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Pediatrics 2 Flashcards

1
Q

kid with drooling fever odynophagia dysphagia muffled voice and trismus what can cause that(3)

A

infection of larynx
Pharynx
or

deep neck space

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2
Q

clue for retropharyngeal abcess in the setting of drooling fever odynophagia dysphagia muffled voice and trismus(2)

A

inability to extend the neck

widened prevertebral space in lateral xray

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3
Q

complication of retropharyngeal abcess(4)

A

airway compromise
bactriemia
carotid artery rupture
jugular venous thrombosis

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4
Q

cause of retropharyngeal abcess

A

direct spread infection from paharyngitis
tonsilitis
otitis media
or sinusitis

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5
Q

bugs involved in retropharyngeal abcess

A

polymicrobial

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6
Q

stable patient with retropharyngeal abcess

A

polymicrobial

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7
Q

clue for early congenital syphilis(5)

A 
hepatosplenomegaly
cutaneous lesion
jaundice
anemia
rhinorrhea
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8
Q

xray in congental syphilis(2)

A

metaphyseal dystrophy

periostitis

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9
Q

late manifestation of congenital syphilis (7)

A 
2 years
frontal bossing
high arched palate
hutchinson teeth
intersticial keratitis
saddle nose
perioral fissures
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10
Q

screening test for syphilis(3)

A

VDRL
RPR
Enzyme immunoassay

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11
Q

confirmatory test for syphilis(3)

A

FTA-ABS

TPPA=traponema particle agglutination assay

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12
Q

in the vignette the clue for syphilis congenital

A

ulcerative on his feet

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13
Q

3 phases of pertussis

A

catarrhal
paroxysmal
convalescent

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14
Q

immunisation in pertusis(2)

A

5 doses of Tdap from 2 months and 6 years

TDAP booster age 11-18 and during pregnancy

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15
Q

CBC in pertussis

A

lymphocyte predominant leukocytosis

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16
Q

does immunization protects for life

A

no immunity doen not provide lifelong immunity

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17
Q

confirmatory dx of pertussis(2)

A

bacterial culture

PCR

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18
Q

rx of pertussis

A

macrolides

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19
Q

complication of pertussis(5)

A 
pneumonia
weight loss
subonjonctival hemorage
pneumothorax
respiratory failure and deat
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20
Q

clue in catarrhal phase

A

mild cough

rhinitis

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21
Q

duration of catarrhal phase

A

1-2 weeks

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22
Q

clue for paroxysmal phase(4)

A

20-30 mn coughing paroxysms
inspiratory whoop
staccato cough
posttussive emesis

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23
Q

duration of paroxysmal phase

A

2 - 6 weeks

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24
Q

clue for convalescent phase(2)

