Pediatrics Flashcards
1
Q
Normal age at which children should be walking?
A
9-16 mo
2
Q
How does Turner’s Syndrome impact intelligence?
A
Normal intelligence (with normal developmental milestones), but increased risk of learning difficulties
3
Q
MSK presentation of Turner’s Syndrome?
A
Lymphedema of hands + feet
4
Q
Inheritance pattern of Turner’s Syndrome?
A
Sporadic
5
Q
Genetic cause of Turner’s Syndrome?
A
Nondisjunction
6
Q
Genotype of Turner’s Syndrome?
A
45 XO
7
Q
When is flu vaccine recommended for babies-children-adults?
A
September-April
8
Q
Is egg allergy a contraindication to flu vaccine?
A
No
9
Q
Influenza is a type of ___ vaccine
A
Inactivated
10
Q
Is mild URI illness a contraindication to flu vaccine?
A
No
11
Q
Clinical presentation of Food Protein-Induced Allergic Proctocolitis (FPIAP)?
A
Painless bloody stools in well appearing infant
12
Q
Epidemiology of Food Protein-Induced Allergic Proctocolitis (FPIAP)?
A
Infants < 6 mo
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
14
Q
Pathophysiology of Food Protein-Induced Allergic Proctocolitis (FPIAP)?
A
Non-IgE mediated allergic reaction
15
Q
Allergic reaction in Food Protein-Induced Allergic Proctocolitis (FPIAP) is most commonly caused by …
A
Cow’s milk protein
16
Q
Best treatment for Food Protein-Induced Allergic Proctocolitis (FPIAP) in a breastfeeding infant?
A
Elimination of dairy from maternal diet
17
Q
Clinical course of Food Protein-Induced Allergic Proctocolitis (FPIAP)?
A
Benign, self-limited; No associated long-term complications
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
19
Q
Which hormone is responsible for neonatal breast hypertrophy?
A
Prolactin
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
21
Q
Prognosis for neonatal breast hypertrophy?
A
Self-limited resolution within 6 months
22
Q
3 additional effects of maternal estrogen in newborn females?
A
Uterine bleeding, labial swelling, leukorrhea
23
Q
When would confidentiality of an adolescent’s medical conditions be condition?
A
When the adolescent poses danger to self or others
24
Q
Initial step of workup for 6 yo male with nocturnal enuresis?
A
UA
25
Role of UA in evaluation of nocturnal enuresis?
Differentiate primary vs. secondary nocturnal enuresis … UA would identify diabetes, UTI
26
Normal UA in a 6 yo male with nocturnal enuresis suggests which diagnosis?
Primary nocturnal enuresis
27
6 yo male presents to receive flu vaccine; Parents report HX of egg allergy (urticaria) – Should patient still receive flu vaccine?
Yes – patient is fine to get flu vaccine
28
Should patient who has severe egg allergy (angioedema, anaphylaxis) receive the flu vaccine?
Yes … but in a supervised healthcare setting
29
What is the ONLY contraindication to flu vaccine?
Severe allergic reaction (angioedema, anaphylaxis) to the flu vaccine itself
30
Which type of flu vaccine should be administered to all patients?
Inactivated IM injection
31
3 risk factors for pediatric dental caries?
Diet, Nighttime bottle feedings, Inadequate fluoride
32
3 aspects of clinical presentation for pediatric dental caries?
Visible plaques, White enamel defects, Brown discoloration
33
When should dental screenings by pediatrician begin?
5-8 mo … when first teeth erupt
34
When should dental screenings by dentists begin?
1 yo, with follow-up every 6 months
35
Inheritance pattern of Marfan Syndrome?
AD
36
Etiology of Marfan Syndrome?
Mutation in fibrillin-1 protein
37
Clinical presentation of Marfan Syndrome?
Tall structure, myopia, increased arm-span:height ratio
38
Main cause of mortality in Marfan Syndrome?
