Pediatrics

Question 1

meningite and refractaire hypotension

Answer 1

waterhouse fredrichsen syndrome

Question 2

hemiplegia in chidren after having seizures

Answer 2

Todd paralysis

Question 3

4 forms of tetanos(2)

Answer 3

generalisee
localisee
cephalic
Neonatale

Question 4

dx differentiel of Lytic lesion on bone puls hypercalcemia(4)

Answer 4

osteomyelitis
endocrine
neoplastic
idiopathic

Question 5

clue for lytic lesion induced by osteomyelitis

Answer 5

brodie abcess

Question 6

endocrine cause of lytic bone lesion(2)

Answer 6

hyperparathyroidie

osteoid fibrosa cystica

Question 7

Neoplastic cause of bone lytic lesion(3)

Answer 7

erwing sarcoma
Langerhans hystiocystosis
Metastases

Question 8

quid of cephalhematoma

Answer 8

hemmoragie sous periostee

Question 9

clue for cephalhematoma

Answer 9

it doesn’t cross suture

limited to one cranial bone

Question 10

clue caput succedaneum

Answer 10

it crosses suture

Question 11

most common cause of functional asplenism in children

Answer 11

sickle cell disease

Question 12

cause of sepsis in asplenia

Answer 12

encapsulated bugs

Question 13

most common bug causing sepsis in asplenia

Answer 13

s pneumoniae

Question 14

cyanosis in infant first 24 hours of life

Answer 14

transposition of great vessels

Question 15

quid of transposition of great vessel

Answer 15

aorta in ventricule droit

artere pulmonaire in ventricule gauche

Question 16

what to suspect in child with reccurrent sinopulmonary infection

Answer 16

cystic fibrosis

Question 17

gold standard dx test for cystic fibrosis

Answer 17

sweat test for Na et CL-

Question 18

consequence of cow milk consumption in infant

Answer 18

iron deficiency anemia

Question 19

cyanosis in children less than 4 years

Answer 19

Fallot

Question 20

tetralogie de Fallot(4)

Answer 20

overriding Aorta
VSD
Subpulmonary stenosis
right ventricular hypertrophy

Question 21

Clue for PDA and VSD

Answer 21

no cyanosis

Question 22

Prader willi syndrome(3)

Answer 22

binge eating
hypotonia
obesity

Question 23

genetics of prader willi

Answer 23

paternal genetics deletion

15q11-q13

Question 24

genetics problem in cat cry syndrome

Answer 24

5p deletion

Question 25

genetics problem in angelman

Answer 25

15q11-q13

Question 26

genetics in beckwith wiedman

Answer 26

11p15

Question 27

clue for bweckwith

Answer 27

macroglossie

Question 28

clue megaoblastic anemia

Answer 28

hypersegmentation of the nucleus of neutrophils and other blodd cells

Question 29

most common cause of congenital hypothyroidism in the US

Answer 29

thyroid dysgenesis

Question 30

quid of thyroid dysgenesis(3)

Answer 30

ectopie aplasie hypoplasia

Question 31

Disease with Howell jolly bodies

Answer 31

sickle cell disease

Question 32

Meaning of howell jolly bodies and why

Answer 32

no spleen | spleen normally removes nuclear rmnants of red blood cells

Question 33

bite cells or heinz bodies(2)

Answer 33

G6PD deficiency | Thalassemia

Question 34

Helmet cells(3)

Answer 34

DIC HUS TTP

Question 35

cause of helmet cells

Answer 35

traumatic hemolysis

Question 36

other finding in traumatic hemolysis

Answer 36

schistocytes

Question 37

casue of basophilic stippling(2)

Answer 37

thalassemia | lead poisonning

Question 38

quid diamond blackfan anemia(2)

Answer 38

macrocytic anemia | congenital malformation in baby

Question 39

Mc cune albright syndrome(4) 3 P

Answer 39

femme Puberte precoce pigmentation polyostotic fibrous dysplasia

Question 40

what will happen in polyostotic fibrous dysplasia

Answer 40

fracture a repetition

Question 41

casue of stroke in children(4)

Answer 41

internal carotid dissection AF homocystinuria Todd paralysis

Question 42

clue for homocystinuria(4)

Answer 42

Marfan's features thromboembolic event downward dislocation of the lens mental retardation

Question 43

clue for marfans features(3)

Answer 43

long emaciated arms and legs arachnodactily hyperlaxity of the skin and joints

Question 44

cause of homocystinuria

Answer 44

deficiency in cystathione synthetase

Question 45

Dx test for homocystinuria(2)

Answer 45

high methionine | high homocysteine

Question 46

Rx of homocystinuria

Answer 46

B6

Question 47

failure of B6 in rx of homocystinuria

Answer 47

cysteine

Question 48

quid of leucocoria in USMLE

Answer 48

white eye reflex

Question 49

cause of leucocoria in kid

Answer 49

retinoblastoma until proven the contrary

Question 50

occlusion in first 24 hr in infant(2)

Answer 50

hirsprung | meconium ileus

Question 51

cause of meconium ileus

Answer 51

cystic fibrosis

Question 52

cause of intestinal occlusion from 24 h to 1 month

Answer 52

volvulus of midgut

Question 53

cause of intestinal occlusion > 1 month of age

Answer 53

stenose pylorique

Question 54

cause of cyanosis from 24 h to 4 ans

Answer 54

tetralogy de Fallot

Question 55

cause of osteogenesis imperfecta

Answer 55

deficiency in type 1 collagen synthesis

Question 56

congenital disease with coarctation of aorta

Answer 56

turner syndrome

Question 57

complication of congenital adrenal hyperplasia

Answer 57

puberte precoce

Question 58

enzyme deficiency in congenital adrenal hyperplasia

Answer 58

21 hydroxylase(CYP21A2)

Question 59

baby with cyanosis during feeding and relieved by crying

Answer 59

choanal atresia

Question 60

Dx of choanal atresia(2)

Answer 60

tube nasal | ct scan

Question 61

Dx test for hereditary spherocytosis

Answer 61

osmotic fragility study

Question 62

when to perform coombs test

Answer 62

autoimmune hemolytic anemia

Question 63

most common cause of nephrotic syndrome in children

Answer 63

minimal change disease

Question 64

next step when dx nephrotic syndrome in adult

Answer 64

biopsy renale

Question 65

calculate APGAR score

Answer 65

``` A:appearance P:pulse G:grimace A:activity R:respiration ```

Question 66

Monitoring Appearance in APGAR(3)

Answer 66

blue=0 blue pink=1 pink=2

Question 67

Monitoring pulse in APGAR(3)

Answer 67

absent=0 | ,100=2

Question 68

Monitoring grimace in APGAR(3)

Answer 68

absent=0 grimace,whimper=1 cough/cry=2

Question 69

Monitoring activity in APGAR(3)

Answer 69

limp=0 flexion=1 spontaneous active=2

Question 70

Monitoring respiration in APGAR(3)

Answer 70

absent =0 slow irregular=1 regular=2

Question 71

Normal APGAR

Answer 71

7-9

Question 72

abnormal APGAR

Answer 72

<7

Question 73

patient with delayed separation of umbilical cord more than 30 days

Answer 73

leucocytes adhesion defect type 1

Question 74

clue for leucocytes adhesion defect type 1

Answer 74

CD18 expression deficiency

Question 75

risk in in baby whom mother taking cocaine during pregnancy

Answer 75

jejunal atresia

Question 76

xray abdomen in jejunal atresia(2)

Answer 76

tripple bubble sign | gasless colon

Question 77

xray showing double bubble sign

Answer 77

duodenal atresia

Question 78

abdomen xray in hirsprung

Answer 78

dilated loops of bowel

Question 79

how to diffenrenciate microcytic anemia caused by iron deficiency from thalassemia

Answer 79

RDW

Question 80

Clue for Iron deficiency anemia using RDW

Answer 80

RDW>20 %

Question 81

Normal RDW with microcytic anemia

Answer 81

thalassemia

Question 82

cause arthropathy in hemophilic patient(2)

Answer 82

deposit of hemosiderrin | fibrosis

Question 83

hemophilic patient cause

Answer 83

deficiency in factor 8 et 9

Question 84

children between 4-10 with hip pain(2)

Answer 84

Legg calve Perthes disease | avascular necrosis of femoral head

Question 85

Quid of measles

Answer 85

rubeola | rougeole en francais

Question 86

quid of koplik spots

Answer 86

bluish white lesions on buccal mucous membranes next to first and second molars

Question 87

gender in Mc cune albright syndrome

Answer 87

femme

Question 88

pigmentation in Mc cune Albright syndrome

Answer 88

cafe au lait spot

Question 89

gender in Lesh Nyhan syndrome

Answer 89

Male

Question 90

clue for Lesh Nyhan Syndrome(3)

Answer 90

Male dystonia self mutilation

Question 91

Gout in male children

Answer 91

Lesh Nyhan Syndrome

Question 92

physiopatho in Lesh Nyhan Syndrome

Answer 92

hypoxanthine guanine phophoribosyl transferase

Question 93

black stool in children

Answer 93

Meckel Diverticulum

Question 94

difference between congenital adrenal hyperplasia and hyperandrogenism

Answer 94

virilization in women

Question 95

Quid of macrosomia

Answer 95

> 4 kg

Question 96

risk in macrosomia

Answer 96

clavicular fracture

Question 97

how to recognize fetal alcoholic syndrome(3)

Answer 97

small palpebral fissures absence philtrum thin upper lip border= thin vermillon border

Question 98

Quid of Edward's syndrome(5)

Answer 98

``` micrognatia microcephaly absent palmar creases rocker bottom feet overlapping fingers ```

Question 99

heart complication of Edward's syndrome

Answer 99

VSD

Question 100

chromosome problem in Edward syndrome

Answer 100

trisomy 18 | election age

Question 101

Heart problem in trisomy 21

Answer 101

ASD

Question 102

Heart problem in william's syndrome

Answer 102

supravalvular aortic stenosis

Question 103

Heart problem in congenital rubella

Answer 103

PDA

Question 104

young kid with stomatitis and cheilitis sore throat andscaly pathes on eyebrows cheek and nose and photophobia dx?

Answer 104

ariboflavinose

Question 105

cause ariboflvinose in the US(3)

Answer 105

Anorexia nervosa Malabsorption syndrome Inborn defect in B2 synthesis

Question 106

pain articulation in young kid(3)

Answer 106

Legg calve transient synovitis hemophilic arthropathy

Question 107

infant with stridor acute respiratory distress toxic appearrance and fever first dx to think

Answer 107

epiglotitis

Question 108

first step in epiglotitis

Answer 108

intubation

Question 109

what to avoid in epiglotitis

Answer 109

never try to watch the epiglotte

Question 110

Bloody diarrhea plus IR plus low platelet

Answer 110

HUS

Question 111

cause of HUS in children

Answer 111

E coli 0157h7

Question 112

how E coli causes HUS

Answer 112

by producing verotoxin

Question 113

young kid with scrotal pain ,purpura and arthralgia

Answer 113

Henoch shonlein purpura

Question 114

complication of Henoch shonlein purpura

Answer 114

intussiception ileoileale

Question 115

age to have henock shonlein purpura

Answer 115

<15 ans

Question 116

seizure in afebrile children with wide qrs complex dry oral mucosa and dilated pupils and hypotension

Answer 116

TCA intoxication to rule out

Question 117

Rx of TCA intoxication

Answer 117

sodium bicarbonate

Question 118

action of Hydroxyurea

Answer 118

Increase HB F

Question 119

importance of hydroxyurea in sickle cell disease

Answer 119

prevention of painful crisis

Question 120

clue for cystic fibrosis(2)

Answer 120

diarrhea | probleme respiratoire a repetition

Question 121

breastfeeding contraindication(9)

