Pediatrics Flashcards
What is a key difference between pediatric and adult history-taking?
A) Pediatric history requires input from caregivers for infants.
B) Vaccination history is not relevant in pediatric history.
C) Pediatric patients can provide a complete medical history independently.
D) Developmental milestones are irrelevant in pediatric history.
Correct Answer: A) Pediatric history requires input from caregivers for infants.
Explanation:
A) Correct. Infants cannot communicate their concerns or medical history, so healthcare providers rely entirely on caregivers for this information.
B) Incorrect. Vaccination history is a critical part of pediatric history as it provides insights into the child’s immunity and adherence to preventive health measures.
C) Incorrect. Pediatric patients, especially younger children, cannot provide a complete medical history independently, though older children and adolescents can contribute partially.
D) Incorrect. Developmental milestones are essential to pediatric history as they help assess whether a child is developing normally for their age.
Which tool is commonly used to assess developmental milestones in pediatric patients?
A) BMI-for-age chart
B) Ages and Stages Questionnaire
C) APGAR score
D) Pediatric Quality of Life Inventory
Correct Answer: B) Ages and Stages Questionnaire
Explanation:
A) Incorrect. The BMI-for-age chart is used to monitor growth patterns, not developmental milestones.
B) Correct. The Ages and Stages Questionnaire is a standardized tool that helps assess developmental milestones across domains such as cognitive, motor, and social-emotional development.
C) Incorrect. The APGAR score is used at birth to assess the newborn’s immediate physical condition, not long-term developmental milestones.
D) Incorrect. The Pediatric Quality of Life Inventory measures quality of life, not specific developmental progress.
Which developmental milestone is typical for a 6-month-old infant?
A) Sits without support steadily
B) Rolls front to back
C) Creeps or crawls
D) Walks with one hand held
Correct Answer: B) Rolls front to back
Explanation:
A) Incorrect. Sitting without support typically develops closer to 7 months of age.
B) Correct. Rolling front to back is a gross motor milestone that is commonly achieved by 4-6 months of age.
C) Incorrect. Creeping or crawling typically develops around 8-9 months.
D) Incorrect. Walking with one hand held is a milestone reached at around 11-12 months.
What is the best approach when taking a history from a school-age child?
A) Only speak to the parents for accurate information.
B) Rely solely on the child’s account of their symptoms.
C) Observe the dynamic between the child and parents during history-taking.
D) Avoid asking the child questions to prevent shyness.
Correct Answer: C) Observe the dynamic between the child and parents during history-taking.
Explanation:
A) Incorrect. Both the parents’ and the child’s input are important for a comprehensive history.
B) Incorrect. While the child’s account is valuable, parents provide additional context and details.
C) Correct. Observing interactions can provide insights into family dynamics and the child’s emotional state, which may influence the assessment.
D) Incorrect. Engaging the child directly when appropriate fosters trust and allows the provider to gather valuable information.
A 9-month-old infant is brought to your clinic. Which observation suggests a delay in gross motor development?
A) Sits without support steadily
B) Pulls to a standing position
C) Creeps on hands and knees
D) Cannot sit independently
Correct Answer: D) Cannot sit independently
Explanation:
A) Incorrect. Sitting without support is a normal milestone for a 9-month-old.
B) Incorrect. Pulling to stand is an advanced milestone often seen around this age.
C) Incorrect. Creeping is a gross motor milestone for 9 months.
D) Correct. By 9 months, infants are expected to sit independently; inability to do so could indicate a motor delay.
Which of the following is the most important when obtaining a pediatric social history?
A) Parental occupational history
B) Child’s extracurricular activities
C) Family structure and dynamics
D) Caregiver’s dietary habits
Correct Answer: C) Family structure and dynamics
Explanation:
A) Incorrect. While parental occupational history may provide context, it is not central to the child’s social environment.
B) Incorrect. Extracurricular activities are relevant but not as critical as understanding family structure and dynamics.
C) Correct. Understanding family structure and dynamics is crucial as it directly influences the child’s environment, support systems, and well-being.
D) Incorrect. Caregiver dietary habits are relevant for nutritional counseling but are not central to the social history.
A 4-year-old child is unable to stack blocks, has difficulty using utensils, and is not toilet-trained. What area of development is most likely delayed?
A) Social-emotional
B) Fine motor
C) Gross motor
D) Language
Correct Answer: B) Fine motor
Explanation:
A) Incorrect. While social-emotional development may impact behavior, it is not the main area of concern based on the described delays.
B) Correct. Stacking blocks and using utensils are fine motor skills. Delays in these activities point to fine motor development issues.
C) Incorrect. Gross motor skills involve larger movements like running or jumping, not the activities described.
D) Incorrect. Language development is not directly assessed through the described activities.
Stacking Blocks (Fine Motor):
By 18 months to 2 years, children can stack 2–4 blocks.
By 3 years, they can stack 6–10 blocks.
A 4-year-old struggling to stack blocks indicates a fine motor delay.
Using Utensils (Fine Motor):
By 15–18 months, children begin to use spoons.
By 2–3 years, they can use a fork effectively.
By 4 years, children should be able to manage basic utensils.
Toilet Training (Social/Behavioral):
Readiness for toilet training typically starts between 2–3 years, though some children may take longer.
By 4 years, most children are toilet trained during the day, with some still working on nighttime dryness. Persistent challenges at this age may warrant evaluation for developmental, sensory, or medical issues.
Which of the following is a red flag in pediatric development?
A) A 12-month-old who has not yet begun walking
B) A 3-year-old who does not speak in sentences
C) A 6-month-old who rolls front to back but not back to front
D) A 9-month-old who cannot pull to stand
Correct Answer: B) A 3-year-old who does not speak in sentences
Explanation:
A) Incorrect. While some children walk by 12 months, it is still within the normal range for walking to occur by 15-18 months.
B) Correct. By age 3, children are expected to speak in short sentences. Lack of this ability warrants further evaluation.
C) Incorrect. Rolling front to back typically develops slightly earlier than back to front, and a 6-month-old may still be developing this skill.
D) Incorrect. Pulling to stand typically develops closer to 10-11 months, so a 9-month-old not doing this is not a red flag.
When communicating with adolescents during a health assessment, which approach is most effective?
A) Address only the caregiver to avoid resistance.
B) Assume adolescents understand all medical terminology.
C) Maintain confidentiality unless there are safety concerns.
D) Avoid asking direct questions about sensitive topics.
Correct Answer: C) Maintain confidentiality unless there are safety concerns.
Explanation:
A) Incorrect. Directly addressing the adolescent helps build trust and ensures their concerns are heard.
B) Incorrect. Adolescents may not understand all medical terminology; it’s important to explain in simple terms.
C) Correct. Confidentiality fosters trust, and exceptions are made only when there are safety concerns such as abuse or harm.
D) Incorrect. Sensitive topics should be addressed appropriately to understand the adolescent’s well-being.
Which behavior might indicate a developmental concern in a 2-year-old child?
A) Limited eye contact with caregivers
B) Using two-word phrases
C) Tantrums during transitions
D) Preferring solitary play at times
Correct Answer: A) Limited eye contact with caregivers
Explanation:
A) Correct. Limited eye contact is a potential early sign of developmental concerns such as autism spectrum disorder.
B) Incorrect. Using two-word phrases is a normal milestone for a 2-year-old.
C) Incorrect. Tantrums are a typical part of development at this age as children learn to manage emotions.
D) Incorrect. Occasional solitary play is normal for toddlers and not a cause for concern.
At what age does an infant typically begin to smile spontaneously at pleasurable sights or sounds?
A. 1 month
B. 4 months
C. 3 months
D. 2 months
Correct Answer: B. 4 months
A. 1 month: Infant may start to show brief social smiles.
C. 3 months: Smiles more responsively, especially at people.
D. 2 months: Social smiles begin, often in response to a caregiver
Which of the following gross motor milestones is typically achieved by a 6-month-old?
A. Rolls back to front
B. Sits momentarily propped on hands
C. Cruises around furniture
D. Bounces when held
Correct Answer: B. Sits momentarily propped on hands
A. Rolls back to front: Typically seen around 4–6 months.
C. Cruises around furniture: Typically seen around 10–12 months.
D. Bounces when held: Usually occurs at 4–5 months.
At what age does a child begin to develop stranger anxiety?
A. 4 months
B. 6 months
C. 9 months
D. 12 months
Correct Answer: B. 6 months
A. 4 months: Prefers familiar people but no clear stranger anxiety yet.
C. 9 months: Stranger anxiety peaks around this age.
D. 12 months: Stranger anxiety continues but may start to decrease.
At what age can a child typically feed themselves crackers and place their hands on a bottle?
A. 5 months
B. 4 months
C. 6 months
D. 8 months
Correct Answer: C. 6 months
A. 5 months: May start to bring objects to their mouth but not coordinated for feeding.
B. 4 months: Hand-mouth coordination begins, but feeding is not developed.
D. 8 months: Starts holding and drinking from a bottle more independently.
A parent reports their child is not babbling consonant sounds. This is concerning if the child is at least:
A. 6 months
B. 9 months
C. 12 months
D. 8 months
Correct Answer: B. 9 months
A. 6 months: Vocalizes with vowel sounds and coos, but consonants are rare.
C. 12 months: Uses words like “mama” or “dada” specifically.
D. 8 months: Begins to babble with more consonant-vowel combinations.
At what age does an infant typically start using gestures with vocalizing, such as waving or reaching?
A. 8 months
B. 10 months
C. 12 months
D. 9 months
Correct Answer: C. 12 months
A. 8 months: Uses gestures like reaching without vocalizing.
B. 10 months: Waves “bye-bye” but not consistently paired with vocalizing.
D. 9 months: May start pointing but not with intentional vocalizing.
Which milestone is expected by 18 months of age?
A. Builds a 4-cube tower
B. Walks well
C. Creeps up stairs
D. Points to 2 objects of 3 when named
Correct Answer: A. Builds a 4-cube tower
B. Walks well: Typically seen by 12–15 months.
C. Creeps up stairs: Typically occurs at 15–18 months.
D. Points to 2 objects of 3 when named: Typically occurs by 24 months.
What social-emotional milestone is typically seen in a 7-month-old infant?
A. Recognizes familiar people visually
B. Follows a point, such as “Look at…”
C. Experiences separation anxiety
D. Alternates gaze between object and parent when wanting help
Correct Answer: D. Alternates gaze between object and parent when wanting help
A. Recognizes familiar people visually: Occurs around 3–4 months.
B. Follows a point, such as “Look at…”: Typically occurs around 12 months.
C. Experiences separation anxiety: Begins around 6–9 months.
At what age can a child typically perform the fine motor skill of transferring objects hand-to-hand?
A. 3 months
B. 6 months
C. 5 months
D. 7 months
Correct Answer: B. 6 months
A. 3 months: Can grasp objects but not transfer between hands.
C. 5 months: May start transferring objects, but not consistently.
D. 7 months: Transfers objects hand-to-hand with more ease.
Which of the following cognitive milestones is most characteristic of a 10-month-old infant?
A. Enjoys gesture games
B. Uncovers toys under a cloth
C. Finds partially hidden objects
D. Looks at pictures in a book
Correct Answer: B. Uncovers toys under a cloth
A. Enjoys gesture games: Typically occurs by 9 months.
C. Finds partially hidden objects: Occurs as early as 7 months.
D. Looks at pictures in a book: Develops around 12 months.
Here a some Mnemonics to help remember mile stones
Motor Milestones
* Sit at 6
* Balance by 7
* Crawl at 8; its
* Night stand/ which is really at 9 you start to stand i.e. creeping or pulling on things to stand & bear walks
* Walk at 1
What symptom differentiates GERD from physiological reflux in infants?
A. Spitting up after feeding
B. Frequent postprandial regurgitation causing failure to thrive
C. Vomiting that resolves by 12 months
D. Turning red and straining during bowel movements
B: Correct. GERD is characterized by symptoms like regurgitation causing failure to thrive, indicating complications beyond normal reflux.
A: Spitting up after feeding is a normal feature of physiological reflux.
C: Vomiting that resolves by 12 months is typical of physiological reflux, not GERD.
D: Straining during bowel movements is unrelated to GERD; it may indicate constipation.
Which of the following is a red flag symptom for infantile colic?
A. Crying >3 hours per day, >3 days per week, for >3 months
B. Corneal abrasion
C. Fever with lethargy
D. Clenched fists and cold feet during crying episodes
**C: Correct. Fever with lethargy could indicate a serious underlying condition, such as sepsis, and warrants further investigation.
**Explanation: Fever combined with lethargy is a potential indicator of serious systemic conditions like sepsis, meningitis, or severe infections.
Why It’s Correct: These symptoms suggest a possible life-threatening condition requiring immediate diagnostic workup (e.g., blood cultures, lumbar puncture).
A: While this describes colic, it is not a red flag symptom.
B: Corneal abrasion is a less severe differential diagnosis for crying and does not constitute a red flag.
D: These are common findings in colic but do not indicate a severe condition.
Colic: Symptoms (crying >3 hours/day, >3 days/week, >3 months, tense abdomen, drawn-up legs), diagnostic criteria (diagnosis of exclusion), and management.
Constipation: Symptoms (e.g., <3 BM/week, pain with defecation, retentive posturing), causes (potty training, fears), and differentiation from normal straining in infants.
Diarrhea: Symptoms of acute and chronic diarrhea (e.g., recurrent unformed stools, malabsorption syndromes) and their potential causes.
Abdominal Pain: Functional abdominal pain (recurrent, non-specific, associated with stress), and red-flag symptoms requiring further investigation (e.g., dysphagia, weight loss, GI blood loss).
What is the first-line naturopathic recommendation for chronic constipation in toddlers?
A. Magnesium citrate powder
B. Castor oil abdominal massage
C. Increasing dietary fiber, fruits, and water
D. Stimulant laxatives such as senna or bisacodyl
C: Correct. Increasing fiber, fruits, vegetables, and water addresses the root cause of constipation.
Explanation: Constipation in children is often functional and related to low dietary fiber or water intake. Addressing the root cause involves improving diet.
