Pediatrics Flashcards
meningite and refractaire hypotension
waterhouse fredrichsen syndrome
hemiplegia in chidren after having seizures
Todd paralysis
4 forms of tetanos(2)
generalisee
localisee
cephalic
Neonatale
dx differentiel of Lytic lesion on bone puls hypercalcemia(4)
osteomyelitis
endocrine
neoplastic
idiopathic
clue for lytic lesion induced by osteomyelitis
brodie abcess
endocrine cause of lytic bone lesion(2)
hyperparathyroidie
osteoid fibrosa cystica
Neoplastic cause of bone lytic lesion(3)
erwing sarcoma
Langerhans hystiocystosis
Metastases
quid of cephalhematoma
hemmoragie sous periostee
clue for cephalhematoma
it doesn’t cross suture
limited to one cranial bone
clue caput succedaneum
it crosses suture
most common cause of functional asplenism in children
sickle cell disease
cause of sepsis in asplenia
encapsulated bugs
most common bug causing sepsis in asplenia
s pneumoniae
cyanosis in infant first 24 hours of life
transposition of great vessels
quid of transposition of great vessel
aorta in ventricule droit
artere pulmonaire in ventricule gauche
what to suspect in child with reccurrent sinopulmonary infection
cystic fibrosis
gold standard dx test for cystic fibrosis
sweat test for Na et CL-
consequence of cow milk consumption in infant
iron deficiency anemia
cyanosis in children less than 4 years
Fallot
tetralogie de Fallot(4)
overriding Aorta
VSD
Subpulmonary stenosis
right ventricular hypertrophy
Clue for PDA and VSD
no cyanosis
Prader willi syndrome(3)
binge eating
hypotonia
obesity
genetics of prader willi
paternal genetics deletion
15q11-q13
genetics problem in cat cry syndrome
5p deletion
genetics problem in angelman
15q11-q13
genetics in beckwith wiedman
11p15
clue for bweckwith
macroglossie
clue megaoblastic anemia
hypersegmentation of the nucleus of neutrophils and other blodd cells
most common cause of congenital hypothyroidism in the US
thyroid dysgenesis
quid of thyroid dysgenesis(3)
ectopie
aplasie
hypoplasia
Disease with Howell jolly bodies
sickle cell disease
Meaning of howell jolly bodies and why
no spleen
spleen normally removes nuclear rmnants of red blood cells
bite cells or heinz bodies(2)
G6PD deficiency
Thalassemia
Helmet cells(3)
DIC
HUS
TTP
cause of helmet cells
traumatic hemolysis
other finding in traumatic hemolysis
schistocytes
casue of basophilic stippling(2)
thalassemia
lead poisonning
quid diamond blackfan anemia(2)
macrocytic anemia
congenital malformation in baby
Mc cune albright syndrome(4) 3 P
femme
Puberte precoce
pigmentation
polyostotic fibrous dysplasia
what will happen in polyostotic fibrous dysplasia
fracture a repetition
casue of stroke in children(4)
internal carotid dissection
AF
homocystinuria
Todd paralysis
clue for homocystinuria(4)
Marfan’s features
thromboembolic event
downward dislocation of the lens
mental retardation
clue for marfans features(3)
long emaciated arms and legs
arachnodactily
hyperlaxity of the skin and joints
cause of homocystinuria
deficiency in cystathione synthetase
Dx test for homocystinuria(2)
high methionine
high homocysteine
Rx of homocystinuria
B6
failure of B6 in rx of homocystinuria
cysteine
quid of leucocoria in USMLE
white eye reflex
cause of leucocoria in kid
retinoblastoma until proven the contrary
occlusion in first 24 hr in infant(2)
hirsprung
meconium ileus
cause of meconium ileus
cystic fibrosis
cause of intestinal occlusion from 24 h to 1 month
volvulus of midgut
cause of intestinal occlusion > 1 month of age
stenose pylorique
cause of cyanosis from 24 h to 4 ans
tetralogy de Fallot
cause of osteogenesis imperfecta
deficiency in type 1 collagen synthesis
congenital disease with coarctation of aorta
turner syndrome
complication of congenital adrenal hyperplasia
puberte precoce
enzyme deficiency in congenital adrenal hyperplasia
21 hydroxylase(CYP21A2)
baby with cyanosis during feeding and relieved by crying
choanal atresia
Dx of choanal atresia(2)
tube nasal
ct scan
Dx test for hereditary spherocytosis
osmotic fragility study
when to perform coombs test
autoimmune hemolytic anemia
most common cause of nephrotic syndrome in children
minimal change disease
next step when dx nephrotic syndrome in adult
biopsy renale
calculate APGAR score
A:appearance P:pulse G:grimace A:activity R:respiration
Monitoring Appearance in APGAR(3)
blue=0
blue pink=1
pink=2
Monitoring pulse in APGAR(3)
absent=0
,100=2
Monitoring grimace in APGAR(3)
absent=0
grimace,whimper=1
cough/cry=2
Monitoring activity in APGAR(3)
limp=0
flexion=1
spontaneous active=2
Monitoring respiration in APGAR(3)
absent =0
slow irregular=1
regular=2
Normal APGAR
7-9
abnormal APGAR
<7
patient with delayed separation of umbilical cord more than 30 days
leucocytes adhesion defect type 1
clue for leucocytes adhesion defect type 1
CD18 expression deficiency
risk in in baby whom mother taking cocaine during pregnancy
jejunal atresia
xray abdomen in jejunal atresia(2)
tripple bubble sign
gasless colon
xray showing double bubble sign
duodenal atresia
abdomen xray in hirsprung
dilated loops of bowel
how to diffenrenciate microcytic anemia caused by iron deficiency from thalassemia
RDW
Clue for Iron deficiency anemia using RDW
RDW>20 %
Normal RDW with microcytic anemia
thalassemia
cause arthropathy in hemophilic patient(2)
deposit of hemosiderrin
fibrosis
hemophilic patient cause
deficiency in factor 8
et
9
children between 4-10 with hip pain(2)
Legg calve Perthes disease
avascular necrosis of femoral head
Quid of measles
rubeola
rougeole en francais
quid of koplik spots
bluish white lesions on buccal mucous membranes next to first and second molars
gender in Mc cune albright syndrome
femme
pigmentation in Mc cune Albright syndrome
cafe au lait spot
gender in Lesh Nyhan syndrome
Male
clue for Lesh Nyhan Syndrome(3)
Male
dystonia
self mutilation
Gout in male children
Lesh Nyhan Syndrome
physiopatho in Lesh Nyhan Syndrome
hypoxanthine guanine phophoribosyl transferase
black stool in children
Meckel Diverticulum
difference between congenital adrenal hyperplasia and hyperandrogenism
virilization in women
Quid of macrosomia
> 4 kg
risk in macrosomia
clavicular fracture
how to recognize fetal alcoholic syndrome(3)
small palpebral fissures
absence philtrum
thin upper lip border= thin vermillon border
Quid of Edward’s syndrome(5)
micrognatia microcephaly absent palmar creases rocker bottom feet overlapping fingers
heart complication of Edward’s syndrome
VSD
chromosome problem in Edward syndrome
trisomy 18
election age
Heart problem in trisomy 21
ASD
Heart problem in william’s syndrome
supravalvular aortic stenosis
Heart problem in congenital rubella
PDA
young kid with stomatitis and cheilitis sore throat andscaly pathes on eyebrows cheek and nose and photophobia dx?