Aortic root disease … causing aortic dissection, aortic aneurysm, AR murmur
39
Important step of pre-participation sports physical in patient with suspected Marfan Syndrome?
ECHO
40
5 diagnostic criteria for Kawasaki disease?
Fever > 105° for > 5 days, Mucositis, Conjunctivitis, Rash, Extremity lymphedema
41
Best management of patient who meets 3/5 diagnostic criteria for Kawasaki disease?
Order ESR/CRP, ibuprofen … Follow-up in 1 day
42
Best management of patient who meets 4/5 diagnostic criteria for Kawasaki disease?
Treat with IVIG + high-dose ASA
43
Complication of Kawasaki disease?
Coronary artery aneurysms
44
Additional step of workup for all children with Kawasaki disease?
ECHO to evaluate Coronary artery aneurysm
45
When should ECHO be performed for children with Kawasaki disease?
At time of diagnosis; 2 weeks after treatment completion; 6 weeks after treatment completion
46
How does administration of IVIG change routine healthcare for children with Kawasaki disease?
IVIG interferes with immune system response to live-attenuated vaccinations … Need to postpone administration of routine vaccinations until 11 months after IVIG treatment
47
Which live-attenuated vaccines are administered at 4 yo?
MMR, Varicella
48
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?
Observation + repeat abdominal XR in 1 week
49
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?
Endoscopic removal of FB
50
Best management of child who swallows a high-risk object (button battery, sharp object, magnet)?
Immediate endoscopic removal of FB … to prevent necrosis/perforation of GI tract
51
Definition of chronic cough in children?
Cough lasting 4+ weeks
52
2 aspects of initial evaluation for chronic cough in children?
Spirometry + CXR
53
2 factors that determine management of adolescent scoliosis?
Risk of progression, Cobb angle
54
Risk of progression for adolescent scoliosis is determined by …
Skeletal maturity
55
How can you determine Skeletal maturity in a patient with adolescent scoliosis?
Pubertal status (Tanner stage)
56
Cobb angle at which surgical evaluation is required for severe scoliosis?
Cobb angle > 40°
57
Best management for adolescent scoliosis in a patient who has reached full skeletal maturity (Tanner Stage 5)?
No additional follow-up required
58
Sleep terrors are a type of ___ sleep disorder
NREM
59
Prognosis for sleep terrors?
Benign, self-limiting
60
Best management for sleep terrors?
Reassurance
61
4 “red-flag” symptoms in setting of scoliosis?
Back pain, Neurologic symptoms, Rapidly-progressing angle curvature, Vertebral anomalies on XR
62
Red-flag symptoms in setting of scoliosis are concerning for …
Spinal cord tumors
63
Gold standard test to assess spinal anatomy in scoliosis with red-flag symptoms?
Spine MRI
64
Definition of macrocephaly in infants?
Infants with head circumference > 98th percentile
65
3 characteristics of macrocephaly in infants, that warrants neuroimaging to evaluate pathologic intracranial process?
Rapidly expanding head circumference, Neurologic abnormalities, Developmental delay
66
Neuroimaging study of choice for macrocephaly in infants?
Head US
67
Next step of workup for infant with macrocephaly, but NML head US?
Reassurance
68
Ocular complication associated with Marfan Syndrome?
Superior + Lateral lens subluxation
69
Relationship between vacuum-assisted delivery and jaundice?
Vacuum-assisted delivery increases risk of cephalohematoma … Cephalohematoma causes increased RBC turnover … Increased hemolysis leads to indirect hyperbilirubinemia
70
What is the danger of extreme indirect hyperbilirubinemia?
Kernicterus … bilirubin encephalopathy
71
How does phototherapy treat indirect hyperbilirubinemia?
Converts unconjugated bilirubin into water-soluble form, which can be excreted in urine
72
Best management of newborn with indirect hyperbilirubinemia ~15?