A

cough and

post tussive emesis resolve

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25
duration of convalecent phase
weeks to months
26
osteomyelitis in sickle cell disease(2)
salmonella # 1 | staph aureus
27
important clue to dx pertussis
inadequate vaccination
28
predisposing factor for sinusitis
viral upper respiratory infection
29
clue for sinusitis(4)
erythema and swelling of the nasal turbinates purulent drainage congestion cough
30
quid of preseptal cellulitis
mild infection of the eyelid anterior to the orbital septum
31
quid of orbital cellulitis
seriuos infection post to the orbital septum
32
clue to distinguish preseptal from orbital cellulitis
ophtalmoplegia in orbital cellulitis(diplopia)
33
eye problem in orbiatl cellulitis(4)
decreased visual acuity diplopia ophtalmoplegia proptosis
34
dangerous complication of orbital cellulitis(4)
blindness intracranial infection orbital abscess cavernous sinus thrombosis
35
characteristic of non inflammatory joint fuid(3)
clear 200-2000 wbc 25% PMN
36
example of non inflammatory joint disease
OA
37
characteristics of inflammatory joint fluid(3)
translucent and opaque 2000-100000 wbc often> 50% PMN
38
example of inflammatory joint disease(2)
crystal | RA
39
characteristics of septic joint(3)
opaque 50 000-150 000 WBC often 80%-90 %
40
first bug in septic joint
staph aureus
41
rx of septic joint(2)
IV antibiotics | emergency surgical drainage
42
complication of septic joint
permanent joint destruction
43
most frequent complication of mumps
orchitis
44
febrile illness with development of rash 1 day after taking amox which infection should be suspected and dx(2)
epstein barr virus | post antibio rash
45
triad in Mononucleosis infection(3)
exsudative tonsillitis or pharyngitis posterior or diffuse cervical lymhadenopathy fever
46
presentation of post antibiotoc rash(2)
polymorphous | maculopapular
47
break time in sport during mononucleosis
> ou egal a 3 semaines
48
common oropharyngeal lesions in kid(5)
``` aphtous stomatitis herpangina herpes gingivostomatitis group A streptococal pharyngitis infectious mono ```
49
quid of aphtous lesions or canker sores(2)
reccurent ant oral mucosa ulcers | no fever
50
localisation of ulcers in canker sores(4)
lips cheeks mouth floor ventrum of the tongue
51
clue for herpangina(2)
vesicles and ulcer on post oropharynx | fever
52
clue for gingivostomatitis
vesicles and ulcer on ant oropharynx | fever
53
clue for group A strep pharyngitis(3)
tonsillar exsudates fever anterior cervical lymphadenopathy
54
cause of unilateral cervical adenitis in children(5)
``` staph aureus and staph pyogenes anaerobic bacteria non tuberculos bacteria Mycobacterium TB bartonella henselae ```
55
clue for adenitis induced by staph and strep(2)
associated cellulitis or suppuration
56
rx of adenitis induced by staph or strep
clindamycin | incision and drainage
57
risk factor for anaerobic bacteria induced adenitis(2)
dental caries | periodontal disease
58
rx of anaerobe adenitis(2)
clindamycin | augmentin
59
clue for non TB mycobacteria adenitis
rarely tender
60
rx of non tb mycobacteria adenitis(2)
excision | macrolide +/- rifampin
61
clue for adenitis caused by bartonella hensellae
exposure to kittens or cats
62
rx for adenitis caused by bartonella hensellae
no needed
63
contraindication to rotavirus vaccination(4)
history of antissuception anaphylaxis to vaccine ingredients history of uncorrected congenital malformation in the GI like Meckel severe combined immunodeficiency
64
age for administration of rotavirus
2-6 months
65
management of cat bite
augmentin pendant 5 jours
66
most common cause of osteomyelitis in kid
staph aureus
67
most common cause of acute tender lymph node in kids
staph aureus
68
clue for rhinosinusitis(3)
persistent symptom> ou egal a 10 jours without improvement or severe symptoms including fever> ou egal 39,purulent discharge or face pain> ou egal a 3 days or worsening symptoms > ou egal a 5 jours after initially improving viral upper respiratory infection
69
bugs causing rhinosinusitis(2)
step pneumoniae | nontypeable haemophilus influenzae
70
rx of choice of bact rhinosinusitis
augmentin
71
step in management of septic joint with effusion(4)
Labs de routine xray arthrocentesis (in some vignette arthrocentesis is more important than Xray)
72
osteomyelitis in kid less than 3 years(3)
staph group B streptococcus gram negative bacilli
73
osteomyelitis in kid more than 3 years(3)
staph aureus group A streptococci strep pneumo
74
rx of osteomyelitis in kid less than 3(2)
nafcillin or vancomycin plus gentamycin or cefotaxime
75
rx of osteomyelitis in kid more than 3(4)
``` nafcilin or clindamycin or cefazolin or vancomycin ```
76
quid of howel jolly bodies(2)
single round blue inclusions on wright stain | nuclear remnants
77
quid of aplastic anemia
everything is low
78
acquired cause of aplastic anemia(6)
``` drugs toxic chemicals idopathic viral infection immune disorder thymoma ```
79
drugs causing aplastic anemia
NSAIDS | sulfonamides
80
toxic chemicals causing aplastic anemia(2)
benzene | glue
81
congenital cause of aplastic anemia
fanconie anemia
82
inheritance of fanconi(2)
autosomal recessive | or xlinked
83
risk in fanconi
cancer by the age of 16
84
Dx of fanconi
chromosomal breaks
85
clue for fanconi(4)
congenital marrow failure poor growth morphologic abnormalities macrocytic anemia
86
disease with cafe au laits spots(2)
fanconi | neurofibromatosis
87
eyes and ears problem in fanconi(3)
strabismus lot set ears middle ear abnormalities
88
middle ear abnormality in fanconi(4)
hemorrgae incomplete development chronic infections deafness
89
definitive rx in fanconi for the anemia
hematopoietic stem cell transplantation
90
most common complication of sickle cell disease
painless hematuria
91
why patient will sickle cell disease pee a lot at night
isisthenuria=inability to concentrate urine
92
kid with foot refent foo woung you decide to vaccinate for tetanos mother who is the guardian accepts but the father not what to do
administer the vaccine
93
in case of separated couple how do you proceed for the consent
the consent of one parent or the guardian is sufficient to perform
94
clue for wiskott aldrich syndrome(3)
low platelet plus eczema plus reccurent bacterial infection
95
cause of thrombocytopenia in wiskott
decreased platelet production
96
platelet in wiskott aldrich
small
97
inheritance of aldrich wiskott
x linked
98
clue for acute lymphoblastic leukemia(5)
``` bone pain lymphadenopathy hepatosplenomegaly pallor from anemia petechia from throbocytopenia ```
99
dx of acute lymphoblastic leukemia
bone marrow biopsy with >25 % lymphoblasts
100
most common cancer in childhood
ALL
101
peak of ALL
2 - 5 ans
102
rx of ALL
chemotherapy
103
clue in the USMLE for ALL(2)
infant | high WBC
104
nosebleed and congestion in a patient with CT shows visible mass at the back of the left nostril and erosion of the adjacent bone dx
angiofibroma
105
male adolescent with epistaxis and bone erosion on the back of the nose
angiofibroma until proven otherwise
106
when to rx angiofibroma(3)
if juvenile angiofibroma is enlarging obstructing the airway cause chronic nosebleeds
107
surgery in angiofibroma
risk of recurrence
108
xray in osteosarcoma of humerus(2)
sunburst periostal reaction | codman triangle
109
the most common bone tumor in kid and young adults
ostosarcoma
110
bone of predilection of osteosarcoma
long bone
111
quid of codman triangle
periostal elevation
112
rx of osteosarcoma(2)
tumor excision | chemotherapy
113
when to suspect herediatary spherocytosis(4)
