolescent depression?

A

Irritable mood

191
Q

Which symptoms should prompt additional screening for adolescent depression?

A

Decline in school or social functioning

192
Q

12 yo female presents for wellness visit; Mother reports that patient slouches; PE shows R thoracic prominence with 9 degree angle of trunk rotation - what is best next step in management?

A

Lateral, posteroanterior XR of spine

193
Q

12 yo female presents for wellness visit; Mother reports that patient slouches; PE shows R thoracic prominence with 9 degree angle of trunk rotation - diagnosis?

A

Adolescent idiopathic scoliosis

194
Q

Adolescent idiopathic scoliosis results in ___ curvature of spine

A

Lateral

195
Q

Spinal rotation of ___ degrees may suggest clinically-significant scoliosis

A

7+

196
Q

12 yo female undergoes Lateral, posteroanterior XR of spine for suspected scoliosis; Cobb angle is 5 degrees - what is best step of management?

A

Follow-up only if patient develops significant pain or neurologic symptoms … for Cobb angle < 10 degrees

197
Q

18 mo male presents for R ear pain; Recent ear infection 4 weeks ago, treated with full course of amoxicillin; PE shows erythema, bulging, immobility of R TM - diagnosis?

A

Concurrent otitis media + purulent conjunctivitis

198
Q

18 mo male presents for R ear pain; Recent ear infection 4 weeks ago, treated with full course of amoxicillin; PE shows erythema, bulging, immobility of R TM - which pathogen is most likely responsible for patient’s symptoms? (Strep pneumoniae not an option)

A

Non-typeable H. influenzae

199
Q

Which pathogen is most likely responsible for concurrent otitis media + conjunctivitis?

A

Non-typeable H. influenzae

200
Q

What is best management for recurrent otitis media?

A

Augmentin

201
Q

Best management for Slipped Capital Femoral Epiphysis (SCFE) in adolescent children?

A

Immediate surgical pinning

202
Q

2 aspects of clinical presentation for SCFE?

A

Hip pain, referred knee pain

203
Q

Which ROM is most limited in setting of SCFE?

A

IR

204
Q

2 complications of SCFE?

A

Avascular necrosis, OA

205
Q

Newborn female is evaluated for respiratory distress; 30 minutes after delivery, patient developed sudden-onset tachypnea and hypoxia; Mother had gestational DM and (+) GBS at 36 weeks; PE shows tachypnea, grunting, nasal flaring, subcostal retractions; CXR shows mild cardiomegaly, prominent horizontal fissure on R – diagnosis?

A

Transient tachypnea of newborn

206
Q

3 risk factors for Transient tachypnea of newborn?

A

Maternal DM, C-section, Prematurity

207
Q

Clinical presentation for Transient tachypnea of newborn?

A

Tachypnea, increased WOB

208
Q

CXR appearance of Transient tachypnea of newborn?

A

Hyperinflation, fluid in fissures

209
Q

Etiology of Transient tachypnea of newborn?

A

Retained fluid in fetal lung

210
Q

Prognosis for Transient tachypnea of newborn?

A

Self-resolution within 1-3 days

211
Q

Best management of Transient tachypnea of newborn?

A

Supportive care

212
Q

15 yo male presents with concerns about delayed puberty; PE shows small testes, no facial hair, no acne; Bone age is consistent with age 13 years 2 months – diagnosis?

A

Delayed puberty

213
Q

Definition of delayed puberty in males?

A

Absent testicular enlargement by age 14 yo

214
Q

Initial workup for delayed puberty?

A

FSH, LH, testosterone, TSH, prolactin; Bine age XR

215
Q

Prognosis for febrile seizures in children?

A

Increased risk of another febrile seizure; Increased risk of developing epilepsy

216
Q

2 definitions of failure to thrive?

A

Weight below 5th percentile; Down-trending weight that crosses 2 major percentile lines

217
Q

Most common etiology of failure to thrive?

A

Inadequate calorie intake due to psychosocial stressors

218
Q

5 high-risk features of brain injury in child < 2 yo after head trauma?

A

Non-frontal hematoma, AMS, Palpable skull fracture, Severe mechanism, LOC

219
Q

Classic clinical presentation of juvenile myoclonic epilepsy?

A

Morning myoclonus (arm jerking) during first few hours of waking

220
Q

Additional clinical presentation of juvenile myoclonic epilepsy?

A

Generalized tonic-clonic seizures

221
Q

Best management of juvenile myoclonic epilepsy?

A

Valproate

222
Q

Additional condition associated with juvenile myoclonic epilepsy?

A

Anxiety

223
Q

4 common AE of valproate?