Why It’s Correct: Increasing dietary fiber (fruits, vegetables, whole grains) adds bulk to stools, while adequate hydration ensures easier stool passage, effectively treating the underlying issue without over-reliance on laxatives.
A: Magnesium citrate may help but is not the first recommendation; dietary changes are prioritized.
B: Castor oil massage is a supportive therapy but not the first-line intervention.
D: Stimulant laxatives are part of allopathic management, not naturopathic.
Which condition requires immediate emergency intervention in a child with diarrhea?
A. Presence of blood in the stool
B. Sunken eyes, dry oral mucosa, no tears
C. Abdominal distension
D. Painless recurrent unformed stools for over 4 weeks
B: Correct. Severe dehydration indicated by sunken eyes, dry oral mucosa, and no tears necessitates immediate medical care.These signs indicate an urgent need for medical intervention, such as intravenous fluids and monitoring of electrolytes, to prevent complications.
A: Blood in the stool is concerning but does not always require emergency intervention unless severe.
C: Abdominal distension could indicate other issues but is not immediately life-threatening.
D: Chronic diarrhea requires evaluation but is not an emergency.
How is Celiac disease definitively diagnosed in young children?
A. Positive response to a gluten-free diet
B. Biopsy showing villous atrophy and intraepithelial lymphocytes
C. Genetic testing for HLA-DQ2 and DQ8
D. Elevated serum IgA antibodies
B: Correct. Biopsy findings of villous atrophy and intraepithelial lymphocytes confirm Celiac disease.
A: A positive dietary response supports the diagnosis but is not definitive.
C: Genetic testing helps rule out Celiac disease but is not definitive for diagnosis.
D: Elevated serum IgA antibodies support diagnosis but require biopsy confirmation.
What is colic and what should be ruled out before diagnosing a baby with colic?
Colic
Colic is a condition commonly seen in infants, characterized by inconsolable crying or fussiness for no apparent reason. It typically follows the “rule of threes”: crying for more than 3 hours a day, at least 3 days a week, for more than 3 weeks. Colic usually starts within the first few weeks of life and peaks around 6 weeks, resolving by 3-4 months of age.
Features:
Intense crying, often in the evening.
Baby may appear in distress (clenched fists, arched back, pulling legs up).
No clear cause is identified, and the baby is otherwise healthy.
Causes (Hypotheses):
Gastrointestinal discomfort (e.g., gas, reflux, immature digestive system).
Overstimulation or difficulty self-soothing.
Maternal diet (in breastfed babies) or formula intolerance.
Differential Diagnoses for Inconsolable Crying
It’s crucial to rule out serious underlying conditions when an infant presents with inconsolable crying. Here’s a breakdown of conditions that can mimic or coexist with colic:
- Meningitis
Definition: Inflammation of the membranes surrounding the brain and spinal cord.
Signs: Fever, lethargy, poor feeding, irritability, bulging fontanelle, seizures, nuchal rigidity (stiff neck).
Why It Matters: Life-threatening; requires immediate medical attention. - Nasal Obstruction
Definition: Blockage of the nasal passages, commonly due to mucus or congenital issues.
Signs: Noisy breathing, difficulty feeding, nasal flaring.
Why It Matters: Infants are obligate nasal breathers, so even minor obstruction can cause distress. - Pneumonia
Definition: Infection or inflammation of the lungs.
Signs: Fever, rapid or labored breathing, retractions, nasal flaring, poor feeding, cyanosis (blue lips or skin).
Why It Matters: Can cause respiratory distress and requires treatment with antibiotics or oxygen. - Heart Failure
Definition: The heart’s inability to pump effectively, leading to poor oxygen delivery.
Signs: Poor feeding, excessive sweating, rapid breathing, failure to thrive, hepatomegaly (enlarged liver), edema.
Why It Matters: Congenital heart defects may present with these symptoms and require urgent intervention. - Intussusception
Definition: Telescoping of one segment of the intestine into another, causing obstruction.
Signs: Sudden, severe abdominal pain, blood-streaked stools (“currant jelly stools”), vomiting, abdominal mass.
Why It Matters: Surgical emergency. - Volvulus
Definition: Twisting of the intestine, leading to obstruction and compromised blood flow.
Signs: Abdominal distension, bilious vomiting, severe pain, shock.
Why It Matters: Surgical emergency; delay can lead to bowel necrosis. - Testicular Torsion
Definition: Twisting of the spermatic cord, cutting off blood flow to the testicle.
Signs: Acute scrotal pain, swelling, redness, irritability.
Why It Matters: Requires immediate surgical intervention to save the testicle. - Sepsis
Definition: A systemic inflammatory response to infection, leading to organ dysfunction.
Signs: Fever or hypothermia, lethargy, irritability, poor feeding, mottled skin, tachycardia, hypotension.
Why It Matters: Life-threatening condition requiring antibiotics and supportive care. - Hypoglycemia
Definition: Low blood glucose levels.
Signs: Lethargy, jitteriness, seizures, poor feeding, irritability.
Why It Matters: Immediate correction of glucose levels is crucial to prevent permanent neurological damage. - Failure to Thrive (FTT)
Definition: Poor growth due to inadequate nutrition or underlying medical conditions.
Signs: Weight below the 3rd percentile, developmental delays, poor feeding, frequent illness.
Why It Matters: Indicates an ongoing issue that needs investigation to determine the cause.
What is the best course of action if a child experiences severe symptoms of an allergic reaction, such as difficulty breathing?
A) Stop giving the offending food and monitor for symptoms
B) Give the child Benadryl and try the food again after a week
C) Call 911 or go to the emergency department immediately
D) Wait to see if symptoms worsen before taking action
C) Correct: Severe symptoms like difficulty breathing indicate an emergency, and immediate action (calling 911 or going to the emergency department) is necessary.
A) Incorrect: Severe symptoms, such as difficulty breathing, indicate anaphylaxis and require immediate medical attention.
B) Incorrect: Benadryl is insufficient for severe allergic reactions, and reintroducing the food could be life-threatening.
D) Incorrect: Waiting for symptoms to worsen can delay critical care, which can be life-threatening.
6-year-old presents with nasal congestion, facial pain, headache, fever, and cough that have persisted for 12 days. What is the most likely diagnosis?
a. Acute viral rhinitis
b. Rhinosinusitis
c. Influenza
d. Allergic rhinitis
(b) Correct: Rhinosinusitis is characterized by symptoms lasting 10 days or more or worsening within 10 days, with symptoms like nasal congestion, facial pain, headache, fever, and cough.
(a) Acute viral rhinitis typically resolves within 7-10 days, and the symptoms described here have lasted longer than 10 days.
(c) Influenza typically presents with fever, chills, myalgia, and can have gastrointestinal symptoms in children, but the timeline and symptoms here align more with rhinosinusitis.
(d) Allergic rhinitis would typically present with clear nasal discharge and sneezing, without the persistent fever and facial pain.
What is the primary cause of the common cold (acute viral rhinitis) in pediatric patients?
a. Streptococcus pneumoniae
b. Rhinovirus
c. Influenza virus
d. Haemophilus influenzae
(b) Correct: Rhinovirus is the most common viral cause of the common cold, presenting with clear to mucoid rhinorrhea, nasal congestion, sore throat, and sometimes a mild fever.
(a) Streptococcus pneumoniae is a bacterial pathogen, not the primary cause of viral rhinitis.
(c) Influenza virus causes more severe symptoms, including fever, malaise, and myalgia, and is not the primary cause of the common cold.
(d) Haemophilus influenzae can cause bacterial respiratory infections but is not a primary cause of viral rhinitis.
Which of the following is NOT one of the five stages of lung development in utero?
a) Embryonic
b) Canalicular
c) Bronchiolar
d) Alveolar
Remember that each stage of lung development starts at 4-6 weeks and increases by 10 weeks with a range for each stage starting with Embryonic and ending with what they become Alveoli
Answer: c) Bronchiolar
Explanation:
it is not a recognized stage of lung development. The five correct stages are Embryonic, Pseudoglandular, Canalicular, Saccular, and Alveolar.
Embryonic Stage (Weeks 4–7)
The lung bud arises from the foregut and branches into the two primary bronchial buds.
These buds grow into the surrounding mesoderm and form the trachea, bronchi, and pleura.
Any defects in this stage can lead to tracheoesophageal fistulas or atresia.
Pseudoglandular Stage (Weeks 5–17)
Conducting airways (bronchi, terminal bronchioles) develop and branch extensively.
The lung resembles an exocrine gland, but gas exchange is not yet possible.
Airways are lined with columnar epithelial cells.
Errors in this stage can result in bronchogenic cysts or congenital airway malformations.
Canalicular Stage (Weeks 16–26)
Terminal bronchioles divide into respiratory bronchioles.
Capillaries invade, forming primitive air-blood barriers.
Type I pneumocytes (gas exchange cells) and Type II pneumocytes (surfactant producers) begin to appear.
By the end of this stage, some limited gas exchange becomes possible, making survival possible (though unlikely) by 22–24 weeks.
Saccular Stage (Weeks 24–38)
Terminal sacs (primitive alveoli) form and begin to expand.
Capillaries grow closer to alveoli, improving gas exchange.
Surfactant production increases, preventing alveolar collapse.
Premature infants born after 28–30 weeks may survive with surfactant therapy.
Alveolar Stage (Week 36–8 years postnatally)
Alveoli continue to form and mature, increasing in number (from ~20 million at birth to ~300 million by 8 years old).
Secondary septation (formation of additional alveolar walls) occurs, optimizing gas exchange.
Surfactant levels reach full maturity by 35 weeks, ensuring alveolar stability at birth.
How These Stages Are Studied
Histological Examination
Lung tissue samples from fetal specimens or animal models are stained and analyzed under a microscope to observe developmental stages.
Genetic & Molecular Studies
Genes like FGF10, SHH, BMP4, and VEGF are studied to understand their roles in lung branching and alveolarization.
Imaging Techniques (Ultrasound, MRI)
High-resolution fetal imaging allows observation of lung growth and abnormalities.
Surfactant Testing in Amniotic Fluid
The Lecithin-to-Sphingomyelin (L/S) Ratio is measured to assess lung maturity in premature infants. A ratio >2.0 indicates sufficient surfactant production.
Which of the following physical exam findings is most suggestive of pneumothorax?
a) Dull percussion note
b) Tympanic (hyperresonant) percussion note
c) Fine crackles on auscultation
d) Increased tactile fremitus
Answer: b) Tympanic (hyperresonant) percussion note
Explanation:
(b) Tympanic (hyperresonant) percussion note is characteristic of a pneumothorax due to the presence of excess air in the pleural space.
(a) Dull percussion note is associated with pleural effusion rather than pneumothorax.
(c) Fine crackles are usually seen in interstitial lung disease or pulmonary edema, not pneumothorax.
(d) Increased tactile fremitus occurs in consolidation (e.g., pneumonia), whereas pneumothorax typically decreases tactile fremitus.
A spirometry test measuring Forced Expiratory Volume in 1 second (FEV1) is most useful in diagnosing which type of lung disease?
a) Interstitial lung disease
b) Asthma
c) Pneumothorax
d) Pulmonary embolism
Answer: b) Asthma
Explanation:
(b) Asthma is an obstructive lung disease where FEV1 is reduced due to airway narrowing and increased resistance.
(a) Interstitial lung disease is a restrictive lung disease, which affects total lung volume more than airflow obstruction.
(c) Pneumothorax and (d) Pulmonary embolism are not primarily diagnosed with spirometry; imaging studies like chest X-ray and CT scans are more useful for these conditions.
Which of the following air clearance techniques involves active breathing control to optimize secretion clearance?
a) Autogenic drainage
b) Postural drainage
c) Manual percussion
d) Bronchodilators
Answer: a) Autogenic drainage
Explanation:
(a) Autogenic drainage is a technique where patients actively control their breathing at different lung volumes to mobilize mucus without excessive coughing.
(b) Postural drainage uses gravity-assisted drainage but does not require active breathing control.
(c) Manual percussion is a passive technique where a caregiver or therapist applies rhythmic clapping to the chest to loosen mucus.
(d) Bronchodilators help open the airways but do not physically remove secretions.
Air Clearance Therapy
* Removal of airway secretions or debris
* Innate: mucociliary clearance and cough
* Manual percussion
* Chest physiotherapy
* Postural drainage
* Forced expiratory technique (huff cough)
* Autogenic drainage
* Positive expiratory pressure with ventilation
* Manual or mechanical insufflation-exsufflation
* Bronchodilators/mucolytics given prior to therapy
Postural Drainage
✅ How it’s done:
The patient is positioned so that gravity helps drain mucus from specific lung areas.
Positions vary based on the lung segment being targeted (e.g., lying on the side, stomach, or back at different angles).
Often combined with chest physiotherapy (percussion or vibration).
💡 Used for: Cystic fibrosis, bronchiectasis, pneumonia, chronic lung conditions with mucus buildup.
If you roll to the right, gravity pulls mucus down from the smaller airways into larger ones, where it’s easier to clear by coughing or using other airway clearance techniques (e.g., huff coughing).
Each position targets a specific lung segment to optimize drainage. For example:
Lying on your left side helps drain the right lung.
Head-down positions help drain lower lung lobes.
Sitting upright helps clear upper lobes.
💡 Why it works: Mucus naturally moves toward the trachea, where it can be coughed out. Gravity helps bring it from deeper parts of the lungs, making clearance more effective.
- Forced Expiratory Technique (Huff Cough)
✅ How it’s done:
Patient inhales deeply and then exhales forcefully with an open mouth, saying “huff” instead of coughing.
This prevents airway collapse and helps move mucus up the airways.
Often followed by a regular cough to clear loosened secretions.
💡 Used for: Clearing mucus in COPD, bronchiectasis, and cystic fibrosis.
- Autogenic Drainage
✅ How it’s done:
A controlled breathing technique using different lung volumes:
Unsticking phase: Slow, deep breaths into low lung volumes to loosen mucus.
Collecting phase: Medium-sized breaths to move mucus up the airways.
Autogenic Drainage – Collecting Phase
Collecting phase = Both inhaling and exhaling, but focus on controlled breathing
How it’s done: After loosening mucus in the unsticking phase, you take medium-sized breaths in to move the mucus higher in the airways.