Phototherapy until bilirubin levels begin to normalize
73
Best management of newborn with indirect hyperbilirubinemia ~20-25?
Exchange transfusion … this is a toxic level of indirect hyperbilirubinemia
74
Prognosis for ADHD diagnosed during childhood?
33-67% will experience persistent symptoms during adulthood
75
Relationship between stimulant therapy (for ADHD) and substance abuse?
No increased risk
76
Weight loss expected during newborn phase?
10% weight loss is expected during 1st week
77
When should a newborn’s weight return to birth weight?
Age 2 weeks
78
How often should infants with weight loss be monitored in office?
Seen every 2-3 days
79
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?
Periodic breathing
80
Best management for periodic breathing?
Reassurance
81
Prognosis for periodic breathing?
Benign
82
Etiology of periodic breathing?
Immaturity of infant’s nervous system
83
When do patients receive childhood tetanus vaccines?
2 mo, 4 mo, 6 mo, 4 years
84
In setting of animal bite – for patient who has received 3+ tetanus toxoid vaccines, when is a booster dose indicated?
If last tetanus dose was 10+ years ago (clean wound); If last tetanus dose was 5+ years ago (dirty wound)
85
In setting of animal bite – best management of patient who is incompletely immunized, with clean wound?
Tetanus toxoid booster
86
In setting of animal bite – best management of patient who is incompletely immunized, with dirty wound?
Tetanus toxoid booster + Tetanus Ig
87
Inheritance pattern for cleft lip?
Multifactorial
88
Best management of cleft lip in an infant?
Surgical reconstruction at 10 weeks, 10g hemoglobin, 10 lbs weight
89
Pregnancy exposure associated with development of cleft lip?
ETOH
90
6 characteristics of intentional immersion injury seen in cases of suspected child abuse?
Burns to back + buttocks, uniform erythema, clear line of demarcation, lack of splash marks, zebra pattern (flexural creases are spared), center of buttocks spared
91
1st step of workup for cases of suspected child abuse?
Hospitalization; Report the case to child protective services
92
Description of kyphosis?
Forward convexity of T-spine
93
Difference between postural kyphosis vs. structural kyphosis?
Postural kyphosis = corrected by voluntary back extension; Structural kyphosis = does not self-correct
94
Etiology of postural kyphosis?
Slouching
95
Prognosis for postural kyphosis?
Deformity is not permanent; No treatment required, proper posture is corrective
96
Clinical presentation of Erb-Duchenne palsy?
Adduction, IR of upper extremity with pronated forearm
97
Which reflex is typically affected by Erb-Duchenne palsy?
Moro
98
Risk factor for Erb-Duchenne palsy in newborn?
Macrosomia, shoulder dystocia
99
Image of the moro reflex?
***
100
___ refers to isolated pubic hair development in male < 9 yo, female < 8 yo
Idiopathic premature pubarche
101
3 aspects of clinical presentation for McCune-Albright Syndrome?
Cafe au lait spots, Precocious puberty, Fibrous dysplasia
102
Etiology of indirect inguinal hernia in newborns?
Failed obiteration of processus vaginalis
103
4 risk factors for development of indirect inguinal hernia in newborns?
Prematurity, Increased abdominal pressure (prune belly syndrome), Cryptoorchidism, Hypospadias
104
3 complications of indirect inguinal hernia in newborns?
Incarcerated hernia + bowel ischemia + impaired fertility
105
Best management of indirect inguinal hernia in newborns?
Elective surgery 1-2 weeks after diagnosis in newborned without incarceration
106
Best management of pediatric obstructive sleep apnea?
Tonsillectomy + adenoidectomy
107
Etiology of pediatric obstructive sleep apnea?
Adenotonsillar hypertrophy
108
Clinical presentation of pediatric obstructive sleep apnea?
Snoring
109
Clinical presentation of neurofibromatosis 2?