coombs negative hemolytic anemia splenomegaly in the setting of reticulocytosis hyperbilirubinemia spherocytosis and family history of anemia
114
confirmatory dx of hereditary spherocytosis
eosin 5 maleimide and acidified glycerol lysis tests
115
stroke in kid next step
peripheral smear and reticulocyte count
116
stroke in kid cause
SCD
117
physiopatho of stroke in SCD(3)
unknown but we think red blood cell adherence to endothelium activation of von willbrand's factor's hyperviscosity
118
patient with history of easy bruising develops knee swelling after trauma first step
platelet count and coagulation studies
119
3 clue for bleeding disorders
prolonged bleeding after dental or minor procedures bruising at pressure points hemarthrosis
120
cause of bleeding disorder(4)
hemophilia A hemophilia B von willebrand disease platelet function disorder
121
disease with platelet dysfunction(2)
bernard souilier | glanzman thromboasthenia
122
patient knee pain and swollen without trauma xray show central lytic lesion onion skinning appearrance dx
ewings sarcoma
123
type of tumor in erwing sarcoma
malignant
124
xray in erwing sarcoma(3)
onion skin, lamelated appearance | with a moth eaten or mottled appearance and extension in soft tissue
125
dx differenciel in erwing sarcoma
osteomyelitis
126
lieu for metastasis in erwing cell sarcoma(2)
lung | lymph nodes
127
patient with reccurrent sinopulmonary infection and diarrrhea since childhood develops anaphylactic transfusion reaction after blood transfusion cause of that
IgA deficiency
128
confirmatory dx of IGA deficiency(2)
low IGA level | normal IGM and IGG
129
prevention of infection and death in SCD(2)
give PNC prophylaxis plus pneumococcal vaccination
130
admistration of PNC in SCD
twice a day | until they reach five yo
131
factors of coagulation missing in cystic fibrosis(3)
vit K dependent 2, 7,9 ,10 protein C et S
132
why you have problem of bleeding in cystic fibrosis(2)
pancreatic insufficiency | problem in liposoluble vit absorbtion
133
toddler with unilateral firm mass and hematuria
tumeur de wilms(nephroblastoma)
134
peak for wilms tumor
2-5 ans
135
associated syndrome with wilms tumor(3)
wagr beckwith wiedman syndrome denys drash syndrome
136
quid of WAGR syndrome(4)
wilms tumor aniridia genitourinary anomalies retardation mental
137
most common primary renl neoplasm in kid
wilms
138
dx of wilms(2)
1- contrast enhanced CT | 2- chest xray for metastasis
139
rx of wilms(3)
tumor excision or nephrectomy chemo +/- radiation therapy
140
prognosis for rx wilms
5 year survival rate with rx :90%
141
role of hydroxyurea
increase fetal Hb
142
side effect of hydroxyurea(3)
leukopenia anemia thrombocytopenia bref marrow suppression
143
marrrow suppression with hydroxyurea
temporary
144
polycythemia in newborn quid
central nervous hematocrit level greater than 65%
145
cause of polycythemia in newborns
delayed clamping of the umbilical cord
146
risk foor neonate in polycythemia(3)
respiratory distress poor feeding neurologic manif
147
clue for ALL(4)
more then 25 % de lymphoblast lymphoblast lacks of peroxydase positive granules but contain periodic acid schiff positive material immunostaining for terminal deoxynucleotidyltransferase
148
immunostaining in ALL
TDT expression dans 95% des cas
149
cells expressing TDT(2)
pre T lymphoblastes | Pre B lymphoblastes
150
SCD patient with hip pain first dx
osteonecrosis(avascular nerosis)
151
mosr common affected bone in osteonecrosis in (2)
humerus | fever
152
patient with SCD presenting with dyspnea fatigue Hg: hb 4,5 wbc: 10000 platelets:300 000 reticulocytes=0,1% dx
aplastic crisis
153
low HB in SCD causes (3)
aplastic crisis hemolysis splenic sequestration
154
differentiate aplastic crisis from aplastic anemia
aplastic anemia =pancytopenia in a patient without SCD
155
characteristics of iron deficiency anemia(8)
``` Hmt< 30% RDW increased total RBC decreased low serum iron ferritin increased TIBC responds to iron supplementation normal electrhoresis no target cells ```
156
characteristics of alpha thalassemia anemia(8)
``` Hmt.> 30% RDW normal total RBC normal normal to increased serum iron ferritin TIBC normal no responds to iron supplementation normal electrophoresis target cells ```
157
characteristics of beta thalassemia anemia(8)
``` Hmt.> 30% RDW normal total RBC normal to increased normal to increased serum iron ferritin TIBC normal no responds to iron supplementation electrophoresis=elevated hb A2 target cells ```
158
shistocytes in the settting of bloody diarhea administration of antibiotics,low Hb low platelet and high creat
microangiopathic hemolytic anemia
159
bugs involved in hus(5)
``` E coli 0157h7 shigella campylobacter salmonella yersinia ```
160
peripheral smear in HUS
schistocytes
161
continuous flow murmur in left sternla border in young child (son)
Patent ductus arteriosus
162
knee chest position of in fallot how it will improve cyanosis (2)
increased systemic vascular resistance | increases pulmonary blood flow
163
viral prodrome(rhinorrhea,fever) and heart failure
viral myocarditis
164
chest xray in viral myocarditis(2)
cardiomegaly | pulmonary edema
165
ECK in viral myocarditis
sinus tachycardia
166
echo in viral myocarditis(2)
decreased ejection fraction | diffuse hypokinesis
167
Biopsin in viral myocarditisdium with myocite necrosis(2)
gold standard | inflammatory infiltrate of the myocardium with myocite necrosis
168
prognosis of viral myocarditis in newborns
mortality 75%
169
prognosis of viral myocarditis in older infants and children
mortality in 25%
170
out come in viral myocarditis
full recovery within2-3 months 66% | dilated cardiomyopathy /chronic heart failure 33%
171
what dysfunction you have in viral myocarditis
systolic and diastolic
172
management of viral myocarditis(3)
ICU to reduce the risk of acute decompensatio fatal arythmia
173
antibiotics used in rheumatic fever prophylaxis
IM PNC G given q 4 semaines
174
duration of prophylaxis of rheumatic fever without carditis
5 years or until the patient reaches 21 yo
175
duration of prophylaxis of rheumatic fever with carditis but no residual heart or valvular disease clinical or by echo
10 years or until the patient reaches 21 yo
176
duration of prophylaxis of rheumatic fever with carditis and persistent heart or valvular disease
10 years or until 40 yo
177
why you give PNC in patient rheumatic fever(2)
to prevent recurrent group A streptococcus pharyngitis | limit progression of rheumatic heart disease
178
patient one day old comes for cyanosis ,pulse oxymetry 80% with no improvement with 100% inspired o2.continuous machine like murmur is heard on auscultation oral mucosa is blue dx
cyanotic heart disease
179
central cyanosis plus 70-90% oxygen saturation dx
cyanotic heart disease
180
what to do in front of cyanotic heart disease
prevent closure of ductus arteriosus by giving prostaglandine E 1
181
PDA dependent congenital heart disease(5)
``` coarction of the aorta D transposition of the great arteries hypoplastic left heart syndrome total pulmonary venous connection tricuspid atresia ```
182
cause of supraventricular tachycardia in adolescent
WPW
183
mechanism involved in WPW
accessory atrioventricular pathway
184
EKG of WPW(3)
shortened PR interval delta waves widening qrs complex
185
clue for tricuspid atresia
left axis deviation | decrease pulmonary markings on chest xray
186
why tricuspid atresia you have decrease pulmonary markings on chest xray
due to hypoplasia of the right ventricle and pulmonary outflow tract
187
neonatal with EKG shwsleft axis deviation
it's never normal