ariboflavinose
cause ariboflvinose in the US(3)
Anorexia nervosa
Malabsorption syndrome
Inborn defect in B2 synthesis
pain articulation in young kid(3)
Legg calve
transient synovitis
hemophilic arthropathy
infant with stridor acute respiratory distress toxic appearrance and fever first dx to think
epiglotitis
first step in epiglotitis
intubation
what to avoid in epiglotitis
never try to watch the epiglotte
Bloody diarrhea plus IR plus low platelet
HUS
cause of HUS in children
E coli 0157h7
how E coli causes HUS
by producing verotoxin
young kid with scrotal pain ,purpura and arthralgia
Henoch shonlein purpura
complication of Henoch shonlein purpura
intussiception ileoileale
age to have henock shonlein purpura
<15 ans
seizure in afebrile children with wide qrs complex dry oral mucosa and dilated pupils and hypotension
TCA intoxication to rule out
Rx of TCA intoxication
sodium bicarbonate
action of Hydroxyurea
Increase HB F
importance of hydroxyurea in sickle cell disease
prevention of painful crisis
clue for cystic fibrosis(2)
diarrhea
probleme respiratoire a repetition
breastfeeding contraindication(9)
herpes mammaire HIV TB varicella drug alcohol fetal galactosemia chemotherapy radiation
for TB when the mother can be allowed to breastfeed
2 weeks after debut of treatment
patient with blue eye and susceptibility to fracture
osteogenesis imperfecta
quid opalescent teeth
yellow teeth
disease with opalescent teeth
osteogenesis imperfecta
red eyes in children in the first 24 h(2)
iatrogenic
nitrate d’argent
red eyes in children in 2-5 days of birth
gonoccoque
rx of conjunctivitis caused by gonoccoque
ceftriaxone
red eyes in children 5- 24 jours of birth
chlamydia
rx for conjuctivitis induced by chlamidya
oral erythromycin
finding in severe combined immunodeficiency
low Lympho B and T
cause of post vermis syndrome(2)
medulloblastoma
astrocytoma
clue for scarlet fever(2)
sore throat
sand paper like appearrance
clue for 21 hydroxylase in children(newborn)(4)
high K+
low TA
Low NA+
high 17 hydroxyprogesterone
clue for 11 B hydroxylase
high 11 deoxycortocosterone
HTA
cause of HTA in 11 B hydroxylase
HTA
cause of HTA in 17 alpha hydroxylase
high corticosterone
substance produced by adrenal cortex
G,F,R
Aldoesterone=G
fascicule=F
reticule=androgen
clue for duchenne muscular dystrophy(2)
weakness in children before 5
wheelchair bound before 5
clue for Becker muscular dystrophy
weakness in children after 5
strawberry tongue in USMLE
kawasaki
clue for Kawasaki(5)
Fever adenopathy extremities swelling red eyes skin erythema
syndrome coronarien in kid
kawasaki
rx of kawasaki(2)
aspirin and
immunoglobulin
genotype of turner
45 XO
gendre in turner
woman
complication of turner(2)
osteoprosis
coarctation of aorta
physiopatho in Marfan syndrome
mutation of the fibrillin -1 gene
vascular problem in Marfan
aortic root dilation
eye problem in marfan
upward dislocation of the lens
children with unsteady gait ,and myocarditis
friedrich ataxia
cause of T wave inversion(5)
MI Myocarditis Pericarditis digoxin toxicity Myocardial contusion
EKG in friedrich ataxia
T wave inversion
CAT in club foot
treat immediately
clue hyper IGM syndrome(2)
Low neutophils
high IGM
low IGA and IGG
sinopulmonary infections and PCP pneumonia
Bruton’s agammaglobulinemia
Low IG M
Low IG G
Low IG A
finding in chronic pyelonephritis in children
focal parenchymal scarring and blunted calices
bugs in otite moyenne(3)
strep pneumo # 1
non typable H flu # 2
Moraxella catharalis # 3
consequence of vit D deficiency in children
rickets
epidemiology for rickets
black children
clue for Neuroblastoma in children(2)
high homovanillic acid
vanylilmandelic acid in urine
origin of neuroblastoma
neural crest cells
origin tumor de wills
metanephros
renal tumor in children(2)
neuroblastoma
tumor de wilms
murmeur in tetralogy of Fallot
squatting increases murmur
cardiac problem in Down syndrome(3)
endocardial cushion defect #1 or complete atrioventricular canal
VSD
ASD
clue for cyclic vomiting in children(2)
any cause can be found
history of migraine in the family
bug in rheumatic fever
strep group A
cause of NEC in baby
formula use
abdomen xray in NEC
pneumatosis intestinalis
quid of pneumatosis intestinalis
intramural air with dilated loops pof bowel
rx of prematurity anemia
fer
Lab for prematurity anemia(5)
mormochromic normocytic anemia low reticulocytes total normal bilirubin level
vasoocclusive manif in hand in sickle cell disease(2)
dactilytis
hand foot syndrome
early manif of vasooclusive crisis in SCD(2)
dactilytis
hand foot syndrome
quid of gastrochisis
no peritoneum covers the intestines
quid omphalocele
ombilic ring herniation covered by peritoneum
most common bugs causing pneumonia in cystic fibrosis(4)
Hi flu # 2
pseudomonas # 1
staph aureus # 4
strep pneumo #3
gram positive diplococci
strep pneumo
gram positive cooci in clusters
staph
gram negativ cocci
neisseria
gram positive rods
Lysteria monocytogenes
gram negative rods(4)
Pseudomonas
Hi flu
Klebsiella
legionella
cause # 1 of bronchiolitis
VSR
risk future in bronchiolitis
asthma
risk in use of erythromycin in baby
hypertrophis pyloric stenosis
clue for Kartagena syndrome(3)
situs inversus
reccurrent sinusitis
bronchiectasis
risk for patient having received inactivated vaccine in 1960
can develop atypical measles
gold standard test for Duchenne muscular dystrophy
genetic studies
number one cause of sepsis in sickle cell disease
Pneumococcus
important thing to do in premature baby
iron till 1 year old
consequence of cow milk consumption
anemia
red blood cells in intrauterine growth restriction
polycythemia
clue for congenital foot deformity
adduction of the foot
Rx for congenital foot deformity(2)
reassurrance
no cast
cardiac problem in congenital rubella(2)
PDA
ASD
clue for turner (3)
feme naine
coarctation of aorta
Miley cyrus concert
cardiac problem in Edward
VSD
bugs causing infection in chronic granulomatosis disease
catalase positive organism
quid of catalase positive organism(5)
SPACE S:STAPH AUREUS P:PSEUDOMANAS A:SPERGILUS CANDIDA ENTEROBACTERIACEA
quid of enterobacteriacae
klebsiella
…..
other name of laryngotracheobronchitis
croup
indication of epinephrine in respiratory problem(2)
croup
asthma
rx of in infection caused by pseudomonas in cystic fibrosis(2)
ceftazidine + gentamycine
or
ticarcilin + gentamycin
rx of CGD
gamma interferon
quid of henoch shonlein purpura
IGA vasculitis
how to prevent sudden infant death syndrome
supine position while sleeping
meaning of non pitting edema
lymphatic problem
why people with turner has edema in feet
lymphedema
kidney appearance in turner
horse shoe kidney
disease with webbed neck
turner syndrome
meaning of barking cough
croup
cause of barking cough
parainfluenza type 1
risk during delivery of macrosomia(3)
clavicle fracture
brachial plexus injury
perinatal asphyxia
intestinal malformation associated with chromosomal abnormality
dudenal atresia
risk in premature infant
intraventricular hemorrage
what disease you can perform gutry test
phenylketonuria
cause of avascular necrosis in children(3)
sickle cell disease
corticosteroid
alcoholism
immune thrombocytopenia and viral infection < 30 000 rx
corticosteroid
immune throbocytopenia and viral infection platelet 30 000
observation
dx digeorge syndrome(5)CATCH
conotruncal cardiac defects abnormal facies thymic aplasia cleft palate hypocalcemia
anomaly chromosomal in Digeorge
22q11,2
facies abnormaly in Digeorge(2)
low set ears
micrognatia
waiters tip attitude and erb duchenne palsy
atteinte C5 C6 C7
extended elbow
pronated forearm
flexed wrist and fingers
kid with failure to thrive and metabolic acidosis with normal anion gap,high urine PH 7,9 cause of failure to thrive
renal tubular acidosis
kid with giardiasis in fection a repetition
genetic b cell deficiency
physiopatho in nieman pick disease
sphingomyelinase deficiency
quid of adrenarche
axillary hair growth
quid of pubarche
pubic hair growth
clue for bruton’s agamma globulinemia(2)
low IGM IGG and IGA
Lymphocytes B absent
how’s temperature in neonatal sepsis(2)
high 30 C
low <36 degree
jaundice in children cause(4)
breastmilk
breast feeding
sepsis
hematologic problem
peak in jaundice caused by breastmilk
2 weeks
complication of galactosemia(2)
E coli neonatal sepsis
cataract in newborn
enzyme deficiency in galactosemia
galactose 1 phosphate uridyl transferase
cause of cirrhosis in neonate
galactosemia
period of infantile colic
< 4 months
cause of alkali ingestion intox
liquid oven cleaner
management of alkali ingestion(4)
no charbon
no vinegar
no lavage gastrique
endoscopy
physiopatho od reye syndrome in aspirin ingestion in infant
hyperammonemia
advantage of breastfeeding in mother(7))
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
advantage of breastfeeding in kid(5)
decreased risk of otite moyenne improve immunity prevention of respiratory illness decreased risk of NEC childhood cancer and type 1 diabetes prevent gastroenteritis
additionnal finding in atresia oesophagienne
tracheo esophageal fistula
clue for foreign body aspiration
wheezing in infant
best test in foreign body aspiration
bronchoscopy
enfant controle tete et cou a quel age
2 mois
controle du bassin(2)
4 mois
6 mois
pull to stand a quel age
9 mois