Breathing out is slow and controlled (not forceful), so the mucus doesn’t move back down.
💡 Goal: Gradually shift mucus upward before the final evacuating phase, where huff coughing clears it out.
Evacuating phase: Larger breaths and huff coughing to clear mucus.
💡 Used for: Patients with bronchiectasis or cystic fibrosis to self-clear mucus efficiently.
- Positive Expiratory Pressure (PEP) with Ventilation
✅ How it’s done:
Patient breathes out against resistance (via a mask, mouthpiece, or oscillating PEP device like the Flutter or Acapella).
Keeps airways open, allowing air to get behind mucus and move it out.
💡 Used for: Chronic lung diseases like COPD, cystic fibrosis, and atelectasis prevention.
- Manual or Mechanical Insufflation-Exsufflation (MI-E, aka Cough Assist)
✅ How it’s done:
A mechanical device delivers a deep breath in (insufflation) and then rapidly switches to negative pressure to help expel secretions (exsufflation).
Manual version involves a bag-mask device to mimic this effect.
💡 Used for: Patients with neuromuscular disorders (ALS, spinal cord injury, muscular dystrophy) who can’t cough effectively.
- Bronchodilators/Mucolytics Given Prior to Therapy
✅ How it’s done:
Bronchodilators (e.g., albuterol, salbutamol): Relax the airway muscles and open up airways before clearance techniques.
Mucolytics (e.g., hypertonic saline, N-acetylcysteine, dornase alfa): Thin mucus to make it easier to clear.
💡 Used for: Cystic fibrosis, COPD, bronchiectasis—given before postural drainage or airway clearance therapy.
Which environmental hazard is a common trigger for airway inflammation and worsening lung conditions?
a) High humidity
b) Essential oil diffusion
c) Airplane cabin pressure
d) Cold weather
Answer: b) Essential oil diffusion
Explanation:
(b) Essential oil diffusion can release volatile organic compounds (VOCs) that act as irritants, worsening conditions like asthma and chronic lung disease.
(a) High humidity can promote mold growth, but it is not a direct airway irritant.
(c) Airplane cabin pressure affects oxygen levels, but is not a common environmental trigger for airway inflammation.
(d) Cold weather can worsen lung disease symptoms, but it does not directly cause airway inflammation like indoor pollutants.
A newborn presents with intermittent high-pitched inspiratory stridor that worsens when supine. What is the most likely diagnosis?
a) Laryngomalacia
b) Laryngeal atresia
c) Laryngeal cleft
d) Subglottic hemangioma
Answer: a) Laryngomalacia: is the most common congenital cause of stridor in infants and is characterized by worsening symptoms in the supine position due to airway collapse.- From birth or first few weeks of life
- Intermittent high pitched inspiratory stridor worse In
supine
- Moderate to severe sxs require visualization of airway
- Resolved by 2 yoa
- Severe: surgical supraglottaoplasty recommended: stridor each breath, retractions, increased work, feeding difficulties
(b) Laryngeal atresia is a severe and fatal complete high airway obstruction syndrome (CHAOS), at birth, requiring immediate emergency tracheostomy.
(c) Laryngeal cleft leads to aspiration and dysphagia, rather than intermittent inspiratory stridor.
(d) Subglottic hemangioma may cause airway obstruction, but it is not typically associated with positional worsening like laryngomalacia.
It’s cutaneous vascular lesions, need
propranolol, steroids, laser ablation
What is the typical presentation of upper airway obstruction in an extrathoracic location?
a) Wheezing
b) Noisy breathing during inspiration
c) Normal breathing pattern
d) Productive cough
Answer: b) Noisy breathing during inspiration
Correct: Upper airway obstruction (nose, mouth, pharynx, larynx) disrupts inspiration, leading to stridor or noisy breathing.
Incorrect Choices:
a) Wheezing occurs with intrathoracic airway obstruction (bronchi, bronchioles), affecting expiration.
Wheezing typically occurs in expiration because during exhalation, the intrathoracic airways narrow, making it harder for air to escape
c) Normal breathing pattern is not expected in airway obstruction.
d) Productive cough is more common in lower respiratory tract infections, not upper airway obstructions.
What is the most common cause of viral pneumonia and bronchiolitis in infants?
a) Streptococcus pneumoniae
b) Respiratory syncytial virus (RSV)
c) Mycoplasma pneumoniae
d) Neisseria meningitidis
Answer: b) Respiratory syncytial virus (RSV) is the most common viral cause of bronchiolitis and pneumonia in infants under 2 years old.
Incorrect Choices:
a) Streptococcus pneumoniae is the most common bacterial cause, not viral.
c) Mycoplasma pneumoniae causes atypical pneumonia and is more common in older children (>5 years old).
d) Neisseria meningitis is linked to meningitis rather than pneumonia.
Which imaging finding is characteristic of croup?
a) Thumbprint sign on lateral neck X-ray
b) Air-fluid levels in lung cavities
c) Steeple sign on anteroposterior neck X-ray
d) Bilateral infiltrates on chest X-ray
Answer: c) Steeple sign on anteroposterior neck X-ray
Correct: Croup (parainfluenza virus) causes subglottic edema, leading to the steeple sign (narrowing of the upper trachea).
Incorrect Choices:
a) Thumbprint sign is seen in epiglottitis, not croup.
b) Air-fluid levels indicate lung abscess, not croup.
d) Bilateral infiltrates suggest pneumonia, not croup.
Which of the following is the recommended first-line treatment for epiglottitis?
a) Oral steroids and inhaled epinephrine
b) Antibiotics and airway management
c) Antiviral therapy
d) Observation with oxygen therapy
Answer: b) Antibiotics and airway management. Epiglottitis is a life-threatening bacterial infection (e.g., Haemophilus influenzae), requiring IV antibiotics (ceftriaxone or cephalosporins) and airway support (intubation if needed).
Incorrect Choices:
a) Steroids and epinephrine are used for croup, not epiglottitis.
c) Antiviral therapy is ineffective since epiglottitis is bacterial.
d) Observation alone is not safe due to the risk of sudden airway obstruction.
Which disorder presents as a superficial, fluid-filled lesion that can cause stridor and requires laser therapy or surgery?
a) Subglottic hemangioma
b) Laryngocele
c) Laryngeal cleft
d) Acute bacterial tracheitis
Correct Answer: a) Subglottic hemangioma
Explanation for Each Option:
A subglottic hemangioma is a benign vascular tumor that appears as a superficial, fluid-filled lesion in the subglottic region of the larynx.
It commonly presents in infants with progressive stridor, which worsens over weeks to months as the hemangioma enlarges.
These lesions can obstruct the airway, leading to respiratory distress.
Treatment: Most cases require laser therapy or surgical excision if the airway is significantly compromised. Propranolol may also be used as a medical treatment.
b) Laryngocele (Incorrect)
A laryngocele is an air-filled dilation of the laryngeal saccule, which can cause hoarseness, cough, and airway obstruction.
Unlike a fluid-filled lesion, laryngoceles contain air and may not necessarily present with stridor.
Treatment is typically surgical, but it is not the same pathology as a subglottic hemangioma.
c) Laryngeal cleft (Incorrect)
A laryngeal cleft is a congenital defect in which there is an abnormal opening between the larynx and esophagus, allowing food and liquids to enter the airway.
It presents with chronic aspiration, recurrent pneumonia, and feeding difficulties, rather than stridor.
Surgical repair is needed, but it is not a superficial, fluid-filled lesion.
d) Acute bacterial tracheitis (Incorrect)
Acute bacterial tracheitis is a severe bacterial infection of the trachea, most commonly caused by Staphylococcus aureus.
It presents with high fever, stridor, toxic appearance, and purulent tracheal secretions.
This is an infectious process, not a structural lesion requiring laser therapy or surgery.
Treatment includes IV antibiotics and airway management, not laser therapy.
Summary:
Subglottic hemangioma is the only fluid-filled lesion associated with stridor that may require laser therapy or surgery.
The other options (laryngocele, laryngeal cleft, acute bacterial tracheitis) involve different pathophysiological processes and do not fit the description given in the question.
Which of the following conditions is associated with a cherry-red epiglottis and drooling?
a) Croup
b) Epiglottitis
c) Laryngeal cleft
d) Acute bacterial tracheitis
Answer: b) Epiglottitis.
Explanation: Epiglottitis, caused by Haemophilus influenzae, presents with drooling, muffled voice, and a cherry-red swollen epiglottis. Also the patient leans forward because it utilizes gravity in keeping the epiglotis open.
Rationale for other choices:
a) Croup: Causes stridor and barking cough, but not a cherry-red epiglottis.
c) Laryngeal cleft: A congenital anomaly causing aspiration, but not epiglottitis symptoms.
d) Acute bacterial tracheitis: Presents with high fever and stridor but does not cause a cherry-red epiglottis.
What is the most appropriate next step in suspected epiglottitis?
a) Obtain a throat culture
b) Secure the airway with endotracheal intubation
c) Administer oral dexamethasone
d) Perform a CT scan
Answer: b) Secure the airway with endotracheal intubation
Rationale for other choices:
a) Obtain a throat culture: This delays airway management and is unsafe.
c) Administer oral dexamethasone: Steroids may help, but securing the airway is the priority.
d) Perform a CT scan: Imaging delays treatment and may worsen obstruction.
Which of the following is a major risk factor for hospitalization in bronchiolitis?
a) Age > 5 years
b) Prematurity and chronic cardiopulmonary disease
c) Recent antibiotic use
d) Vaccination history
b) Prematurity and chronic cardiopulmonary disease → Correct ✅
Why? These conditions increase the risk of severe bronchiolitis, hospitalization, and respiratory failure.
Risk factors include:
Premature birth (<37 weeks gestation) → smaller airways, weaker lung function
Congenital heart disease (CHD) → poor oxygenation, increased risk of respiratory distress
Chronic lung disease (e.g., bronchopulmonary dysplasia)
Immunodeficiency
a) Age > 5 years → Incorrect
Why? Bronchiolitis primarily affects infants and young children (<2 years old).
Older children (>5 years)* have larger airways, so they are less susceptible to severe airway obstruction.
Most common age group: 3–6 months old (due to smaller airways and immature immune system).
c) Recent antibiotic use → Incorrect
Why? Bronchiolitis is viral (most commonly RSV) → antibiotics do not treat viral infections.
When are antibiotics considered? Only if there is secondary bacterial pneumonia.
d) Vaccination history → Incorrect
Why? Vaccines reduce the risk of infections, but lack of vaccination is not a direct risk factor for bronchiolitis hospitalization.
Exception: Lack of palivizumab prophylaxis in high-risk infants increases RSV risk.
Which bacterial pathogen is the most common cause of community-acquired pneumonia in children?
a) Staphylococcus aureus
b) Streptococcus pneumoniae
c) Klebsiella pneumoniae
d) Mycoplasma pneumoniae
b) Streptococcus pneumoniae → Correct ✅
S. pneumoniae is the most common bacterial cause of community-acquired pneumonia (CAP) in children worldwide.
Features:
Lobar pneumonia with fever, productive cough, pleuritic chest pain
Crackles, decreased breath sounds, dullness to percussion
Can progress to complications like pleural effusion or empyema
* Prevention: Pneumococcal vaccine (PCV13, PPSV23)
c) Klebsiella pneumoniae → Incorrect
Why? Klebsiella is rare in healthy children; it typically causes pneumonia in:
Adults with alcoholism or diabetes
Hospitalized or immunocompromised patients
Classic feature: “Currant jelly” sputum due to necrotizing pneumonia
d) Mycoplasma pneumoniae → Incorrect (but common in older children)
Why? M. pneumoniae is a leading cause of atypical pneumonia but is more common in school-aged children and teenagers, not young children.
Features:
Walking pneumonia with a persistent dry cough, malaise, low-grade fever
X-ray findings often look worse than symptoms
Treated with macrolides (azithromycin, clarithromycin)
What is the most appropriate first-line antibiotic for pneumonia in a 3-month-old infant?
a) Macrolides
b) Amoxicillin
c) Ciprofloxacin
d) Vancomycin
Answer: b) Amoxicillin.
Explanation: Amoxicillin is the first-line treatment for community-acquired pneumonia in young children.
a) Macrolides: Used for atypical pneumonia (e.g., Mycoplasma), but not first-line in infants.
c) Ciprofloxacin: Not used in children due to risk of cartilage damage.
d) Vancomycin: Used for MRSA pneumonia but not first-line.
Which virus is the most common cause of croup?
a) Influenza A
b) Parainfluenza virus
c) Respiratory Syncytial Virus (RSV)
d) Streptococcus pneumoniae
Answer: b) Parainfluenza virus
Rationale for other choices:
a) Influenza A: Can cause severe pneumonia and bronchiolitis but is not the main cause of croup.
c) RSV (Respiratory Syncytial Virus): More common in bronchiolitis, not croup.
d) Streptococcus pneumoniae: A bacterial pathogen causing pneumonia, not viral croup.
Which of the following preventive measures is recommended for high-risk infants to reduce the risk of RSV-related bronchiolitis?
a) Routine influenza vaccination
b) Monthly palivizumab prophylaxis
c) Daily antibiotic prophylaxis
d) Vitamin D supplementation
Answer: b) Monthly palivizumab prophylaxis.
Explanation: Palivizumab is a monoclonal antibody used to prevent severe RSV infection in high-risk infants.
a) Routine influenza vaccination: Prevents flu, not RSV.
c) Daily antibiotic prophylaxis: Antibiotics do not prevent RSV.
d) Vitamin D supplementation: Important for bone health, but not for RSV prevention.
Which of the following is NOT a common complication of pneumonia?
a) Lung abscess
b) Pulmonary embolism
c) Bacterial superinfection
d) Pleural effusion
(a) Lung abscess – Incorrect (Common complication of pneumonia)
Why? A lung abscess forms when necrotic lung tissue develops due to inadequate bacterial clearance.
Seen in: Aspiration pneumonia, anaerobic infections.