Answer 121

``` herpes mammaire HIV TB varicella drug alcohol fetal galactosemia chemotherapy radiation ```

Question 122

for TB when the mother can be allowed to breastfeed

Answer 122

2 weeks after debut of treatment

Question 123

patient with blue eye and susceptibility to fracture

Answer 123

osteogenesis imperfecta

Question 124

quid opalescent teeth

Answer 124

yellow teeth

Question 125

disease with opalescent teeth

Answer 125

osteogenesis imperfecta

Question 126

red eyes in children in the first 24 h(2)

Answer 126

iatrogenic | nitrate d'argent

Question 127

red eyes in children in 2-5 days of birth

Answer 127

gonoccoque

Question 128

rx of conjunctivitis caused by gonoccoque

Answer 128

ceftriaxone

Question 129

red eyes in children 5- 24 jours of birth

Answer 129

chlamydia

Question 130

rx for conjuctivitis induced by chlamidya

Answer 130

oral erythromycin

Question 131

finding in severe combined immunodeficiency

Answer 131

low Lympho B and T

Question 132

cause of post vermis syndrome(2)

Answer 132

medulloblastoma | astrocytoma

Question 133

clue for scarlet fever(2)

Answer 133

sore throat | sand paper like appearrance

Question 134

clue for 21 hydroxylase in children(newborn)(4)

Answer 134

high K+ low TA Low NA+ high 17 hydroxyprogesterone

Question 135

clue for 11 B hydroxylase

Answer 135

high 11 deoxycortocosterone | HTA

Question 136

cause of HTA in 11 B hydroxylase

Answer 136

HTA

Question 137

cause of HTA in 17 alpha hydroxylase

Answer 137

high corticosterone

Question 138

substance produced by adrenal cortex

Answer 138

G,F,R Aldoesterone=G fascicule=F reticule=androgen

Question 139

clue for duchenne muscular dystrophy(2)

Answer 139

weakness in children before 5 | wheelchair bound before 5

Question 140

clue for Becker muscular dystrophy

Answer 140

weakness in children after 5

Question 141

strawberry tongue in USMLE

Answer 141

kawasaki

Question 142

clue for Kawasaki(5)

Answer 142

``` Fever adenopathy extremities swelling red eyes skin erythema ```

Question 143

syndrome coronarien in kid

Answer 143

kawasaki

Question 144

rx of kawasaki(2)

Answer 144

aspirin and | immunoglobulin

Question 145

genotype of turner

Answer 145

45 XO

Question 146

gendre in turner

Answer 146

woman

Question 147

complication of turner(2)

Answer 147

osteoprosis | coarctation of aorta

Question 148

physiopatho in Marfan syndrome

Answer 148

mutation of the fibrillin -1 gene

Question 149

vascular problem in Marfan

Answer 149

aortic root dilation

Question 150

eye problem in marfan

Answer 150

upward dislocation of the lens

Question 151

children with unsteady gait ,and myocarditis

Answer 151

friedrich ataxia

Question 152

cause of T wave inversion(5)

Answer 152

``` MI Myocarditis Pericarditis digoxin toxicity Myocardial contusion ```

Question 153

EKG in friedrich ataxia

Answer 153

T wave inversion

Question 154

CAT in club foot

Answer 154

treat immediately

Question 155

clue hyper IGM syndrome(2)

Answer 155

Low neutophils high IGM low IGA and IGG sinopulmonary infections and PCP pneumonia

Question 156

Bruton's agammaglobulinemia

Answer 156

Low IG M Low IG G Low IG A

Question 157

finding in chronic pyelonephritis in children

Answer 157

focal parenchymal scarring and blunted calices

Question 158

bugs in otite moyenne(3)

Answer 158

strep pneumo # 1 non typable H flu # 2 Moraxella catharalis # 3

Question 159

consequence of vit D deficiency in children

Answer 159

rickets

Question 160

epidemiology for rickets

Answer 160

black children

Question 161

clue for Neuroblastoma in children(2)

Answer 161

high homovanillic acid | vanylilmandelic acid in urine

Question 162

origin of neuroblastoma

Answer 162

neural crest cells

Question 163

origin tumor de wills

Answer 163

metanephros

Question 164

renal tumor in children(2)

Answer 164

neuroblastoma | tumor de wilms

Question 165

murmeur in tetralogy of Fallot

Answer 165

squatting increases murmur

Question 166

cardiac problem in Down syndrome(3)

Answer 166

endocardial cushion defect #1 or complete atrioventricular canal VSD ASD

Question 167

clue for cyclic vomiting in children(2)

Answer 167

any cause can be found | history of migraine in the family

Question 168

bug in rheumatic fever

Answer 168

strep group A

Question 169

cause of NEC in baby

Answer 169

formula use

Question 170

abdomen xray in NEC

Answer 170

pneumatosis intestinalis

Question 171

quid of pneumatosis intestinalis

Answer 171

intramural air with dilated loops pof bowel

Question 172

rx of prematurity anemia

Answer 172

fer

Question 173

Lab for prematurity anemia(5)

Answer 173

``` mormochromic normocytic anemia low reticulocytes total normal bilirubin level ```

Question 174

vasoocclusive manif in hand in sickle cell disease(2)

Answer 174

dactilytis | hand foot syndrome

Question 175

early manif of vasooclusive crisis in SCD(2)

Answer 175

dactilytis | hand foot syndrome

Question 176

quid of gastrochisis

Answer 176

no peritoneum covers the intestines

Question 177

quid omphalocele

Answer 177

ombilic ring herniation covered by peritoneum

Question 178

most common bugs causing pneumonia in cystic fibrosis(4)

Answer 178

Hi flu # 2 pseudomonas # 1 staph aureus # 4 strep pneumo #3

Question 179

gram positive diplococci

Answer 179

strep pneumo

Question 180

gram positive cooci in clusters

Answer 180

staph

Question 181

gram negativ cocci

Answer 181

neisseria

Question 182

gram positive rods

Answer 182

Lysteria monocytogenes

Question 183

gram negative rods(4)

Answer 183

Pseudomonas Hi flu Klebsiella legionella

Question 184

cause # 1 of bronchiolitis

Answer 184

VSR

Question 185

risk future in bronchiolitis

Answer 185

asthma

Question 186

risk in use of erythromycin in baby

Answer 186

hypertrophis pyloric stenosis

Question 187

clue for Kartagena syndrome(3)

Answer 187

situs inversus reccurrent sinusitis bronchiectasis

Question 188

risk for patient having received inactivated vaccine in 1960

Answer 188

can develop atypical measles

Question 189

gold standard test for Duchenne muscular dystrophy

Answer 189

genetic studies

Question 190

number one cause of sepsis in sickle cell disease

Answer 190

Pneumococcus

Question 191

important thing to do in premature baby

Answer 191

iron till 1 year old

Question 192

consequence of cow milk consumption

Answer 192

anemia

Question 193

red blood cells in intrauterine growth restriction

Answer 193

polycythemia

Question 194

clue for congenital foot deformity

Answer 194

adduction of the foot

Question 195

Rx for congenital foot deformity(2)

Answer 195

reassurrance | no cast

Question 196

cardiac problem in congenital rubella(2)

Answer 196

PDA | ASD

Question 197

clue for turner (3)

Answer 197

feme naine coarctation of aorta Miley cyrus concert

Question 198

cardiac problem in Edward

Answer 198

VSD

Question 199

bugs causing infection in chronic granulomatosis disease

Answer 199

catalase positive organism

Question 200

quid of catalase positive organism(5)

Answer 200

``` SPACE S:STAPH AUREUS P:PSEUDOMANAS A:SPERGILUS CANDIDA ENTEROBACTERIACEA ```

Question 201

quid of enterobacteriacae

Answer 201

klebsiella | .....

Question 202

other name of laryngotracheobronchitis

Answer 202

croup

Question 203

indication of epinephrine in respiratory problem(2)

Answer 203

croup | asthma

Question 204

rx of in infection caused by pseudomonas in cystic fibrosis(2)

Answer 204

ceftazidine + gentamycine or ticarcilin + gentamycin

Question 205

rx of CGD

Answer 205

gamma interferon

Question 206

quid of henoch shonlein purpura

Answer 206

IGA vasculitis

Question 207

how to prevent sudden infant death syndrome

Answer 207

supine position while sleeping

Question 208

meaning of non pitting edema

Answer 208

lymphatic problem

Question 209

why people with turner has edema in feet

Answer 209

lymphedema

Question 210

kidney appearance in turner

Answer 210

horse shoe kidney

Question 211

disease with webbed neck

Answer 211

turner syndrome

Question 212

meaning of barking cough

Answer 212

croup

Question 213

cause of barking cough

Answer 213

parainfluenza type 1

Question 214

risk during delivery of macrosomia(3)

Answer 214

clavicle fracture brachial plexus injury perinatal asphyxia

Question 215

intestinal malformation associated with chromosomal abnormality

Answer 215

dudenal atresia

Question 216

risk in premature infant

Answer 216

intraventricular hemorrage

Question 217

what disease you can perform gutry test

Answer 217

phenylketonuria

Question 218

cause of avascular necrosis in children(3)

Answer 218

sickle cell disease corticosteroid alcoholism

Question 219

immune thrombocytopenia and viral infection < 30 000 rx

Answer 219

corticosteroid

Question 220

immune throbocytopenia and viral infection platelet 30 000

Answer 220

observation

Question 221

dx digeorge syndrome(5)CATCH

Answer 221

``` conotruncal cardiac defects abnormal facies thymic aplasia cleft palate hypocalcemia ```

Question 222

anomaly chromosomal in Digeorge

Answer 222

22q11,2

Question 223

facies abnormaly in Digeorge(2)

Answer 223

low set ears | micrognatia

Question 224

waiters tip attitude and erb duchenne palsy

Answer 224

atteinte C5 C6 C7 extended elbow pronated forearm flexed wrist and fingers

Question 225

kid with failure to thrive and metabolic acidosis with normal anion gap,high urine PH 7,9 cause of failure to thrive

Answer 225

renal tubular acidosis

Question 226

kid with giardiasis in fection a repetition

Answer 226

genetic b cell deficiency

Question 227

physiopatho in nieman pick disease

Answer 227

sphingomyelinase deficiency

Question 228

quid of adrenarche

Answer 228

axillary hair growth

Question 229

quid of pubarche

Answer 229

pubic hair growth

Question 230

clue for bruton's agamma globulinemia(2)

Answer 230

low IGM IGG and IGA | Lymphocytes B absent

Question 231

how's temperature in neonatal sepsis(2)

Answer 231

high 30 C | low <36 degree

Question 232

jaundice in children cause(4)

Answer 232

breastmilk breast feeding sepsis hematologic problem

Question 233

peak in jaundice caused by breastmilk

Answer 233

2 weeks

Question 234

complication of galactosemia(2)

Answer 234

E coli neonatal sepsis | cataract in newborn

Question 235

enzyme deficiency in galactosemia

Answer 235

galactose 1 phosphate uridyl transferase

Question 236

cause of cirrhosis in neonate

Answer 236

galactosemia

Question 237

period of infantile colic

Answer 237

< 4 months

Question 238

cause of alkali ingestion intox

Answer 238

liquid oven cleaner

Question 239

management of alkali ingestion(4)

Answer 239

no charbon no vinegar no lavage gastrique endoscopy

Question 240

physiopatho od reye syndrome in aspirin ingestion in infant

Answer 240

hyperammonemia

Question 241

advantage of breastfeeding in mother(7))

Answer 241

``` decreased the risk of breast cancer ovarian cancer more rapid uterine involution and post partum bleeding fastter return to prepartum weight improved maternal infant bonding imp[roved child spacing ```

Question 242

advantage of breastfeeding in kid(5)

Answer 242

``` decreased risk of otite moyenne improve immunity prevention of respiratory illness decreased risk of NEC childhood cancer and type 1 diabetes prevent gastroenteritis ```

Question 243

additionnal finding in atresia oesophagienne

Answer 243

tracheo esophageal fistula

Question 244

clue for foreign body aspiration

Answer 244

wheezing in infant

Question 245

best test in foreign body aspiration

Answer 245

bronchoscopy

Question 246

enfant controle tete et cou a quel age

Answer 246

2 mois

Question 247

controle du bassin(2)

Answer 247

4 mois | 6 mois

Question 248

pull to stand a quel age

Answer 248

9 mois

Question 249

stand and marche a quel age

Answer 249

12 mois

Question 250

can say papa mama

Answer 250

9 mois

Question 251

language of baby in 12 months(3)

Answer 251

mama papa plus one word

Question 252

fine motor development in baby a 2 mois

Answer 252

ferme les mains

Question 253

fine motor development in baby a 4 mois

Answer 253

ouvre mains

Question 254

fine motor development in baby a 6 mois

Answer 254

passe objet d'une main a une autre

Question 255

fine motor development in baby a 9 mois

Answer 255

pince a 3 doigts

Question 256

fine motor development in baby a 12 mois

Answer 256

pince a 2 doigts

Question 257

skin rash and vasomotor collapse during meningoccemia cause of death in children

Answer 257

adrenal gland failure

Question 258

meningoccemia and adrenal failure percentage of death

Answer 258

100%

Question 259

hemiplegia in infant after seizures that usually improves within 24 hours

Answer 259

Todd paralysis

Question 260

seizure description in infant in the USMLE

Answer 260

sudden loss of consciousness with following disorientationand slow gain of consciousness