stand and marche a quel age
12 mois
can say papa mama
9 mois
language of baby in 12 months(3)
mama
papa
plus one word
fine motor development in baby a 2 mois
ferme les mains
fine motor development in baby a 4 mois
ouvre mains
fine motor development in baby a 6 mois
passe objet d’une main a une autre
fine motor development in baby a 9 mois
pince a 3 doigts
fine motor development in baby a 12 mois
pince a 2 doigts
skin rash and vasomotor collapse during meningoccemia cause of death in children
adrenal gland failure
meningoccemia and adrenal failure percentage of death
100%
hemiplegia in infant after seizures that usually improves within 24 hours
Todd paralysis
seizure description in infant in the USMLE
sudden loss of consciousness with following disorientationand slow gain of consciousness
importanse of todds paralysis
there ‘s a structural abnormality underlying the seizure
patient with spasms 14 yo and swollen and erythemastous ombilical cord dx
tetanus neonatal
major source of protein in milk
whey
advantage of human mlik
more easily absorbs
improves gastric emptying
evolution of cephalematoma
resorb spontaneously wuthin weeks to 3 months
clue for drinking cow milk in USMLE
whole milk
clue for tetralogy de fallot(2)
tet spell
cyanosis during tet
cause of tet spells
sudden spasm of the right ventricular outflow tract during exertion
murmur in Fallot
crescendo decrescendo systolic murmur over the left upper sternal border
complication of praderr willi syndrome(4)
sleep apnea
Type 2 diabetes mellitus
gastric distension and rupture
death by choking
howel jolly bodyes
nuclear remnant of red blood cell
congenital malformation in diamond blacfan diamond(4)
short stature
webbed neck
shieleded chest
triphalangeal thumbs
lens dislocation in marfan syndrome
upward
lens dislocation in homocystinuria
down ward
what to do devant leukocoria
refer to ophtalmologist
clue for midgut volvulus(3)
child less than 1 month with bilious vomiting
abdominal distension
passage of bloodstained stools
development of child of 2 years(3)
speak in 2 words
follow two steps command
two quarters of speech intelligible
development of child of 3 years(3)
use three word sentences
threequarters of speech intellible
ride tricycle
complicationin severe type 2 osteogenesis imperfecta(4)
death in utero
multiple intrauterine fracture
blue sclera
growth retardtion
patient with menigitidis requires urgent LP who must give consent for the procedure and why(2)
no consent is needed
it’s an emergency procedure
emergent act with no need of consent(2)
intubation for respiratory failure
LP
xray finding in coarctation of the aorta
rib notching
cause of rib nocthing in coarctzation of aorta in turner
dilatation of the collaterals between the hypertensive chest walls vessels
characteristics of coarctation of aorta(2)
hypertension in upper part of the body
hypoperfusion in the lower part of the body
why continuous murmur on chest in coarctation of aorta
development of collaterals betweenthe hypertensive and hypoperfused vessels
young boy with bitemoral hemianopsia,symptom of intracranial pressure calcified lesion above the sella dx
craniopharyngioma
MRI with cystic calcified parasellar lesion
craniopharyngioma
clue for congenital adrenal hyperplasia late onset(non classic)(4)
advanced bone age
coarse axillary and pubic hair
severe cystic acne
normal electrolytes
clue for peripheral precocious puberty(2)
low baseline levels of LH
no modification of LH after stimulation with a gonadotrophin releasing hormone agonist
clue for classic CAH(3)
neonatal period manifestation
adrenal insufficiency
ambiguous genitalia
hemolytic anemia characteristics(5)
mild to moderate anemia reticulocytosis unconjugated bilirubinemia low to absent serum haptoglobin high lactate dehydrogenase
first step in children with meningitidis(2)
LP
followed by ceftriaxone plus vancomycine
when using imaging prior to LP(3)
focal neurologic finding
coma
history of neurosurgical surgery
local impetigo characteristics
vesiculopustular lesions golden yellow and encrusted
rx of impetigo
topical mupirocin
spherocytose hereditaire in new born(3)
hemolytic anemia
jaundice
splenomegaly
increased mean corpuscular hb concentration
problem in hereditary spherocytosis
defect of red blood cell membrane
ankyrin gene abnormality causes spectrin defivciency
dx of spherocytosis(2)
high osmotic fragility in acidified glycerol lysis test
abnormal eosin5 maleimide binding test
rx of hereditary spherocytosis(3)
folic acid supplementation
blood transfusions
splenectomy
complication of hereditary spherocytosis(2)
pigment gallstones
aplastic crisis from parvovirus B19
hemiplegia in child after accident with pencil penetration in mouth at school
traumatic carotid artery dissection
consequence of trauma in the soft palate
risk of stroke in children
rx of minimal change
prednisone
during apgar evaluation baby has HR< 80 and irregular respiration APGAR a 5 /10 next step(2)
pulse oxymetry monitoring
positive pressure ventilation
clue for impaired leucocytes adhesion type 1(5)
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
maternal I drug user , baby with failure to thrive,lymphadenopathy,thrush dx
HIV infection
hiv testing in hiv drug use during pregnancy(2)
1 trimestre
3e trimestre
xray in duodenal atresia
double bubble sign
cause of microcytic anemia in children
consumption of > 24 ounces per day of cow milk(700ml)
inheritance of hemophilia
Xlinked recessive
screening test of hemophilia(2)
coagulation studies
platelet count
rx of hemophilia
administration of factor 8 et 9
boy 4 -10 ans with hip and knee pain with insidious onset and antalgic gait.xray
legg calve perthes disease
adolescent with hip pain obese
slipped femoral capital epiphysis
when to suspect respiratory distress syndrome in premature infant(3)
premature infant with
grunting
flaring
retraction immediately after birth
dx in prematured infant with respiratory distress
hyaline membrane disease
xray in hyaline membrane disease
fine reticular granularity
treatment of hyaline membrane disease
continuous positive air pressure ventilation
charactheristics of acquired aplastic anemia
everything is low=pancytopenia
cause of acquired aplactic anemia(2)
drugs
infectiom
drug causing acquired aplastic anemia
chemo
chloramphenicol
toxins causing aplastic anemia(2)
benzene
carbon tetrachloride
mode de contamination of measles
infected droplets from respiratory secretions
rash characteristic in measles(2)
cephalocaudal and
centrifugal spread
confirmatory dx of measles
PCR
complication of measles(4)
otitis media
pneumonia
neurologic
gastroenteritis
neurologic complication of measles(2)
encephalitis within days
subacute sclerosing panencephalitis within years
premature child with seizures hypotension focal neurologic findings bulging and tense fontanel apna and bradychardia cause of symptoms
intraventricular hemmorage
what do to in any premature infant even if asymptomatic
transfontanel ultrasound
why gout in lesh nyhan syndrome
deficiency in hypoxanthine guanine phosphorybosil transferase
role of hypoxanthine guanine phosphorybosil transferase
purine metabolism
young boy with gout
lesh nyhan syndrome
clue for intussuception in USMLE
palpable cylindrical mass on the right side of the abdomen
patient with recurrent intussuception
rule out meckel
cause of intussuception(3)
recent viral illness
rotavirus vaccination
pathological lead point
quid of pathological lead point(5)
congenital malformation of the intestines like meckel henoch shonlein purpura celiac disease intestinal tumor polyps
clue for meckel(3)
suden intermittent abdominal pain
currant jelly stools
sausage shaped abdominal mass
dx of Meckel(3)
target sign on ultrasound
technetium 99m pertechnetate scanning
explorative laparoscopy
rx of intussuception(2)
enema
surgery for removal of lead point
management of cyanosis in fallot(2)
knee chest positionning
inhaled o2
definitive rx of Fallot
surgery before age of 6
the most common cause of congenital adrenal hyperplasia
21 hydroxylase deficiency
what will happen in 21 hydroxylase deficiency(2)
hyeperandrogenism=hirsutism
Plus virilism
clue for congenital adrenal hyperplasia(2)
elevated 17 hydroxyprogesterone
certain degree of dsalt wasting
most common cause of hyperandrogenism and oligo ovulation
PCOS
cause of hyperandrogenism en dehors de PCOS(6)
ovarian or adrenal tumors late onset of adrnal hyperplasia hyperprolactinemia hyperprolactinemia acromegaly cushing disease
hyperandrogenism plus high 17 hydroxyprogesterone
CAH
clue for acromegaly
high insulin like growth factor
clue for clavicular fracture in baby(2)
crepitus
moro reflex asymetric
consequence of hyperinsulinism in macrosome(2)
viceromegaly
fat accumulation
cause of intellectual disability(3)
fetal alcohol syndrome
down syndrome
fragile X syndrome
clue fragile x syndrome(5)
macroorchidism macrocephaly large ears long narrow face prominent forehead and chin
face of patient with down syndrome
flat facial profile
slanted palpebral fissure
small low set ears
body of patient with Down(4)
excessive skin at nepe of the neck
single transvers palmar crease
clinodactyly
large space between the first 2 toes
2 yo kid with noisy breathing worsen when lying on his back or crying or feeding dx?