(b) Pulmonary embolism – Correct (NOT a direct complication of pneumonia)
Why? Pneumonia does not directly cause PE, but inflammation and immobilization may increase clot risk.
True cause of PE: Deep vein thrombosis (DVT), not lung infection.
(c) Bacterial superinfection – Incorrect (Common complication of pneumonia)
Why? A secondary bacterial infection may develop if the primary infection weakens immune defenses.
Example: Influenza pneumonia can be followed by Staphylococcus aureus or Streptococcus pneumoniae superinfection.
(d) Pleural effusion – Incorrect (Common complication of pneumonia)
Why? Pneumonia can cause fluid accumulation in the pleural space, leading to parapneumonic effusion or empyema.
Diagnosed by: Chest X-ray or ultrasound.
What is the most appropriate antibiotic treatment for an infant less than 4 weeks old with pneumonia?
a) Ampicillin and aminoglycoside
b) Macrolides
c) IV ceftriaxone
d) Oral amoxicillin
(a) Ampicillin and aminoglycoside → Correct ✅
Neonates (<4 weeks old) are at risk for Group B Streptococcus (GBS), E. coli, and Listeria.
Ampicillin covers GBS and Listeria, while aminoglycosides cover Gram-negative organisms like E. coli.
(b) Macrolides → Incorrect
Macrolides (e.g., azithromycin) are used for atypical pneumonia (Mycoplasma, Chlamydia), not neonatal pneumonia.
(c) IV ceftriaxone → Incorrect
Ceftriaxone is avoided in neonates due to the risk of kernicterus and interactions with calcium-containing IV fluids.
(d) Oral amoxicillin → Incorrect
Not suitable for neonates; severe infections require IV treatment
Which of the following pathogens is most commonly responsible for lung abscesses in immunocompromised patients?
a) Staphylococcus aureus
b) Anaerobic and Gram-negative bacteria ✅
c) Streptococcus pneumoniae
d) Influenza virus
(b) Anaerobic and Gram-negative bacteria → Correct ✅
In immunocompromised patients, lung abscesses are more often caused by Nocardia, Mycobacteria, Legionella, and fungi.
(a) Staphylococcus aureus → Incorrect
S. aureus can cause lung abscesses, but it’s more common in healthy individuals or post-viral pneumonia.
(c) Streptococcus pneumoniae → Incorrect
S. pneumoniae causes lobar pneumonia, not typically cavitary lung abscesses.
(d) Influenza virus → Incorrect
Influenza is viral and does not cause lung abscesses directly.
Which of the following is an independent risk factor for life-threatening asthma exacerbations?
a) Use of inhaled corticosteroids (ICS)
b) History of ICU admission for asthma
c) Exposure to pets
d) Mild intermittent symptoms
(b) History of ICU admission for asthma → Correct ✅
Past severe exacerbations (e.g., intubation, ICU stay) strongly predict future severe attacks.
(a) Use of ICS → Incorrect
ICS are protective against exacerbations, not a risk factor.
(c) Exposure to pets → Incorrect
Exposure may trigger asthma in allergic individuals, but it’s not a primary risk factor for life-threatening events.
(d) Mild intermittent symptoms → Incorrect
Severe, poorly controlled asthma is the main risk factor.
Which of the following statements about asthma management is TRUE?
a) Beta-2 agonists (SABAs) should be used as the sole treatment
b) Avoiding all exposure to animals is necessary
c) Tracking FEV1 pre- and post-bronchodilator can help monitor lung function over time ✅
d) Asthma does not cause chronic airway inflammation
(a) Beta-2 agonists (SABAs) should be used as the sole treatment → Incorrect
SABAs provide quick relief, but ICS are essential for long-term inflammation control.
(b) Avoiding all exposure to animals is necessary → Incorrect
Exposure to dogs may reduce asthma risk, but avoiding allergens is helpful for sensitized individuals.
(c) Tracking FEV1 pre- and post-bronchodilator can help monitor lung function over time → Correct ✅
Spirometry is key for tracking disease progression.
(d) Asthma does not cause chronic airway inflammation → Incorrect
Asthma is characterized by chronic inflammation, not just episodic symptoms.
What is a potential complication of lung abscess?
a) Pulmonary embolism
b) Tension pneumothorax
c) Hemothorax
d) Pericarditis
(b) Tension pneumothorax → Correct ✅
Abscess rupture can lead to pneumothorax and mediastinal shift.
(a) Pulmonary embolism → Incorrect
PE is not a direct complication of lung abscess.
(c) Hemothorax → Incorrect
Hemothorax is typically from trauma, aortic dissection, or malignancy, not lung abscess.
(d) Pericarditis → Incorrect
Pericarditis is more associated with viral infections or post-MI Dressler syndrome, not lung abscess.
What is the recommended first-line therapy for atypical pneumonia (e.g., Mycoplasma pneumoniae) in children?
a) Amoxicillin
b) Macrolides ✅
c) IV vancomycin
d) Ceftriaxone
(b) Macrolides → Correct ✅
Azithromycin or clarithromycin treat atypical pathogens (e.g., Mycoplasma, Chlamydia pneumoniae).
(a) Amoxicillin → Incorrect
Amoxicillin targets typical bacteria (e.g., S. pneumoniae) but does not cover Mycoplasma.
(c) IV vancomycin → Incorrect
Used for MRSA pneumonia, not atypical pneumonia.
(d) Ceftriaxone → Incorrect
Ceftriaxone covers typical bacteria (S. pneumoniae, H. influenzae) but not Mycoplasma.
What laboratory finding is expected in a severe asthma exacerbation?
a) Normal PCO2
b) Metabolic alkalosis
c) Hypoxemia with respiratory alkalosis
d) Leukopenia
(c) Hypoxemia with respiratory alkalosis → Correct ✅
Hyperventilation leads to respiratory alkalosis (low PCO2, high pH).
(a) Normal PCO2 → Incorrect
Early on, PCO2 is low due to hyperventilation. If PCO2 is normal in a worsening patient, it suggests impending respiratory failure.
(b) Metabolic alkalosis → Incorrect
Asthma affects the lungs, not metabolism.
(d) Leukopenia → Incorrect
Leukocytosis may be present due to stress or corticosteroids.
Which of the following is a potential complication of severe asthma?
a) Respiratory acidosis
b) Hyperoxia
c) Increased lung compliance
d) Pulmonary embolism
Answer: (a) Respiratory acidosis.
(✅) a) Correct → Severe asthma can cause hypercapnia (high CO₂) and respiratory acidosis, signaling impending failure.
(❌) b) Wrong → Hyperoxia is not a typical asthma complication (patients have hypoxia, not excessive oxygen).
(❌) c) Wrong → Asthma causes bronchoconstriction and airway inflammation, not increased lung compliance (seen in emphysema).
(❌) d) Wrong → Pulmonary embolism is not a direct complication of asthma.
Which of the following is a sign of severe asthma exacerbation?
A) Pulsus paradoxus
B) Increased PCO2 in early stages
C) Absence of wheezing
D) Normal oxygen saturation
✅ Correct Answer: A) Pulsus paradoxus
🔹 Pulsus paradoxus (drop in systolic BP during inspiration) occurs in moderate-severe asthma attacks due to air trapping and increased intrathoracic pressure.
❌ Why the others are wrong?
B) Increased PCO2 in early stages → Early stages show low PCO2 due to hyperventilation; high PCO2 indicates respiratory failure.
C) Absence of wheezing → No wheezing in a severe attack is a bad sign—silent chest means near-complete airway obstruction.
D) Normal oxygen saturation → Severe asthma causes hypoxia, leading to low O2 saturation.
Which organization provides global asthma management guidelines?
A) NAEPP
B) GINA
C) WHO
D) CDC
Asthma Management
* Long term controller meds
- Inhaled corticosteroids, leukotriene modifiers (chronic tx and seasonal allergic rhinitis), long acting bronchodilators (LABAs); daily, long acting antimuscarinic agents (LAMAs for once daily maintenance for 6+ ypa), biologics (monoclonal antibodies ti IgE to prevent activation in mast cells
* Quick relief meds
- Short acting Beta2 agonists (SABAs)
- Ex) child/adolescent 12 + yoa: can use a combined ICS Formoterol for reliever therapy
- Ex) 14 yo m asthmatic attack: use SABA, prednisolone, oxygen, reassess after 1 hour then refer to urgent care if not resolved.
✅ Correct Answer: B) GINA (Global Initiative for Asthma)
🔹 GINA provides global guidelines for asthma diagnosis and management.
❌ Why the others are wrong?
A) NAEPP → US-based National Asthma Education Prevention Program (not global).
C) WHO → Guides public health policies but does not provide specific asthma management protocols.
D) CDC → Focuses on disease surveillance, not direct management guidelines.
- Management of Acute Asthma episodes
- At home: SABA (Albuterol) 2-6 puffs q 20 mins up to 3x,
continue q 3-4 hrs for 24-48 hours if sxs improve
a) >12 puffs/d > 24 hours seek medical advice - In office/emergency department: functional tests are done PEFR, FEV1, flow volume loops, oxygen saturation, blood gases,
a) SABA by puffer or inhaler in the first hr 4-8 puffs up to 3 doses
b) Oxygen given to maintain O2 sat >90%
c) Oral Coricosteroids if poor response to therapy 60mg/kg/d for <12 80mg/kg/d > 12
d) Severe: high dose SABA + ipratropium bromide q 20 mins 3
doses - Hospitalization: worst case scenario, education for parents
to continue at home care, compliancy is key
Which of the following is the most critical factor in evaluating abnormal growth?
A) Absolute height
B) Height velocity
C) Bone age
D) Parental height
Correct Answer: B) Height velocity
✅ Height velocity is the most critical factor because it reflects ongoing growth patterns rather than just a single measurement. A child who falls off their growth curve is more concerning than a child who is simply short but growing steadily.
❌ A) Absolute height is less useful because some children may be naturally short due to genetics rather than pathology.
❌ C) Bone age is helpful but not the most critical factor. Some children may have delayed bone maturation but still reach normal height.
❌ D) Parental height helps predict a child’s expected height but does not directly indicate if abnormal growth is occurring.
Which of the following is true about evaluating skeletal maturation in children?
A) Bone age is assessed using radiographs of the right hand and wrist
B) Children with delayed bone age always remain short in adulthood
C) The Greulich & Pyle method is used to compare bone age standards
D) Skeletal maturation cannot change over time once determined
Correct Answer: C) The Greulich & Pyle method is used to compare bone age standards
✅ C) The Greulich & Pyle method is used to compare bone age standards – This method compares a child’s hand and wrist X-rays to standardized images representing different stages of bone development.
❌ A) Bone age is assessed using radiographs of the right hand and wrist – The left hand and wrist are typically used for assessment.
❌ B) Children with delayed bone age always remain short in adulthood – Many children with constitutional growth delay catch up later and reach a normal adult height.
❌ D) Skeletal maturation cannot change over time once determined – Growth potential can change, especially in cases of delayed puberty or hormonal interventions.
Which of the following characteristics differentiates Constitutional Growth Delay (CGD) from Familial Short Stature (FSS)?
A) CGD children have a normal birth weight and length
B) CGD children reach a final height appropriate for their family
C) CGD children follow a growth percentile consistent with parental height
D) CGD children have a delay in skeletal maturation and puberty onset
Correct Answer: D) CGD children have a delay in skeletal maturation and puberty onset
✅ D) CGD is characterized by delayed bone age and delayed puberty, but these children continue to grow beyond the average stop point, eventually reaching their genetic height potential.
❌ A) Both CGD and FSS children have normal birth weight and length, so this does not differentiate them.
❌ B) While final height is usually appropriate, it is the growth pattern (late blooming) that distinguishes CGD.
❌ C) Unlike FSS, CGD children initially follow a growth percentile below what is expected based on parental height.
Which of the following is NOT a common cause of pathological short stature?
A) Chronic systemic illness
B) Intrauterine growth restriction
C) Parental short stature
D) Chromosomal defects
Correct Answer: C) Parental short stature
✅ C) Parental short stature is a feature of Familial Short Stature (FSS), which is a normal variation, not a pathological cause of short stature.
❌ A) Chronic illnesses (e.g., celiac disease, inflammatory conditions) can impair growth.
❌ B) Intrauterine growth restriction (IUGR) can result in persistent short stature if catch-up growth does not occur.
❌ D) Chromosomal defects like Turner syndrome are well-known causes of growth failure.
Which statement is true regarding Growth Hormone Deficiency (GHD)?
A) It is caused by excessive secretion of IGF-1
B) It is often associated with excess truncal adiposity
C) Random serum GH levels are the best way to diagnose it
D) GH therapy is always effective in treating short stature
Correct Answer: B) It is often associated with excess truncal adiposity
✅ B) GH deficiency leads to decreased lipolysis, which can cause increased truncal fat accumulation.
❌ A) IGF-1 production is actually reduced in GHD because GH stimulates IGF-1 release.
❌ C) Random GH levels are unreliable since GH secretion is pulsatile; IGF-1 levels provide a better estimate.
❌ D) GH therapy is ineffective in cases of GH resistance, where children do not respond to treatment.
Truncal adiposity refers to excessive fat accumulation around the abdomen and torso. In Growth Hormone Deficiency (GHD), truncal adiposity occurs because GH plays a key role in lipolysis (fat breakdown). When GH levels are low:
more on truncal adiposity
Fat metabolism is impaired, leading to increased fat storage, especially in the trunk area.
Lean muscle mass decreases, making the body composition more fat-heavy.
Insulin resistance may develop, as GH normally helps regulate glucose metabolism.
This results in a characteristic “chubby” appearance in children with GHD, even though their overall growth is stunted.
What is the first step in evaluating infantile growth hormone deficiency?
A) MRI of the brain
B) Random serum GH level
C) Serum IGF-1 level
D) Growth hormone stimulation test
Correct Answer: C) Serum IGF-1 level
✅ C) IGF-1 is a more stable marker of GH secretion and is the first step in screening.
❌ A) MRI is used later if GHD is confirmed, to check for pituitary abnormalities.
❌ B) Random GH levels are not useful due to pulsatile secretion.
❌ D) Stimulation tests are done if IGF-1 is low but not as a first step.
