Pediatrics

Question 1

intussusception

Answer 1

telescoping of intestine in on itself, leading to obstruction. Presentation: intermittent crampign abdominal pain, crying and drawing up legs, vomiting (bilious or not), bloody stool: LATE, palpable mass.

Abdo US confirms, but XR may show obstruction. Management is hydrostatic reduction (air contrast enema) done by interventional radiology.

Question 2

Painless brihgt red blood per rectum

Answer 2

meckels diverticulum

Question 3

pyloric stenosis

Answer 3

typically 3-5 weeks, rare after 12 weeks. Non-bilious emesis and dehydration.

Question 4

BP discrepancy in one of the limbs in 3-year old female (much higher on right arm), lower BP in legs. What would you do?

Answer 4

Echo!
Pediatric hypertension is important to assess.
Primary: now most common in children due to lifestyle/obesity
secondary: need to rule out coarctation of the aorta, renal disease, stimulants, endocrine.

Coarctation of the aorta; weak femoral pulses, right arm>legs. Management is surgery.

Question 5

Hirschsprung Disease red flags

Answer 5

no bowel movements in the first 24 hours of life, parents have to give enemas regularly.

Question 6

Key milestones gross motor

Answer 6

1year: first step
2 years: jumps on two feet
3 years: rides a tricycle

Question 7

key fine motor

Answer 7

6 months: transfers hand to hand
1 year: throws things
2 years: handedness established
3: undresses

Question 8

speech:

Answer 8

6 months: babbling
1 year: 1 word
2 year: 2 word phases
3 years: 3/4 intellibile
4 years: 4/4 intelligible

Question 9

cognitive milestones

Answer 9

3 years: count to 3
5 years: count to 10

Question 10

social milestones

Answer 10

6 months: stranger anxiety
9 months: separation anxiety
2 years: No and Mine/no sharing
3 years: pretend play

Question 11

strabismus

Answer 11

estotropia: inward deviation
exotropia: outward deviation

indications for referral: constant strabismus, intermittent strabismus

corneal light reflex
cover uncover
pseudostrabismas: look at the corneal light reflex

Question 12

generic name of a medication approved to treat ADHD

Answer 12

methylphenidate
dextroamphetamine
lisdexamphetamine
atomoxetine (non stim)
guanfacine(non stim)

Question 13

best initial step to address agression in youth

Answer 13

behavioural intervention
family therapy

Question 14

most effective treatmnet for child and adolescent anxiety disorder

Answer 14

CBT, combo with SSRI
fluoxetine is best

Question 15

mild to modeate depresstion: CBT or IPT
for moderate to severe depression: consider adding an SSRI.
treat co-morbid disorders including substance use and anxiety.

Question 16

physical features or recurrent emesis assocaited with an eating disorder

Answer 16

russels sign
tooth decalcification
enlarged parotid glands
lanugo hair

bradycardia would be seen in many eating disorders.

Question 17

adjustment vs bereavmenet

Answer 17

bereavment; grieving after being subjected to big stressors (within the last 3 months– must take into cultural factor)

adjustment: - taking significant reduction in function while grieivng and maybe also doing poor compensatory behaviours like alcoholism