laryngomalacia
2 yo kid with noisy breathigh worset when lying on his back or crying way to confirm the dx
flexible laryngoscopy
flexible laryngoscopy of laryngomalacia(2)
collapse of supraglottic structures with inspiration
omega shape epiglottis
evolution of laryngomalacia
spontaneous resolution by age of 18 months
inspiratory stridor in laryngomalacia
noisy breathing
peak for laryngomalacia
4-8 mois
clue for hypothyroidism in infant(6)
baby normal at birth later apathy hypotonia sluggish movement abdominal bloating umbilical hernia
screening test in baby in the US(3)
hypothyroidism
Phenylketonuria
galactosemia
murmur in VSD
holosystolic murmur at the left sternal border
most common cause of congenital abnormality
VSD
best tes if you suspect VSD
echocardiography
evolution of vSD
75% des cas close spontaneously by age 2
blood stained odorless vaginal discherger in kid < 3 months next step
reassurrance
cause of vaginal discherge in infant
effect of maternal estrogen
how many doses a kid from 6 weeks to 6 years should receive
5 doses
patient in the past has febrile seizure when receiving DTP acellular can we give this patient hs 4 th dose and why (2)
yes
febrile seizure is not a contrindication for acellular pertussis
contrindication for further administration of pertussis(3)
immediate anphylaxia
unstable neurologic disorder
encephalopathy
wthin a week administration of pertussis containing vaccines
child from 3-10 year old develops hip pain following rhinorrhea and intermittent cough xrayu is normal no history of fever is noted dx
transient synovitis
rx of transient synovitis(3)
Ibu
rest
follow up in 1 week
indicator to look at in dx septic arthritis
fever > 38.5 inability to bear weight wBC> 12000 ERS > 40 CRP>2.0 mg/dl
normal CRP
20 mg/l
why you should ask bilateral hip xray even if you suspect transient synovitis
to rule out leg calve perthes disease
patient presenting in consultation a 24 mois d’age with .cover test reveals moderate deviation of the left eye dx
strabismus
complication of strabismus
amblyopia
what to do in dx of strabismus
occlusion of the normal eye
cause of amblyopia(3)
strabismus
errors of refraction
opacity of the media along the visual axis
can you see a patient with epiglotittis like out patient
no because it’s a medical emergency
patient dx with epiglotitis with respiratory distress next step
endotracheal intubation with a set up for tracheostomy
why you can ‘t encounter epiglotitis caused by HIB
because of vaccination
after bloody diarrhea patient develops anemia
low platelet
and renal insufficiency dx?
SHU
cause of SHU
E coli producing verotoxin
patient between 2-12 ans with bilateral lower extremities pain occurring at night bilateral with normal physical exam with normal activity leveldx?
growing pain
cause of growing pain
unknown
rx of growing pain(4)
observation
parental reassurance
massage
over the counter pain medications
quid of purpura in USMLE
non blanching rash
pathogenesis of Henoch shonlein purpura(2)
IG A deposit in affected organs
immune mediated leukocytoclastic vasculitis
role in sodium bicarb in the rx of TCA intoxication(2)
correct the acidosis
narrow the qrs complex prolongation
patient presenting with microcephaly,hypotonia
short stature and cat like cry
cri du chat syndrome
weight loss in baby
up to 7% in the first 5 days
baby comes by the day five with weight loss of < 7% next step
continue exclusive breast feeding
baby comes by the day five with weight loss of > 7% next step(4)
assess for oromotor dysfunction
assess for lactation failure
daily weights
consider formula supplementation
in vignette diaper with brick dust appearance or pink stains in baby with dehydration why
it’s caused by uric acid crystals
when should a babay regain weight after losing weight during the 5 first days
entre 10 a 14 jours
cause of growth failure in cystic fibrosis
pancreatic insufficiency
cause of pancreatic insufficiency in cystic fibrosis(2)
inspissation
obstructionof pancreatic ducts
tests for cystic fibrosis(3)
Sweat chloride test
genotyping
fecal elastase
kid with growth failure and reccurrent respiratory infection
cystic fibrosis
contrindication of breast feeding maternal conditions(8)
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
when a mother on anti TB can begin to breast feed baby
2 weeks after beginning anti TB drugs
infants condition with contrindication of breastfeeding
galactosemia
clue for osteogenesis imperfecta(5)
autosomal dominant osteopenia blue sclerae hearing loss dentinogenesis imperfecta
quid of dentinogenesis imperfecta
opalescent blue gray to yellow brown discoloration caused by discolored dentin shining through the transluscent and weak enamel
what about intelligence in patient with osteogenesis imperfecta
normal intelligence
rx of neonatal conjunctivitis induced by gonoccoque
parenteral ceftriaxone
or
cefotaxime
rx of neonatal conjunctivitis induced by chlamydia trachomatis
oral erythromycin
characteristic of chlamydial neonatal conjunctivitis(2)
blood stained eye discharge
mucoid discharge
patient with reccurent sinopulmonary infections oral candidiasis persistent diarrhea absent lymp nodes Low B and T cells and natural killer absent thymic shadow dx
severe combined immunodeficiency
most 2 common tumor of posterior fossa(infratentorial tumor) in children(2)
astrocytoma
medulloblastoma
if a kid has a medulloblastoma what area of the brain will be most likely affected
cerebellar vermis
post vermis syndrome(4)
unbalanced gait
trunk dystaxia
horizontal nystagmus
papilledema
vaginal discharge and enlargement of mammary glands in newborn infants next step?
observation
bugs causing scarlet fever
Group A streptococcus producing exotoxins
kid with sore throat ,fever sand paper rash stawberry tongue and circumoral pallor dx
scarlet fever
rx of choice of scarlet fever
penicillin V
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
pyloric stenosis
metabolic problem in pyloric stenosis(3)
hypochloremic
hypokalemia
metyabolic acidosis
dx of pyloric stenosis (2)
abdominal US
elongated and thickened pylorus
rx of choice of pyloric stenosis
pylotomyotomy
what to do before surgical rx of pyloric stenosis and why(2)
correct metabolic problem
sinon risque of post op apnea
characteristics in 21 hydroxylase deficiency(5)
anbiguous genitalia in girl salt wasting hypotension low NA+ high K+
hormone abnormality in 21 hydroxylase deficiency(3)
low cortisol and aldosterone
high testo
high hydroxyprogesterone
characteristics in 11 B hydroxylase deficiency(3)
ambiguous genitalia in girls
fluid and salt retention
hypertension
hormone abnormality in 11 B hydroxylase deficiency(4)
low cortisol and aldosterone
high testo
high 11-deoxycorticosterone
high deoxycortisol
characteristics in 17 @ hydroxylase deficiency(3)
all patients are female
fluid and salt retention
hTA
hormone abnormality in 17 2 hydroxylase deficiency(3)
low cortisol and testo
high mineralocorticoids
high corticosterone
first step in the management of choanal atresia(2)
placing oral airway
lavage feeding
definitive rx of choanal atresia(2)
repairing obstruction with surgery
or
with endoscopy
child less than 5 years with proximal muscles weakness gower sign and bilateral calf pseudohypertrophy dx
duchenne muscular dystrophy
quid of gower sign
patient uses hands to walk up the legs in order to stand up
cause of DMD
dystrophin gene deletion on XP 21
cause of death in DMD(2)
respiratory failure
or
heart failure
clue for kawasaki disease(6)
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)
mucositis in kawasaki disease(3)
strawberry tongur
injected or fissured lips
injected pharynx
complication of kawasaki(2)
coronary artery aneurism
myocardial infarction and ischemia
rx of kawasaki(2)
aspirin
plus
IV immunoglobulin
role of aspirin and immunoglobulin in kawasaki
to reduce incidence of complications such as coronary artery aneurisms
clue for turner(4)
short height
high arched palate
widely spaced nipples
45 X0 karyotype
why osteoporosis in turner(2)
low estrogen levels
only one X chromosome involved in bone metabolism
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
Marfan syndrome
patient at risk for transposition of great vessels(2)
diabetic mother
males
physical examination in transposition of great vessels(2)
loud second heart sound
cyanosis
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
celiac disease
extraintestinal manifestation on celiac disease in the vignette(3)
diabete type 1
dermatitis herpetiforme
iron deficiency anemia
skin problem in celiac disease(2)
dermatite herpetiforme
vitiligo
endocrine problem in celiac disease(2)
diabete type 1 autoimmune thyroiditis (hypo ou hyper)
psychiatric problem in celiac disease(2)
depression
psychosis
musculoskeletal problem in celiac disease(2)
osteopenia/osteoporosis
osteomalacia
dx of celiac disease
upper GI andoscopy with biopsy of small intestine
marker of celiac
IG A antitissue transglutaminase
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
friedrich ataxia
MRI in friedrich ataxia(2)
marked atrophy of cervical spinal cord
minimal cerebellar atrophy
what you should advise to mother with kid suffering from friedrich ataxia
prenatal counselling if the mother desires any future pregnancy
quid of friedrich ataxia(2)
autosomal recessive
abnormality in tocopherol transfer protein
infectious protection by sickle cell trait
severe complication of malaria
differenciate hyper IGM syndrome from xlinked agammaglobulinemia(3)
in hyper IgM syndrome
opportunistic infection+++
neutropenia
high IGM levels
risk factor for chronic pyelonephritis
vesicoureteral reflux
clinical feature of media otitis(2)
middle ear effusion\
bulging tympannic membrane
complication of otitis media(3)
conductive hearing loss
mastoiditis
meningitis
rx of otitis media(2)
amox
or
amox clavulanate
risk factor for media otitis in children(4)
age 6-36 months
formula intake
exposure to cigarette smoke
upper respiratory infection
Ct for mastoiditis(2)
no air in mastoid air cells
they are opacified
patient 11 months with pliable skull bones,bony prominences of costochondral junctions genu varum cause of these findings(2)
nutritionnal deficiency
vit D
costochondral joint hypertrophy in rickets quid?