Insulin-like Growth Factor 1 (IGF-1) is preferred over direct GH measurement because:
GH secretion is pulsatile – It fluctuates throughout the day, making random serum GH levels unreliable. A low GH level at any given moment may not mean true deficiency.
IGF-1 levels reflect overall GH activity – IGF-1 is produced in the liver in response to GH, so its levels remain relatively stable over time.
Easier to interpret – Unlike GH, which varies widely throughout the day, IGF-1 provides a better estimate of average GH function over time.
Less invasive – GH stimulation tests (which require multiple blood draws over hours) are only done if IGF-1 is low.
What is the most critical factor in evaluating abnormal growth in children?
A) Absolute height at a given age
B) Height velocity over time
C) Parental height
D) Mid-parental height calculation
✅ Correct Answer: B) Height velocity over time
🔹 Height velocity (rate of growth over time) is the best indicator of whether a child is growing normally or has a growth disorder.
❌ A) Absolute height at a given age – A child’s height alone doesn’t determine abnormal growth because children grow at different rates. A short child may still have normal growth velocity.
❌ C) Parental height – While genetics influence height, growth velocity changes are more useful for detecting abnormalities.
❌ D) Mid-parental height calculation – This estimates expected height but does not indicate current growth issues.
Why are specific growth charts necessary for conditions like Turner syndrome?
A) These children have different growth patterns from the general population
B) Standard growth charts underestimate their final height potential
C) It helps diagnose conditions earlier
D) Growth hormone therapy is only used if these charts show low height percentiles
✅ Correct Answer: A) These children have different growth patterns from the general population
🔹 Turner syndrome, Down syndrome, and some ethnic groups have distinct growth patterns, so using standard growth charts can lead to misinterpretation.
❌ B) Standard growth charts underestimate final height potential – This isn’t always true; rather, they don’t accurately reflect expected growth for these conditions.
❌ C) It helps diagnose conditions earlier – Growth charts are for monitoring, but diagnosis requires genetic and medical evaluation.
❌ D) Growth hormone therapy is only used if these charts show low height percentiles – GH therapy decisions involve clinical assessment, not just chart placement.
How does Constitutional Growth Delay (CGD) differ from Familial Short Stature (FSS)?
A) Children with CGD follow their genetic percentile from birth
B) Children with CGD have delayed puberty and skeletal maturation
C) FSS children never reach a normal growth curve
D) CGD results in permanent short stature
✅ Correct Answer: B) Children with CGD have delayed puberty and skeletal maturation
🔹 CGD is characterized by slower-than-expected growth with delayed puberty, but they eventually reach their genetic height potential.
❌ A) Children with CGD follow their genetic percentile from birth – No, they initially grow below their expected percentile but later catch up.
❌ C) FSS children never reach a normal growth curve – FSS children do settle into a normal growth pattern that aligns with their genetics.
❌ D) CGD results in permanent short stature – CGD kids tend to catch up after puberty and achieve normal final height.
What happens to infants who are Small for Gestational Age (SGA) but fail to show catch-up growth?
A) They are always diagnosed with GH deficiency
B) They may have normal growth velocity but remain below their expected height percentile
C) They never achieve normal adult height
D) They develop excess adiposity due to metabolic imbalances
✅ Correct Answer: B) They may have normal growth velocity but remain below their expected height percentile
🔹 Some SGA infants fail to catch up and track a lower height percentile, but this doesn’t always indicate a growth disorder.
❌ A) They are always diagnosed with GH deficiency – Not all SGA children have GH deficiency. Some have other causes of short stature.
❌ C) They never achieve normal adult height – Some do, especially if treated appropriately.
❌ D) They develop excess adiposity due to metabolic imbalances – While SGA children may have metabolic risks, this is not a universal outcome.
What is the most common cause of short stature associated with syndromes?
A) Turner Syndrome
B) Down Syndrome
C) Noonan Syndrome
D) Prader-Willi Syndrome
✅ Correct Answer: A) Turner Syndrome
🔹 Turner Syndrome is one of the most common genetic causes of short stature in females, characterized by various physical features like a webbed neck, micrognathia, and low hairline.
❌ B) Down Syndrome – While Down Syndrome can lead to short stature, Turner Syndrome is more commonly associated with it.
❌ C) Noonan Syndrome – Although Noonan Syndrome can cause short stature, it is less frequent compared to Turner Syndrome.
❌ D) Prader-Willi Syndrome – Prader-Willi Syndrome can also cause short stature but is less common than Turner Syndrome.
========================================
B) Down Syndrome
Characteristics: Down Syndrome (Trisomy 21) is a genetic condition caused by an extra chromosome 21. It is associated with intellectual disabilities, characteristic facial features (e.g., flattened face, upward slanting eyes, small ears), and various health issues.
Short Stature: Children with Down Syndrome typically have short stature, although their growth is usually consistent with a specific growth chart for Down Syndrome. While short stature is common, it is not usually as significant as in Turner Syndrome.
Other Features: It is associated with developmental delays, congenital heart defects, and an increased risk of other health conditions (e.g., hearing problems, gastrointestinal issues).
C) Noonan Syndrome
Characteristics: Noonan Syndrome is a genetic disorder that affects multiple parts of the body. It can cause congenital heart defects, developmental delays, short stature, and characteristic physical features like a webbed neck, wide-set eyes, and low-set ears.
Short Stature: Short stature is common in Noonan Syndrome, but it tends to be less pronounced than in Turner Syndrome. The growth may be slow but consistent with the individual’s genetic potential. Children with Noonan Syndrome may benefit from growth hormone therapy.
Other Features: Noonan Syndrome is also associated with learning disabilities, heart conditions, and other physical abnormalities (e.g., chest deformities, low muscle tone).
D) Prader-Willi Syndrome
Characteristics: Prader-Willi Syndrome is a genetic disorder caused by a deletion of specific genes on chromosome 15. It leads to a range of physical, mental, and behavioral problems, including obesity, intellectual disabilities, and compulsive eating behaviors.
Short Stature: Short stature is often seen in children with Prader-Willi Syndrome, but it is less commonly severe than in Turner Syndrome. Growth hormone therapy can help improve growth and body composition.
Other Features: Prader-Willi Syndrome is characterized by an insatiable appetite (leading to obesity), intellectual disabilities, hyperphagia (compulsive eating), and muscle weakness. Monitoring for sleep apnea and other respiratory problems is essential.
Which of the following is a characteristic feature of Prader-Willi Syndrome?
A) Webbed neck
B) Intellectual impairment
C) Increased risk of malignancies
D) Sleep apnea and upper airway obstruction
✅ Correct Answer: D) Sleep apnea and upper airway obstruction
🔹 Prader-Willi Syndrome is associated with sleep apnea, upper airway obstruction, and other physical features. Monitoring for these issues is important before starting growth hormone therapy.
❌ A) Webbed neck – Webbed neck is a hallmark of Turner Syndrome, not Prader-Willi Syndrome.
❌ B) Intellectual impairment – While intellectual impairment may occur, it is not as prominent a feature as other aspects in Prader-Willi.
❌ C) Increased risk of malignancies – This is associated with Down Syndrome, not Prader-Willi Syndrome.
In which condition is growth hormone therapy not usually necessary?
A) Turner Syndrome
B) Down Syndrome
C) Prader-Willi Syndrome
D) Hypothyroidism
✅ Correct Answer: B) Down Syndrome
🔹 In Down Syndrome, growth hormone therapy may be considered but is not typically necessary unless there is a clear growth hormone deficiency.
❌ A) Turner Syndrome – Growth hormone therapy can improve final height in Turner Syndrome and is often recommended.
❌ C) Prader-Willi Syndrome – Growth hormone therapy is used to improve growth and body composition in Prader-Willi Syndrome.
❌ D) Hypothyroidism – Hypothyroidism requires thyroid hormone replacement, not growth hormone therapy.
Which of the following is a typical symptom of congenital hypothyroidism?
A) Delayed bone age
B) Short stature due to undernutrition
C) Jaundice and poor muscle tone
D) Increased physical activity
✅ Correct Answer: C) Jaundice and poor muscle tone
🔹 Congenital hypothyroidism presents with thick tongue, large fontanels, hoarseness, poor muscle tone, and jaundice. Early diagnosis and treatment are essential for normal cognitive outcomes.
❌ A) Delayed bone age – Delayed bone age can occur with hypothyroidism but is not the most characteristic feature of congenital hypothyroidism.
❌ B) Short stature due to undernutrition – This is a characteristic of psychosocial short stature, not congenital hypothyroidism.
❌ D) Increased physical activity – Hypothyroidism generally leads to reduced physical activity due to low metabolism and energy levels.
Which of the following is a recommended screening test for hypothyroidism in newborns?
A) Serum T3 and T4 levels only
B) Urinalysis and serum electrolytes
C) Total T4 or TSH screening test
D) Bone age X-ray
✅ Correct Answer: C) Total T4 or TSH screening test
🔹 Newborns are typically screened for hypothyroidism using a total T4 or TSH test to detect potential issues early. If abnormal, confirmation is done with venous T4 and TSH levels.
❌ A) Serum T3 and T4 levels only – TSH screening is more commonly used in newborn screening as the primary test.
❌ B) Urinalysis and serum electrolytes – These tests are not used for screening hypothyroidism but may be done to assess overall health or other conditions.
❌ D) Bone age X-ray – While bone age may be delayed in hypothyroidism, it is not used as a primary screening method.
What is a known side effect of recombinant GH therapy?
A) Excessive weight loss
B) Intracranial hypertension
C) Increased bone density
D) Decreased bone growth
✅ Correct Answer: B) Intracranial hypertension
🔹 A rare side effect of recombinant GH therapy is intracranial hypertension, which requires monitoring and early detection to prevent complications.
❌ A) Excessive weight loss – GH therapy typically helps with growth and may improve body composition, but weight loss is not a common side effect.
❌ C) Increased bone density – GH therapy promotes growth and normal bone development, but excessive bone density is not a typical side effect.
❌ D) Decreased bone growth – GH therapy is used to enhance bone growth, especially in children with growth hormone deficiency.
Which of the following is true about the growth pattern of children with Klinefelter Syndrome?
A) They tend to have a normal height for their age
B) They often exhibit gigantism or acromegaly
C) They are at risk for tall stature due to GH excess
D) They are usually shorter than their peers
✅ Correct Answer: D) They are usually shorter than their peers
🔹 Children with Klinefelter Syndrome are typically shorter than expected for their age due to the presence of an extra X chromosome, which affects growth.
❌ A) They tend to have a normal height for their age – Children with Klinefelter Syndrome generally have shorter stature than their peers.
❌ B) They often exhibit gigantism or acromegaly – Gigantism or acromegaly is related to GH excess, not Klinefelter Syndrome.
❌ C) They are at risk for tall stature due to GH excess – Klinefelter Syndrome typically causes short stature, not tall stature due to GH excess.
At what point in fetal development does thyroid hormone (TH) first appear in serum?
A) 6 weeks
B) 8 weeks
C) 10 weeks
D) 11 weeks
Answer:
✅ D) 11 weeks – TH is produced at 10 weeks and appears in serum at 11 weeks.
❌ A) 6 weeks – Too early; the thyroid gland is still forming.
❌ B) 8 weeks – TH production has not yet started.
❌ C) 10 weeks – This is when TH is produced, but it appears in serum at 11 weeks.
What happens to thyroid hormone levels after birth?
A) TSH surges, causing a temporary rise in TH, which normalizes in a few weeks.
B) TH immediately decreases due to maternal hormone withdrawal.
C) TSH and TH remain stable.
D) TH increases gradually over the first year of life.
Answer:
✅ A) TSH surges, causing a temporary rise in TH, which normalizes in a few weeks. – This can lead to false-positive newborn screening for hypothyroidism.
❌ B) TH immediately decreases – The TSH surge actually causes an initial increase in TH.
❌ C) TSH and TH remain stable – There is a fluctuation right after birth.
❌ D) TH increases gradually over the first year – TH normalizes within weeks, not over a year.
Which of the following can cause low T4 levels?
A) Hypothyroidism
B) Prematurity
C) Malnutrition
D) All of the above
Answer:
✅ D) All of the above – All these factors can contribute to decreased T4 levels.
- Causes of low T4: hypothyroidism, prematurity, malnutrition, severe illness, following therapy with T3 a) Situation that decreased TBG: familial TBG deficiency, cirrhosis, renal failure, glucocorticoids, androgens
Which condition is associated with an increased risk of Hashimoto’s thyroiditis?
A) Celiac disease
B) Type 2 diabetes
C) Marfan syndrome
D) Klinefelter syndrome
Answer:
✅ A) Celiac disease – Autoimmune diseases like celiac disease increase the risk of Hashimoto’s thyroiditis.
❌ B) Type 2 diabetes – Type 1 diabetes, not type 2, is linked to Hashimoto’s.
❌ C) Marfan syndrome – Not associated with autoimmune thyroid disorders.
❌ D) Klinefelter syndrome – No strong connection to Hashimoto’s.
What is the preferred first-line treatment for Grave’s disease?
A) Beta-blockers
B) Methimazole
C) Radioactive iodine
D) Surgery
Answer:
✅ B) Methimazole – First-line antithyroid drug for controlling hyperthyroidism.
❌ A) Beta-blockers – Used to manage symptoms, but they do not treat the underlying disease.
❌ C) Radioactive iodine – Used when antithyroid drugs fail or in specific cases.
❌ D) Surgery – Reserved for large goiters, nodules, or refractory cases.
What is a key characteristic of thyroid storm?
A) Fever, delirium, cardiovascular collapse.
B) Painless thyroid swelling with normal thyroid function.
C) Cold intolerance and bradycardia.
D) Transient hyperthyroidism followed by hypothyroidism.
✅ A) Fever, delirium, cardiovascular collapse – Life-threatening hyperthyroidism emergency.
❌ B) Painless thyroid swelling with normal thyroid function – This describes painless thyroiditis.
❌ C) Cold intolerance and bradycardia – These are signs of hypothyroidism, not thyroid storm.
❌ D) Transient hyperthyroidism followed by hypothyroidism – This describes subacute thyroiditis.