Question 261

importanse of todds paralysis

Answer 261

there 's a structural abnormality underlying the seizure

Question 262

patient with spasms 14 yo and swollen and erythemastous ombilical cord dx

Answer 262

tetanus neonatal

Question 263

major source of protein in milk

Answer 263

whey

Question 264

advantage of human mlik

Answer 264

more easily absorbs | improves gastric emptying

Question 265

evolution of cephalematoma

Answer 265

resorb spontaneously wuthin weeks to 3 months

Question 266

clue for drinking cow milk in USMLE

Answer 266

whole milk

Question 267

clue for tetralogy de fallot(2)

Answer 267

tet spell | cyanosis during tet

Question 268

cause of tet spells

Answer 268

sudden spasm of the right ventricular outflow tract during exertion

Question 269

murmur in Fallot

Answer 269

crescendo decrescendo systolic murmur over the left upper sternal border

Question 270

complication of praderr willi syndrome(4)

Answer 270

sleep apnea Type 2 diabetes mellitus gastric distension and rupture death by choking

Question 271

howel jolly bodyes

Answer 271

nuclear remnant of red blood cell

Question 272

congenital malformation in diamond blacfan diamond(4)

Answer 272

short stature webbed neck shieleded chest triphalangeal thumbs

Question 273

lens dislocation in marfan syndrome

Answer 273

upward

Question 274

lens dislocation in homocystinuria

Answer 274

down ward

Question 275

what to do devant leukocoria

Answer 275

refer to ophtalmologist

Question 276

clue for midgut volvulus(3)

Answer 276

child less than 1 month with bilious vomiting abdominal distension passage of bloodstained stools

Question 277

development of child of 2 years(3)

Answer 277

speak in 2 words follow two steps command two quarters of speech intelligible

Question 278

development of child of 3 years(3)

Answer 278

use three word sentences threequarters of speech intellible ride tricycle

Question 279

complicationin severe type 2 osteogenesis imperfecta(4)

Answer 279

death in utero multiple intrauterine fracture blue sclera growth retardtion

Question 280

patient with menigitidis requires urgent LP who must give consent for the procedure and why(2)

Answer 280

no consent is needed | it's an emergency procedure

Question 281

emergent act with no need of consent(2)

Answer 281

intubation for respiratory failure | LP

Question 282

xray finding in coarctation of the aorta

Answer 282

rib notching

Question 283

cause of rib nocthing in coarctzation of aorta in turner

Answer 283

dilatation of the collaterals between the hypertensive chest walls vessels

Question 284

characteristics of coarctation of aorta(2)

Answer 284

hypertension in upper part of the body | hypoperfusion in the lower part of the body

Question 285

why continuous murmur on chest in coarctation of aorta

Answer 285

development of collaterals betweenthe hypertensive and hypoperfused vessels

Question 286

young boy with bitemoral hemianopsia,symptom of intracranial pressure calcified lesion above the sella dx

Answer 286

craniopharyngioma

Question 287

MRI with cystic calcified parasellar lesion

Answer 287

craniopharyngioma

Question 288

clue for congenital adrenal hyperplasia late onset(non classic)(4)

Answer 288

advanced bone age coarse axillary and pubic hair severe cystic acne normal electrolytes

Question 289

clue for peripheral precocious puberty(2)

Answer 289

low baseline levels of LH | no modification of LH after stimulation with a gonadotrophin releasing hormone agonist

Question 290

clue for classic CAH(3)

Answer 290

neonatal period manifestation adrenal insufficiency ambiguous genitalia

Question 291

hemolytic anemia characteristics(5)

Answer 291

``` mild to moderate anemia reticulocytosis unconjugated bilirubinemia low to absent serum haptoglobin high lactate dehydrogenase ```

Question 292

first step in children with meningitidis(2)

Answer 292

LP | followed by ceftriaxone plus vancomycine

Question 293

when using imaging prior to LP(3)

Answer 293

focal neurologic finding coma history of neurosurgical surgery

Question 294

local impetigo characteristics

Answer 294

vesiculopustular lesions golden yellow and encrusted

Question 295

rx of impetigo

Answer 295

topical mupirocin

Question 296

spherocytose hereditaire in new born(3)

Answer 296

hemolytic anemia jaundice splenomegaly increased mean corpuscular hb concentration

Question 297

problem in hereditary spherocytosis

Answer 297

defect of red blood cell membrane | ankyrin gene abnormality causes spectrin defivciency

Question 298

dx of spherocytosis(2)

Answer 298

high osmotic fragility in acidified glycerol lysis test | abnormal eosin5 maleimide binding test

Question 299

rx of hereditary spherocytosis(3)

Answer 299

folic acid supplementation blood transfusions splenectomy

Question 300

complication of hereditary spherocytosis(2)

Answer 300

pigment gallstones | aplastic crisis from parvovirus B19

Question 301

hemiplegia in child after accident with pencil penetration in mouth at school

Answer 301

traumatic carotid artery dissection

Question 302

consequence of trauma in the soft palate

Answer 302

risk of stroke in children

Question 303

rx of minimal change

Answer 303

prednisone

Question 304

during apgar evaluation baby has HR< 80 and irregular respiration APGAR a 5 /10 next step(2)

Answer 304

pulse oxymetry monitoring | positive pressure ventilation

Question 305

clue for impaired leucocytes adhesion type 1(5)

Answer 305

delayed separation od umbilical cord reccurrent bacterial infections of skin and mucosal surfaces necrotic perriodontal infection no pus in inflamed or infected tissue leucocytosis with neutrophil predominance

Question 306

maternal I drug user , baby with failure to thrive,lymphadenopathy,thrush dx

Answer 306

HIV infection

Question 307

hiv testing in hiv drug use during pregnancy(2)

Answer 307

1 trimestre | 3e trimestre

Question 308

xray in duodenal atresia

Answer 308

double bubble sign

Question 309

cause of microcytic anemia in children

Answer 309

consumption of > 24 ounces per day of cow milk(700ml)

Question 310

inheritance of hemophilia

Answer 310

Xlinked recessive

Question 311

screening test of hemophilia(2)

Answer 311

coagulation studies | platelet count

Question 312

rx of hemophilia

Answer 312

administration of factor 8 et 9

Question 313

boy 4 -10 ans with hip and knee pain with insidious onset and antalgic gait.xray

Answer 313

legg calve perthes disease

Question 314

adolescent with hip pain obese

Answer 314

slipped femoral capital epiphysis

Question 315

when to suspect respiratory distress syndrome in premature infant(3)

Answer 315

premature infant with grunting flaring retraction immediately after birth

Question 316

dx in prematured infant with respiratory distress

Answer 316

hyaline membrane disease

Question 317

xray in hyaline membrane disease

Answer 317

fine reticular granularity

Question 318

treatment of hyaline membrane disease

Answer 318

continuous positive air pressure ventilation

Question 319

charactheristics of acquired aplastic anemia

Answer 319

everything is low=pancytopenia

Question 320

cause of acquired aplactic anemia(2)

Answer 320

drugs | infectiom

Question 321

drug causing acquired aplastic anemia

Answer 321

chemo | chloramphenicol

Question 322

toxins causing aplastic anemia(2)

Answer 322

benzene | carbon tetrachloride

Question 323

mode de contamination of measles

Answer 323

infected droplets from respiratory secretions

Question 324

rash characteristic in measles(2)

Answer 324

cephalocaudal and | centrifugal spread

Question 325

confirmatory dx of measles

Answer 325

PCR

Question 326

complication of measles(4)

Answer 326

otitis media pneumonia neurologic gastroenteritis

Question 327

neurologic complication of measles(2)

Answer 327

encephalitis within days | subacute sclerosing panencephalitis within years

Question 328

premature child with seizures hypotension focal neurologic findings bulging and tense fontanel apna and bradychardia cause of symptoms

Answer 328

intraventricular hemmorage

Question 329

what do to in any premature infant even if asymptomatic

Answer 329

transfontanel ultrasound

Question 330

why gout in lesh nyhan syndrome

Answer 330

deficiency in hypoxanthine guanine phosphorybosil transferase

Question 331

role of hypoxanthine guanine phosphorybosil transferase

Answer 331

purine metabolism

Question 332

young boy with gout

Answer 332

lesh nyhan syndrome

Question 333

clue for intussuception in USMLE

Answer 333

palpable cylindrical mass on the right side of the abdomen

Question 334

patient with recurrent intussuception

Answer 334

rule out meckel

Question 335

cause of intussuception(3)

Answer 335

recent viral illness rotavirus vaccination pathological lead point

Question 336

quid of pathological lead point(5)

Answer 336

``` congenital malformation of the intestines like meckel henoch shonlein purpura celiac disease intestinal tumor polyps ```

Question 337

clue for meckel(3)

Answer 337

suden intermittent abdominal pain currant jelly stools sausage shaped abdominal mass

Question 338

dx of Meckel(3)

Answer 338

target sign on ultrasound technetium 99m pertechnetate scanning explorative laparoscopy

Question 339

rx of intussuception(2)

Answer 339

enema | surgery for removal of lead point

Question 340

management of cyanosis in fallot(2)

Answer 340

knee chest positionning | inhaled o2

Question 341

definitive rx of Fallot

Answer 341

surgery before age of 6

Question 342

the most common cause of congenital adrenal hyperplasia

Answer 342

21 hydroxylase deficiency

Question 343

what will happen in 21 hydroxylase deficiency(2)

Answer 343

hyeperandrogenism=hirsutism | Plus virilism

Question 344

clue for congenital adrenal hyperplasia(2)

Answer 344

elevated 17 hydroxyprogesterone | certain degree of dsalt wasting

Question 345

most common cause of hyperandrogenism and oligo ovulation

Answer 345

PCOS

Question 346

cause of hyperandrogenism en dehors de PCOS(6)

Answer 346

``` ovarian or adrenal tumors late onset of adrnal hyperplasia hyperprolactinemia hyperprolactinemia acromegaly cushing disease ```

Question 347

hyperandrogenism plus high 17 hydroxyprogesterone

Answer 347

CAH

Question 348

clue for acromegaly

Answer 348

high insulin like growth factor

Question 349

clue for clavicular fracture in baby(2)

Answer 349

crepitus | moro reflex asymetric

Question 350

consequence of hyperinsulinism in macrosome(2)

Answer 350

viceromegaly | fat accumulation

Question 351

cause of intellectual disability(3)

Answer 351

fetal alcohol syndrome down syndrome fragile X syndrome

Question 352

clue fragile x syndrome(5)

Answer 352

``` macroorchidism macrocephaly large ears long narrow face prominent forehead and chin ```

Question 353

face of patient with down syndrome

Answer 353

flat facial profile slanted palpebral fissure small low set ears

Question 354

body of patient with Down(4)

Answer 354

excessive skin at nepe of the neck single transvers palmar crease clinodactyly large space between the first 2 toes

Question 355

2 yo kid with noisy breathing worsen when lying on his back or crying or feeding dx?