A

Hepatotoxicity, pancreatitis, thrombocytopenia, teratogenic

224
Q

2 aggravators of juvenile myoclonic epilepsy?

A

Sleep deprivation, ETOH

225
Q

Appearance of juvenile myoclonic epilepsy on EEG?

A

Bilateral polyspikes with slow-wave activity

226
Q

When does normal testicular descent through the inguinal occur during gestation?

A

28 weeks

227
Q

At what age should children with undescended testicle be referred for orchiopexy?

A

6+ months

228
Q

5 do female presents with adoptive parents; concern for Hemophilia A; Biologic father has hemophilia A; Biologic mother has no family or personal history of bleeding (even in male relatives) – what is patient’s likelihood of having Hemophilia A?

A

Patient will be a carrier

229
Q

Inheritance pattern of Hemophilia A?

A

X-linked recessive

230
Q

3 yo male presents for wellness visit; Labs show venous lead level 60 (NML <5); What is best management?

A

DMSA, succimer

231
Q

Best management of venous lead level 5-44 (NML <5)?

A

Observation

232
Q

Best management of venous lead level 45-69 (NML <5)?

A

DSMA, succimer

233
Q

Best management of venous lead level >70 (NML <5)?

A

Dimercaprol + EDTA

234
Q

What is best workup for adolescents with cutting behavior?

A

Screening for suicidal ideation, comprehensive psychiatric evaluation; Hospitalization is not necessary if patient is not suicidal

235
Q

3 yo male presents with LE weakness; Parents report mildly-slowed development; PE shows large calves, hyporeflexic response; Patient walks with a waddling gait – diagnosis?

A

Duchenne Muscular Dystrophy

236
Q

First step of workup for patient with suspected Duchenne Muscular Dystrophy?

A

CK level

237
Q

2 additional aspects of clinical presentation for Duchenne Muscular Dystrophy (not calf enlargement)?

A

Dilated cardiomyopathy, scoliosis

238
Q

Definition of neonatal polycythemia?

A

HCT > 65%, HGB > 22

239
Q

3 complications of neonatal polycythemia?

A

Hyperviscosity, Hypoglycemia, Hyperbilirubinemia

240
Q

Best first step for suspected neonatal polycythemia?

A

Recheck HCT on sample of peripheral venous blood

241
Q

Best initial management of neonatal polycythemia, complicated by hyperviscosity?

A

Hydration, correction of hypoglycemia

242
Q

Best next management of neonatal polycythemia, complicated by hyperviscosity, unresponsive to hydration, correction of hypoglycemia?

A

Partial exchange transfusion … blood is withdrawn from infant, replaced with NML saline

243
Q

Sydenham chorea most commonly occurs ___ after streptococcal infection

A

1-8 months

244
Q

5 aspects of clinical presentation for Acute Rheumatic Fever?

A

JONES – Joint pain, Carditis, Nodules, Erythema marginatum, Sydenham chorea

245
Q

Best management of Sydenham chorea?

A

IM penicillin until adulthood … treat the underlying Acute Rheumatic Fever, and prevent recurrent ARF

246
Q

2 mo female presents with mom for well-child visit; Mother asks for advice on preventing atopic dermatitis – best recommendation?

A

Attend daycare as planned, keep family dogs in household as normal

247
Q

Clinical presentation of atopic dermatitis in infants?

A

Pruritis over extensor surfaces, trunk, face

248
Q

Clinical presentation of atopic dermatitis in children/adults?

A

Pruritis over flexural creases

249
Q

Clinical presentation of chronic atopic dermatitis?

A

Lichenified plaques

250
Q

Firstline treatment of atopic dermatitis?

A

Topical emollients + Topical steroids

251
Q

Secondline treatment of atopic dermatitis?

A

Topical emollients + Topical calcineurin inhibitors

252
Q

2 most common pathogens that complicate cases of atopic dermatitis?

A

Staph aureus, HSV

253
Q

___ refers to atopic dermatitis that is complicated by HSV infection

A

Eczema herpeticum

254
Q

Pathogenesis of atopic dermatitis?

A

Skin barrier dysfunction, Th2-skewed immune response

255
Q

Why is exposure to daycare and family pets recommended for prevention of atopic dermatitis?

A

Shifts the immune response away from a Th2 predominant response

256
Q

When is solid food typically introduced?

A

4-6 months

257
Q

17 yo female presents with pain in R hip and groin; Occasionally experiences a “clicking” sensation in R hip; PE shows L pelvis drops when patient bears weight on R leg; Patient stands on R toes with L foot flat on ground; During supine exam, R hip shows decreased aBduction – diagnosis?

A

Developmental dysplasia of hip (DDH)

258
Q

Description of Developmental dysplasia of hip (DDH)?