Which of the following describes a major risk of total thyroidectomy for Graves’ disease?
A) Hypoparathyroidism and recurrent laryngeal nerve damage.
B) Increased thyroid hormone production.
C) Spontaneous remission.
D) Increased risk of hyperthyroidism..
✅ A) Hypoparathyroidism and recurrent laryngeal nerve damage – Removal of the thyroid can accidentally damage the parathyroid glands (leading to hypocalcemia) or the recurrent laryngeal nerve (causing hoarseness).
❌ B) Increased thyroid hormone production – A total thyroidectomy removes hormone production.
❌ C) Spontaneous remission – Graves’ disease can have remissions, but not after thyroid removal.
❌ D) Increased risk of hyperthyroidism – Surgery eliminates hyperthyroidism, but the patient will require lifelong hormone replacement.
Why might a patient with Hashimoto’s thyroiditis develop hyperthyroidism (Hashitoxicosis)?
A) Temporary thyroid inflammation causes excess hormone release.
B) Overdose of levothyroxine
C) The pituitary overproduces TSH
D) The thyroid becomes permanently hyperactive
Why might a patient with Hashimoto’s thyroiditis develop hyperthyroidism (Hashitoxicosis)?
✅ A) Temporary thyroid inflammation causes excess hormone release – In early Hashimoto’s, thyroid cells break down and release stored hormones, causing transient hyperthyroidism.
❌ B) Overdose of levothyroxine – While this can cause hyperthyroidism, Hashitoxicosis is due to inflammation, not medication.
❌ C) The pituitary overproduces TSH – Hashimoto’s is an autoimmune disease, not a pituitary disorder.
❌ D) The thyroid becomes permanently hyperactive – Hashimoto’s eventually leads to hypothyroidism, not permanent hyperthyroidism.
Which of the following is the first-line treatment for an obese patient with PCOS?
A) Spironolactone
B) Oral contraceptives
C) Metformin
D) Weight loss
✅ D) Weight loss – First-line intervention for obese PCOS patients as it improves insulin resistance, hormone balance, and overall symptoms.
❌ A) Spironolactone – Used for hirsutism but does not address underlying metabolic dysfunction.
❌ B) Oral contraceptives – Effective for cycle regulation and hyperandrogenism but do not treat insulin resistance.
❌ C) Metformin – Helps insulin resistance but is not first-line over lifestyle changes like weight loss.
Which of the following findings is most suggestive of CAH in a newborn female?
A) Hypoglycemia and jaundice
B) Labial fusion and clitoromegaly
C) Microcephaly and hypotonia
D) Hypotension and bradycardia
✅ B) Labial fusion and clitoromegaly – Classic signs of CAH due to excess androgen exposure in utero.
❌ A) Hypoglycemia and jaundice – Can be seen in other endocrine or metabolic disorders but are not specific to CAH.
❌ C) Microcephaly and hypotonia – More indicative of genetic or neurological disorders.
❌ D) Hypotension and bradycardia – Would be seen in myxedema coma rather than CAH.
Which test confirms a diagnosis of Cushing syndrome?
A) Random ACTH level
B) Low-dose dexamethasone suppression test
C) Plasma renin activity
D) ACTH stimulation test
✅ B) Low-dose dexamethasone suppression test – Failure to suppress cortisol confirms Cushing syndrome.
❌ A) Random ACTH level – Used to differentiate between ACTH-dependent vs. independent Cushing but does not confirm the diagnosis.
❌ C) Plasma renin activity – More relevant in conditions like hyperaldosteronism.
❌ D) ACTH stimulation test – Used to diagnose adrenal insufficiency, not Cushing syndrome.
A 7-year-old girl presents with breast development and advanced bone age. What is the best initial test?
A) Serum estrogen level
B) MRI of the brain
C) GnRH stimulation test
D) Ultrasound of the ovaries
✅ C) GnRH stimulation test – Differentiates between central (gonadotropin-dependent) and peripheral (gonadotropin-independent) precocious puberty.
❌ A) Serum estrogen level – Not the most reliable first-line test.
❌ B) MRI of the brain – Indicated if central precocious puberty is confirmed, but not first-line.
❌ D) Ultrasound of the ovaries – Useful for peripheral causes but not the first step.
A 15-year-old boy has no signs of secondary sexual development. What is the most common cause?
A) Klinefelter syndrome
B) Primary hypogonadism
C) Constitutional growth delay
D) Pituitary tumor
✅ C) Constitutional growth delay – Most common cause of delayed puberty, associated with delayed bone age and normal adult height.
❌ A) Klinefelter syndrome – Can cause delayed puberty but is less common and often presents with small testes.
❌ B) Primary hypogonadism – More likely in Turner syndrome (females) or genetic disorders affecting gonads.
❌ D) Pituitary tumor – Can cause delayed puberty but is far less common than constitutional growth delay.
A female newborn presents with ambiguous genitalia, salt-wasting crisis, and elevated 17-hydroxyprogesterone. What is the most likely diagnosis?
A) Turner Syndrome
B) Congenital Adrenal Hyperplasia
C) Androgen Insensitivity Syndrome
D) Klinefelter Syndrome
Answer: ✅ B) Congenital Adrenal Hyperplasia (CAH)
CAH is the most common cause of ambiguous genitalia in newborn females.
21-hydroxylase deficiency leads to:
Excess androgens → Virilization (ambiguous genitalia).
Mineralocorticoid deficiency → Salt wasting, hyponatremia, hyperkalemia.
Elevated 17-hydroxyprogesterone (diagnostic marker).
❌ A) Turner Syndrome → Causes primary amenorrhea, but NOT virilization or salt wasting.
❌ C) Androgen Insensitivity Syndrome → 46 XY karyotype with female external genitalia, but no uterus.
❌ D) Klinefelter Syndrome → 47 XXY karyotype, causes infertility and gynecomastia, but does not affect genital development at birth.
Which of the following is an expected developmental milestone within the first week of life?
a) Rolls from back to side
b) Moves arms and legs ✅
c) Laughs when spoken to
d) Sits with support with head and neck control
a) Rolls from back to side ❌ – Rolling requires more developed motor control and typically emerges around 4-5 months.
b) Moves arms and legs ✅ – Newborns exhibit spontaneous and reflexive movements of the arms and legs as part of their early motor activity.
c) Laughs when spoken to ❌ – Social smiling and laughter usually develop around 2-4 months, so this is too early.
d) Sits with support with head and neck control ❌ – Sitting with support and good head control occurs around 4-5 months, making this an inappropriate milestone for a newborn.
A baby at 2 weeks should be able to:
a) Sequence 2 or more sucks before swallowing/breathing ✅
b) Reach and grasp objects with both hands
c) Vocalize pleasure and displeasure with good eye contact
d) Walk with assistance
a) Suck well on the nipple ✅ – Newborns have a strong sucking reflex, which is essential for feeding.
b) Say simple words ❌ – Speech development doesn’t begin until around 9-12 months, with simple words like “mama” and “dada” forming later.
c) Have a preference for one hand ❌ – Hand preference (dominance) isn’t evident until around 2-3 years old. Early preference may indicate neurological concerns.
d) Walk with assistance ❌ – Walking typically begins around 12 months, so this is far too early.
What is a typical response of a newborn to sound at 2 weeks of age?
a) Ignores sounds
b) Turns head towards the sound
c) Startles to sounds
d) Claps in response
c) Startles to sounds ✅ – The startle (Moro) reflex is present at birth and causes the baby to react to sudden noises.
a) Ignores sounds ❌ – A baby ignoring sounds at 2 weeks could indicate hearing issues, as newborns should react to sound.
b) Turns head towards the sound ❌ – Babies do not consistently turn toward sounds until around 3-4 months when neck control improves.
d) Claps in response ❌ – Clapping is a fine motor milestone that usually develops closer to 9-12 months.
A baby at 2 weeks should be able to:
a) Sequence 2 or more sucks before swallowing/breathing
b) Reach and grasp objects with both hands
c) Vocalize pleasure and displeasure with good eye contact
d) Walk with assistance
a) Sequence 2 or more sucks before swallowing/breathing ✅ – Coordinating sucking, swallowing, and breathing is a crucial newborn feeding skill.
b) Reach and grasp objects with both hands ❌ – Voluntary reaching and grasping occur around 4 months. Before then, newborns rely on reflexive grasping.
c) Vocalize pleasure and displeasure with good eye contact ❌ – Babies typically start cooing and vocalizing socially around 6-8 weeks, so this is premature.
d) Walk with assistance ❌ – Again, walking occurs around 12 months, making this option incorrect.
Which of the following is an appropriate developmental milestone for a 1-month-old?
a) Rolls from back to side
b) Uses pincer grasp to pick up objects
c) Sits without support
d) Says “mama” and “dada” intentionally
a) Rolls from back to side ✅ – Some infants may begin to roll partially by 1 month, though full rolling (back to front) usually occurs by 4-5 months.
b) Uses pincer grasp to pick up objects ❌ – The pincer grasp (thumb and forefinger) emerges between 9-12 months, making this incorrect.
c) Sits without support ❌ – Sitting independently is a 6-month milestone, though supported sitting starts earlier.
d) Says “mama” and “dada” intentionally ❌ – Babies may babble mama/dada sounds around 6-7 months, but they don’t use them meaningfully until 9-12 months.
At 1 month of age, which of the following is not expected?
a) Reaches/grasp objects with both hands
b) Hears sounds and laughs when spoken to
c) Vocalizes pleasure and displeasure with good eye contact
d) No persistent closed/fisted hands
a) Reaches/grasps objects with both hands ✅ – At 1 month, babies do not yet have voluntary grasping; they only exhibit a palmar grasp reflex.
b) Hears sounds and laughs when spoken to ❌ – Hearing sounds is expected, but laughing is more common at around 2-4 months.
c) Vocalizes pleasure and displeasure with good eye contact ❌ – Some vocalizations may be present, but true social vocalization and eye contact develop closer to 6-8 weeks.
d) No persistent closed/fisted hands ❌ – By 1 month, persistent fist-clenching should start decreasing, but full hand relaxation happens later.
What is the first-line medication treatment for ADHD?
A) Guanfacine
B) Atomoxetine
C) Methylphenidate
D) Clonidine
✅ Answer: C) Correct – Methylphenidate (e.g., Ritalin) is a stimulant, which is the first-line treatment.
Explanation:
❌ A) Incorrect – Guanfacine is a non-stimulant used only if stimulants fail.
❌ B) Incorrect – Atomoxetine (a norepinephrine reuptake inhibitor) is not first-line.
❌ D) Incorrect – Clonidine is another non-stimulant, mainly used for sleep problems or tics.
===============================
Management Medications
1. Stimulants considered first line: methylphenidate (ritalin) & amphetamine preparations: tablet, capsule, liquid, dermal patch: rapid active
i) Enhance dopamine and norepinephrine neurotransmission
to improve impulse, attention and hyperactivity
ii) Side effects: appetite suppression, sleep disturbances, anxiety, exacerbate or improve motor tics
2. Nonstimulants, Extended release clonidine or guanfacine: a2 presynaptic agonists, atomoxetine: norepinephrine reuptake inhibitor; takes more time to take effect 2-4 weeks
i) SE similar to stimulants as well as sedation, dizziness, constipation
Which is the most common side effect of stimulant medications for ADHD?
A) Weight gain
B) Constipation
C) Appetite suppression
D) Increased salivation
✅ Answer: C) Stimulants suppress appetite, which may lead to weight loss.
Explanation:
❌ A) Incorrect – Stimulants typically cause weight loss, not gain.
❌ B) Incorrect – Non-stimulants (e.g., Atomoxetine, Guanfacine) are more likely to cause constipation.
❌ D) Incorrect – Stimulants do not increase saliva production.
Why is cardiovascular history important before prescribing stimulants for ADHD?
A) Stimulants increase the risk of sudden death in all children
B) Stimulants increase blood pressure and heart rate
C) Stimulants are contraindicated in all children with heart murmurs
D) Stimulants cause a permanent change in heart structure
✅ Answer: B) Stimulants increase blood pressure and heart rate, so heart history should be taken.
Explanation:
❌ A) Incorrect – Stimulants do not cause sudden death unless there is a pre-existing heart condition.
❌ C) Incorrect – Not all heart murmurs are contraindications for stimulants.
❌ D) Incorrect – Stimulants do not permanently change heart structure.
==================================
ADHD Management
- Cardiovascular effects of stimulants
1. Does not increase risk of sudden death
2. Take history of syncope, palpitations, chest pain, family history of sudden death prior to 30 yoa
3. Stimulants not for those with serious heart problems or for those that would cause problems with an increase in BP or HR
4. Consult child’s cardiologist prior to medication
administration
- Family & Social Support
1. Education on ADHD symptoms; symptoms are part of a neurological disorder that cannot be controlled
2. Education on interventions: compliance with medications,
positive behavioural reinforcement
At what age do early signs of Autism Spectrum Disorder (ASD) typically appear?
A) At birth
B) 6 months
C) 12-18 months
D) 5 years
✅ Answer: C) 12-18 months; Atypical communication and interaction appear between 12-18 months.
Explanation:
❌ A) Incorrect – Autism is not usually detectable at birth.
❌ B) Incorrect – By 6 months, symptoms are usually not apparent.
❌ D) Incorrect – Most children are diagnosed around 3-4 years, but symptoms appear earlier.
Which of the following acupuncture/acupressure points are commonly used to promote relaxation in individuals with ADHD or ASD?
A) Yintang, PC 6, auricular Zero, Shen men
B) LI 4, ST 36, UB 60, DU 20
C) SP 6, LV 3, UB 23, GB 34
D) HT 7, SI 3, KD 7, GB 20
Answer: A) Yintang, PC 6, auricular Zero, Shen men
A is correct because these points are known for their calming and relaxing effects, making them beneficial for ADHD/ASD.
B is incorrect because LI 4 and ST 36 are more commonly used for general vitality and digestion rather than relaxation.
C is incorrect because SP 6 and LV 3 are more related to hormonal balance and liver qi stagnation, not specific to relaxation in ADHD/ASD.