188
quid of tricuspid atresia
cyanotic heart disease
189
post pericardiotomy syndrome
pericardial effusion occurring within days or months after cardiac surgery
190
cardiomegalie with hypotension tachycardia muffled heart sound after surgery
pericardial effusion
191
most common heart malformation
VSD
192
clue for VSD
holosystolic murmur in left sternal border plus apical diastolic rumble
193
when will you have cyanosis in VSD
eisenmenger syndrome
194
quid of eisenmenger syndrome(2)
right to left shunt | unrepaired large VSD causes permanent pulmonary Hypertension and right to left shunt
195
cause of diastolic rumble in VSD at the apex
increased flow across the mitral valve
196
patietn 5y0 with asymptomaticgrade 2 left sternal border systolic ejection murmur best heard when the child is lying down and decreases with standing dx
benign chilhood murmurs
197
what to do in benign childhood murmur
observation
198
characteristics of inocent murmur(6)
``` asymptomatic no structural heart disease associated grade 2/6 early or mid systolic decreases with standing and valsalva have a normal associated s2 ```
199
characteristics of pathologic murmur(6)
``` syptomatic structural heart disease associated grade 3/6 or higher hars and holosystolic or diastolic increases with standing and valsalva loud s2 fixed s2 splitted ```
200
adolescent losing consciousness after crying or anytime she gets frustrated .EP normal dx and rx
breath holding spell | reassure the patients
201
type of breath holding spell(3)
pallid =patient pale cyanotic= mixed=cyanose plus seizure/pallid plus seizure
202
stridor improving with neck extension chez 1 patient de moins d'un an with cardiac abnormalities no improvement with epinephrine corticosteroids or bronchodilators
vascular ring
203
where can you have vascular rings(2)
trachea=stridor wheezing esophagus=dysphagia
204
age pour vascular ring
mois d'un an
205
risk in long Qt syndrome(3)
syncope ventricular arythmia sudden cardiac death
206
medication used in prevention of death in long Qt syndrome(2)
betablocker | pacemaker
207
what a patient with long qt syndrome should avoid(2)
electrolyte derangement | medications that block K+ channels
208
ventricular arythmia in long Qt syndrome
torsade de pointes
209
congenital cause of long Qt syndrome(2)
Jervell and lange nielsen syndrome=autosomal recessive romano ward syndrome=autosomal dominant
210
jervel and lange nielsen syndrome(3)
family history of sudden death congenital neurosensorineural deafness qt interval=600ms
211
what happen in jervell and lange nielsen syndrome
molecular defect in potassium channels
212
rx of JLN syndrome(3)
refrain from vogorous exercice maintaining normal ca++,K+and Mg++ avoid medication that can lengthen the qt interval
213
metabolic derangements causing long Qt syndrome(3)
hypocalcemia hypoK+ hypoMg++
214
antibiotics induced long qt syndrome(2)
macrolide | fluoquinolone
215
psychotics meds induced long qt syndrome(3)
antipsychotics TCA SSRI
216
opioids meds induced long qt syndrome(2)
methadone | oxycodone
217
antiemetics meds induced long qt syndrome(2)
ondansetron | granisetron
218
antiarythmics meds induced long qt syndrome(5)
``` quinidine procainamide flecainide amiodarone sotalol ```
219
Qt interval
debut qrs a fin onde T
220
scaly rash in eyebrows nasolabial fold and scalp dx
seborrheic dermatidis
221
rx of seborheic dermatidis(3)
moisturisers antifungals topical steroids
222
quid cradle cap
seborrheic dermatidis
223
platelet in henock shonlein purpura
normal
224
problem in henock shonlein purpura
IGA mediated vasculitis
225
clue for Henock shonlein purpura(4)
palpable purpura on lower extremities abdominal pain arthralgia renal involvement
226
atopic dermatitis in infant(2)
pruritis | skin lesions
227
skin lesions in atopic dermatitis localisation(4)
face scalp extensor surfaces diaper region is spared
228
rx of atopic dermatitis in kid
improve the skin barrier function through the use of mild cleanserss and thick bland emollients in addition to mild topical antiinflammatory ointments
229
Tinea corporis=date
erythematous scaly pruritic rash with central clearing
230
rx of tinea corporis
topical antifungals
231
dx of tinea corporis(2)
skin scraping | koh examination
232
rash in neonates(4)
erythema toxicum neonatorium neonatal herpes simplex virus neonatal varicella staphyloccocal scalded skin syndrome
233
quid of erythema toxicum neonatorium(2)
asymptomatic erythematous blanching macules ,papules and pustules throughout the bodies resolves spontaneously within 2 weeks after birth
234
Rx of erythema toxicum neonatorium
none
235
quid of neonatal herpes simplex virus(3)
vesicular clusters on skin eyes and mucous membranes central nervous system involvement fulminanat multiorgan failure
236
rx of neonatal herpes simplex virus
acyclovir
237
neonatal varicella(3)
fever vesicular clusters on skin fulminant disseminated disease
238
rx of neonatal varicella
acyclovir
239
quid of staphyloccocal scalded syndrome(4)
fever irritability and diffuse erythema followed by blistering and exfoliation positive nickolsky sign
240
rx of staphyloccocal scalded syndrome(3)
oxacillin or nafcillin or vancomycin
241
recommendtion during sunburn even if if the patient is suing factor 50 sunscreen and develops sunburn(prevention)
apply sun protection factor(15-30) or higher 50 sunscreen 15- 30 mn before sun exposure avoid tannig beds
242
rx of mild to moderate sunburn(4)
cool compresses aloe vera calamine lotion NSAIDS
243
severe sunburn rx(4)
hospitalization IV fluids analgesia wound care
244
complications of sunburn(2)
cancer | photoaging
245
cancer in sunburn(4)
melanoma basal cell carcinoma squamous cell carcinoma
246
after camping patietn presents with itching,burning and oozing skin lesions in both legs dx
allergic contact dermatitis
247
type of hypersenstivity in allergic contact dermatitis
cell mediated hypersensitivity
248
bugs in impetigo(2)
staph aureus | strep
249
2 types of impetigo
vesicular pustulous | bullous
250
cause of bullous impetigo
staphylococcus
251
characteristics of impetigo(3)
erythmatous papules rapidly evolves in vesicles and pustules and at last honey colored crusted exsudates
252
primary herpes simplex virus associated with dermatitis atopic
eczema herpeticum
253
clue for eczema herpeticum(2)
numerous vesicles over area of atopic dermatitis | fever
254
rx of eczema herpeticum(2)
can be life threatning | acyclovir
255
physiopatho of staphylococal scalded skin syndrome
toxins produced targeting desmoglein 1
256
role of desmoglein 1
keratinocyte adhesion in the superficial dermis
257
rash in staphylococal scalde skin syndromeSSSS(5)
``` 1- erythema starting on the face 2-generalizes in 24-48 h 3-superficial flaccid blisters develops 4 nickolsky sign posive 5-fever ```
258
age de SSSS(3)
children below 10 adults with kidney disease immune compromise patient
259
capillary hemangioma(strawberry)(2)
tumors composed of capillaries separated by connective tissues appear first week and regress by 5-8 yo
260
clue for measles(rubeola)(4)
cough coryza conjunctivitis koplik spots
261
rash in measles
maculor papular rash spreading in a cranial caudal pattern sparing palms and soles
262
prevention of measles
vaccination
263
rx of measles(2)
isolation in private room with negative air pressure and a minimum of 6-12 air changes per hour with door closed wear of facemask N95 by staff and parents
264
transmission of measles
respiratory droplets
265
dx of measles(2)
PCR | serology
266
what should be given to any kid with measles
vit A
267
complications of measles(4)