rachitic rosary
genu varum in rickets
femoral and tibial bowing
risk factor for Vit D deficiency(4)
increasd skin pigmentation(black)
exclsive breastfeeding
inadequate sun exposure
maternal vit D deficiency
pliable skull bones with step offs in rickets or ping pond ball skull
craniotabes
xray in rickets
metaphysal cupping and fraying of long bones
rx of rickets
Vit D 1000-2000 UI daily
most common form of cerebral palsy seen in premature infants
spastic diplegia
quid of spastic displegia(4)
hypertonia
hyperreflexia
involving lower extremities
clasp knife
quid of clasp knife in cerebral palsy
resistance to passive muscle movement increases with more rapid movement of the affected extremity
leading cause of cerebral palsy
prematurity
other causes of cerebral palsy(7)
intrauterine growth restriction intrauterine infection antepartum hemorrage placental pathology multiple gestation maternal alcohol consumption maternal tobacco use
rx of cerebral palsy in spasticity(2)
baclofen and
botulinum toxin
comorbidities associated with cerebral palsy(4)
intellectual disability
epilepsy
strabismus
scoliosis
localisation of neuroblastoma(2)
adrenal gland
any location along the paravertebral sympathetic chains
quid of neural crest cells
precursor cells of the sympathetic chains and adrenal medulla
CT or Xray in neuroblastoma(2)
calcifications
hemorrage
quid of metanephros
embryologic precursor of renal parenchyma
quid of metabolites of cathecholamines found in neuroblastoma(2)
HVA
VMA
key physical exam for down syndrome(5)
upslanting palpebral fissures epicanthal folds brushfield spots single transverse crease sandal gap toes
GI problem associated with Down(2)
duodenal atresia
hirshprung disease
neurocognitive problem associated with Down syndrome(2)
intellectual disability
early onset alzheimer
hematologic problem associated with Down syndrome
acute leukemia
endocrine problem associated with Down syndrome(2)
hypothyroidism
type 1 diabetes mellitus
musculoskeletal problem associated with Down syndrome(2)
atlantoaxial instability
porcentage of down with heart problem
50%
what age down syndrome patient will have heart failure
around 6 weeks
auscultation finding in heart failure in patient with down
S2 due to pulmonary hypertension
patient with circular rash after trip in connecticut dx
lyme disease
prevention of lyme in lyme endemic area(2)
wear permethrin treated pants
long sleeved shirts
7 yo girl comes for vomiting,this is the 3 episode the last two were self limiting .Physical exam is ok dx
cyclical vomiting
parental antecedent for children with cyclical vomiting
migraine in parents
patient with severe dehydration IV line can be found next step
intraosseous access
how long can you use an intraosseous access
24 a 48 heures
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?
rheumatic fever
cause of rheumatic fever
Group A streptococus
5 major criterai in jones criteria(5)
polyartritis carditis chorea subcutaneous nodules erythema marginatum
3 minor criteria for jones
fever
athralgia
previous rheumatic fever
dx of rheumatic fever(3)
one major pour 2 minor
or
two major
plus detection af antistreptolysin antibodies or cultures or varrious antigens detection
rx of rheumatic fever
PNC G
2 day old baby is seen with irritabilioty,high pithed cry,poor sleeping tremors,seizures sweating sneezing tachypnea poor feeding vomiting and diarrhea dx
neonatal abstinence syndrome
drug involved in neonatal abstinence syndrome(2)
heroin
methadone
time of apparition of neonatal abstinence syndrome(2)
48 h after birth for heroin withdrawal
48 a 72 h for methadone withdrawal
clue for NEC(5)
newborn with abdominal distension bloody diarhea and leucocytosis after introduction of formula feeding
clue for craniopharyngyoma(3)
young boy with increased intracranial pressure
bitemporal hemianopsia
calcified lesion above the sella
clue for cranyopharyngioma
cystic clcified parasellar lesion on MRI
cause of anemia in premature infant(4)
transition in the erythropoiesis sites of the neonate
shorter red blood cells in neonates
diminished fetoplacental transfusion
blood loss
black child 9 month old with augmentation de volume des pieds et mains et douleur dx
dactylitis caused by sickle cell anemia
pathophysiology of dactilytis
vaso occlusive phenomena
what the earliest manif of vasoocclusive disease in sickle
dactylitis
neonate seen in with matted mass of edematous bowel loops protruding from the abdomen .There is no covering ovr the bowel loops dx
gastrochisis
gastrochisis next step after the DX
sterile saline dressing and wrapping of exposed bowel
characteristics of gastrochisis(4)
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
characteristics of omphalocele(3)
intera abdominal contents through the umbilical ring
bowel is covered with amnioperitoneal membrane
associated with other abnormalities(heart ,kidney)
patient with omphalocele what other organ to look at(2)
heart
kidney
why you should wrap and dress bowel in gastrochisis(2)
to minimize heat loss
and fluid loss
most common cause of pneumonia in cystic fibrosis
Pseudomonas aeruginosa
mode de transmission de cystic fibrosis CF
autosomal recessive
why bronchiectasia in CF
recuurrent pneumonia
quid of clubbing
bulbing enlargement of the tips of digits
cause of clubbing in CF
chronic hypoxia
appearance of thorax in CF
barrel chest
3 phases in developping bordetella pertussis(3)
catarrhal phase
paroxysmal phase
convalescent phase
whooping chronic cough in kid with delayed immunization with posttussive emesis
bordetela pertussis infection
clue for catarrhal phase in pertussis(2)
mild cough
rhinitis
clue for paroxysmal phase in pertussis(4)
coughing paroxysm lasting 20 a 30 mn
inspiratoty whoop
staccato cough
posttussive emesis
clue for convalescent phase in pertussis(2)
cough
posttussive emesis resolve
duration of paroxysmal phase
4-6 weeks
dx pf pertussis(2)
PCR
pertussis culture
hemogramme in pertussis
lymphocyte predominant leukocytosis
complication of pertussis(6)
pneumonia weight loss subconjonctival hemorrage pneumothorax respiratory failure death
rx of pertussis
macrolides
macrolides used in pertussis(3)
azythromycin
erythromycin
clarythromycin
what age you can have death in infant with pertussis
less than 6 months
the only way to prevent chlamydial conjunctivitis in neonates
maternal prenatal testing
clue for duchenne muscular dystrophy(3)
bilateral calf pseudohypertrophy
gower sign
mx weakness
transmission of Duchenne
x linked recessive transmission
screening of Duchenne muscular dystrophy(2)
elevated serum creatine phosphokinase
elevated aldolase levels
dx support of duchenne(2)
fibrosis
fatty infiltration in biopsy
gold standard to confirm the dx of DMD
genetic studies
risk factor for iron deficiency anemia in kid(3)
cow’s milk before 12 months
prematurity
maternal iron deficiency
why you should introduce vit D to all chldren exclusively breastfed during first month of life
human milk does not contain enough VIT D to meet daily requirement of the infant
dose of VIT D to give in infant exclusively breast fed
400 UI
quid of small for gestationnal age infant for age
weight under 10 th percentile for gestationnal age at birth
complication of small gestationnal age child(5)
hypoxia polycythemia hypoglycemia hypothermia hypocalcemia
classification of intrauterine growth restriction(2)
symmetrical
assymetrical
clue for symmetrical intrauterine growth restriction
head weight and head are equally affected
clue for asymmetrical intrauterine growth restriction
weight is affected more than height and head circumference
quid of metatarsal adductus(2)
deformity of foot
adduction of the anterior aspect of the foot with convex lateral border and concave medial border
rx of metatarsal adductus
reassurrance
rx of internal torsion of tibia in infant