D is incorrect because HT 7 is calming but the other points are not primarily used for relaxation in ADHD/ASD.
Naturopathic Interventions
* ADHD/ASD
- Relaxing acupuncture/acupressure
1. Yintang, PC 6, auricular Zero, Shen men
- Botanical nervines/sedatives
1. Melissa officinalis, chamomile, passionflower, valerian, lavender
2. Irritability, aggression, sleep, anxiety
- Nutraceuticals
1. Zinc: synergistic with stimulants
2. Multivitamin: poor appetite and low weight
3. Probiotics: help with constipation (diet modifications, water intake)
4. Omega 3 fatty acids: brain cell health
5. Magnesium: deficiencies, muscular tension
Which of the following is NOT a first-line treatment for mild depression in children?
A) Selective Serotonin Reuptake Inhibitors (SSRIs)
B) Cognitive Behavioral Therapy (CBT)
C) Psychoeducation with parental involvement
D) Close monitoring
Answer: A) Selective Serotonin Reuptake Inhibitors (SSRIs) because SSRIs are not first-line for mild depression; they are typically reserved for moderate-to-severe cases.
B is correct because CBT is a primary treatment for pediatric depression.
C is correct because psychoeducation helps parents support children and recognize symptoms.
D is correct because close monitoring is recommended in mild cases before initiating medication.
==================================
Depression Treatment
- Mild: close monitoring + psychoeducation with parents
- Moderate-severe: treatment for depressive episode, help family respond to patient’s emotional needs, build supports in the school setting
- CBT and interpersonal therapy, psycohotherapy
- Toddlers/young children: parent-child relational
therapies
- Evidence: CBT and interpersonal therapy + Fluoxetine in the first 12 weeks (2 psychotherapy treatments and medication)
Which antidepressant is contraindicated in patients with a history of seizures or bulimia nervosa?
A) Fluoxetine
B) Bupropion
C) Sertraline
D) Duloxetine
Answer: B) Bupropion
B is correct because bupropion lowers seizure threshold and is contraindicated in seizure disorders and bulimia nervosa, both of which increase the risk of seizures.
Explanation:
A is incorrect because Fluoxetine is commonly used in depression.
C is incorrect because Sertraline is safe in these populations.
D is incorrect because Duloxetine is an SNRI, not primarily associated with seizure risk.
==================================
Medications for depression
- SNRIs: venlafaxine, duloxetine etc.
1. Contraindicated in HTN
2. Side effects: nausea, nervousness, sweating, skin issues, suicidal ideation
- Bupropion: few anticholinergic and cardiotoxic effects
1. Interferes with sleep
2. Contraindicated with seizure disorder or bulimia
nervosa
3. Side effects: psychomotor activation, headache,
nausea, anorexia, weight loss, insomnia, seizures (does
>450mg/d)
Which of the following is a major concern associated with all antidepressants in children and adolescents?
A) Increased risk of suicide
B) Significant weight gain
C) Hypertension
D) High risk of dependence and addiction
Answer: A) Increased risk of suicide bcause all antidepressants carry a “black box warning” for increased risk of suicidal ideation in young patients.
Explanation:
B is incorrect because weight gain is more common with mirtazapine but not all antidepressants.
C is incorrect because hypertension is a concern with SNRIs but not with SSRIs in general.
D is incorrect because antidepressants are not addictive, unlike benzodiazepines.
=======================
Depression medication most significant Suicide
- Most significant side effect associated with episodes
- Higher risk for substance abuse and self injurious behaviours
- Co-exists with ADHD, ODD, anxiety, eating disorders, substance abuse disorders, hypothyroidism
- “Black box warning” on all antidepressants
* Prognosis
- Psychoeducation, psychotherapy, medication assessment, evaluation of school/home environments can lead to remission in 1-2 months, then continued for 6-12 months
1. Reassess every 6 months to help prevent relapses or treat
acute episodes
Which of the following medications is contraindicated in a patient with hypertension?
A) Sertraline
B) Mirtazapine
C) Venlafaxine
D) Fluoxetine
swer: C) Venlafaxine because Venlafaxine (SNRI) can increase blood pressure and is contraindicated in hypertension.
Explanation:
A is incorrect because Sertraline does not raise blood pressure significantly.
B is incorrect because Mirtazapine has sedative and weight-gaining effects, but no major hypertensive risk.
D is incorrect because Fluoxetine does not significantly affect BP.
Which of the following antidepressants enhances central nonadrenergic and serotonin activity?
A) Mirtazapine
B) Sertraline
C) Bupropion
D) Venlafaxine
Correct Answer: A) Mirtazapinevbecause Mirtazapine enhances central noradrenergic and serotonin activity.
Explanation:
B is incorrect because Sertraline is an SSRI that primarily affects serotonin reuptake.
C is incorrect because Bupropion primarily affects dopamine and norepinephrine, not serotonin.
D is incorrect because Venlafaxine is an SNRI that inhibits serotonin and norepinephrine reuptake rather than enhancing their activity directly
================
Depression Medications
- Mirtazapine: enhances central nonadrenergic and
serotonin activity
1. Contraindicated with MAOIs
2. Side effects: liver failure, neutropenia, agranulocytosis, dry mouth, increase appetite, constipation, weight gain, increased sedation
- Tricyclic Antidepressants (TCAs): imipramine, desipramine, clomipramine, nortriptyline, amitriptyline
1. High risk side effect profile–>not recommended for
children and adolescents
Which of the following statements about Generalized Anxiety Disorder (GAD) is FALSE?
A) Symptoms can include physical manifestations like headaches, abdominal pain, and palpitations.
B) It is commonly misdiagnosed when physical symptoms are mistaken for anxiety.
C) Drug-induced anxiety can be caused by medications such as thyroid hormones and beta-adrenergic agonists.
D) GAD is most commonly diagnosed in infants and toddlers.
Correct Answer: D) GAD is most commonly diagnosed in infants and toddlers.
Explanation:
A is correct because GAD often presents with physical symptoms such as headaches, abdominal pain, and palpitations.
B is correct because it is important to investigate physical symptoms to avoid misdiagnosing them as anxiety.
C is correct because drugs like caffeine, amphetamines, beta-adrenergic agonists, and thyroid hormones can induce anxiety symptoms.
D is incorrect because GAD is more commonly diagnosed in school-age children and adolescents, not infants and toddlers.
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* Generalized Anxiety Disorder (GAD)
- Anticipation of fear/anxiety that is excessive or persisting beyond the developmentally appropriate period
1. 10% of school age children have some sort of anxiety
disorder
- Fear/anxiety accompanies by behavioural disturbances
or physical manifestations
- Symptoms cause functional impairment or significant
distress
GAD
* Diagnosis
- Associated symptoms: headaches, abdominal pain, dependance on home/parents, avoidance of anxiety producing stimuli, decreased school performance, self doubt, irritability, frightening themes in play and fantasy, hyperactivity, sleep disturbances, decreased concentration, ritualistic behaviours, dizziness, palpitations, shortness of breath, flushing sweating, dry mouth, panic, nausea, vomiting
1. Very important to not misdiagnose a physical symptom as anxiety -> investigate the root cause of their physical symptoms
2. Drug induced: caffeine, marijuana, amphetamines, cocaine, alcohol, steroids, tacrolimus, B adrenergic agonists, dopamine agonists, angiotesin-converting enzyme inhibitors, thyroids medication, procaine derivatives
3. Illnesses: hyperthyroid, hypoglycemia, hypoxia, pheochromocytoma
- Comorbidities: depression
Which of the following is a common obsession in children with OCD?
A) Need for symmetry
B) Repetitive counting
C) Nail biting
D) Difficulty focusing on schoolwork
Explanation:
A is correct because the need for symmetry is a common obsession in OCD.
B is incorrect because repetitive counting is a compulsion, not an obsession.
C is incorrect because nail-biting is more commonly associated with general anxiety rather than OCD-specific obsessions.
D is incorrect because difficulty focusing on schoolwork is a nonspecific symptom that can be associated with ADHD, anxiety, or depression rather than being a hallmark of OCD.
====================================Obsessive Compulsive Disorder (OCD)
* Onset: childhood, if untreated can have a lifelong course
- Males: earlier onset, <10 yrs
- Leads to avoidance of situations which interferes with development
* Recurrent obsessive thoughts, impulses or images that are experiences as intrusive at times
* Repetitive compulsive behaviours or mental acts that are performed to prevent or reduce distress from obsessive thoughts
* Obsessions and compulsions cause distress, time consuming (last >2 hours/day) and interfere with normal activities
OCD
* Examples of obsessions
- Sexual, aggressive or religiously taboo images
- Thoughts of contamination
- Need for symmetry
- Fears of harming others, oneself or loved ones
- Obsessions bring about panic, depression, irritability and
suicidality
- Hard to see in children because of internal thoughts
- Adolescence will try to hide their thoughts
* Obsessions can change over time
* Sudden onset of symptoms: screen child for group A strep infections (PANDAS-pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)
Obsessive Compulsive Disorder (OCD)
* Onset: childhood, if untreated can have a lifelong course
- Males: earlier onset, <10 yrs
- Leads to avoidance of situations which interferes with development
* Recurrent obsessive thoughts, impulses or images that are experiences as intrusive at times
* Repetitive compulsive behaviours or mental acts that are performed to prevent or reduce distress from obsessive thoughts
* Obsessions and compulsions cause distress, time consuming (last >2 hours/day) and interfere with normal activities
OCD
* Examples of obsessions
- Sexual, aggressive or religiously taboo images
- Thoughts of contamination
- Need for symmetry
- Fears of harming others, oneself or loved ones
- Obsessions bring about panic, depression, irritability and
suicidality
- Hard to see in children because of internal thoughts
- Adolescence will try to hide their thoughts
* Obsessions can change over time
* Sudden onset of symptoms: screen child for group A strep infections (PANDAS-pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)
Which of the following treatments has the most evidence for effectiveness in pediatric OCD?
A) Psychoeducation alone
B) Cognitive Behavioral Therapy (CBT)
C) Benzodiazepines
D) Antihistamines
Correct Answer: B) Cognitive Behavioral Therapy (CBT) because CBT is the gold standard treatment for OCD, helping patients manage obsessions and compulsions effectively.
Explanation:
A is incorrect because psychoeducation is helpful but insufficient as a standalone treatment.
C is incorrect because benzodiazepines are not first-line treatments for OCD and pose a risk of dependency.
D is incorrect because antihistamines are sometimes used for anxiety but are not a primary treatment for OCD.
=================
OCD Treatment
- Psychoeducation: puts symptoms in perspective and outline
treatment progression
- Combination of CBT and medication (severe cases)
1. SSRIs: diminish symptoms, sometimes with higher doses
2. Fluoxetine, fluvoxamine, sertraline for pediatric OCD
3. Tricyclic antidepressants clomipramine for adults
4. Severe cases: gamma knife brain surgery
5. Neurofeedback, transcranial magnetic stimulation: not FDA
approved
* Comorbidities
- Anxiety, ADHD, depression and tics
- Differential diagnosis: eating disorders, psychotic disorders,
obsessive compulsive personality disorder
Which of the following is a reason why GAD can be misdiagnosed?
A) Many physical symptoms overlap with medical conditions
B) It only presents with psychological symptoms, not physical ones
C) Anxiety is always easy to distinguish from medical conditions
D) GAD does not cause functional impairment
Answer:
✅ A) Many physical symptoms overlap with medical conditions → Correct. GAD presents with symptoms like palpitations, dizziness, and nausea, which can also be seen in conditions like hyperthyroidism, cardiac arrhythmias, or hypoglycemia.
❌ B) It only presents with psychological symptoms, not physical ones → Incorrect. GAD presents with both psychological (worry, fear) and physical symptoms (headaches, stomachaches, etc.).
❌ C) Anxiety is always easy to distinguish from medical conditions → Incorrect. A careful differential diagnosis is needed to rule out organic causes before concluding that symptoms are due to anxiety.
❌ D) GAD does not cause functional impairment → Incorrect. GAD can significantly impact daily life, including school/work performance, relationships, and overall well-being.
What is the most evidence-based psychological treatment for PTSD in children?
A) Exposure therapy
B) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
C) Psychoanalysis
D) Benzodiazepines
Answer:
✅ B) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) → Correct. TF-CBT is the most evidence-based therapy for PTSD in children and adolescents, helping them process trauma in a structured manner.
❌ A) Exposure therapy → Incorrect. While exposure techniques are used within TF-CBT, general exposure therapy alone may not be as effective for PTSD.
❌ C) Psychoanalysis → Incorrect. There is limited evidence for psychoanalysis in treating PTSD, especially in children.
❌ D) Benzodiazepines → Incorrect. Benzodiazepines are not first-line treatment for PTSD in children due to risks of dependence and limited efficacy.
===========================
PTSD Treatment
- Trauma focused CBT (TF-CBT): most evidence for
children and adolescence
- Establish daily routines
- In severe cases: pharmacology to treat the associated symptoms: antiadrenergic agents, mood stabilizers, 2nd generation antipsychoticsall for treating secondary effects since there is no medication that is FDA approved for treating PTSD specifically in children
1. Children who lived in abusive environments for years
and/or who experienced multiple traumas
Which of the following statements about OCD in children is true?
A) Children with OCD always recognize their compulsions as irrational
B) Pediatric OCD can be associated with streptococcal infections (PANDAS)
C) Obsessions do not change over time
D) OCD cannot be diagnosed if symptoms last less than 6 months
Answer: ✅ B) Pediatric OCD can be associated with streptococcal infections (PANDAS) → Correct. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) is a subset of OCD that can occur after group A streptococcal infections.
❌ A) Children with OCD always recognize their compulsions as irrational → Incorrect. Young children may not have full insight into the irrational nature of their compulsions.
❌ C) Obsessions do not change over time → Incorrect. Obsessions can evolve with age and environmental influences.
❌ D) OCD cannot be diagnosed if symptoms last less than 6 months → Incorrect. OCD is diagnosed if symptoms persist for more than 2 hours a day and interfere with daily life, not based on a 6-month duration.