otitis media pneumonia neurologic gastroenteritis
268
neurologic complications in measles(3)
encephalitis within days acute disseminated encephalomyelitis(within weeks) subacute sclerosing panencephalitis(within years)
269
after trauma 5 yo kid develops headcahe vomiting and left pupil dilation dx possible
epidural hematoma
270
ct of epidural hematoma
biconvex mass on ct
271
indication of emergent craniotomy in epidural hematoma(5)
``` GCS< 8 sign of increased ICP pupillary abnormalities hemiparesis cerebellar signs ```
272
6 yo boy with poor feeding and bulging anterior fontanelle best next step in the management ot this baby
CT of the brain
273
clue for hydrocephalus
rapidly increasing in size of head circumference greater than the 97 th percentile(growth chart)
274
symptoms in hydrocephalus(4)
poor feeding irritability decreased activity vomiting
275
physical exam in hydrocephalus(4)
tense and bulging fontanelle prominent scalp veins widely spaced cranial sutures rapidly increasing head circumference
276
when using ultrasound in the setting of hydrocephalus
kid less than 6 months
277
drug of choice for absence seizure in kid(2)
ethosuximide(++++++) or acid valproic
278
patient with ear pain on antibio develops vomiting and awakened headaches inthe morning.Physical exam shows left tender mastoid next step in the patient
CT of brain
279
red flag for intracranial pathology
morning vomiting | nocturnal headaches
280
risk in otitis media or mastoiditis
brain abcess formation
281
dx of brain abcess formation
ring enhancing and hypointense center lesion on CT or MRI
282
ceiteria dx for febrile seizure(5)
``` age 6 months -6 years T.> ou egal a 38 no history of previous afebrile seizures no CNS infection no acute metabolic cause of seizure ```
283
quid of simple febrile seizure(3)
non focal (tonic clonic or atonic) one episode last< 15 mn or multiple episode< 30 mn
284
quid of complex febrile seizure(3)
focal one episode > ou egal a 15 mn or multiple episode > ou egal a 30 mn
285
risk factor of febrile seizure
infection virale immunization family history
286
immunization involved in febrile seizure(2)
DTAP | MMR
287
management of febrile seizure(2)
reassurance | abortive rx if seizure lasts more ou egal a 5 mn
288
prognosis of febrile seizure(3)
normal intelligence and development environ 30% risk of recuurrence less than 5% risk of epilepsy
289
quid of petit mal
absence seizure
290
confirmatory test for petit mal
EEG studies
291
clue for generalised seizures(3)
can have loss of consciousness bilateral motor findings can be convulsive or non convulsive(bsence)
292
physiopatho of generalised seizures
both hemisphere is involved
293
seizure activity in partial seizures
appears limited to part of oen hemisphere in brain
294
quid of simple partial seizures(4)
no loss of consciousness feeling of deja vu(familiarity) can have aura patient remeber event well
295
partial seizure with generalisation(2)
1- loss of consciousness | 2-tonic clonic activity
296
complex partial seizures(6)
``` loss of consciousness can have aura motor automatism bilateral motor findings staring spells postictal confusion ```
297
motor automatism in complex partial seizures(4)
chewing swallowing sucking picking movements
298
clue for partial seizure with secondary generalisation(2)
blood tinged sputum suggesting bite tongue | urinary incontinence
299
fever with tonic clonic seizure in a patient with digeorge during exam babay cries and develops cyanosis
brain abcess
300
risk factor for brain abcess
``` otitis media /mastoiditis frontal and ethmoidal sinusitis dental infection cyanotic heart diasease bacteriemia from ather sites of infection ```
301
pathogenesis of brain abcess in otitis media and mastoiditis(2)
direct spread | temporal lobe and cerebellum abcess
302
pathogenesis of brain abcess in frontal and ethmoidal sinusitis(2)
direct spread | frontal lobe
303
pathogenesis of brain abcess dental infection(2)
direct spread | frontal lobe
304
pathogenesis of brain abcess in bacteriemia from other sites of infection and cyanotic heart disease(2)
hematogenous spread | mulptiple abcess along the distribution of middle cerebral artery(gray white matter junction)
305
most common cause of headaches acute and reccurent in the pediatric population
migraine headache
306
firs-line regimen in rx migraine(2)
acetaminophen | NSAID
307
EEg in complex partial seizures(2)
normal or show brief discharges
308
day dreaming episodes in 4 to 8 yo child , brief staring spells and decline in school performance and post ictal phase rx and dx(3)
ethosusuximide valproate dx absence seizures
309
skin changes in aptient taking anabolic steroid(2)
acne | accelarated male pattern baldness
310
why gynecomastia in patient taking anabolic steroid
testosterone is converted to estrogen and will drive breast enlargement
311
psychiatric problem in anabolic steroid(2)
aggresssion | major mood disorder
312
metabolic problem in anabolic steroid
low HDL
313
cardiac problem in anabolic steroid
cardiac dysfunction in high dose of anabolic steroid use
314
why erythrocytosis in anabolic steroid use
androgen stimulating erythropoiesis
315
endocrine problem in patient taking anabolic steroid(3)
decreased testicular size low sperm count virilization
316
quid of anabolic steroids(3)
testosterone stanalozolol nadrolone
317
clue for neurofibromatosis type 1(7))
``` cafe au lait spots axillary freckles lish nodules ot the iris bony lesion neurofibroma macrocephaly short stature ```
318
complication or assoiciated problem in neurofibromatosis(4)
tumor in CNS tumor in peripheral nervous system skin viscera
319
learning problem in neurofibromatosis
learning disability
320
dx differetiel in delayed passage of meconium(2)
hirshprung | meconium ileus
321
level of obstruction in hirsprung
rectosigmoid
322
level of obstruction in meconium ileus
ileum
323
consistency of meconium in hirsprung
normal
324
consistency of meconium in meconium ileus
inspissated
325
earliest manif of cystic fibrosis
ileus meconial
326
associated condition in cystic fibrosis
rhinosinusitis
327
clue for duodenal atresia(2)
bilious vomiting | double bubble sign
328
congenital problem associated with down
duodenal atresia
329
blood in stool of 2 yo boy
meckel
330
rule of 2's in Meckel(4)
2% prevalence 2/1 male to female ratio 2% asymptomatic at age 2 located 2 feet of ileoceacal valve
331
dx of Meckel
technetium 99 m pertechnetate scan
332
clinic of Meckel(4)
painless hematochezia intussuception intestinal obstruction volvulus
333
most common congenital small intestine anomaly
meckel's diverticulum
334
cause of Meckel(2)
incomplete obliteration of vitelline duct(omphalomesenteric duct)
335
why bleeding in meckel
ectopic gastric tissue secretes HCL
336
risk factor for NEC(4)
prematurite very low birth weight reduced mesenteric perfusion by hypotension and congenital heart disease enteral feeding
337
pathogenesis of NEC(2)
gut immaturity | expose to bacteria from enteral feeds
338
measure to decrease NEC
breast feeding premature infant
339
clue for NEC in abdominal xray(4)
visible air in bowel wall=pneumatosis intestinalis portal venous air normally you have inside the bowell train track appearance or double line
340
complication of NEC(5)
``` necrosis and pneumoperitoneum septic shock intestinal strictures short bowel syndrome death ```
341
patient with ulcerative colitis develops diarrhea irritability and poor concentration rash resembles to sunburn on distal arms and legs dx
niacin deficiency
342
4 D in Niacin deficiency
Diarrhea Dermatitis Dementia Death
343
clue for intussuception (3)