A

Abnormal acetabular development resulting in shallow hip socket and inqdequate support of femoral head

259
Q

2 signs of Developmental dysplasia of hip (DDH) at birth?

A

Hip clunk, asymmetric leg creases

260
Q

3 aspects of clinical presentation for Developmental dysplasia of hip (DDH) in older children?

A

Leg-length discrepancy, Trendelenburg gait, Activity-related pain

261
Q

Complication of Developmental dysplasia of hip (DDH)?

A

OA in adolescents and young adults

262
Q

1 mo female presents with parents due to worsening diaper rash; Parents first noticed red bumps in diaper area 1 week ago; During past 2 day, rash has spread and formed pustules that drain yellow fluid; T 101.3; PE shows crusted, erythematous papules and pustules over the lower abdomen, upper thighs – diagnosis?

A

Impetigo secondary infection in diaper dermatitis

263
Q

2 most common pathogens responsible for impetigo?

A

Staph aureus (MC), Strep pyogenes

264
Q

Appearance of diaper rash complicated by candida infection?

A

Beefy red plaques with skinfold involvement and satellite lesions

265
Q

Best management of diaper impetigo in a neonate?

A

Hospital admission for IV ABX and sepsis workup

266
Q

6 indications for hospitalization for adolescents with anorexia?

A

HD instability, arrhythmia, bradycardia, acute food refusal, electrolyte abnormalities, suicidality

267
Q

4 electrolyte abnormalities associated with refeeding syndrome?

A

Low phosphate, potassium, magnesium, thiamine

268
Q

Complication of refeeding syndrome?

A

CHF, arrhythmia

269
Q

Best management of pubertal gynecomastia?

A

Reassurance, observation; Will typically resolve within 1 year

270
Q

Clinical features of pubertal gynecomastia?

A

Small subareolar masses, without pathologic features (nipple discharge, axillary LAD, systemic illness)

271
Q

3 wo male with Down’s Syndrome presents with parents for feeding difficulty; Per mother, patient becomes SOB with facial cyanosis during feeding and crying; PE shows holosystolic murmur over lower L sternal border – diagnosis?

A

Endocardial cushion defect … ASD/VSD

272
Q

4 conditions that are more common in patients with Down’s Syndrome?

A

Hypothyroidism, AA instability, Hirschsprung’s disease, Duodenal atresia

273
Q

Best test for diagnosis of Endocardial cushion defect?

A

ECHO

274
Q

5 conditions that patients with Down’s Syndrome are at risk of developing?

A

ADHD, depression disorder, seizure disorder, Alzheimer’s dementia, autism, ALL

275
Q

Newborn male is delivered at 39 weeks to mother with gestational DM; Weight is 8.8 lb, BP 70/40, RR 66; PE shows nasal flaring with retractions, heart murmur; CXR shows mild pulmonary congestion - diagnosis?

A

Transient Hypertophic Cardiomyopathy

276
Q

Clinical presentation for Transient Hypertophic Cardiomyopathy?

A

Tachypnea + murmur in infant

277
Q

Appearance of Transient Hypertophic Cardiomyopathy on ECHO?

A

Thickned IV septum

278
Q

Etiology of Transient Hypertophic Cardiomyopathy in newborns?

A

Gestational DM … fetal hyperinsulinemia … excess glycogen deposited in the myocardium

279
Q

Prognosis for Transient Hypertophic Cardiomyopathy in infants?

A

Spontaneous resolution within a few weeks after delivery

280
Q

3 yo male presents with weakness and decreased appetite; Older brother reports that he saw patient eating cement and woodwork - what is next best step of workup?

A

CBC

281
Q

Initial labs for workup of lead poisoning?

A

CBC, iron levels, ferritin, ret count

282
Q

Best diet for child with viral gastroenteritis?

A

Resume a normal age-appropriate diet (with limited sugars)

283
Q

16 yo female presents after head injury 7 days ago; At that time, diagnoses clinically with concussion; Rested for 2 days, then gradually returned to playing sports; Today became dizzy and nauseous while playing sports; PE is unremarkable - what is best next step of workup?

A

Prescribe rest for 24 hours, followed by return to light aerobic activity

284
Q

3 do female presents to ED for profuse eye drainage; PE shows heavy purulent drainage from R eye; Born to 24 yo female who insisted on unmedicated labor and perinatal course - which peripartum intervention would have prevented this patient’s condition?

A

Topical erythromycin

285
Q

3 do female presents to ED for profuse eye drainage; PE shows heavy purulent drainage from R eye; Born to 24 yo female who insisted on unmedicated labor and perinatal course - diagnosis?

A

Gonococcal conjunctivitis

286
Q

Best prevention of Gonococcal conjunctivitis?