==================================
Obsessive Compulsive Disorder Onset: childhood, if untreated can have a lifelong course
- Males: earlier onset, <10 yrs
- Leads to avoidance of situations which interferes with development
* Recurrent obsessive thoughts, impulses or images that are experiences as intrusive at times
* Repetitive compulsive behaviours or mental acts that are performed to prevent or reduce distress from obsessive thoughts
* Obsessions and compulsions cause distress, time consuming (last >2 hours/day) and interfere with normal activities
OCD Examples of obsessions
- Sexual, aggressive or religiously taboo images
- Thoughts of contamination
- Need for symmetry
- Fears of harming others, oneself or loved ones
- Obsessions bring about panic, depression, irritability and
suicidality
- Hard to see in children because of internal thoughts
- Adolescence will try to hide their thoughts
* Obsessions can change over time
* Sudden onset of symptoms: screen child for group A strep infections (PANDAS-pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)
Which of the following is NOT a known risk factor for the development of eating disorders?
A) Gymnastics and ballet
B) Genetic predisposition
C) Hypothyroidism
D) Media influence
Answer:
✅ C) Hypothyroidism → Correct. Hypothyroidism can cause weight changes but is not a risk factor for eating disorders. Instead, it should be ruled out in patients presenting with significant weight fluctuations.
❌ A) Gymnastics and ballet → Incorrect. Sports that emphasize body weight and shape, like gymnastics and ballet, are associated with higher rates of eating disorders.
❌ B) Genetic predisposition → Incorrect. Family history plays a significant role, with studies showing higher incidence in first-degree relatives.
❌ D) Media influence → Incorrect. Unrealistic portrayals of beauty in media contribute to body dissatisfaction and disordered eating behaviors.
❌ D) Media influence → Incorrect. Unrealistic portrayals of beauty in media contribute to body dissatisfaction and disordered eating behaviors.
Answer: ✅ C) Hypothyroidism → Correct. Hypothyroidism can cause weight changes but is not a risk factor for eating disorders. Instead, it should be ruled out in patients presenting with significant weight fluctuations.
❌ A) Gymnastics and ballet → Incorrect. Sports that emphasize body weight and shape, like gymnastics and ballet, are associated with higher rates of eating disorders.
❌ B) Genetic predisposition → Incorrect. Family history plays a significant role, with studies showing higher incidence in first-degree relatives.
Etiology of Eating Disorders
- Evidence for genetic component
1. 7% incidence for anorexia in first degree relative
2. Monozygotic twins: 55% concordance rate
- Altered serotonergic and dopaminergic function and
alterations in neuropeptides and gut peptides
1. Blunted serotonin responses to eating and satiety
- Leptin physiology is damaged in anorexia patient
- Enmeshment of mother/daughter: no identity
- Fear or dislike of body changes in puberty
- Transgender youth use food to restriction to control pubertal
development
- Media: unrealistic constructs of beauty and healthy bodies
- Incidence: 1-2% of teenagers develop anorexia and 2-4%
develop bulimia, 10% of those patients are male
Eating Disorders
* Predisposing factors
- Gymnastic
- figure skating
- Ballet
- activities that emphasize thin bodies
A patient with bulimia nervosa who frequently self-induces vomiting is at risk for which electrolyte imbalance?
A) Hyperkalemia
B) Metabolic acidosis
C) Metabolic alkalosis
D) Hypernatremia
Answer: ✅ C) Metabolic alkalosis → Correct. Repeated vomiting leads to loss of stomach acid (HCl), resulting in metabolic alkalosis and hypokalemia.
❌ A) Hyperkalemia → Incorrect. Bulimia causes hypokalemia due to excessive vomiting and loss of potassium.
❌ B) Metabolic acidosis → Incorrect. Metabolic acidosis occurs with laxative abuse, not vomiting.
❌ D) Hypernatremia → Incorrect. While dehydration may cause hypernatremia in some cases, electrolyte disturbances in bulimia are more commonly characterized by hypokalemia, hypochloremia, and metabolic alkalosis.
=================================
Bulimia Nervosa
* Recurrent episodes of binge eating with
- Eating an amount of food that is larger than what most
people would eat
- Sense of lack of control during the episode
* Recurrent inappropriate compensatory behaviour to prevent weight gain: self induced vomiting, laxative misuse, diuretics, overexercising due to extreme guilt
* Symptoms occur once a week for 3 months
Bulimia Nervosa Diagnosis
- Difficult unless adolescent is forthcoming: usually normal or slightly overweight
- Assess eating patterns, binge eating, loss of control over food, use
of laxatives, self induced vomiting
- Involuntary vomiting or food coming up is reported
- Sialadenitis: parotid gland enlargement and pain
- PE: dehydration signs, orthostatic hypotension, tooth enamel
loss/dental. Caries, abdominal tenderness
* Labs
- Electrolytes disturbances
- Vomiting: metabolic alkalosis, hypokalemia, hypochloremia
- Laxatives: metabolic acidosis, hypokalemia, hypochloremia
- Diuretics: hypokalemia, hyponatremia, hypocalcemia, metabolic
alkalosis
Posttraumatic Stress Disorder (PTSD)
Which of the following is NOT a core symptom of PTSD?
A) Hypervigilance
B) Avoidance of trauma-related stimuli
C) Elevated mood and increased energy
D) Flashbacks
Correct Answer: C) Elevated mood and increased energy– PTSD is characterized by negative mood changes, such as fear, irritability, and emotional detachment, not elevated mood or increased energy.
❌ A) Hypervigilance – PTSD often includes arousal symptoms like being on edge, difficulty sleeping, and being easily startled.
❌ B) Avoidance of trauma-related stimuli – Individuals with PTSD frequently avoid anything that reminds them of the traumatic event.
❌ D) Flashbacks – PTSD is associated with re-experiencing the trauma through nightmares, intrusive thoughts, and flashbacks.
=================================
PTSD characteristics
* Arousal and reactivity such as hypervigilance, difficulty concentrating, sleep disturbance
* Avoidance of reminders of the trauma
* Negative changes in thought and mood
* Flashbacks to a traumatic event such as nightmares, intrusive thoughts or repetitive play
* Follows traumatic events: violence, physical or sexual abuse, natural disasters, car accidents, dog bites, unsuspected personal tragedies
Which of the following describes Purging Disorder?
A) Purging occurs, but there is no binge eating
B) Purging occurs at least twice a week for 3 months
C) Purging is followed by excessive exercise
D) Purging is only seen in Anorexia Nervosa
Correct Answer: A) Purging occurs, but there is no binge eating ✅ but there is no binge eating – Purging Disorder is characterized by recurrent purging (vomiting, laxatives, diuretics) without episodes of binge eating.
❌ B) Purging occurs at least twice a week for 3 months – This was an old DSM-IV criterion for Bulimia Nervosa, but frequency is not a distinguishing factor in Purging Disorder.
❌ C) Purging is followed by excessive exercise – Excessive exercise can be present in various eating disorders but is not a defining feature of Purging Disorder.
❌ D) Purging is only seen in Anorexia Nervosa – Purging is present in multiple disorders, including Bulimia Nervosa and Purging Disorder.
==================================
Other Specified Feeding or Eating Disorders
* Feeding or eating behaviours that cause clinically significant distress and impairment but do not meet criteria for other eating disorders mentioned
- Atypical Anorexia: only difference is weight is within or
above normal range
- Limited duration Bulimia: occurs for less than 3 months
- Purging Disorder: recurrent purging but no binge eating
- Night Eating Syndrome: excessive eating after waking
up in the middle of the night or after the evening meal
Avoidant/Restrictive Food Intake Disorder (ARFID)
Which of the following is a defining feature of ARFID?
A) Intense fear of weight gain
B) Food restriction leading to weight loss or nutritional deficiency
C) Frequent binge eating episodes
D) Preoccupation with body image
**Correct Answer: B) Food restriction leading to weight loss or nutritional deficiency ✅ – ARFID is characterized by avoidance of food due to sensory sensitivities, fear of choking, or lack of interest, leading to weight loss or deficiencies.
❌ A) Intense fear of weight gain – ARFID is not associated with body image concerns, unlike Anorexia or Bulimia.
❌ C) Frequent binge eating episodes – Binge eating is not part of ARFID.
❌ D) Preoccupation with body image – Unlike Anorexia and Bulimia, ARFID is not driven by body dissatisfaction.
================================
Avoidant/Restrictive Food Intake Disorder
* Avoiding food because of sensory characteristics, concern for averse consequences of eating, failing to meet nutrition requirements, plus one or more of
- Weight loss
- Nutritional deficiency
- Dependance on enteral feeding or oral nutritional
supplementation
- Interference with psychosocial functioning
* Not associated with lack of available food or culturally sanctioned practices
* No disturbance in body weight or shape
* Not attributed to medical conditions, mental disorder
Case: 9-year-old boy with repetitive thoughts about time
A 9-year-old boy’s parents report that he constantly asks about time, spends hours adjusting his toy clock, and experiences extreme distress when schedules change. What is the most likely diagnosis?
A) Generalized Anxiety Disorder (GAD)
B) Obsessive-Compulsive Disorder (OCD)
C) Attention-Deficit Hyperactivity Disorder (ADHD)
D) Autism Spectrum Disorder (ASD)
Correct Answer: ✅ B) OCD – The child’s repetitive thoughts (obsessions) about time and compulsive behavior (adjusting the clock) strongly suggest OCD.
❌ A) GAD – While GAD involves excessive worrying, it is usually broader and not tied to specific, compulsive rituals.
❌ C) ADHD – ADHD is marked by inattention and hyperactivity, not obsessive rituals.
❌ D) ASD – While ASD involves restricted interests, OCD’s key feature is distress when routines are disrupted, which fits this case better.
Case: 16-year-old girl avoiding meals and socializing
A 16-year-old girl has become withdrawn, lost interest in activities, wears baggy clothes, and avoids family mealtimes. What is the most likely diagnosis?
A) Major Depressive Disorder (MDD)
B) Anorexia Nervosa
C) Social Anxiety Disorder
D) Avoidant/Restrictive Food Intake Disorder (ARFID)
Correct Answer: ✅ B) Anorexia Nervosa – Social withdrawal, meal avoidance, and baggy clothing (to hide weight loss) strongly suggest Anorexia.
❌ A) MDD – While depression can cause withdrawal, it does not typically include meal avoidance or preoccupation with weight.
❌ C) Social Anxiety Disorder – Social anxiety is fear-based but does not typically lead to food restriction.
❌ D) ARFID – ARFID lacks body image concerns, while Anorexia does.
Case: 17-year-old male with weight loss and low mood
A 17-year-old male reports low mood, loss of interest in activities, reduced appetite, and weight loss over the past two months. What is the most likely diagnosis?
A) Generalized Anxiety Disorder
B) Major Depressive Disorder
C) Anorexia Nervosa
D) Social Anxiety Disorder
Correct Answer: B) Major Depressive Disorder
✅ B) MDD – Persistent low mood, social withdrawal, and weight loss due to loss of appetite are hallmark signs of depression.
❌ A) GAD – GAD involves chronic worry, not necessarily weight loss.
❌ C) Anorexia Nervosa – There is no mention of body image concerns, which are central to Anorexia.
❌ D) Social Anxiety Disorder – While social withdrawal is seen in SAD, the low mood and appetite loss make depression more likely.
Which of the following is a potential short-term complication of Bulimia Nervosa?
A) Barrett esophagitis
B) Osteoporosis
C) Hypoglycemia
D) Type 2 diabetes
Correct Answer: ✅ A) Barrett esophagitis – Chronic acid reflux from purging can cause esophagitis, which may lead to Barrett esophagus, a precancerous condition.
❌ B) Osteoporosis – More commonly associated with Anorexia Nervosa due to prolonged malnutrition and low estrogen levels, not a direct short-term complication of Bulimia.
❌ C) Hypoglycemia – Bulimia Nervosa does not primarily cause hypoglycemia; it is more common in Anorexia or insulin-related conditions.
❌ D) Type 2 diabetes – While eating disorders can impact metabolism, Type 2 diabetes is more often linked to prolonged obesity, not Bulimia.
Which of the following is an indication for inpatient hospitalization in Bulimia Nervosa?
A) Presence of depressive symptoms
B) Failure to gain weight
C) Hypokalemia
D) Mild electrolyte imbalances
✅ C) Hypokalemia – Severe electrolyte imbalances, particularly hypokalemia (low potassium), can lead to life-threatening cardiac complications, necessitating inpatient hospitalization.
❌ A) Presence of depressive symptoms – While depression is common in Bulimia Nervosa, it does not automatically require inpatient care unless there is a risk of self-harm.
❌ B) Failure to gain weight – More characteristic of Anorexia Nervosa, where weight restoration is a priority. Bulimia patients often have normal weight or mild fluctuations.
❌ D) Mild electrolyte imbalances – Mild imbalances can often be managed in outpatient care with dietary and medical interventions.
Which medication is FDA-approved for the treatment of Bulimia Nervosa in adolescents?
A) Sertraline (Zoloft)
B) Fluoxetine (Prozac)
C) Bupropion (Wellbutrin)
D) Venlafaxine (Effexor)
Correct Answer: ✅ B) Fluoxetine (Prozac) – Fluoxetine, at a dose of 60 mg/day, is the only FDA-approved SSRI for reducing the binge-purge cycle in adolescents with Bulimia.
❌ A) Sertraline (Zoloft) – Although an SSRI, it is not specifically FDA-approved for Bulimia.
❌ C) Bupropion (Wellbutrin) – Contraindicated in Bulimia Nervosa due to increased risk of seizures.
❌ D) Venlafaxine (Effexor) – A serotonin-norepinephrine reuptake inhibitor (SNRI) used for depression and anxiety but not first-line for Bulimia Nervosa.
==================================
Bulimia Nervosa
* Short term complications
- Esophageal rupture, acute/chronic esophagitis, Barrett
esophagitis
- Chronic dehydration with laxative use
1. Congestive heart failure
* Treatment
- Inpatient hospitalization when hypokalemia is present,
supplemental potassium
- Outpatient management: CBT, nutrition therapy,
medical monitoring
- SSRIs helps to stop the binge-purge cycle in adolescents
1. Fluoxetine, 60mg/d