periodic abdominal pain associated with drawing the legs up the abdomen vomiting intestinal obstruction currant jelly stools
344
most common cause of intestinal obstruction in kid
intussuception
345
why currant jelly stools in intussuception(2)
ichemia of bowel wall | occult bleeding
346
risk factor for intussuception
viral infection plays role in inflaming intestinal lymphatic tissue(payers patches) which can serve as a lead point for intussucetion
347
ultrasound in intussuception
target sign
348
rx of intussuception
reduction with air or water soluble enema
349
role of lead point in intussuception
75% des cas no lead point identified
350
25 % des cas cause of intussuception(2)
meckel | polyps and hematoma in case henock shonlein purpura
351
esophageal coin in asymptomatic patient
observe for 24 hours after ingestion
352
symptomatic esophageal coin or time of ingestion is unknown
prompt removal with flexible endoscopy
353
most common foreign body ngested by children
coin
354
when to suspect foreign body aspiration(3)
difficulty swallowing feeding refusal vomiting
355
rx of NEC(3)
supportive care IV antibiotics surgery
356
supportive care in NEC(2)
bowel rest | parenteral hydration /nutrition
357
importanceof abdominal xray in the setting of intestinal occlusion
to rule out pneumoperitoneum
358
next step after ruling out pneumoperitoneum in teh setting of intestinal occlusion
contrast enema to determine the level of obstruction
359
contrast enema in meconium ileus
microcolon
360
role hyperosmolar enema
can break up the inssipated meconium and remove the obstruction
361
physiopatho in cystic fibrosis(2)
delta F508 mutation responsible chlorde transport and tenacious secretions in multiple organs
362
when to perform sweat chloride testing(2)
age > 2 weeks or weight > 2 Kg
363
timing in breatfeeding failure jaundice
first week of life
364
timing in breast milk jaundice(2)
starts at 3-5 days | peaks at 2 weeks
365
physiopatho of breastfeeding failure jaundice(3)
lactation failure results in decreased bilirubib elimination increased enterohepatic circulation
366
physiopatho of breast milk jaundice
high levels of B-glucuronidase in breast milk deconjugate intestinal bilirubin and increase enterohepatic circulation
367
clinical features in breastfeeding failure(2)
suboptimal breastfeeding | signs of dehydration
368
clinical features in breastfeeding failure(2)
adequate breastfeeding | normal examination
369
normal number of wet diaper in the first week of life
should equal the infants age in days
370
sign of dehydration in infant during first week of life(3)
slightly decreased urine output brick red urate crystals in diaper lost of weight
371
rx of breastfeeding failure(2)
breakfast 15 mn per side every 2-3 hours | supplementation with cow's milk if the mother's milk supply is inadequate
372
squirt sign in hirshprung
positive
373
squirt sign in meconium ileus
negative
374
baby with failure to pass meconium within 48 hours in the setting of down syndrome
hirsprung
375
presentation of hirshprung(3)
poor feeding abdominal distension absent air in the rectum
376
associated disease with hirsprung
down
377
associated disease with meconium ileus
cystic fibrosis
378
differential dx in vomiting and regurgitation in infants(4)
physiologic GER Milk protein allergy GERD pyloric stenosis
379
clue physiologic gastroesophageal reflux(2)
happy spitter | asymptomatic
380
clue milk protein allergy(3)
regurgitation eczema bloody stools
381
GERD in baby(3)
failure to thrive significant irritability sandifer syndrome
382
pyloric stenosis in baby(3)
projectile non bilious vomiting olive shaped abdominal mass dehydration and weight loss
383
management of physiologic GER(2)
reassurance | positionning therapy
384
management of milk protein allergy
elimination of dairy and soy protein from diet
385
management of GERD(4)
thickened feeds antacid therapy esophageal PH probe monitoring upper endoscopy
386
management of pyloric stenosis(2)
abdominal US | pylomyotomy
387
why post prandial regurgitation is frequent in infant(4)
shorter esophagus decreased angle between the stomach and the esophagus incomplete closure of the lower esophageal sphincter greater time spent in the suoine position
388
management of physiologic GER(2)
frequent small volume feeds | hold the infant upright 20-30 mn after feeds
389
Mild dehydration in kid(2)
3 a 5 % volume loss | minimal or no clinical symptoms
390
moderate dehydration (7)
``` 6 -9 % volume loss decreased skin turgor dry mucus membranes tachycardia irritability a delayed capilary refill(2-3 seconds) decreased urine output ```
391
severe dehydration (10)
``` 10-15 % volume loss cool clammy skin delated capillary refill> 3 seconds cracked lips dry mucous membrane sunken eyes sunken fontanelle tachycardia lethargy minimal or no urine output ```
392
rx of moderate to severe dehydration
IV bolus of isotonic fluid
393
indication for renal and bladder US(4)
infants and children age < 24 months with a first febrile UTI recurrent febrile uti in children of any age children who do not respond to appropriate antibio rx UTI in a child of any age with a family history of renal or urologic disease HTA and poor growth
394
children < 24 months with first febrile UTI(2)
rx for 7-14 jours antibio | renal and bladder US for structurakl abnormality that could predispose to UTI
395
first cause of vulvovaginitis in prepubertal children
vaginal foreign bodies
396
most common vaginal foreign body in kid
toilet paper
397
removing of toilet paper in vaginal(2)
calcium alginate swab or irrigation with warmed fluid
398
quid of monosymptomatic enuresis
urinary incontinence occuring at least twice a week after age of 5 without any medical condition
399
first line rx of enuresis
enuresis alarm
400
second line regimen in enuresis
medication
401
first line medication used in enuresis
desmopressin
402
second line medication used in enuresis
TCA
403
most efficient long term rx of enuresis
enuresis alrm
404
inconvenient with desmopressin
high risk of relapse
405
normal age for bedwetting
before 5
406
mastery of the nightime continence in kid
can take months to years
407
gender in nightime continence
boys generally achieves this milestone later than girls
408
most common urologic problem in children
vesicoureteral reflux
409
quid of vesicoureteral reflux
retrograde flow of urine from the bladder up into the ureter and renal pelvis
410
long term complication of vesicoureteral reflux
renal scarring
411
best test to Dx vesiculo ureteral reflux
voiding cystourethrogram
412
first UTI next step
renal ultrasound
413
reccurent UTI next step
voiding cystouretrogram
414
acute pyelonephritis next step(2)
bood and urine culture | hospitalizatin and empiric therapy with IV antibiotics
415
patient with fever and rhinorrhea ,an incidental urine shows 2 + protein
transient proteiunuria
416
what to do in transient proteinuria
repeat urine dipstick testing on 2 separate occasions to rule out persistant proteinuria
417
most common cause of isolated proteinuria
transient proteinuria
418
transient proteinuria cause(5)
``` fever exercice seizure stress volume depletion ```
419
causes of secondary enuresis(5)
``` psychological stress urinary tract diabetes mellitus diabetes insipidus obstructive sleep apnea ```
420
associated symptom of secondary enuresis with psychological stress(2)
behavior regression | mood lability
421
secondary enuresis in urinary tract infection(4)
dysuria hesitancy urgency abdominal pain
422
diabetes mellitus (6)
``` polyuria polydipsia polyphagia weight loss lethargy candidiasis ```