Answer 355

laryngomalacia

Question 356

2 yo kid with noisy breathigh worset when lying on his back or crying way to confirm the dx

Answer 356

flexible laryngoscopy

Question 357

flexible laryngoscopy of laryngomalacia(2)

Answer 357

collapse of supraglottic structures with inspiration | omega shape epiglottis

Question 358

evolution of laryngomalacia

Answer 358

spontaneous resolution by age of 18 months

Question 359

inspiratory stridor in laryngomalacia

Answer 359

noisy breathing

Question 360

peak for laryngomalacia

Answer 360

4-8 mois

Question 361

clue for hypothyroidism in infant(6)

Answer 361

``` baby normal at birth later apathy hypotonia sluggish movement abdominal bloating umbilical hernia ```

Question 362

screening test in baby in the US(3)

Answer 362

hypothyroidism Phenylketonuria galactosemia

Question 363

murmur in VSD

Answer 363

holosystolic murmur at the left sternal border

Question 364

most common cause of congenital abnormality

Answer 364

VSD

Question 365

best tes if you suspect VSD

Answer 365

echocardiography

Question 366

evolution of vSD

Answer 366

75% des cas close spontaneously by age 2

Question 367

blood stained odorless vaginal discherger in kid < 3 months next step

Answer 367

reassurrance

Question 368

cause of vaginal discherge in infant

Answer 368

effect of maternal estrogen

Question 369

how many doses a kid from 6 weeks to 6 years should receive

Answer 369

5 doses

Question 370

patient in the past has febrile seizure when receiving DTP acellular can we give this patient hs 4 th dose and why (2)

Answer 370

yes | febrile seizure is not a contrindication for acellular pertussis

Question 371

contrindication for further administration of pertussis(3)

Answer 371

immediate anphylaxia unstable neurologic disorder encephalopathy wthin a week administration of pertussis containing vaccines

Question 372

child from 3-10 year old develops hip pain following rhinorrhea and intermittent cough xrayu is normal no history of fever is noted dx

Answer 372

transient synovitis

Question 373

rx of transient synovitis(3)

Answer 373

Ibu rest follow up in 1 week

Question 374

indicator to look at in dx septic arthritis

Answer 374

``` fever > 38.5 inability to bear weight wBC> 12000 ERS > 40 CRP>2.0 mg/dl ```

Question 375

normal CRP

Answer 375

20 mg/l

Question 376

why you should ask bilateral hip xray even if you suspect transient synovitis

Answer 376

to rule out leg calve perthes disease

Question 377

patient presenting in consultation a 24 mois d'age with .cover test reveals moderate deviation of the left eye dx

Answer 377

strabismus

Question 378

complication of strabismus

Answer 378

amblyopia

Question 379

what to do in dx of strabismus

Answer 379

occlusion of the normal eye

Question 380

cause of amblyopia(3)

Answer 380

strabismus errors of refraction opacity of the media along the visual axis

Question 381

can you see a patient with epiglotittis like out patient

Answer 381

no because it's a medical emergency

Question 382

patient dx with epiglotitis with respiratory distress next step

Answer 382

endotracheal intubation with a set up for tracheostomy

Question 383

why you can 't encounter epiglotitis caused by HIB

Answer 383

because of vaccination

Question 384

after bloody diarrhea patient develops anemia low platelet and renal insufficiency dx?

Answer 384

SHU

Question 385

cause of SHU

Answer 385

E coli producing verotoxin

Question 386

patient between 2-12 ans with bilateral lower extremities pain occurring at night bilateral with normal physical exam with normal activity leveldx?

Answer 386

growing pain

Question 387

cause of growing pain

Answer 387

unknown

Question 388

rx of growing pain(4)

Answer 388

observation parental reassurance massage over the counter pain medications

Question 389

quid of purpura in USMLE

Answer 389

non blanching rash

Question 390

pathogenesis of Henoch shonlein purpura(2)

Answer 390

IG A deposit in affected organs | immune mediated leukocytoclastic vasculitis

Question 391

role in sodium bicarb in the rx of TCA intoxication(2)

Answer 391

correct the acidosis | narrow the qrs complex prolongation

Question 392

patient presenting with microcephaly,hypotonia | short stature and cat like cry

Answer 392

cri du chat syndrome

Question 393

weight loss in baby

Answer 393

up to 7% in the first 5 days

Question 394

baby comes by the day five with weight loss of < 7% next step

Answer 394

continue exclusive breast feeding

Question 395

baby comes by the day five with weight loss of > 7% next step(4)

Answer 395

assess for oromotor dysfunction assess for lactation failure daily weights consider formula supplementation

Question 396

in vignette diaper with brick dust appearance or pink stains in baby with dehydration why

Answer 396

it's caused by uric acid crystals

Question 397

when should a babay regain weight after losing weight during the 5 first days

Answer 397

entre 10 a 14 jours

Question 398

cause of growth failure in cystic fibrosis

Answer 398

pancreatic insufficiency

Question 399

cause of pancreatic insufficiency in cystic fibrosis(2)

Answer 399

inspissation | obstructionof pancreatic ducts

Question 400

tests for cystic fibrosis(3)

Answer 400

Sweat chloride test genotyping fecal elastase

Question 401

kid with growth failure and reccurrent respiratory infection

Answer 401

cystic fibrosis

Question 402

contrindication of breast feeding maternal conditions(8)

Answer 402

``` active unrx TB maternal hiv infection herpetic breast lesions varicella infection < 5 days earlier or 2 dyas after delivery specific maternal medications chemo ongoing radiation active abuse of street drug or alcohol ```

Question 403

when a mother on anti TB can begin to breast feed baby

Answer 403

2 weeks after beginning anti TB drugs

Question 404

infants condition with contrindication of breastfeeding

Answer 404

galactosemia

Question 405

clue for osteogenesis imperfecta(5)

Answer 405

``` autosomal dominant osteopenia blue sclerae hearing loss dentinogenesis imperfecta ```

Question 406

quid of dentinogenesis imperfecta

Answer 406

opalescent blue gray to yellow brown discoloration caused by discolored dentin shining through the transluscent and weak enamel

Question 407

what about intelligence in patient with osteogenesis imperfecta

Answer 407

normal intelligence

Question 408

rx of neonatal conjunctivitis induced by gonoccoque

Answer 408

parenteral ceftriaxone or cefotaxime

Question 409

rx of neonatal conjunctivitis induced by chlamydia trachomatis

Answer 409

oral erythromycin

Question 410

characteristic of chlamydial neonatal conjunctivitis(2)

Answer 410

blood stained eye discharge | mucoid discharge

Question 411

patient with reccurent sinopulmonary infections oral candidiasis persistent diarrhea absent lymp nodes Low B and T cells and natural killer absent thymic shadow dx

Answer 411

severe combined immunodeficiency

Question 412

most 2 common tumor of posterior fossa(infratentorial tumor) in children(2)

Answer 412

astrocytoma | medulloblastoma

Question 413

if a kid has a medulloblastoma what area of the brain will be most likely affected

Answer 413

cerebellar vermis

Question 414

post vermis syndrome(4)

Answer 414

unbalanced gait trunk dystaxia horizontal nystagmus papilledema

Question 415

vaginal discharge and enlargement of mammary glands in newborn infants next step?

Answer 415

observation

Question 416

bugs causing scarlet fever

Answer 416

Group A streptococcus producing exotoxins

Question 417

kid with sore throat ,fever sand paper rash stawberry tongue and circumoral pallor dx

Answer 417

scarlet fever

Question 418

rx of choice of scarlet fever

Answer 418

penicillin V

Question 419

first born boy 3 a 5 semaines de naissance with projectile nonbilious vomiting after feed physical exam reveals palpable olive shaped mass in the RUQ

Answer 419

pyloric stenosis

Question 420

metabolic problem in pyloric stenosis(3)

Answer 420

hypochloremic hypokalemia metyabolic acidosis

Question 421

dx of pyloric stenosis (2)

Answer 421

abdominal US | elongated and thickened pylorus

Question 422

rx of choice of pyloric stenosis

Answer 422

pylotomyotomy

Question 423

what to do before surgical rx of pyloric stenosis and why(2)

Answer 423

correct metabolic problem | sinon risque of post op apnea

Question 424

characteristics in 21 hydroxylase deficiency(5)

Answer 424

``` anbiguous genitalia in girl salt wasting hypotension low NA+ high K+ ```

Question 425

hormone abnormality in 21 hydroxylase deficiency(3)

Answer 425

low cortisol and aldosterone high testo high hydroxyprogesterone

Question 426

characteristics in 11 B hydroxylase deficiency(3)

Answer 426

ambiguous genitalia in girls fluid and salt retention hypertension

Question 427

hormone abnormality in 11 B hydroxylase deficiency(4)

Answer 427

low cortisol and aldosterone high testo high 11-deoxycorticosterone high deoxycortisol

Question 428

characteristics in 17 @ hydroxylase deficiency(3)

Answer 428

all patients are female fluid and salt retention hTA

Question 429

hormone abnormality in 17 2 hydroxylase deficiency(3)

Answer 429

low cortisol and testo high mineralocorticoids high corticosterone

Question 430

first step in the management of choanal atresia(2)

Answer 430

placing oral airway | lavage feeding

Question 431

definitive rx of choanal atresia(2)

Answer 431

repairing obstruction with surgery or with endoscopy

Question 432

child less than 5 years with proximal muscles weakness gower sign and bilateral calf pseudohypertrophy dx

Answer 432

duchenne muscular dystrophy

Question 433

quid of gower sign

Answer 433

patient uses hands to walk up the legs in order to stand up

Question 434

cause of DMD

Answer 434

dystrophin gene deletion on XP 21

Question 435

cause of death in DMD(2)

Answer 435

respiratory failure or heart failure

Question 436

clue for kawasaki disease(6)

Answer 436

fever > ou egal a 5 jours plus > ou egal a 4 findings bilateral non exsudative conjunctivitis mucositis cervical lymph node with at least one > 1,5 in diameter erythematous polymorphous rash extremity changes( edema or erythema)

Question 437

mucositis in kawasaki disease(3)

Answer 437

strawberry tongur injected or fissured lips injected pharynx

Question 438

complication of kawasaki(2)

Answer 438

coronary artery aneurism | myocardial infarction and ischemia

Question 439

rx of kawasaki(2)

Answer 439

aspirin plus IV immunoglobulin

Question 440

role of aspirin and immunoglobulin in kawasaki

Answer 440

to reduce incidence of complications such as coronary artery aneurisms

Question 441

clue for turner(4)

Answer 441

short height high arched palate widely spaced nipples 45 X0 karyotype

Question 442

why osteoporosis in turner(2)

Answer 442

low estrogen levels | only one X chromosome involved in bone metabolism

Question 443

patient with an autosomal dominant disorder presenting with tall stature,long and emaciated extremities,arachnodactyly hypermobility of joints upward lens dislocation aortic root dilation dx

Answer 443

Marfan syndrome

Question 444

patient at risk for transposition of great vessels(2)

Answer 444

diabetic mother | males

Question 445

physical examination in transposition of great vessels(2)

Answer 445

loud second heart sound | cyanosis

Question 446

patietn with history of diabetes mellitus type 1 presents with conjonctival pallor and micrcytic anemia but no blood in feces examination.skin with vesicule erythemateuses symmetrically distributed over the extensor surfaces of elbows and knees .dx

Answer 446

celiac disease

Question 447

extraintestinal manifestation on celiac disease in the vignette(3)

Answer 447

diabete type 1 dermatitis herpetiforme iron deficiency anemia

Question 448

skin problem in celiac disease(2)

Answer 448

dermatite herpetiforme | vitiligo

Question 449

endocrine problem in celiac disease(2)

Answer 449

``` diabete type 1 autoimmune thyroiditis (hypo ou hyper) ```

Question 450

psychiatric problem in celiac disease(2)

Answer 450

depression | psychosis

Question 451

musculoskeletal problem in celiac disease(2)

Answer 451

osteopenia/osteoporosis | osteomalacia

Question 452

dx of celiac disease

Answer 452

upper GI andoscopy with biopsy of small intestine

Question 453

marker of celiac

Answer 453

IG A antitissue transglutaminase

Question 454

9 yo girl with unsteady gait and weakness in the lower limbs .On examination widebased gait and constant shifting of position to maintain her balance.you have decreased vibratory and position sense in lower extremities

Answer 454

friedrich ataxia

Question 455

MRI in friedrich ataxia(2)

Answer 455

marked atrophy of cervical spinal cord | minimal cerebellar atrophy

Question 456

what you should advise to mother with kid suffering from friedrich ataxia

Answer 456

prenatal counselling if the mother desires any future pregnancy

Question 457

quid of friedrich ataxia(2)

Answer 457

autosomal recessive | abnormality in tocopherol transfer protein

Question 458

infectious protection by sickle cell trait

Answer 458

severe complication of malaria

Question 459

differenciate hyper IGM syndrome from xlinked agammaglobulinemia(3)

Answer 459

in hyper IgM syndrome opportunistic infection+++ neutropenia high IGM levels

Question 460

risk factor for chronic pyelonephritis

Answer 460

vesicoureteral reflux

Question 461

clinical feature of media otitis(2)

Answer 461

middle ear effusion\ | bulging tympannic membrane

Question 462

complication of otitis media(3)

Answer 462

conductive hearing loss mastoiditis meningitis

Question 463

rx of otitis media(2)

Answer 463

amox or amox clavulanate

Question 464

risk factor for media otitis in children(4)

Answer 464

age 6-36 months formula intake exposure to cigarette smoke upper respiratory infection

Question 465

Ct for mastoiditis(2)

Answer 465

no air in mastoid air cells | they are opacified

Question 466

patient 11 months with pliable skull bones,bony prominences of costochondral junctions genu varum cause of these findings(2)

Answer 466

nutritionnal deficiency | vit D

Question 467

costochondral joint hypertrophy in rickets quid?