reassurrance
baby 4 months old with blue macules on buttocks and and lower back (2)
mongolian spot
also called congenital dermal melanocytosis
epidemiology of mongolian spots(4)
african
asian
hispanic
native american
evolution of mongolian spots
fades spontaneously in the first decade of life
is mongolian spot dangerous
no its benign
triad for congental rubella(german measles)(3)
sensorineural deafness
cardiac defects
cataracts
complication of first trimaester rubella(2)
spontaneous abortion
congenital rubella syndrome
clue cataract in USMLE
leukokoria
cardiovascular anomaly in turner
bicuspid aortic valve
face and neck of turner patient(3)
narrow high arched palate
low set ears
low hairline
webbed neck
chest of turner(3)
broad chest with widely spaced nipples
coarctation of aorta
bicuspid aortic valve
abdomen of turner
horse shoe kidney
limbs of turner(2)
cubitus valgus
short stature
pelvis of turner(3)
streak ovaries
amenorrhea
infertility
why echo coeur should be done in patient with turner(3)
to dx
bicuspid aortic valve
coarctation of aorta
aortic root dilation
dx of chronic granulomatus disease(3)
nitro blue tetrazolium slide test
flow cytometry
cytochrome c reduction
Rx of CGD(2)
daily TMS
gamma inrterferon 3 f jour
patient with recurrent or unusual lymphadenitis hepatic abcess or osteomyelitis at multiple sites or infection with catalase positive organisms
CGD
patient seen in emergency with barking cough and difficulty respiratoire DX
croup
first thing to do in croup
racemic epinephrine before any invasive procedure
pneumonia plus influenza in young children with CF, bugs in cause
staphyloccocus aureus
medication to use in patient with cystic fibrosis in a context of influenza
vancomycin
most common cause of pneumonia in cystic fibrosis in young children
staph aureus
most common cause of pneumonia in cystic fibrosis in adult
pseudomonas aeruginosa
Henoch shonlein purpura clue(4)HSP
lower extremity purpura
athralgias and arthritis
coliky abdominal pain
reenal involvement
why coliky abdominal pain in HSP
local vasculitis
dx of HSP
clinical
dx of HSP in atypical presentation
renal biopsy
renal biopsy in HSP
deposition of IGA in the mesangium by immunofluorescence
peak of incidence sudden infant death syndrome
1 month and 1 year in the US
cause of edema in turner syndrome
lymphedema
cause of lymphedema in turner
dysgenesis of the lymphatic network
kid with with ascending symmetric flaccid paralysis in both legs absent deep tendon treflexes and decreased superficial touch and vibratory senses.dx
guillain barre
structures affected in guillain barre
peripheral motor nerves
albumino cytologic dissociation dx
guillain barre syndrome
rx of Guillain barre(2)
plasmapheresis
or
human immunoglobulin
cause of GBS
most of the time follows viral infection
macrosome with clavicle fracture next step
reassurrance and gentle handling
period of time for healing clavicle fracture
7-10 jours
prema with neurologic symptoms
intraventricular hemorrage
risk for intracerebral hemorrage in prema(2)
< 30 semaines de gestation
or <1500 g
screening test for intracerebral hemorrage in prematurity
serial head ultrasounds
clue for intracerebral hemorrage(4)
rapidly increasing head circumference
bulging fontanel
hypotonia
lethargy
cranial ultrasound of intraventricular hemorrage in prema(2)
bilateral IVH
dilated ventricles
why communicating hydrocephalus in intracerebral hemorrage
accumulation of blood in subarachnoid space impaitr the ability of the arachnoid villi to absorb cerebrospinal fluid
main problem in phenylketonuria(2)
deficiency in phenylalanine hydroxylase
accumulation of phenylalanine in the blod and body tissues
screening test for phenylketonuria
gutrie test
clue for phenylketonuria(4)
faitr hair and skin
blue eyes
eczematous changes
urine with mousy odor
what to avoid in phenylketonuria
protein
12 yo with back pain with or without incontinence ,physical exam reveals step off of lumbosacral area dx
spondylisthesis
physiopatho of spondylisthesis
developmental disorder with forward slip of vertebra usually L5 over S1
6 yo with down syndrome presents urinary incontinence,hyptonic and hyperreflexia wit positive babinski
atlanto axial instability
cause of atlanto axial instability in down syndrome
excessive laxity in the post transverse ligament causing increased mobility between atlas C1 ant the axis C2
upper motor neuron findings in patient presenting with down syndrome
atlantoaxial instability
children with inattention impulsivity and hyperactivity in 2 or more settings dx
deficit hyperactivity syndrome disorder
patiuetn with sickle cell disease presents with pain in his right hip that started several days ago dx
avascular necrosis
cause of avascular necrosis(6)
sickle cell disease SC hemoglobin disease corticosteroid therapy SLE alcoholism' Gaucher disease
physiopatho of aeptic necrosis in sickle cell disease(3)
occlusion of end arteries supplying the femoral head
bone necrosis
colapse of the periarticular bone and cartilage
children with isolated thrombocytopenia and petechiae after viral infection dx
immune thrombocytopenia
children with isolated thrombocytopenia and petechiae after viral infection next step
observation regardless the level of platelet
children with isolated thrombocytopenia and petechiae after viral infection ,experiencing bleeding next step(2)
IV glucorticoids
or
IV immunoglobulin
physiopatho of immune purpura(2)
antibody binds to platele
destruction of complex antibody-platelet-in spleen
period of time to recover from immune purpura
6 months
hemogram in measles(2)
leukopenia(T cell cytopenia)
thrombocytopenia
what seem to decrease the morbidity and mortality in measles
vit A
regression of milesstones after meningitis cause of that
meningitis
neurologic sequelae associated with bacterial meningitis(5)
hearing loss loss of cognitive functions seixures mental retardation spasticity or paresis
principal risk in Digeorge
hypocalcemia
tests to ask if youb suspect Digeorge(2)
serum calcium levels
echocardio
risk associated with hypocalcemia(3)
tetany
seizures
arrythmia
complication of absent thymus in Digeorge
T cell lymphopenia
complication of T cell lymphopenia(2)
viral
fungal infection
bay born with cyanosis,tremulation,low set ears,micrognatia and cleft palate.No thymic shadow in chest xray DX
Digeorge syndrome
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
Erb Duchenne
reassurance about prognosis
maternal risk factor for macrosomia
advanced age diabetes excessive weight gain during pregnancy preexisting obesity multiparity
fetal risk factor for macrosomia(3)
african american or hispanic ethnicity
male sex
post term pregnancy
evolution of erb duchenne
80 % spontaneous recovery within 3 months
quid of renal tubular acidosis
inability for renal tubules to reabsorb bicarb or excrete hydrogen
quid of type 1 renal tubular acidosis
defect in hydrogen secretion
cause of type 1 renal tubular acidosis
genetic disorder
metabolic problem in type 1 renal tubular acidosis(4)
acidotic
hypokaliemic
high PH urinaire
nephrolithiasis commonly develops
quid of type 2 renal tubular acidosis
decreased bicarb reabsorbtion in proximal tubule
cause of type 2 renal tubular acidosis
Fancony syndrome
quid of type 4 renal tubular acidosis
defect in sodium potassium exchange in the distal tubule
metabolic problem in type 4 renal tubular acidosis(2)
hyperkaliemie
hyperchloremie
cause of type 4 renal tubular acidosis(3)
obstructive uropathy
renal disease
multiplastic dysplastic kidneys
patient with less than 3 yo with impairment of social interaction and communication delayed language and stereotypical behaviors
autism
what will need patient with autism
behavioral and educationnal programs
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 ?