423
diabete insipidus in secondary enuresis(2)
polyuria | polydipsia
424
assoicated symptom in obstructive sleep apnea(4)
snoring dry mouth fatigue hyperactivity irritability
425
syndrome nephrotic in kid eleven YO with postive HBsag HBe ag dx
membranous glomerulonephritis
426
what marker will be positive in membranous glomerulonephritis induced by infectious viral hepatitis B
HBe ag
427
Potter sequence
urinary tract anomaly--->anuria and oligoanuria in utero------> oligohydramnios
428
three consequences of oligohydramnios in potter (3)
pulmonary hypoplasia flat facies limb deformities
429
prenal US showing bladder distension ,bilateral hydronephrosis and bilateral hydroureters Dx?
posterior uretral valves
430
why respiratory distress in oligoamnios
pulmonary hypoplasia
431
most common cause of secondary HTA in children
fibromuscular dysplasia
432
clue fibormuscular dysplasia(2)
hum or bruit in the costovertebral angle due to well developped collaterals HTA
433
angiography in fibromuscular dysplasia
strings and beds pattern of renal artery
434
most common artery involved in fibromuscular dysplasia
right one
435
patient with severe pneumonia with absolute level of CD3 normal and low CD19 dx(2)
x linked agammaglobulinemia or bruton's agammaglobulinemia
436
rx in bruton's
regular infusion of IV immunoglobulin
437
quid of CD 3
lymphocytes T
438
quid of CD 19
Lymphocytes B
439
lymho low in bruton's
lympho B
440
indication of endotracheal intubation and mechanical ventilation in asthma(6)
``` asthma unresponsive to medications who have Fatigue altered mental status Co2 retention worsening hypoxemia poor air movement on examination ```
441
first line rx of anaphylaxis
IV epinephrine
442
age for brutons
6-18 mois
443
physical exam in brutons
absent tonsils and other palpable lymphoid tissue
444
chest xray in infant les than 3
tonsils will be seen
445
tonsil on xray(2)
sail sign | triangular shape
446
role of thymus
production of lymphocyte and maturation
447
what to do in a patient with history of anaphylaxis
patient should carry self injectable epinephrine
448
next step in hymenoptera sting triggers
refferal to an allergist for venom immunotherapy
449
patient with neck swelling and irritability ,he keeps his head rotated slightly to the right side dx
acquired torticollis
450
next step in acquired torticollis
xray of the neck
451
most common cause of acquired torticollis(5)
``` upper respiratory infections minor trauma cervical lymphadenitis retropharyngeal abcess atlantoaxial subluxation ```
452
why neck xray in acquired torticollis(3)
to rule out cervical spine fracture dislocation which requires extreme caution
453
prematured infant with respiratory distress dx
hyaline membrane disease
454
risk factor for hyaline membrane disease(5)
``` prematurity maternal diabetes c section without labor perinatal asphyxia sexe male ```
455
how maternal diabetes increases the risk of respiratory distress syndrome or hyaline membrane disease(2)
delays maturation of surfactant | hyperinsulinism antagonizes the action of cortisol and the lung maturation process
456
how do you differentiate artralgia in jones criteria
if you choose arthritis in major criteria you can't choose arthralgia anymore
457
clue for lyme disease
trip in northeastern and upper midwestern united states
458
time to have early localised Lyme
days to 1 month after the bite
459
clue for early localised Lyme disease(2)
erythema migrans | myalgias and arthralgias
460
time to have early disseminated lyme
weeks to months
461
carditis in early disseminated lyme(2)
AV block | cardiomyopathy
462
neurologic problem in early disseminated lyme(3)
unilateral or bilateral cranial nerve defects meningitis encephalitis
463
cranial nerve most commonly involved in Lyme disease
7
464
muscular problem in early disseminated lyme
migratory arthralgias
465
skin problem in early disseminated lyme
multiple erythema migrans
466
eye problem in early disseminated lyme
conjunctivitis
467
most common finding in early disseminated Lyme
migratory arthralgia dans 60% des cas non traites
468
time for late or chronic manif of Lyme disease
months to years after the bite
469
problem in late or chronic manif of Lyme disease(3)
muscular =arthritis dans 60% des cas non traites encephalomyelitis peripheral neuropathy
470
adolescent male athlete with knee pain
osgood schlatter disease
471
quid of osgood schlatter disease
traction apophysitis of the tibial tubercle
472
xray finding in osgood schlatter(3)
soft tissue swelling lifting of tubercle from the shaft irregularity and fragmentation of the tubercle
473
rx osgood schlatter(3)
activity restriction strectching exercice NSAIDS
474
synovial fluid in lyme disease
average leucocyte count 25000
475
patient rx for sore throat fever difficulty swallowing ,symptom subsides rapidly with PNC.ten days later the patient presents with fever ,skin rash fleeting joint pain in lower extremities dx
serum sickness like reaction
476
quid of serum sickness like reaction
hypersensitivity reaction occurring one to 2 weeks after administration of certain drugs
477
drugs involved in serum sickness like reaction (4)
PNC amox TS cefaclor
478
physiopatho of serum sickness like reaction
immune complex mediated hypersensitivity reaction to non human proteins
479
age for kawasaki
less than 5 years
480
conjunctivitis in kawasaki
spares limbus
481
oral mucosae changes in kawasaki(3)
erythema fissure lips strawberry tongue
482
extremity changes in kawasaki(3)
erythema edema desquamation of the hands and feet
483
quid of kawasaki
vasculitis
484
lab in kawasaky(4)
elevated CRP and ESR leucocytosis with neutrophilia (viral= lymphocytosis) reactve thrombocytosis sterile pyuria in uninalysis
485
rx of kawasaki(2)
aspirin | plus IV immunoglobulin
486
complications of kawasaki(2)
coronary artery aneurisms | myocardial infarction and ischemia
487
consequense of coronary artery aneurism
thrombotic occlusion ---> myocardial ischemia and death
488
echocardiography in kawasaki(2)
at the time of Dx | repeat 6-8 weeks later
489
baby born at 33 semaines de gestation how will you deal with immunization
immunization should be given according to chronologic age
490
what is the rule to administer hep B vaccine
weight should be > ou egal a 2 kg
491
region with high level of hepatitis b infection(2)
asia and africa
492
cancer preventable by vaccination
hep B
493
congenital manif of german measles(4)
sensorineural hearing loss cardiac anomalies cataracts glaucoma
494
cardiac problem in rubella(german measles)
PDA
495
children with german measles(4)
low grade fever conjunctivitis coryza and cervical lymphadenopathy cephalocaudal spread of blanching erythematous maculopapular rash
496
german measles in adults (5)
low grade fever conjunctivitis coryza and cervical lymphadenopathy cephalocaudal spread of blanching erythematous maculopapular rash arthritis
497
prevention of german measles in baby
vaccination (live atenuated vaccine )
498
rubella in first trimester
teratogenic
499
screening test in infant 0-5 ans recommneded by the USPSTF(united preventive services task force)(3)
strabismus amblyopia refractive errors( bref vision screening)
500
the most common reservoir for rabies in the US(2)
racoon | bats
501
clue for encephalitis rabies(2)
hydrophobie | aerophobie
502
post exposure prophylaxis of rabies(2)
rabies immune globulin plus rabies vaccine
503
quid of encephalitic rabies(5)
hydrophobie aerophobie pharyngeal spasm agitation spastic paralysis
504
quid of paralytic rabies
ascending flaccid paralysis
505
complication of rabies(3)