Hypopigmented spots, Bilateral deafness
110
What accounts for Bilateral deafness seen in neurofibromatosis 2?
Bilateral acoustic neuromas
111
Red flag feature for a case of suspected SIDS?
Age > 6 months
112
Age definition of SIDS?
Age < 12 months … but uncommon after 6 mo
113
Clinical presentation of salicylate poisoning?
Tachycardia, tachypnea, dizziness, nausea, vomiting
114
Metabolic changes seen in salicylate poisoning?
Anion gap metabolic acidosis (lactic acidosis) + Respiratory alkalosis
115
Best initial management of salicylate poisoning?
Sodium bicarbonate
116
3 additional aspects of treatment for salicylate poisoning?
Glucose, dialysis, activated charcoal
117
Indication for dialysis in salicylate poisoning?
Pulmonary edema, fluid overload
118
Lead poisoning is concerning in homes built before …
1978
119
Best screening test for lead poisoning in children?
Finger-stick capillary blood testing
120
Next step of workup for a child with a (+) Finger-stick capillary blood testing for lead poisoning?
Venous lead level confirmation
121
Best management for lead poisoning > 45?
Chelation therapy
122
Complication of lead poisoning in children?
Cognitive impairment + behavioral problems
123
Location of caput succedaneum?
Above the periosteum
124
Best management of caput succedaneum?
Benign … observation
125
Does caput succedaneum cross suture lines?
Yes … (caput crosses)
126
Location of subgaleal hematoma?
Between scalp and periosteum
127
Best management of subgaleal hematoma?
ICU placement … continuous monitoring, volume replacement, blood count, coagulation studies
128
Does subgaleal hematoma cross suture lines?
Yes … (gallo crosses)
129
Location of cephalohematoma?
Subperiosteal
130
Prognosis of cephalohematoma?
May calcify and lead to skull deformation
131
Does cephalohematoma cross suture lines?
No
132
Best management for a child who appears chronically-malnourished and dehydrated (dry MM)?
Oral rehydration solution
133
Risk of IV rehydration in a child who appears chronically-malnourished and dehydrated (dry MM)?
Heart failure
134
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?
PCP pneumonia … (asthma won’t cause fever)
135
PCP pneumonia is seen in patients with ___ immunodeficiency
Cell-mediated
136
Medication that can prevent development of PCP pneumonia in child with kidney transplant 3 months ago?
TMP-SMX
137
What is best strategy for stopping nosebleeding that is unresponsive to pressure applied to nares?
Place cotton pledget with topical vasoconstrictor
138
Most epistaxis originates from ___ nasal septal mucosa
Anterior
139
Why does most epistaxis originate from the anterior nasal septal mucosa?
Keisselbach plexus
140
3 arteries that make up Keisselbach plexus?
Sphenopalatine, greater palatine, anterior ethmoid
141
What is the topical vasoconstrictor used to stop nosebleeds in children?
Oxymetazoline
142
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?
NF-1
143
Inheritance pattern of NF-1?
AD
144
Clinical presentation of NF-1?
Multiple cafe-au-lait spots with axillary and inguinal freckling
145
What is next step of workup in patient with suspected NF-1?
Ophthalamic screening for optic glioma
146
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?
Hearing evaluation
147
Normal vocabulary for a 18 mo child?
10-25
148
Normal vocabulary for a 2 yo child?
50, with 2-word phrases
149
Language delay in any child warrants …
Hearing evaluation
150
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?
Age
151
55 yo female presents to hospital for NV; treated with metoclopramide, ondansetron; Later that night, develops torticollis - what is DOC?
Diphenhydramine, Benztropine
152
55 yo female presents to hospital for NV; treated with metoclopramide, ondansetron; Later that night, develops torticollis - diagnosis?
Metoclopramide-induced acute dystonia
153
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?
Drug0induced SLE
154
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?
ANA screening
155
5 drugs associated with SLE?