Answer 467

rachitic rosary

Question 468

genu varum in rickets

Answer 468

femoral and tibial bowing

Question 469

risk factor for Vit D deficiency(4)

Answer 469

increasd skin pigmentation(black) exclsive breastfeeding inadequate sun exposure maternal vit D deficiency

Question 470

pliable skull bones with step offs in rickets or ping pond ball skull

Answer 470

craniotabes

Question 471

xray in rickets

Answer 471

metaphysal cupping and fraying of long bones

Question 472

rx of rickets

Answer 472

Vit D 1000-2000 UI daily

Question 473

most common form of cerebral palsy seen in premature infants

Answer 473

spastic diplegia

Question 474

quid of spastic displegia(4)

Answer 474

hypertonia hyperreflexia involving lower extremities clasp knife

Question 475

quid of clasp knife in cerebral palsy

Answer 475

resistance to passive muscle movement increases with more rapid movement of the affected extremity

Question 476

leading cause of cerebral palsy

Answer 476

prematurity

Question 477

other causes of cerebral palsy(7)

Answer 477

``` intrauterine growth restriction intrauterine infection antepartum hemorrage placental pathology multiple gestation maternal alcohol consumption maternal tobacco use ```

Question 478

rx of cerebral palsy in spasticity(2)

Answer 478

baclofen and | botulinum toxin

Question 479

comorbidities associated with cerebral palsy(4)

Answer 479

intellectual disability epilepsy strabismus scoliosis

Question 480

localisation of neuroblastoma(2)

Answer 480

adrenal gland | any location along the paravertebral sympathetic chains

Question 481

quid of neural crest cells

Answer 481

precursor cells of the sympathetic chains and adrenal medulla

Question 482

CT or Xray in neuroblastoma(2)

Answer 482

calcifications | hemorrage

Question 483

quid of metanephros

Answer 483

embryologic precursor of renal parenchyma

Question 484

quid of metabolites of cathecholamines found in neuroblastoma(2)

Answer 484

HVA | VMA

Question 485

key physical exam for down syndrome(5)

Answer 485

``` upslanting palpebral fissures epicanthal folds brushfield spots single transverse crease sandal gap toes ```

Question 486

GI problem associated with Down(2)

Answer 486

duodenal atresia | hirshprung disease

Question 487

neurocognitive problem associated with Down syndrome(2)

Answer 487

intellectual disability | early onset alzheimer

Question 488

hematologic problem associated with Down syndrome

Answer 488

acute leukemia

Question 489

endocrine problem associated with Down syndrome(2)

Answer 489

hypothyroidism | type 1 diabetes mellitus

Question 490

musculoskeletal problem associated with Down syndrome(2)

Answer 490

atlantoaxial instability

Question 491

porcentage of down with heart problem

Answer 491

50%

Question 492

what age down syndrome patient will have heart failure

Answer 492

around 6 weeks

Question 493

auscultation finding in heart failure in patient with down

Answer 493

S2 due to pulmonary hypertension

Question 494

patient with circular rash after trip in connecticut dx

Answer 494

lyme disease

Question 495

prevention of lyme in lyme endemic area(2)

Answer 495

wear permethrin treated pants | long sleeved shirts

Question 496

7 yo girl comes for vomiting,this is the 3 episode the last two were self limiting .Physical exam is ok dx

Answer 496

cyclical vomiting

Question 497

parental antecedent for children with cyclical vomiting

Answer 497

migraine in parents

Question 498

patient with severe dehydration IV line can be found next step

Answer 498

intraosseous access

Question 499

how long can you use an intraosseous access

Answer 499

24 a 48 heures

Question 500

patient with difficulty writting and jerky movements,days later he has sore throat but now has low grade fever.pericardial friction,a subcutaneous nodules over the hands dx?

Answer 500

rheumatic fever

Question 501

cause of rheumatic fever

Answer 501

Group A streptococus

Question 502

5 major criterai in jones criteria(5)

Answer 502

``` polyartritis carditis chorea subcutaneous nodules erythema marginatum ```

Question 503

3 minor criteria for jones

Answer 503

fever athralgia previous rheumatic fever

Question 504

dx of rheumatic fever(3)

Answer 504

one major pour 2 minor or two major plus detection af antistreptolysin antibodies or cultures or varrious antigens detection

Question 505

rx of rheumatic fever

Answer 505

PNC G

Question 506

2 day old baby is seen with irritabilioty,high pithed cry,poor sleeping tremors,seizures sweating sneezing tachypnea poor feeding vomiting and diarrhea dx

Answer 506

neonatal abstinence syndrome

Question 507

drug involved in neonatal abstinence syndrome(2)

Answer 507

heroin | methadone

Question 508

time of apparition of neonatal abstinence syndrome(2)

Answer 508

48 h after birth for heroin withdrawal | 48 a 72 h for methadone withdrawal

Question 509

clue for NEC(5)

Answer 509

``` newborn with abdominal distension bloody diarhea and leucocytosis after introduction of formula feeding ```

Question 510

clue for craniopharyngyoma(3)

Answer 510

young boy with increased intracranial pressure bitemporal hemianopsia calcified lesion above the sella

Question 511

clue for cranyopharyngioma

Answer 511

cystic clcified parasellar lesion on MRI

Question 512

cause of anemia in premature infant(4)

Answer 512

transition in the erythropoiesis sites of the neonate shorter red blood cells in neonates diminished fetoplacental transfusion blood loss

Question 513

black child 9 month old with augmentation de volume des pieds et mains et douleur dx

Answer 513

dactylitis caused by sickle cell anemia

Question 514

pathophysiology of dactilytis

Answer 514

vaso occlusive phenomena

Question 515

what the earliest manif of vasoocclusive disease in sickle

Answer 515

dactylitis

Question 516

neonate seen in with matted mass of edematous bowel loops protruding from the abdomen .There is no covering ovr the bowel loops dx

Answer 516

gastrochisis

Question 517

gastrochisis next step after the DX

Answer 517

sterile saline dressing and wrapping of exposed bowel

Question 518

characteristics of gastrochisis(4)

Answer 518

bowel protrude through a defect on the right side of the ombilical cord bowel is not covered by protective membrane bowel looks angry and matted no other abnormalities associated

Question 519

characteristics of omphalocele(3)

Answer 519

intera abdominal contents through the umbilical ring bowel is covered with amnioperitoneal membrane associated with other abnormalities(heart ,kidney)

Question 520

patient with omphalocele what other organ to look at(2)

Answer 520

heart | kidney

Question 521

why you should wrap and dress bowel in gastrochisis(2)

Answer 521

to minimize heat loss | and fluid loss

Question 522

most common cause of pneumonia in cystic fibrosis

Answer 522

Pseudomonas aeruginosa

Question 523

mode de transmission de cystic fibrosis CF

Answer 523

autosomal recessive

Question 524

why bronchiectasia in CF

Answer 524

recuurrent pneumonia

Question 525

quid of clubbing

Answer 525

bulbing enlargement of the tips of digits

Question 526

cause of clubbing in CF

Answer 526

chronic hypoxia

Question 527

appearance of thorax in CF

Answer 527

barrel chest

Question 528

3 phases in developping bordetella pertussis(3)

Answer 528

catarrhal phase paroxysmal phase convalescent phase

Question 529

whooping chronic cough in kid with delayed immunization with posttussive emesis

Answer 529

bordetela pertussis infection

Question 530

clue for catarrhal phase in pertussis(2)

Answer 530

mild cough | rhinitis

Question 531

clue for paroxysmal phase in pertussis(4)

Answer 531

coughing paroxysm lasting 20 a 30 mn inspiratoty whoop staccato cough posttussive emesis

Question 532

clue for convalescent phase in pertussis(2)

Answer 532

cough | posttussive emesis resolve

Question 533

duration of paroxysmal phase

Answer 533

4-6 weeks

Question 534

dx pf pertussis(2)

Answer 534

PCR | pertussis culture

Question 535

hemogramme in pertussis

Answer 535

lymphocyte predominant leukocytosis

Question 536

complication of pertussis(6)

Answer 536

``` pneumonia weight loss subconjonctival hemorrage pneumothorax respiratory failure death ```

Question 537

rx of pertussis

Answer 537

macrolides

Question 538

macrolides used in pertussis(3)

Answer 538

azythromycin erythromycin clarythromycin

Question 539

what age you can have death in infant with pertussis

Answer 539

less than 6 months

Question 540

the only way to prevent chlamydial conjunctivitis in neonates

Answer 540

maternal prenatal testing

Question 541

clue for duchenne muscular dystrophy(3)

Answer 541

bilateral calf pseudohypertrophy gower sign mx weakness

Question 542

transmission of Duchenne

Answer 542

x linked recessive transmission

Question 543

screening of Duchenne muscular dystrophy(2)

Answer 543

elevated serum creatine phosphokinase | elevated aldolase levels

Question 544

dx support of duchenne(2)

Answer 544

fibrosis | fatty infiltration in biopsy

Question 545

gold standard to confirm the dx of DMD

Answer 545

genetic studies

Question 546

risk factor for iron deficiency anemia in kid(3)

Answer 546

cow's milk before 12 months prematurity maternal iron deficiency

Question 547

why you should introduce vit D to all chldren exclusively breastfed during first month of life

Answer 547

human milk does not contain enough VIT D to meet daily requirement of the infant

Question 548

dose of VIT D to give in infant exclusively breast fed

Answer 548

400 UI

Question 549

quid of small for gestationnal age infant for age

Answer 549

weight under 10 th percentile for gestationnal age at birth

Question 550

complication of small gestationnal age child(5)

Answer 550

``` hypoxia polycythemia hypoglycemia hypothermia hypocalcemia ```

Question 551

classification of intrauterine growth restriction(2)

Answer 551

symmetrical | assymetrical

Question 552

clue for symmetrical intrauterine growth restriction

Answer 552

head weight and head are equally affected

Question 553

clue for asymmetrical intrauterine growth restriction

Answer 553

weight is affected more than height and head circumference

Question 554

quid of metatarsal adductus(2)

Answer 554

deformity of foot | adduction of the anterior aspect of the foot with convex lateral border and concave medial border

Question 555

rx of metatarsal adductus

Answer 555

reassurrance

Question 556

rx of internal torsion of tibia in infant

Answer 556

reassurrance

Question 557

baby 4 months old with blue macules on buttocks and and lower back (2)

Answer 557

mongolian spot | also called congenital dermal melanocytosis

Question 558

epidemiology of mongolian spots(4)

Answer 558

african asian hispanic native american

Question 559

evolution of mongolian spots

Answer 559

fades spontaneously in the first decade of life

Question 560

is mongolian spot dangerous

Answer 560

no its benign

Question 561

triad for congental rubella(german measles)(3)

Answer 561

sensorineural deafness cardiac defects cataracts

Question 562

complication of first trimaester rubella(2)

Answer 562

spontaneous abortion | congenital rubella syndrome

Question 563

clue cataract in USMLE

Answer 563

leukokoria

Question 564

cardiovascular anomaly in turner

Answer 564

bicuspid aortic valve

Question 565

face and neck of turner patient(3)

Answer 565

narrow high arched palate low set ears low hairline webbed neck

Question 566

chest of turner(3)

Answer 566

broad chest with widely spaced nipples coarctation of aorta bicuspid aortic valve

Question 567

abdomen of turner

Answer 567

horse shoe kidney

Question 568

limbs of turner(2)

Answer 568

cubitus valgus | short stature

Question 569

pelvis of turner(3)

Answer 569

streak ovaries amenorrhea infertility

Question 570

why echo coeur should be done in patient with turner(3)

Answer 570

to dx bicuspid aortic valve coarctation of aorta aortic root dilation

Question 571

dx of chronic granulomatus disease(3)

Answer 571

nitro blue tetrazolium slide test flow cytometry cytochrome c reduction

Question 572

Rx of CGD(2)

Answer 572

daily TMS | gamma inrterferon 3 f jour

Question 573

patient with recurrent or unusual lymphadenitis hepatic abcess or osteomyelitis at multiple sites or infection with catalase positive organisms

Answer 573

CGD

Question 574

patient seen in emergency with barking cough and difficulty respiratoire DX

Answer 574

croup

Question 575

first thing to do in croup

Answer 575

racemic epinephrine before any invasive procedure

Question 576

pneumonia plus influenza in young children with CF, bugs in cause

Answer 576

staphyloccocus aureus

Question 577

medication to use in patient with cystic fibrosis in a context of influenza

Answer 577

vancomycin

Question 578

most common cause of pneumonia in cystic fibrosis in young children

Answer 578

staph aureus

Question 579

most common cause of pneumonia in cystic fibrosis in adult

Answer 579

pseudomonas aeruginosa

Question 580

Henoch shonlein purpura clue(4)HSP

Answer 580

lower extremity purpura athralgias and arthritis coliky abdominal pain reenal involvement