A

Erythromycin ointment

287
Q

Best treatment of Gonococcal conjunctivitis?

A

Single-dose ceftriaxone

288
Q

When does Gonococcal conjunctivitis typically occur?

A

2-5 days after birth

289
Q

Characteristic of infantile hemangioma?

A

Non-blanchable

290
Q

Description of nevus flammeus?

A

Blanchable, port-wine stains, unilateral + do not cross midline, associated with Sturge-Weber

291
Q

Description of nevus simplex?

A

Blanchable, pink patches on eyelids, glabella, nape of neck

292
Q

Time at which TDAP vaccines are administered?

A

2 mo, 4 mo, 6 mo, 15-18 mo, 4-6 yrs

293
Q

2 contraindications for TDAP vaccination?

A

Encephalopathy, Anaphylaxis

294
Q

13-year-old female presents for recurrent episodes of maxillary sinusitis; both parents smoke cigarettes -his most likely etiology of disease?

A

Secondhand smoke exposure

295
Q

5-year-old male presents with mother due to redness and white discharge around penis; mother reports frequent episodes of nocturnal enuresis after months of dryness overnight; penis is uncircumcised, glans is erythematous with thick white discharge around the glans when foreskin is retracted; what is next best step in management?

A

Obtain BG level

296
Q

5-year-old male presents with mother due to redness and white discharge around penis; mother reports frequent episodes of nocturnal enuresis after months of dryness overnight; penis is uncircumcised, glans is erythematous with thick white discharge around the glans when foreskin is retracted; diagnosis?

A

Balanitis

297
Q

Pathogen responsible for balanitis?

A

Candida albicans

298
Q

Clinical presentation of balanitis?

A

Inflammation of the glans penis with thick, white discharge present

299
Q

Confirmatory test for balanitis?

A

Presence of budding yeast on potassium hydroxide microscopy

300
Q

Best management of balanitis?

A

Obtained blood glucose level, proper hygiene, topical antifungal

301
Q

2-week-old female presents to office for jaundice; maternal blood type AB+; breast-feeding every 2-3 hours for 15 minutes on each side; total bilirubin 10.0, direct bilirubin 0.6: Diagnosis?

A

Breastmilk jaundice

302
Q

Etiology of breastmilk jaundice?

A

High beta glucuronidase activity

303
Q

Typical clinical presentation of breastmilk jaundice?

A

Asymptomatic

304
Q

When does breastmilk jaundice typically peak?

A

2 weeks of life

305
Q

Clinical features of breastmilk jaundice?

A

Infant with adequate feeding and normal exam

306
Q

Wendy is breast-feeding failure jaundice typically present?

A

Within first week of life

307
Q

Etiology of breast-feeding failure jaundice?

A

Decreased bilirubin elimination

308
Q

Clinical features of breast-feeding failure jaundice?

A

Suboptimal breast-feeding, evidence of dehydration on exam

309
Q

Best management of breastmilk jaundice?

A

Continue breast-feeding exclusively

310
Q

Prognosis for breastmilk jaundice?

A

Spontaneous resolution by 3 months old

311
Q

7-month-old male presents for well-child check; genital exam reveals hypoplastic, hypopigmented empty left scrotum; small palpable mass is present in left inguinal canal; what is next step in management?

A

Schedule orchiopexy

312
Q

At what age is referral for orchiopexy indicated for cryptorchidism?

A

6 months old

313
Q

Is testicular cancer still concerned after patient undergoes orchiopexy?

A

Yes, risk of testicular cancer is decreased, but not eliminated after orchiopexy

314
Q

3-year-old male presents for cough, increased work of breathing; 9 months ago, presented with left buttock abscess that grew staph aureus; admitted at age 1 for hepatic abscess that also grew staph aureus; family history of recurrent infection; T102; labs show WBC 17 with neutrophil predominance; CT chest demonstrated small scattered nodules -diagnosis?

A

Chronic granulomatous disease

315
Q

Inheritance pattern of chronic granulomatous disease?

A

X-linked recessive

316
Q

Pathogenesis of chronic granulomatous disease?

A

Mutation in any DPH oxidase, no super oxide free radicals in neutrophils during oxidative burst; impaired intracellular killing

317
Q

3-year-old male presents for cough, increased work of breathing; 9 months ago, presented with left buttock abscess that grew staph aureus; admitted at age 1 for hepatic abscess that also grew staph aureus; family history of recurrent infection; T102; labs show WBC 17 with neutrophil predominance; CT chest demonstrated small scattered nodules -pathogen responsible for patient’s symptoms?

A

Aspergillus (catalase +)

UWorld (21 decks)

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