Procainamide, hydralazine, anti-TNF (infliximab, etanercept), minocycline
156
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?
Cystic fibrosis
157
___ refers to intestinal obstruction in distal ileum
Meconium ileus
158
4 aspects of clinical presentation for cystic fibrosis?
Recurrent sinopulmonary infections, intestinal obstruction (meconium ileus), pancreatic insufficiency + DM, male infertility
159
35 yo male deemed brain dead, but organ donor; What is best approach to organ donation at this time?
Ensure adequate volume resuscitation, continued ventilation, and pressor support if necessary
160
3 types of hormone therapy that should be administered to patients in preparation of organ donation?
Vasopressin, thyroid hormone, methylprednisolone
161
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?
Stop isosorbide dinitrate
162
3 medications that should be stopped in setting of orthostatic hypotension?
Alpha blockers, diuretics, nitrates
163
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?
Constitutional pubertal delay
164
In constitutional pubertal delay, bone age is …
Delayed (when compared to chronologic age)
165
2 aspects of clinical presentation for Constitutional pubertal delay?
“Late bloomers” … delayed bone age, short stature
166
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?
Reassurance
167
Prognosis of symmetric genu valgus in childhood?
Spontaneous reassurance
168
Most common age for symmetric genu valgus?
2-5 yo
169
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?
Reassurance … lack of menarche is fine if secondary sex characteristics are present
170
Earliest event in puberty for females?
Breast development
171
Last event in puberty for females?
Menarche
172
Should you administer varicella vaccine to patient who has sister with recent kidney transplant? What about vaccination for sister?
Yes to vaccine for patient
173
When is varicella vaccine administered?
12-15 mo; 4-6 yo
174
4 absolute contraindications to varicella vaccine?
Anaphylaxis to neomycin; Anaphylaxis to gelatin; Pregnancy, Immunodeficiency
175
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?
Oral electrolyte solution
176
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?
Developmental delay … psychomotor, or neurocognitive
177
4 mo female passes away from SIDS - what is greatest risk factor that lead to this outcome?
Prematurity
178
3 non-modifiable risk factors for SIDS?
Prematurity, Low BW, Maternal age < 20
179
10 mo male presents for abnormal gait and feet; Just began pulling himself to stand; PE shows plantar flexion, adduction, inversion of feet - diagnosis?
Congenital clubfoot
180
Etiology of Congenital clubfoot?
Deformity of talus bone
181
10 mo male presents for abnormal gait and feet; Just began pulling himself to stand; PE shows plantar flexion, adduction, inversion of feet - prognosis?
Can be corrected by applying molding casts to feet
182
Positioning of foot in congenital clubfoot?
Plantarflexed, adducted, inverted
183
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?
ECHO
184
4 cardiac abnormalities associated with Turner’s Syndrome?
Coarctation of aorta, Bicuspid aortic valve, MVP, Hypoplastic heart
185
Peak age at which SIDS occurs?
2-4 months
186
3 major risk factors for SIDS?
Smoke exposure (pre- or post-natal), prematurity, prone sleep position)
187
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?
Reassurance
188
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?
Genu varum
189
Genu varum is considered physiologic between years …
0-2
190
Typical presentation of adolescent depression?
Irritable mood
191
Which symptoms should prompt additional screening for adolescent depression?
Decline in school or social functioning
192
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?
Lateral, posteroanterior XR of spine
193
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?
Adolescent idiopathic scoliosis
194
Adolescent idiopathic scoliosis results in ___ curvature of spine
Lateral
195
Spinal rotation of ___ degrees may suggest clinically-significant scoliosis
7+
196
12 yo female undergoes Lateral, posteroanterior XR of spine for suspected scoliosis; Cobb angle is 5 degrees - what is best step of management?
Follow-up only if patient develops significant pain or neurologic symptoms … for Cobb angle < 10 degrees
197
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?