Question 581

why coliky abdominal pain in HSP

Answer 581

local vasculitis

Question 582

dx of HSP

Answer 582

clinical

Question 583

dx of HSP in atypical presentation

Answer 583

renal biopsy

Question 584

renal biopsy in HSP

Answer 584

deposition of IGA in the mesangium by immunofluorescence

Question 585

peak of incidence sudden infant death syndrome

Answer 585

1 month and 1 year in the US

Question 586

cause of edema in turner syndrome

Answer 586

lymphedema

Question 587

cause of lymphedema in turner

Answer 587

dysgenesis of the lymphatic network

Question 588

kid with with ascending symmetric flaccid paralysis in both legs absent deep tendon treflexes and decreased superficial touch and vibratory senses.dx

Answer 588

guillain barre

Question 589

structures affected in guillain barre

Answer 589

peripheral motor nerves

Question 590

albumino cytologic dissociation dx

Answer 590

guillain barre syndrome

Question 591

rx of Guillain barre(2)

Answer 591

plasmapheresis or human immunoglobulin

Question 592

cause of GBS

Answer 592

most of the time follows viral infection

Question 593

macrosome with clavicle fracture next step

Answer 593

reassurrance and gentle handling

Question 594

period of time for healing clavicle fracture

Answer 594

7-10 jours

Question 595

prema with neurologic symptoms

Answer 595

intraventricular hemorrage

Question 596

risk for intracerebral hemorrage in prema(2)

Answer 596

< 30 semaines de gestation | or <1500 g

Question 597

screening test for intracerebral hemorrage in prematurity

Answer 597

serial head ultrasounds

Question 598

clue for intracerebral hemorrage(4)

Answer 598

rapidly increasing head circumference bulging fontanel hypotonia lethargy

Question 599

cranial ultrasound of intraventricular hemorrage in prema(2)

Answer 599

bilateral IVH | dilated ventricles

Question 600

why communicating hydrocephalus in intracerebral hemorrage

Answer 600

accumulation of blood in subarachnoid space impaitr the ability of the arachnoid villi to absorb cerebrospinal fluid

Question 601

main problem in phenylketonuria(2)

Answer 601

deficiency in phenylalanine hydroxylase | accumulation of phenylalanine in the blod and body tissues

Question 602

screening test for phenylketonuria

Answer 602

gutrie test

Question 603

clue for phenylketonuria(4)

Answer 603

faitr hair and skin blue eyes eczematous changes urine with mousy odor

Question 604

what to avoid in phenylketonuria

Answer 604

protein

Question 605

12 yo with back pain with or without incontinence ,physical exam reveals step off of lumbosacral area dx

Answer 605

spondylisthesis

Question 606

physiopatho of spondylisthesis

Answer 606

developmental disorder with forward slip of vertebra usually L5 over S1

Question 607

6 yo with down syndrome presents urinary incontinence,hyptonic and hyperreflexia wit positive babinski

Answer 607

atlanto axial instability

Question 608

cause of atlanto axial instability in down syndrome

Answer 608

excessive laxity in the post transverse ligament causing increased mobility between atlas C1 ant the axis C2

Question 609

upper motor neuron findings in patient presenting with down syndrome

Answer 609

atlantoaxial instability

Question 610

children with inattention impulsivity and hyperactivity in 2 or more settings dx

Answer 610

deficit hyperactivity syndrome disorder

Question 611

patiuetn with sickle cell disease presents with pain in his right hip that started several days ago dx

Answer 611

avascular necrosis

Question 612

cause of avascular necrosis(6)

Answer 612

``` sickle cell disease SC hemoglobin disease corticosteroid therapy SLE alcoholism' Gaucher disease ```

Question 613

physiopatho of aeptic necrosis in sickle cell disease(3)

Answer 613

occlusion of end arteries supplying the femoral head bone necrosis colapse of the periarticular bone and cartilage

Question 614

children with isolated thrombocytopenia and petechiae after viral infection dx

Answer 614

immune thrombocytopenia

Question 615

children with isolated thrombocytopenia and petechiae after viral infection next step

Answer 615

observation regardless the level of platelet

Question 616

children with isolated thrombocytopenia and petechiae after viral infection ,experiencing bleeding next step(2)

Answer 616

IV glucorticoids or IV immunoglobulin

Question 617

physiopatho of immune purpura(2)

Answer 617

antibody binds to platele | destruction of complex antibody-platelet-in spleen

Question 618

period of time to recover from immune purpura

Answer 618

6 months

Question 619

hemogram in measles(2)

Answer 619

leukopenia(T cell cytopenia) | thrombocytopenia

Question 620

what seem to decrease the morbidity and mortality in measles

Answer 620

vit A

Question 621

regression of milesstones after meningitis cause of that

Answer 621

meningitis

Question 622

neurologic sequelae associated with bacterial meningitis(5)

Answer 622

``` hearing loss loss of cognitive functions seixures mental retardation spasticity or paresis ```

Question 623

principal risk in Digeorge

Answer 623

hypocalcemia

Question 624

tests to ask if youb suspect Digeorge(2)

Answer 624

serum calcium levels | echocardio

Question 625

risk associated with hypocalcemia(3)

Answer 625

tetany seizures arrythmia

Question 626

complication of absent thymus in Digeorge

Answer 626

T cell lymphopenia

Question 627

complication of T cell lymphopenia(2)

Answer 627

viral | fungal infection

Question 628

bay born with cyanosis,tremulation,low set ears,micrognatia and cleft palate.No thymic shadow in chest xray DX

Answer 628

Digeorge syndrome

Question 629

macrome presenting with right upper extremity held in adduction and rotation interne,with the elbow pronated and wrists and fingers flexed,moro and biceps reflexes absent bilateraly next step in the management in the patient and dx

Answer 629

Erb Duchenne | reassurance about prognosis

Question 630

maternal risk factor for macrosomia

Answer 630

``` advanced age diabetes excessive weight gain during pregnancy preexisting obesity multiparity ```

Question 631

fetal risk factor for macrosomia(3)

Answer 631

african american or hispanic ethnicity male sex post term pregnancy

Question 632

evolution of erb duchenne

Answer 632

80 % spontaneous recovery within 3 months

Question 633

quid of renal tubular acidosis

Answer 633

inability for renal tubules to reabsorb bicarb or excrete hydrogen

Question 634

quid of type 1 renal tubular acidosis

Answer 634

defect in hydrogen secretion

Question 635

cause of type 1 renal tubular acidosis

Answer 635

genetic disorder

Question 636

metabolic problem in type 1 renal tubular acidosis(4)

Answer 636

acidotic hypokaliemic high PH urinaire nephrolithiasis commonly develops

Question 637

quid of type 2 renal tubular acidosis

Answer 637

decreased bicarb reabsorbtion in proximal tubule

Question 638

cause of type 2 renal tubular acidosis

Answer 638

Fancony syndrome

Question 639

quid of type 4 renal tubular acidosis

Answer 639

defect in sodium potassium exchange in the distal tubule

Question 640

metabolic problem in type 4 renal tubular acidosis(2)

Answer 640

hyperkaliemie | hyperchloremie

Question 641

cause of type 4 renal tubular acidosis(3)

Answer 641

obstructive uropathy renal disease multiplastic dysplastic kidneys

Question 642

patient with less than 3 yo with impairment of social interaction and communication delayed language and stereotypical behaviors

Answer 642

autism

Question 643

what will need patient with autism

Answer 643

behavioral and educationnal programs

Question 644

patient with respiratory distress ,examination reveals nasal falring grunting,and barre shaped chest.auscultation reveals absent breath sounds in the left abdomen is scphoid .chest xray shows devation pf the heart in the right and gasless abdomen dx ?

Answer 644

congenital diaphragmatic hernia

Question 645

next after dx of congenital diaphragmatic hernia

Answer 645

endotracheal intubation

Question 646

complication of diaphragmatic hernia(2)

Answer 646

pulmonary hypoplasia | pulmonary hpertension

Question 647

sites of diaphragmatic hernia in the chest(2)

Answer 647

85% in the left | 15 % in the right

Question 648

why polyhydramnios in congenital diaphragmatic hernia

Answer 648

esophageal compression

Question 649

consequence of abdominal viscera in the chest(2)

Answer 649

concave abdomen | barrel shaped chest

Question 650

congenital diaphragmatic hernia with respiratory distress

Answer 650

emergency intubation

Question 651

why you cannot use blow by oxygen and bag and mask ventilation in congenital diaphragmatic hernia

Answer 651

you will pump air in the intestines ,and further compromise the pulmonary function

Question 652

why after intubation in diaphragmatic hernia ,gastric tube should be used

Answer 652

to decompress the stomach and bowel

Question 653

in vignette patient after 6 months of age with reccurrent sinopulmonary infections and giardiaisis, DX

Answer 653

abnormal B lymphocyte maturation

Question 654

problem with genetic B cells deficiency(2)

Answer 654

ressurrent infections after 6 months with encapsulated organisms lack of IGA predisposes to infection

Question 655

clue for Nieman pick disease(5)

Answer 655

``` cherry red macula protruding abdomen hepatosplenomegaly lymphadenopathy regression of developmental milestones ```

Question 656

complication of sphingomyelinase deficiency in Nieman pick

Answer 656

sphingolipidosis

Question 657

risk of premature adrenarche(2)

Answer 657

obesity | hispanic and black ethnicities

Question 658

risk in patient with isolated premature adrenarche(3)

Answer 658

PCOS Diabete type 2 metabolic syndrome

Question 659

cause of premature adrenarche

Answer 659

early activation of adrenal androgen relaease

Question 660

characteristics premature (5)

Answer 660

``` pubic hair axillary hair acne body odor in girls before 8 for girl before 9 for boy ```

Question 661

role of adipocytes during obesity(2)

Answer 661

increase secretion of insulin | increase secretion of leptin

Question 662

consequence of increased insulin secretion in obesity(2)

Answer 662

increase adrenal production---->periphera activation of adrenarche increase ovarian estrogen production------->peripheral activation of thelarche

Question 663

consequence of leptin secretion in obesity

Answer 663

axctivation of the axis hypothalamus pituitary gonadal axis------->central activation of puberty-----> LH ans FSH release --->ovarian stimulation and estrogen production

Question 664

patient with reccurrent sinopulmonary infection with deceased IGA,IGM IGD and IGG absence circulating B cells Dx

Answer 664

bruton's agammaglobulinemia

Question 665

transmission of Bruton agammaglobulinemia

Answer 665

X linked recessive

Question 666

differenciation between Bruton and common varable immunodeficiency(3)

Answer 666

CVID occurs later 15-35 ans CVID no decrease or no absence of Lymphocytes B circulant in CIVD all gender can be touched by the disease

Question 667

male 6-9 ans with recurrent sino pulmonary infection

Answer 667

Brutons agammaglobulinemia

Question 668

most common cause of neonatal jaundice

Answer 668

breastfeeding jaundice breast milk jaundice sepsis

Question 669

when to suspect neonatal sepsis(3)

Answer 669

fever or hypothermia ictere neurologic symptom

Question 670

patient with ictere and neurologic symptom and hypothermia next step(2)

Answer 670

PL | blood culture

Question 671

patient with ingestion battery plain xray shows battery in esophagus next step?

Answer 671

immediate endoscopic removal

Question 672

why you should remove battery in esophagus

Answer 672

to prevent mucosal damage and esophageal ulceration

Question 673

patient with ingestion battery plain xray shows battery in distal to esophagus next step?

Answer 673

observe stool

Question 674

newborn with failure to thrive,bilateral cataracts,jaundice and hypoglycemia DX

Answer 674

galactosemia

Question 675

whta to do after dx galactosemia

Answer 675

elimination of galactose in from the diet

Question 676

healthy infant crying for than three hours a day, more than three days a week and more than 3 weeks a month

Answer 676

colic

Question 677

rx of infantile colic

Answer 677

simethicone or probiotics

Question 678

steatorrhea in USMLE

Answer 678

oily and nasty smelling stools

Question 679

gold standard test for cystic fibrosis

Answer 679

swaet testing by quantitative pilocarpine iontophoresis

Question 680

why you can have ADEK deficiency in cystic fibrosis(2)

Answer 680

because of pancreatic insufficiency | no absorption of fat soluble vit

Question 681

consequence of ADEK deficiency

Answer 681

A=Night blindness D=ricket E=neuropathy K=coagulapathy

Question 682

value of chloride to confirtm the DX of CF

Answer 682

> ou egal a 60 mmol /l on 2 separate occasions

Question 683

organ always involved in Cystic fibrosis(2)

Answer 683

respiratory tract and Pancreas

Question 684

problem in cystic fibrosis

Answer 684

defective chloride transport results in inpissated secretions in multiple organs

Question 685

clue for CF(3)

Answer 685

steatorrhea failure to thrive respiratory infections

Question 686

step in management of children after ingestion of oven cleaner liquid(4)

Answer 686

ABC assessment remove contaminated clothing chest xray if respiratory symptom endoscopy within 24 hours

Question 687

when to perform upper endoscopy after alkali ingestion

Answer 687

within 24 hours

Question 688

risk for delay in performing upper endoscopy in alkali ingestion

Answer 688

risk of perforation during procedure

Question 689

quid of alkali ingestion

Answer 689

oven cleaner liquid

Question 690

complication of alkali ingestion(5)

Answer 690