coma respiratory failure death within weeks
506
transmission of rabies
exposure to saliva
507
clue for acute otitis media(2)
middle ear effusion plus acute eardrum inflammation
508
quid of acute eardrum inflammation(2)
bulging eardrum | fever
509
clue for otitis media with effusion(2)
middle ear effusion without acute inflammation
510
clue for bullous myringitis
serous liquid filled blisters on the tympannic membrane
511
clue for cerumen impaction(2)
liquid or wax in auditory cana | no visualisation of eardrum
512
clue for hemotympanum
purple or red eardrum plus ou moins bulging
513
clue for otitis externa(3)
pain with tragal traction erythematous and swollen external auditory canal +/- otorhea
514
dx in otalgia(6)
``` acute otitis media otitis media with effusion bullous myringitis cerumen impaction hemotympanum otitis externa ```
515
cardinal clue for otitis media(2)
bulging of the tympannic membrane | which reflects middle ear effusion
516
peak for otits media(2)
6-18 mois in daycare | around 5 when school initiation
517
next step in any children with trouble in school to understand or behavioral disorder in childhood dx
undetected hearing impairement
518
first cause of hearing impairment
conductive hearing loss due to repeated ear infection
519
when to suspect hearing inpairment(3)
poor language development social skills inattentiveness
520
patient with sore throat dysphagia odynophagia pharyngeal and tonsillar erythema dx(2)
viral pharyngitis | strep pharyngitis
521
when to think about strep pharyngitis(5)
``` presence of exsudates edema palatal petechiea tender anterior cervical lymphadenopathy absence of viral symptoms ```
522
when to think of viral pharyngitis
presence of viral symptoms
523
quid of viral symptoms(4)
cough rhinorrhea conjonctivitis oral ulcers
524
what to do if you suspect strep paharyngitis
rapid antigen test
525
what to do if you suspect strep paharyngitis with neagtive rapid antigen test
obtain throat culture
526
left sided ear discherge resistant to antibiotics EP reveals granulation and some skin debris
cholesteatoma
527
new onset of hearing loss or chronic ear drainage despite antibiotic therapy dx
cholesteatoma
528
otoscopy in cholesteatoma(3)
granulation tissue skin debris retraction pockets of the tympannic membrane
529
cause of cholesteatoma(2)
congenital | ssecondary to chronic middle ear disease
530
criteria to dx attention deficit hyperactivity disorder
symptoms present before age of 12 | in at least 2 settings(schoole home and other)
531
what is so improtant to make the dx of attention deficit hyperactivity disorder
teachers evaluation
532
clue for night terrors(5)
``` fear crying screaming decreased level of consciuosness amnesia of the event ```
533
when does night terror occurs
during non REM sleep
534
triggers for night terrors(4)
acute stress sleep deprivation illness medication affecting central nervous system
535
peak of incidence of night terrors
2 a 12 ans
536
patient 11 yo with continuous thought of stabbing his mother dx
Obssessive compulsive disorder
537
rx of obssessive compulsive disorder (2)
CBT plus high dose of selective serotonin inhibitor
538
rx of obssesive compulsive disorder with no response to CBT and serotonin reuptake inhibitor(2)
clomipramine or increase dose of antipsychotic rx
539
severe refractory obsessive compulsive disorder
deep brain stimulation
540
which of the following behaviors should be concerning in a young children 2-5 years(extensive sexual knowledge)(5)
``` simulating forplay simulating intercourse preoccupation of masturbation touching other genitals excessive talk about swxuality ```
541
what sexual extensive knowledge can teach us in kid
possibility of sexual abuse
542
quid of constitutionnal growth delay(3)
delayed growth spurt delayed puberty delayed bone age
543
14 yo boy with feeling of a mass under his right nipple.Physical exam is normal dx
gynecomastia
544
physiologic cause of gynecomastia(3)
preburte can be unilateral or bilateral you have firnm subareolar nodules sometimes tender with the touch
545
rx of pubertal gynecomastia (2)
nothing | resolve within few months to years
546
percentage of adolescent with gynecosmatia in prepuberte
2/3
547
pathological causes of gynecomastia(2)
increased estrogen production or peripheral conversion | androgen deficiency
548
pathology with increased estrogen production or peripheral conversion causing gynecomastia(9)
``` testicular adrenal or HCG secreting tumors cirrhosis malnutrition thyrotoxicosis congenital excessive aromatase activity androgen use medications herbal products illicit drugs ```
549
medication induced gynecomastia by increasing estrogen production or peripheral conversion(2)
spironolactone | cimetidine
550
illicit drugs induced gynecomastia by increasing estrogen production or peripheral conversion(4)
alcohol amphetamines heroin marijuana
551
herbal products induced gynecomastia by increasing estrogen production or peripheral conversion(2)
tea tree oil | lavender oil
552
androgen deficiency causing gynecomastia(3)
primary or secondary male hypogonadism hyperprolactinemia renal failure
553
cause of primary or secondary male hypogonadism(2)
klinefelter syndrome | testicular damage
554
4 yo boy comes with nausea vomiting and abdominal pain.parents found pills scattered on the kitchen floor next to an open unlabeled bottle.boys develops hematemesis abdominal xtay reveals several small opacities in teh stomach and duodenum dx
iron poisonning
555
acid base problem in iron poisonning
metabolic acidosis with anion gap
556
complication of iron poisonning within 2 days
hepatic necrosis
557
complication of iron poisonning within 2-8 weeks
pyloric stenosis
558
rx of iron poisonning(3)
whole bowel irrigation deferoxamine supportive care for circulation airway and breathing
559
risk for factor for lead poisonning(5)
``` home built before 1978 under renovation with peeling paint Pica sibling with lead poisonning low socio economic status immigrant or international adoptee ```
560
screening for lead poisonning
capillary blood specimens
561
confirmatory test for lead poisonning when lead level > ou egal a 5 microgram/dl
vcenous lead
562
venous lead 2-44 Micro/dl (mild)next step(2)
nothing | repeat in < 1 month
563
venous lead 45-69Micro/dl(moderate) next step
use meso 2,3 dimercaptosuccinic acid(DMSA)
564
venous lead > ou egal a 70 Micro/dl(moderate) next step(2)
use meso 2,3 dimercaptosuccinic acid(DMSA) plus calcium dodium edetate(EDTA)
565
action of iron pills
disruption of basic cell process
566
action of deferoxamine(2)
binds ferric iron | allowing urinary excretion
567
cause of hypervolemic hypernatremia
renal losses | extrarenal looses
568
renal losses in hypervolemic hypernatremia(2)
diuretic use | glycosuria
569
extrarenal losses cause of hypovolemic hypernatremia(2)
GI upset | excessive sweating
570
rx of hypovolemic hypernatremia
nacl 0,9 %
571
cause of hypervolemic hypernatremia(2)
``` exogenous sodium intake mineralocorticoid excess(hyperaldosteronism) ```
572
patient with vomiting caused by pyloric stenosis metabolic disturbance(5)
``` Hco3increased cl decreased K+ decreased Paco2 increased PH increased ```
573
metabolic problem in pyloric stenosis induced vomiting
hypochloremic hypokaliemic metabolic alkalosis
574
complication of supracondylar fracture in kid
compartment syndrome
575
clue for compartment syndrome
severe pain pallor paresthesia
576
late finding in compartment syndrome(2)
pulselessnes | paralysis

Main Deck Step 2 Content Review (24 decks)

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