Concurrent otitis media + purulent conjunctivitis
198
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)
Non-typeable H. influenzae
199
Which pathogen is most likely responsible for concurrent otitis media + conjunctivitis?
Non-typeable H. influenzae
200
What is best management for recurrent otitis media?
Augmentin
201
Best management for Slipped Capital Femoral Epiphysis (SCFE) in adolescent children?
Immediate surgical pinning
202
2 aspects of clinical presentation for SCFE?
Hip pain, referred knee pain
203
Which ROM is most limited in setting of SCFE?
IR
204
2 complications of SCFE?
Avascular necrosis, OA
205
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?
Transient tachypnea of newborn
206
3 risk factors for Transient tachypnea of newborn?
Maternal DM, C-section, Prematurity
207
Clinical presentation for Transient tachypnea of newborn?
Tachypnea, increased WOB
208
CXR appearance of Transient tachypnea of newborn?
Hyperinflation, fluid in fissures
209
Etiology of Transient tachypnea of newborn?
Retained fluid in fetal lung
210
Prognosis for Transient tachypnea of newborn?
Self-resolution within 1-3 days
211
Best management of Transient tachypnea of newborn?
Supportive care
212
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?
Delayed puberty
213
Definition of delayed puberty in males?
Absent testicular enlargement by age 14 yo
214
Initial workup for delayed puberty?
FSH, LH, testosterone, TSH, prolactin; Bine age XR
215
Prognosis for febrile seizures in children?
Increased risk of another febrile seizure; Increased risk of developing epilepsy
216
2 definitions of failure to thrive?
Weight below 5th percentile; Down-trending weight that crosses 2 major percentile lines
217
Most common etiology of failure to thrive?
Inadequate calorie intake due to psychosocial stressors
218
5 high-risk features of brain injury in child < 2 yo after head trauma?
Non-frontal hematoma, AMS, Palpable skull fracture, Severe mechanism, LOC
219
Classic clinical presentation of juvenile myoclonic epilepsy?
Morning myoclonus (arm jerking) during first few hours of waking
220
Additional clinical presentation of juvenile myoclonic epilepsy?
Generalized tonic-clonic seizures
221
Best management of juvenile myoclonic epilepsy?
Valproate
222
Additional condition associated with juvenile myoclonic epilepsy?
Anxiety
223
4 common AE of valproate?
Hepatotoxicity, pancreatitis, thrombocytopenia, teratogenic
224
2 aggravators of juvenile myoclonic epilepsy?
Sleep deprivation, ETOH
225
Appearance of juvenile myoclonic epilepsy on EEG?
Bilateral polyspikes with slow-wave activity
226
When does normal testicular descent through the inguinal occur during gestation?
28 weeks
227
At what age should children with undescended testicle be referred for orchiopexy?
6+ months
228
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?
Patient will be a carrier
229
Inheritance pattern of Hemophilia A?
X-linked recessive
230
3 yo male presents for wellness visit; Labs show venous lead level 60 (NML <5); What is best management?
DMSA, succimer
231
Best management of venous lead level 5-44 (NML <5)?
Observation
232
Best management of venous lead level 45-69 (NML <5)?
DSMA, succimer
233
Best management of venous lead level >70 (NML <5)?
Dimercaprol + EDTA
234
What is best workup for adolescents with cutting behavior?
Screening for suicidal ideation, comprehensive psychiatric evaluation; Hospitalization is not necessary if patient is not suicidal
235
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?
Duchenne Muscular Dystrophy
236
First step of workup for patient with suspected Duchenne Muscular Dystrophy?
CK level
237
2 additional aspects of clinical presentation for Duchenne Muscular Dystrophy (not calf enlargement)?
Dilated cardiomyopathy, scoliosis
238
Definition of neonatal polycythemia?
HCT > 65%, HGB > 22
239
3 complications of neonatal polycythemia?