``` uppper airway compromise perforation stricture /stenosis(2-3 weeks) ulcers cancer ```

Question 691

what to not do if alkali ingestion

Answer 691

try to neutralize the alkali with vinegar or lavage

Question 692

symptom in reye syndrome and lab finging(6))

Answer 692

``` vomiting increased AST and ALT PT prolonged Normal bilrubin hyperammonemia hypoglycemia ```

Question 693

context for reye syndrome

Answer 693

chil less than 15 years treated with salycilates after viral infection

Question 694

Ct scan in reye syndrome

Answer 694

cerebral edema

Question 695

viral infection and fever

Answer 695

no salycylates

Question 696

biopsy of liver in reye syndrome

Answer 696

microvesicular steatosis

Question 697

newborn with choking spell and coughing after first feeding

Answer 697

atresia oesophagienne with possible fistule tracheo esophagienne

Question 698

what will happen in attempting to pass a nasogastric tube in case of esophageal atresia

Answer 698

xray will show the tube in proximal esophageal pouch

Question 699

why you can have pneumonia par aspiration in esophageal atresia

Answer 699

gastric reflux can go into the distal esophagus through the fistula and into trhe trachea and lungs

Question 700

prenatl clue for osophageal atresia

Answer 700

polyhydramnios

Question 701

toddler with sudden onset respiratory istress bwith focal findings in auscultation

Answer 701

foreign body aspiration

Question 702

why chest xray is limited in foreihn body aspiration

Answer 702

because most object are radioluscent

Question 703

next step in foreign body aspiration

Answer 703

bronchoscopy

Question 704

most common aspirated foreign body*3)

Answer 704

peanuts popcorn pieces of toys

Question 705

physical exam in foreign body aspiration(2)

Answer 705

focal monophonis wheezing on affected side | diminished aeration on affected side

Question 706

gross motor in 2 months

Answer 706

lift head/chest in prone position

Question 707

gross motor in 4 months(12)

Answer 707

sits with trunk suppotrt | begins rolling

Question 708

gross motor in 6 months

Answer 708

sits momentarilypropped on hands( unsupported by 7 months)

Question 709

gross motor in 9 months(2)

Answer 709

pull to stand | cruises

Question 710

gross motor in 9 month(3)

Answer 710

stands well walks first steps independently throws ball

Question 711

fine motor in 2 months(2)

Answer 711

hands unfisted 50 % of the time | track past midline

Question 712

fine motor in 4 month(2)

Answer 712

hands mostly open | reaches midline

Question 713

fine motor in 6 month(2)

Answer 713

transfers objects hand to hand | raking grasp

Question 714

fine motor in 9 month(2)

Answer 714

3 finger pincer grasp | hold bottle or cup

Question 715

fine motor in 12 month

Answer 715

2 finger pincer grasp

Question 716

language in 2 month(2)

Answer 716

alerts to voice and sound | coos

Question 717

language in 4 month(2)

Answer 717

laughs | turn to voice

Question 718

language in 6 month(2)

Answer 718

responds to name | babble

Question 719

language in 9 month

Answer 719

say dada mama

Question 720

language in 12 month

Answer 720

say first words

Question 721

social cognitive in 2 months(2)

Answer 721

social smile | recognizes parents

Question 722

social cognitive in 4 months

Answer 722

enjoys looking around

Question 723

social cognitive in 6 months

Answer 723

stranger anxiety

Question 724

social cognitive in 9 months(2)

Answer 724

wave bye | plays pat a cake

Question 725

social cognitive in 12 months(2)

Answer 725

separation anxiety | comes when called

Question 726

what a 6 month baby can do(4)

Answer 726

should be able to sit momentarily transfer objects from hand to hand respond to name stranger anxiety

Question 727

language development in 2 yo child(3)

Answer 727

vocabulary of hundred words able to combine words into short sentences half of the baby speech should be understood by stranger

Question 728

neonate with painless bloody stools dx

Answer 728

milk or soy protein proctocolitis

Question 729

what to do in soy protein proctocolits(2)

Answer 729

elimination of soy and dairy product in mama diet | initiation of hydrolysed formula in formula fed children

Question 730

symptoms of soy protein proctocolitis(3)

Answer 730

severe reflux or vomiting painless bloody stools eczema

Question 731

peak of apparition of soy protein proctocolits and prognosis(2)

Answer 731

2 a 8 semaines | resolution by age of one

Question 732

neonatal jaundice with conjugated bilirubinemia DX

Answer 732

neonatal cholestasis

Question 733

indication for further evaluation of jaundice(6)

Answer 733

conjugated hyperbilirubinemia > 2 mg/dl jaundice that apperas in the first 24-36 hours of life serum bilirubin greater than 12 mg/dl in full term infantor 10-14 in preterm infant jaundice persist after 10-14 days of life the presence of sign and symptom serum bilirubin rising at a rate faster than 5 mg/24 hours

Question 734

cause of neonatal cholestasis in infant

Answer 734

biliary atresia

Question 735

quid of friedrich ataxia

Answer 735

the most common spinocerebellar ataxia

Question 736

triad of friedrich(3)

Answer 736

neurologic (atxia and dysarthria) skeletal(scoliosis, foot deformities cardiac(concentric hypertrophic cardiomyopathy)

Question 737

cause of death in friedrich(2)

Answer 737

cardiomyopathy respiratory failure

Question 738

speech difficulty in USMLE

Answer 738

dysartria

Question 739

hammer toe

Answer 739

friedrich

Question 740

quid of overlapping finger s in edwards

Answer 740

third and the 5 th overlaping the 4 th

Question 741

dx diffrentiel of flaccid pralysis in kid(3)

Answer 741

infant botulism foodborne botulism guillain barre syndrome

Question 742

pathogenis of infant botulism

Answer 742

ingestion of clostridium spores from environmental dust

Question 743

pathogenis of food borne botulism

Answer 743

ingestion of preformed C botuinum toxin

Question 744

pathogenis of Guillain barre syndrome

Answer 744

autoimmune peripheral nerve demyelination

Question 745

differentiate GBS and botulism(2)

Answer 745

descending flaccid paralysis in botulism | ascending flaccid paralysis in GBS

Question 746

rx of infant botulism

Answer 746

human derived botulism immune globulin

Question 747

rx of food borne botulism

Answer 747

equine derived botulism immune globulin

Question 748

rx of GBS

Answer 748

pooled human immune globulin

Question 749

clue for infant botulinism(4)

Answer 749

constpation hypotonia bulbar palsies no honey feeding

Question 750

what to do in neonates in term of screening

Answer 750

hip dysplasia

Question 751

maneuver to screen hip dysplasia(2)

Answer 751

barlow and 'orthelani

Question 752

next step if you feel palpable clunk during maneuvers in screening of hip dysplasia

Answer 752

referral to orthopedic surgeon

Question 753

hip dysplasia suspected soft click during barlow and orthelani or asymmetric inguinal skin folds or leg lenght discrepancy (2)

Answer 753

Ultrasound in < 6 mois | Xrays > ou egal a 4 a 6 mois

Question 754

rx of choice for hip dysplasia in kid >< 6 months

Answer 754

pavlik hip harness

Question 755

complication of hip discrepancy

Answer 755

limp=trndelenburg gait

Question 756

risk in supracondylar fracture

Answer 756

brachial artery injury

Question 757

consequence of brachial artery injury

Answer 757

loss of radial artery pulse

Question 758

what to in household with one person with pertussis even if the contact has received immunizations

Answer 758

prescribe macrolide antibiotic for all households contacts

Question 759

pertussis rx and post exposure prophylaxis in person < 1 an

Answer 759

azytromycin for 5 days

Question 760

pertussis rx and post exposure prophylaxis in person > 1 an(3)

Answer 760

azytromycin for 5 days clarythromycin for 7 days erythromycin for 14 days

Question 761

basics in post exposure prophylaxis for pertussis(3)

Answer 761

rx regardless of age statut immunitaire symptoms

Question 762

clue for nursemaid's elbow

Answer 762

infants or children whenare lifted or pulled by the hand or arm you have rasdial head subluxation

Question 763

clue for nursemaids elbow

Answer 763

child keeps hand in a pronated position and refuses attempted forearm supination

Question 764

clue for fragile X syndrome(6)

Answer 764

``` low to normal IQ generalised language disability short attention span large head prominent jaw large low set ears macroorchidism ```

Question 765

cause of mental retardation in fragile X syndrome

Answer 765

increased number of CGG trinucleotide repeats

Question 766

overweight adolescent 10-16 yo with hip pain dx

Answer 766

slipped capital femoral epiphysis

Question 767

rx of slipped femoral capital epiphysis

Answer 767

immediate surgical screw fixation

Question 768

complication untreated slipped capital femoral epiphysis

Answer 768

avascular necrosis

Question 769

xray slipped capital femoral epiphysis

Answer 769

glissement du reste de la tete humeral asur l'epiphyse

Question 770

xray slipped legg calve

Answer 770

lyse of the head of femur

Question 771

developmental milestone in child by age of 12 months(6)

Answer 771

``` they should triple weight height should be increased by 50% walk independently using 2 pincre grasps saying few words like mama dada imitate action of others ```

Question 772

Ct scan finding in congenital toxo(3)

Answer 772

inflammatory lesions hydrocephalus intracranial calcificaions

Question 773

triad for congenital toxo(3)

Answer 773

chorioretinitis hydrocephalus intracranial calcifications

Question 774

clue for von gierke(8)

Answer 774

``` hypoglycemia lactic acidosis hyperuricemia hyperlipidemia doll like facies thin extremities short stature protuberant abdomen ```

Question 775

Age for von gierke

Answer 775

3 -4 month

Question 776

why seizure in von gierke

Answer 776

hypoglycemia

Question 777

why protuberant abdomen in von gierke (*2)

Answer 777

enlarged liver and kidney

Question 778

physiopatho for von gierke

Answer 778

glucose 6 phosphatase deficiency

Question 779

quid of von gierke

Answer 779

type 1 collagen storage disease

Question 780

what to do if apgar is 8 in infant (3)

Answer 780

removal of airway secretions drying and keeping him warm early preventive measures

Question 781

first thing to do in neonates

Answer 781

APGAR calculation

Question 782

quid of early preventives measure in newborn(2)

Answer 782

gonococcal ophtalmia prevention | vit K supplementation

Question 783

first step in children with speech delay

Answer 783

audiology evaluation

Question 784

confirmatory test for SLE(2)

Answer 784

anti SM | anti DsDNA

Question 785

risk factor for pyloric stenosis(3)

Answer 785

first born boy erythromycin formula feeding

Question 786

why peak of incidence of infantile hypertrophic pyloric stenosis

Answer 786

age 3-5 weeks

Question 787

dx of pyloric stenosis clinic(2)

Answer 787

projectile nonbilious vomiting | olived shaped presentation

Question 788

lab finding in infantile pyloric stenosis

Answer 788

hypochloremic metabolic alkalosis

Question 789

paraclinic dx in infantile pyloric stenosis

Answer 789

abdominal ultrasound

Question 790

finding in infantile pyloric stenosis

Answer 790

thick and elongated pylorus

Question 791

physiopatho of formula feeding inducing pyloric hypertrophy(2)

Answer 791

slower gastric emptying | increase burden stimulates growth of the pylorus muscle

Question 792

2 day baby with jaundice mother A positive and negative screening for GBS during pregnancy.lab show 7 mg/dl bilirubin with 0.4 conjugated bilirubin Dx

Answer 792

physiologic jaundice

Question 793

peak of incidence of physiologic jaundice

Answer 793

2-4 days of life

Question 794

resolution of physiologic jaundice

Answer 794

1-2 weeks

Question 795

physiopatho of physiologic jaundice(3)

Answer 795

increased bilirubin production due to high Hb turn over decreased bilirubin clearance increased enterohepatic cycling