congenital diaphragmatic hernia
next after dx of congenital diaphragmatic hernia
endotracheal intubation
complication of diaphragmatic hernia(2)
pulmonary hypoplasia
pulmonary hpertension
sites of diaphragmatic hernia in the chest(2)
85% in the left
15 % in the right
why polyhydramnios in congenital diaphragmatic hernia
esophageal compression
consequence of abdominal viscera in the chest(2)
concave abdomen
barrel shaped chest
congenital diaphragmatic hernia with respiratory distress
emergency intubation
why you cannot use blow by oxygen and bag and mask ventilation in congenital diaphragmatic hernia
you will pump air in the intestines ,and further compromise the pulmonary function
why after intubation in diaphragmatic hernia ,gastric tube should be used
to decompress the stomach and bowel
in vignette patient after 6 months of age with reccurrent sinopulmonary infections and giardiaisis, DX
abnormal B lymphocyte maturation
problem with genetic B cells deficiency(2)
ressurrent infections after 6 months with encapsulated organisms
lack of IGA predisposes to infection
clue for Nieman pick disease(5)
cherry red macula protruding abdomen hepatosplenomegaly lymphadenopathy regression of developmental milestones
complication of sphingomyelinase deficiency in Nieman pick
sphingolipidosis
risk of premature adrenarche(2)
obesity
hispanic and black ethnicities
risk in patient with isolated premature adrenarche(3)
PCOS
Diabete type 2
metabolic syndrome
cause of premature adrenarche
early activation of adrenal androgen relaease
characteristics premature (5)
pubic hair axillary hair acne body odor in girls before 8 for girl before 9 for boy
role of adipocytes during obesity(2)
increase secretion of insulin
increase secretion of leptin
consequence of increased insulin secretion in obesity(2)
increase adrenal production—->periphera activation of adrenarche
increase ovarian estrogen production——->peripheral activation of thelarche
consequence of leptin secretion in obesity
axctivation of the axis hypothalamus pituitary gonadal axis——->central activation of puberty—–> LH ans FSH release —>ovarian stimulation and estrogen production
patient with reccurrent sinopulmonary infection with deceased IGA,IGM IGD and IGG absence circulating B cells Dx
bruton’s agammaglobulinemia
transmission of Bruton agammaglobulinemia
X linked recessive
differenciation between Bruton and common varable immunodeficiency(3)
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
male 6-9 ans with recurrent sino pulmonary infection
Brutons agammaglobulinemia
most common cause of neonatal jaundice
breastfeeding jaundice
breast milk jaundice
sepsis
when to suspect neonatal sepsis(3)
fever or hypothermia
ictere
neurologic symptom
patient with ictere and neurologic symptom and hypothermia next step(2)
PL
blood culture
patient with ingestion battery plain xray shows battery in esophagus next step?
immediate endoscopic removal
why you should remove battery in esophagus
to prevent mucosal damage and esophageal ulceration
patient with ingestion battery plain xray shows battery in distal to esophagus next step?
observe stool
newborn with failure to thrive,bilateral cataracts,jaundice and hypoglycemia DX
galactosemia
whta to do after dx galactosemia
elimination of galactose in from the diet
healthy infant crying for than three hours a day, more than three days a week and more than 3 weeks a month
colic
rx of infantile colic
simethicone
or
probiotics
steatorrhea in USMLE
oily and nasty smelling stools
gold standard test for cystic fibrosis
swaet testing by quantitative pilocarpine iontophoresis
why you can have ADEK deficiency in cystic fibrosis(2)
because of pancreatic insufficiency
no absorption of fat soluble vit
consequence of ADEK deficiency
A=Night blindness
D=ricket
E=neuropathy
K=coagulapathy
value of chloride to confirtm the DX of CF
> ou egal a 60 mmol /l on 2 separate occasions
organ always involved in Cystic fibrosis(2)
respiratory tract
and
Pancreas
problem in cystic fibrosis
defective chloride transport results in inpissated secretions in multiple organs
clue for CF(3)
steatorrhea
failure to thrive
respiratory infections
step in management of children after ingestion of oven cleaner liquid(4)
ABC assessment
remove contaminated clothing
chest xray if respiratory symptom
endoscopy within 24 hours
when to perform upper endoscopy after alkali ingestion
within 24 hours
risk for delay in performing upper endoscopy in alkali ingestion
risk of perforation during procedure
quid of alkali ingestion
oven cleaner liquid
complication of alkali ingestion(5)
uppper airway compromise perforation stricture /stenosis(2-3 weeks) ulcers cancer
what to not do if alkali ingestion
try to neutralize the alkali with vinegar or lavage
symptom in reye syndrome and lab finging(6))
vomiting increased AST and ALT PT prolonged Normal bilrubin hyperammonemia hypoglycemia
context for reye syndrome
chil less than 15 years treated with salycilates after viral infection
Ct scan in reye syndrome
cerebral edema
viral infection and fever
no salycylates
biopsy of liver in reye syndrome
microvesicular steatosis
newborn with choking spell and coughing after first feeding
atresia oesophagienne with possible fistule tracheo esophagienne
what will happen in attempting to pass a nasogastric tube in case of esophageal atresia
xray will show the tube in proximal esophageal pouch
why you can have pneumonia par aspiration in esophageal atresia
gastric reflux can go into the distal esophagus through the fistula and into trhe trachea and lungs
prenatl clue for osophageal atresia
polyhydramnios
toddler with sudden onset respiratory istress bwith focal findings in auscultation
foreign body aspiration
why chest xray is limited in foreihn body aspiration
because most object are radioluscent
next step in foreign body aspiration
bronchoscopy
most common aspirated foreign body*3)
peanuts
popcorn
pieces of toys
physical exam in foreign body aspiration(2)
focal monophonis wheezing on affected side
diminished aeration on affected side
gross motor in 2 months
lift head/chest in prone position
gross motor in 4 months(12)
sits with trunk suppotrt
begins rolling
gross motor in 6 months
sits momentarilypropped on hands( unsupported by 7 months)
gross motor in 9 months(2)
pull to stand
cruises
gross motor in 9 month(3)
stands well
walks first steps independently
throws ball
fine motor in 2 months(2)
hands unfisted 50 % of the time
track past midline
fine motor in 4 month(2)
hands mostly open
reaches midline
fine motor in 6 month(2)
transfers objects hand to hand
raking grasp
fine motor in 9 month(2)
3 finger pincer grasp
hold bottle or cup
fine motor in 12 month
2 finger pincer grasp
language in 2 month(2)
alerts to voice and sound
coos
language in 4 month(2)
laughs
turn to voice
language in 6 month(2)
responds to name
babble
language in 9 month
say dada mama
language in 12 month
say first words
social cognitive in 2 months(2)
social smile
recognizes parents
social cognitive in 4 months
enjoys looking around
social cognitive in 6 months
stranger anxiety
social cognitive in 9 months(2)
wave bye
plays pat a cake
social cognitive in 12 months(2)
separation anxiety
comes when called
what a 6 month baby can do(4)
should be able to sit momentarily
transfer objects from hand to hand
respond to name
stranger anxiety
language development in 2 yo child(3)
vocabulary of hundred words
able to combine words into short sentences
half of the baby speech should be understood by stranger
neonate with painless bloody stools dx
milk or soy protein proctocolitis
what to do in soy protein proctocolits(2)
elimination of soy and dairy product in mama diet
initiation of hydrolysed formula in formula fed children
symptoms of soy protein proctocolitis(3)
severe reflux or vomiting
painless bloody stools
eczema
peak of apparition of soy protein proctocolits and prognosis(2)
2 a 8 semaines
resolution by age of one
neonatal jaundice with conjugated bilirubinemia DX
neonatal cholestasis
indication for further evaluation of jaundice(6)
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
cause of neonatal cholestasis in infant
biliary atresia
quid of friedrich ataxia
the most common spinocerebellar ataxia
triad of friedrich(3)
neurologic (atxia and dysarthria)
skeletal(scoliosis, foot deformities
cardiac(concentric hypertrophic cardiomyopathy)
cause of death in friedrich(2)
cardiomyopathy
respiratory
failure
speech difficulty in USMLE
dysartria
hammer toe
friedrich
quid of overlapping finger s in edwards
third and the 5 th overlaping the 4 th
dx diffrentiel of flaccid pralysis in kid(3)
infant botulism
foodborne botulism
guillain barre syndrome
pathogenis of infant botulism
ingestion of clostridium spores from environmental dust
pathogenis of food borne botulism
ingestion of preformed C botuinum toxin
pathogenis of Guillain barre syndrome
autoimmune peripheral nerve demyelination
differentiate GBS and botulism(2)
descending flaccid paralysis in botulism
ascending flaccid paralysis in GBS
rx of infant botulism
human derived botulism immune globulin
rx of food borne botulism
equine derived botulism immune globulin
rx of GBS
pooled human immune globulin
clue for infant botulinism(4)
constpation
hypotonia
bulbar palsies
no honey feeding
what to do in neonates in term of screening
hip dysplasia
maneuver to screen hip dysplasia(2)
barlow
and