Hyperviscosity, Hypoglycemia, Hyperbilirubinemia
240
Best first step for suspected neonatal polycythemia?
Recheck HCT on sample of peripheral venous blood
241
Best initial management of neonatal polycythemia, complicated by hyperviscosity?
Hydration, correction of hypoglycemia
242
Best next management of neonatal polycythemia, complicated by hyperviscosity, unresponsive to hydration, correction of hypoglycemia?
Partial exchange transfusion … blood is withdrawn from infant, replaced with NML saline
243
Sydenham chorea most commonly occurs ___ after streptococcal infection
1-8 months
244
5 aspects of clinical presentation for Acute Rheumatic Fever?
JONES – Joint pain, Carditis, Nodules, Erythema marginatum, Sydenham chorea
245
Best management of Sydenham chorea?
IM penicillin until adulthood … treat the underlying Acute Rheumatic Fever, and prevent recurrent ARF
246
2 mo female presents with mom for well-child visit; Mother asks for advice on preventing atopic dermatitis – best recommendation?
Attend daycare as planned, keep family dogs in household as normal
247
Clinical presentation of atopic dermatitis in infants?
Pruritis over extensor surfaces, trunk, face
248
Clinical presentation of atopic dermatitis in children/adults?
Pruritis over flexural creases
249
Clinical presentation of chronic atopic dermatitis?
Lichenified plaques
250
Firstline treatment of atopic dermatitis?
Topical emollients + Topical steroids
251
Secondline treatment of atopic dermatitis?
Topical emollients + Topical calcineurin inhibitors
252
2 most common pathogens that complicate cases of atopic dermatitis?
Staph aureus, HSV
253
___ refers to atopic dermatitis that is complicated by HSV infection
Eczema herpeticum
254
Pathogenesis of atopic dermatitis?
Skin barrier dysfunction, Th2-skewed immune response
255
Why is exposure to daycare and family pets recommended for prevention of atopic dermatitis?
Shifts the immune response away from a Th2 predominant response
256
When is solid food typically introduced?
4-6 months
257
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?
Developmental dysplasia of hip (DDH)
258
Description of Developmental dysplasia of hip (DDH)?
Abnormal acetabular development resulting in shallow hip socket and inqdequate support of femoral head
259
2 signs of Developmental dysplasia of hip (DDH) at birth?
Hip clunk, asymmetric leg creases
260
3 aspects of clinical presentation for Developmental dysplasia of hip (DDH) in older children?
Leg-length discrepancy, Trendelenburg gait, Activity-related pain
261
Complication of Developmental dysplasia of hip (DDH)?
OA in adolescents and young adults
262
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?
Impetigo secondary infection in diaper dermatitis
263
2 most common pathogens responsible for impetigo?
Staph aureus (MC), Strep pyogenes
264
Appearance of diaper rash complicated by candida infection?
Beefy red plaques with skinfold involvement and satellite lesions
265
Best management of diaper impetigo in a neonate?
Hospital admission for IV ABX and sepsis workup
266
6 indications for hospitalization for adolescents with anorexia?
HD instability, arrhythmia, bradycardia, acute food refusal, electrolyte abnormalities, suicidality
267
4 electrolyte abnormalities associated with refeeding syndrome?
Low phosphate, potassium, magnesium, thiamine
268
Complication of refeeding syndrome?
CHF, arrhythmia
269
Best management of pubertal gynecomastia?
Reassurance, observation; Will typically resolve within 1 year
270
Clinical features of pubertal gynecomastia?
Small subareolar masses, without pathologic features (nipple discharge, axillary LAD, systemic illness)
271
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?
Endocardial cushion defect … ASD/VSD
272
4 conditions that are more common in patients with Down’s Syndrome?
Hypothyroidism, AA instability, Hirschsprung’s disease, Duodenal atresia
273
Best test for diagnosis of Endocardial cushion defect?