Question 796

why in newborn you can have decreased bilirubin clearance

Answer 796

decreased hepaticuridine diphosphoglucuronate transferase activity until age 2 weeks

Question 797

why in asian newborn you can have decreased bilirubin clearance

Answer 797

Asian have decreased UGT activity

Question 798

why enterohepatic cycling is increased in new born

Answer 798

because sterile newborn gut

Question 799

possible complication of physiologic jaundice

Answer 799

kernicterus

Question 800

indication of exchange transfusion in physiologic jaundice

Answer 800

total bilirubin levels > 20-25 mg/dl

Question 801

phototherapy for physiologic jaundice

Answer 801

gold standard rx for rapidly increasing hyperbilirubinemia to prevent kernicterus

Question 802

quid of bitot spots

Answer 802

gray silver plaques on the bulbar conjunctiva

Question 803

manif of vit A deficiency(7)

Answer 803

``` impaired adaptation to dryness photophobia dry scaly skin xerosis conjonctiva xerosis cornea keratomalacia bitot spots hyperkeratosis ```

Question 804

localization of hyperkeratosis in vit A deficiency(3)

Answer 804

shoulders buttocks extensor surfaces

Question 805

microscopy light finding in nephrotic syndrome

Answer 805

normal findings

Question 806

immunofluorescence finding in SN

Answer 806

no abnormality

Question 807

electron microcopy finding in SN

Answer 807

difuse effacement of foot process of podocytes

Question 808

quid of podocytes

Answer 808

renal epithelial cells

Question 809

kids seen with seizures EP reveals decreased muscle strength of the left side of the body with brisk deep tendon reflexes in the left arm and leg.MRI reveals space occupying lesions of the parietal lobe droit dx

Answer 809

benign astrocytoma

Question 810

the most common solid tumors in kids

Answer 810

CNS tumors

Question 811

the most common malignancy in kid

Answer 811

leukemia

Question 812

the second most common malignancy in kid

Answer 812

CNS tumor

Question 813

most common localization of CNS tumor

Answer 813

supratentorial

Question 814

the most common tumon which could be found infratentorial and supratentorial localization in kid

Answer 814

astrocytoma

Question 815

most common complication of E coli 0157h7

Answer 815

renal damage

Question 816

mortality in renal damage in HUS

Answer 816

5 a 10%

Question 817

the organ system with higher mortality and morbidity after HUS

Answer 817

kidneys

Question 818

complication of shoulder dystocia(5)

Answer 818

``` fractured clavicle fractured humerus erb duchenne klumpke paralysis perinatal asphyxia ```

Question 819

clue for clavicular fracture in macrosome(4)

Answer 819

clavicular crepitus bony irregularity decreased Moro reflexe due to pain on affected side intact biceps and grasp reflexes

Question 820

clue for humerus fracture in macrosome(4)

Answer 820

upper arm crepitus crepitus bony irregularity decreased Moro reflexe due to pain on affected side intact biceps and grasp reflexes

Question 821

moro and biceps reflexes in erb duchenne

Answer 821

decreased on affected side

Question 822

clue for klumpke palsy(3)

Answer 822

claw hand ipsilateral horner syndrome intact moro and bicep reflexes

Question 823

claw hand in klumpke(4)

Answer 823

extended wrist hyperextended metacarpophalangeal joints fixed interphalangeal joints absent grasp reflexes

Question 824

clue for horner syndrome(2)

Answer 824

ptosis | miosis

Question 825

manif of perinatal asphyxia(4)

Answer 825

altered mental status poor tone seizure difficulte respiratoire

Question 826

nerve fibers involved in Klumpke(2)

Answer 826

c8 | T1

Question 827

rx for klumpke(2)

Answer 827

controverse | physical therapy to prevent contracture

Question 828

klumpke with no improvement after 3-9 months

Answer 828

surgery

Question 829

clue for myotonic muscular dystrophy type 1(8)

Answer 829

``` grip myotonia=delayed muscle relaxation facial weakness foot drop dysphagia cardiac conduction abnormalities cataracts testicular atrophy/infertility baldness ```

Question 830

transmission of muscular dystrophy type 1

Answer 830

autosomal dominant

Question 831

other name of muscular dystrophy type 1

Answer 831

steinert disease

Question 832

why dysphagia is the most dangerous smooth muscle manif in steinert disease

Answer 832

because of risk of aspiration pneumonia

Question 833

reflexes in steinert disease

Answer 833

normal

Question 834

quid of sturge weber

Answer 834

neurocutaneous syndrome characterized by | congenital unilateral hemangioma along the trigeminal nerve

Question 835

xray in sturge weber

Answer 835

intracranial calcifications that resemble a tramline

Question 836

usual neurological symptom in sturge weber

Answer 836

seizures

Question 837

other neurological finding in sturge weber(4)

Answer 837

hemianopsia hemiparesis hemisensory disturbance ipsilateral glaucoma

Question 838

skin problem in sturge weber

Answer 838

port wine stain or nevus flammeus along the trigeminal nerve

Question 839

rx of sturge weber

Answer 839

controlling seizures | reducing intraocclualr pressure

Question 840

how to remove skin lesions in sturge weber

Answer 840

argon laser

Question 841

7 yo boy with decreased urine output and lethargy and high creat and BUN appropriate next step in this patient

Answer 841

urinalysis

Question 842

first test to di in all patient with renal disease

Answer 842

urinalysis

Question 843

14 yo boy is seen in the clinic for fire setting in the neigbor's house.months later he has been arrested by police for stealing,parents say one time he steals money and tries to hurt the pets dx

Answer 843

conduct disorder

Question 844

quid of conduct disorder

Answer 844

disruptive behavioral patterns that violate basic social norms for at least one year in patients less than 18 years

Question 845

19 yo boy is seen in the clinic for fire setting in the neigbor's house.months later he has been arrested by police for stealing,parents say one timeone year he steals money and tries to hurt the pets dx

Answer 845

antisocial personality disorder

Question 846

5 year old boy born at home developed bruises and prolonged PT> 15 cause of that

Answer 846

vit K deficiency

Question 847

origin of vit K in the body(2)

Answer 847

gut flora | diet

Question 848

why can you have Vit K deficiency in baby(3)

Answer 848

poor placental transfer absent gut flora inadequate levels in breast milk

Question 849

what to do to avoid hemorrhagic disease of newborn

Answer 849

all new born babies must receive vit K injection

Question 850

mild vit K deficiency

Answer 850

prolonged PT | normal PTT

Question 851

barking cough in patient less than 3 years hoarseness and varying degree of respiratory distress DX

Answer 851

croup

Question 852

lateral neck xray in croup

Answer 852

subglottic narrowing

Question 853

bug causing croup

Answer 853

parainfluenza virus

Question 854

quid of chickenpox

Answer 854

varicella

Question 855

Manif in chicken pox

Answer 855

pruritic vesicles appearing in different stages across the face and the body and usually fully crusted within a week

Question 856

child > ou egal a 1 an asymptomatic who never received varicella vaccine is exposed to chickenpox what to do

Answer 856

administer varicella vaccine

Question 857

contagiosity in chikenpox

Answer 857

patient is contagious 2 days prior to rash

Question 858

child > ou egal a 1 an immunodeprime asymptomatic who never received varicella vaccine is exposed to chickenpox what to do

Answer 858

givevaricella zoster immunoglobulin

Question 859

physical examination in beckwith wiedemann syndrome(6)

Answer 859

``` fetal macrosomia during delivery rapid growth until late childhood omphalocele or ombilical hernia macroglossia hemihyperplasia hypoglycemia ```

Question 860

complications of beckwith wiedmann(2)

Answer 860

wilms tumor | hepatoblastoma

Question 861

surveillance in beckwith wiedmann

Answer 861

serum alpha fetoprotein | abdominal and renal ultrasound

Question 862

serum alpha protein surveillance of beckwith wiedman

Answer 862

every 3 months from birth to 4 years for

Question 863

abdominal ultrasound in surveillance ofbeckwith wiedman

Answer 863

every 3 months from age 4-8

Question 864

renal ultrasound surveillance in beckwith wiedmann

Answer 864

from age 8 years to adolescent

Question 865

patient who is particular at risk for hepatoblastoma or wilms tumor in wiedmann beckwith

Answer 865

patient with hemihyperplasia

Question 866

example of hemihyperplasia

Answer 866

right upper and lower extremities are significantly larger in circumference than the left extremities

Question 867

pathogenesis of wiedman beckwith

Answer 867

deregulation of imprinted gene expression in chromosome 11p15

Question 868

quid of parinaud syndrome

Answer 868

paralysis of vertical gaze =paralysis of downward and upward gaze

Question 869

quid of collier sign

Answer 869

poor pupillary reaction to light and eyelid retraction

Question 870

meaning of parinaud syndrome and collier's sign

Answer 870

rostral midbrain lesion

Question 871

cause of rostral midbrain lesion(2)

Answer 871

germinoma | pinealoma

Question 872

why you can have development of dark facial hair ,deeping voice and rapid croissance in lesion pinealoma(2)

Answer 872

interruption of hypothalamic inhibiting pathways | bhcg secretion and consequent leydig's cells stimulation

Question 873

why eye problem in pinealoma

Answer 873

the lesion is located at the level of superior colliculus and CN3

Question 874

patient with multiple skin infection and recurrent pneumonia.In the last bout of skin infection cultures of secretions reveals S aureus Dx probable

Answer 874

CGD

Question 875

problem in CGD(2)

Answer 875

impaired metabolism within phagocytes | a mutation causes loss or inactivation of the NADPH oxidase responsible for oxydation

Question 876

main pathogenesis in CGD

Answer 876

intracellular killing deficiency

Question 877

clue for CGD

Answer 877

gram stain of fluid aspirated from the affected lymph nodes reveals numerous bacteria filled segmented neutrophils

Question 878

most common infection in CGD(2)

Answer 878

pneumonia | suppurative adenitis

Question 879

5 yo Mexican girl is seen for nocturnal vulvar itching next step

Answer 879

do a scotch tape test

Question 880

5 yo Mexican girl is seen for nocturnal vulvar itching dx

Answer 880

pinworms infection

Question 881

rx of pinworms

Answer 881

mebendazole

Question 882

clue for ombilcal hernia(2)

Answer 882

abdominal swelling | more pronounced when crying or coughing

Question 883

3 yo girl with ombilical hernia next step

Answer 883

refer to pediatric surgeon for operative management

Question 884

indication of surgery in ombilical hernia(5)

Answer 884

``` persistence to the age of 3 and 4 years exceeds 2 cm in diameter causes symptom becomes strangulated progressively enlarges after the age 1 and 2 years ```

Question 885

evolution of ombilical hernia

Answer 885

disappear spontaneously by age of 1

Question 886

patient with severe coughing develops subcutaneous emphysema over the anterior chest most appropriate next step

Answer 886

chest xray

Question 887

why chest xray in case of emphysema secondary to severe coughing

Answer 887

to rule out pneumothorax

Question 888

patient newborn seen with mild atrophy of the calf,clcaneum and talus are in equinus and varus positions his midfoot is in varus position and his forefoot in adduction dorsiflexion and plantar flexion is limited dx

Answer 888

club foot

Question 889

management of clubfoot(3)

Answer 889

stretching manipulation of the foot followed by serial plaster casts

Question 890

indication of surgery in clubfoot(2)

Answer 890

failure in conservative management | surgery is performed within 3 and 6 months of age

Question 891

why polycythemia in small gestational age

Answer 891

increased erythropoietin secretion in response to fetal hypoxia

Question 892

rx of Lyme disease in children less than 8 years

Answer 892

oral amox

Question 893

anal pruritis in kid dx

Answer 893

enterovermicularis infection

Question 894

rx of enterovermicularis infection(2)

Answer 894

albendazole/mebendazole or pyrantel pamoate

Question 895

dx of enterovermicularis infection

Answer 895

scotch tape

Question 896

the most common causes of viral meningitis(2)

Answer 896

echoviruses | coxsakievirus

Question 897

brudzinsky ????????

Answer 897

you flexe the neck lower leds are flexed too

Question 898

quid of non-polio viruses

Answer 898

echoviruses | coxsakievirus

Question 899

clue for meningococcal meningitis(3)

Answer 899

fever neurologic finding petechial or purpuric rash

Question 900

most common cause of neonatal sepsis

Answer 900

GBS

Question 901

prevention of GBS(2)

Answer 901

maternal testing and | rx with intrapartum IV antibiotics

Question 902

antibio used in prevention of GBS sepsis

Answer 902

PNC