ECHO
274
5 conditions that patients with Down’s Syndrome are at risk of developing?
ADHD, depression disorder, seizure disorder, Alzheimer’s dementia, autism, ALL
275
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?
Transient Hypertophic Cardiomyopathy
276
Clinical presentation for Transient Hypertophic Cardiomyopathy?
Tachypnea + murmur in infant
277
Appearance of Transient Hypertophic Cardiomyopathy on ECHO?
Thickned IV septum
278
Etiology of Transient Hypertophic Cardiomyopathy in newborns?
Gestational DM … fetal hyperinsulinemia … excess glycogen deposited in the myocardium
279
Prognosis for Transient Hypertophic Cardiomyopathy in infants?
Spontaneous resolution within a few weeks after delivery
280
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?
CBC
281
Initial labs for workup of lead poisoning?
CBC, iron levels, ferritin, ret count
282
Best diet for child with viral gastroenteritis?
Resume a normal age-appropriate diet (with limited sugars)
283
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?
Prescribe rest for 24 hours, followed by return to light aerobic activity
284
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?
Topical erythromycin
285
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?
Gonococcal conjunctivitis
286
Best prevention of Gonococcal conjunctivitis?
Erythromycin ointment
287
Best treatment of Gonococcal conjunctivitis?
Single-dose ceftriaxone
288
When does Gonococcal conjunctivitis typically occur?
2-5 days after birth
289
Characteristic of infantile hemangioma?
Non-blanchable
290
Description of nevus flammeus?
Blanchable, port-wine stains, unilateral + do not cross midline, associated with Sturge-Weber
291
Description of nevus simplex?
Blanchable, pink patches on eyelids, glabella, nape of neck
292
Time at which TDAP vaccines are administered?
2 mo, 4 mo, 6 mo, 15-18 mo, 4-6 yrs
293
2 contraindications for TDAP vaccination?
Encephalopathy, Anaphylaxis
294
13-year-old female presents for recurrent episodes of maxillary sinusitis; both parents smoke cigarettes -his most likely etiology of disease?
Secondhand smoke exposure
295
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?
Obtain BG level
296
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?
Balanitis
297
Pathogen responsible for balanitis?
Candida albicans
298
Clinical presentation of balanitis?
Inflammation of the glans penis with thick, white discharge present
299
Confirmatory test for balanitis?
Presence of budding yeast on potassium hydroxide microscopy
300
Best management of balanitis?
Obtained blood glucose level, proper hygiene, topical antifungal
301
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?
Breastmilk jaundice
302
Etiology of breastmilk jaundice?
High beta glucuronidase activity
303
Typical clinical presentation of breastmilk jaundice?
Asymptomatic
304
When does breastmilk jaundice typically peak?
2 weeks of life
305
Clinical features of breastmilk jaundice?
Infant with adequate feeding and normal exam
306
Wendy is breast-feeding failure jaundice typically present?
Within first week of life
307
Etiology of breast-feeding failure jaundice?
Decreased bilirubin elimination
308
Clinical features of breast-feeding failure jaundice?
Suboptimal breast-feeding, evidence of dehydration on exam
309
Best management of breastmilk jaundice?
Continue breast-feeding exclusively
310
Prognosis for breastmilk jaundice?
Spontaneous resolution by 3 months old
311
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?
Schedule orchiopexy
312
At what age is referral for orchiopexy indicated for cryptorchidism?
6 months old
313
Is testicular cancer still concerned after patient undergoes orchiopexy?
Yes, risk of testicular cancer is decreased, but not eliminated after orchiopexy
314
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?
Chronic granulomatous disease
315
Inheritance pattern of chronic granulomatous disease?
X-linked recessive
316
Pathogenesis of chronic granulomatous disease?
Mutation in any DPH oxidase, no super oxide free radicals in neutrophils during oxidative burst; impaired intracellular killing
317
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?
Aspergillus (catalase +)