‘orthelani
next step if you feel palpable clunk during maneuvers in screening of hip dysplasia
referral to orthopedic surgeon
hip dysplasia suspected soft click during barlow and orthelani or asymmetric inguinal skin folds or leg lenght discrepancy (2)
Ultrasound in < 6 mois
Xrays > ou egal a 4 a 6 mois
rx of choice for hip dysplasia in kid >< 6 months
pavlik hip harness
complication of hip discrepancy
limp=trndelenburg gait
risk in supracondylar fracture
brachial artery injury
consequence of brachial artery injury
loss of radial artery pulse
what to in household with one person with pertussis even if the contact has received immunizations
prescribe macrolide antibiotic for all households contacts
pertussis rx and post exposure prophylaxis in person < 1 an
azytromycin for 5 days
pertussis rx and post exposure prophylaxis in person > 1 an(3)
azytromycin for 5 days
clarythromycin for 7 days
erythromycin for 14 days
basics in post exposure prophylaxis for pertussis(3)
rx regardless of age
statut immunitaire
symptoms
clue for nursemaid’s elbow
infants or children whenare lifted or pulled by the hand or arm you have rasdial head subluxation
clue for nursemaids elbow
child keeps hand in a pronated position and refuses attempted forearm supination
clue for fragile X syndrome(6)
low to normal IQ generalised language disability short attention span large head prominent jaw large low set ears macroorchidism
cause of mental retardation in fragile X syndrome
increased number of CGG trinucleotide repeats
overweight adolescent 10-16 yo with hip pain dx
slipped capital femoral epiphysis
rx of slipped femoral capital epiphysis
immediate surgical screw fixation
complication untreated slipped capital femoral epiphysis
avascular necrosis
xray slipped capital femoral epiphysis
glissement du reste de la tete humeral asur l’epiphyse
xray slipped legg calve
lyse of the head of femur
developmental milestone in child by age of 12 months(6)
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
Ct scan finding in congenital toxo(3)
inflammatory lesions
hydrocephalus
intracranial calcificaions
triad for congenital toxo(3)
chorioretinitis
hydrocephalus
intracranial calcifications
clue for von gierke(8)
hypoglycemia lactic acidosis hyperuricemia hyperlipidemia doll like facies thin extremities short stature protuberant abdomen
Age for von gierke
3 -4 month
why seizure in von gierke
hypoglycemia
why protuberant abdomen in von gierke (*2)
enlarged liver
and
kidney
physiopatho for von gierke
glucose 6 phosphatase deficiency
quid of von gierke
type 1 collagen storage disease
what to do if apgar is 8 in infant (3)
removal of airway secretions
drying and keeping him warm
early preventive measures
first thing to do in neonates
APGAR calculation
quid of early preventives measure in newborn(2)
gonococcal ophtalmia prevention
vit K supplementation
first step in children with speech delay
audiology evaluation
confirmatory test for SLE(2)
anti SM
anti DsDNA
risk factor for pyloric stenosis(3)
first born boy
erythromycin
formula feeding
why peak of incidence of infantile hypertrophic pyloric stenosis
age 3-5 weeks
dx of pyloric stenosis clinic(2)
projectile nonbilious vomiting
olived shaped presentation
lab finding in infantile pyloric stenosis
hypochloremic metabolic alkalosis
paraclinic dx in infantile pyloric stenosis
abdominal ultrasound
finding in infantile pyloric stenosis
thick and elongated pylorus
physiopatho of formula feeding inducing pyloric hypertrophy(2)
slower gastric emptying
increase burden stimulates growth of the pylorus muscle
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
physiologic jaundice
peak of incidence of physiologic jaundice
2-4 days of life
resolution of physiologic jaundice
1-2 weeks
physiopatho of physiologic jaundice(3)
increased bilirubin production due to high Hb turn over
decreased bilirubin clearance
increased enterohepatic cycling
why in newborn you can have decreased bilirubin clearance
decreased hepaticuridine diphosphoglucuronate transferase activity until age 2 weeks
why in asian newborn you can have decreased bilirubin clearance
Asian have decreased UGT activity
why enterohepatic cycling is increased in new born
because sterile newborn gut
possible complication of physiologic jaundice
kernicterus
indication of exchange transfusion in physiologic jaundice
total bilirubin levels > 20-25 mg/dl
phototherapy for physiologic jaundice
gold standard rx for rapidly increasing hyperbilirubinemia to prevent kernicterus
quid of bitot spots
gray silver plaques on the bulbar conjunctiva
manif of vit A deficiency(7)
impaired adaptation to dryness photophobia dry scaly skin xerosis conjonctiva xerosis cornea keratomalacia bitot spots hyperkeratosis
localization of hyperkeratosis in vit A deficiency(3)
shoulders
buttocks
extensor surfaces
microscopy light finding in nephrotic syndrome
normal findings
immunofluorescence finding in SN
no abnormality
electron microcopy finding in SN
difuse effacement of foot process of podocytes
quid of podocytes
renal epithelial cells
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
benign astrocytoma
the most common solid tumors in kids
CNS tumors
the most common malignancy in kid
leukemia
the second most common malignancy in kid
CNS tumor
most common localization of CNS tumor
supratentorial
the most common tumon which could be found infratentorial and supratentorial localization in kid
astrocytoma
most common complication of E coli 0157h7
renal damage
mortality in renal damage in HUS
5 a 10%
the organ system with higher mortality and morbidity after HUS
kidneys
complication of shoulder dystocia(5)
fractured clavicle fractured humerus erb duchenne klumpke paralysis perinatal asphyxia
clue for clavicular fracture in macrosome(4)
clavicular crepitus
bony irregularity
decreased Moro reflexe due to pain on affected side
intact biceps and grasp reflexes
clue for humerus fracture in macrosome(4)
upper arm crepitus crepitus
bony irregularity
decreased Moro reflexe due to pain on affected side
intact biceps and grasp reflexes
moro and biceps reflexes in erb duchenne
decreased on affected side
clue for klumpke palsy(3)
claw hand
ipsilateral horner syndrome
intact moro and bicep reflexes
claw hand in klumpke(4)
extended wrist
hyperextended metacarpophalangeal joints
fixed interphalangeal joints
absent grasp reflexes
clue for horner syndrome(2)
ptosis
miosis
manif of perinatal asphyxia(4)
altered mental status
poor tone
seizure
difficulte respiratoire
nerve fibers involved in Klumpke(2)
c8
T1
rx for klumpke(2)
controverse
physical therapy to prevent contracture
klumpke with no improvement after 3-9 months
surgery
clue for myotonic muscular dystrophy type 1(8)
grip myotonia=delayed muscle relaxation facial weakness foot drop dysphagia cardiac conduction abnormalities cataracts testicular atrophy/infertility baldness
transmission of muscular dystrophy type 1
autosomal dominant
other name of muscular dystrophy type 1
steinert disease
why dysphagia is the most dangerous smooth muscle manif in steinert disease
because of risk of aspiration pneumonia
reflexes in steinert disease
normal
quid of sturge weber
neurocutaneous syndrome characterized by
congenital unilateral hemangioma along the trigeminal nerve
xray in sturge weber
intracranial calcifications that resemble a tramline
usual neurological symptom in sturge weber
seizures
other neurological finding in sturge weber(4)
hemianopsia
hemiparesis
hemisensory disturbance
ipsilateral glaucoma
skin problem in sturge weber
port wine stain or nevus flammeus along the trigeminal nerve
rx of sturge weber
controlling seizures
reducing intraocclualr pressure
how to remove skin lesions in sturge weber
argon laser
7 yo boy with decreased urine output and lethargy and high creat and BUN appropriate next step in this patient
urinalysis
first test to di in all patient with renal disease
urinalysis
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
conduct disorder
quid of conduct disorder
disruptive behavioral patterns that violate basic social norms for at least one year in patients less than 18 years
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
antisocial personality disorder
5 year old boy born at home developed bruises and prolonged PT> 15 cause of that
vit K deficiency
origin of vit K in the body(2)
gut flora
diet
why can you have Vit K deficiency in baby(3)
poor placental transfer
absent gut flora
inadequate levels in breast milk
what to do to avoid hemorrhagic disease of newborn
all new born babies must receive vit K injection
mild vit K deficiency
prolonged PT
normal PTT
barking cough in patient less than 3 years hoarseness and varying degree of respiratory distress DX
croup
lateral neck xray in croup
subglottic narrowing
bug causing croup
parainfluenza virus
quid of chickenpox
varicella
Manif in chicken pox
pruritic vesicles appearing in different stages across the face and the body and usually fully crusted within a week
child > ou egal a 1 an asymptomatic who never received varicella vaccine is exposed to chickenpox what to do
administer varicella vaccine
contagiosity in chikenpox
patient is contagious 2 days prior to rash
child > ou egal a 1 an immunodeprime asymptomatic who never received varicella vaccine is exposed to chickenpox what to do
givevaricella zoster immunoglobulin
physical examination in beckwith wiedemann syndrome(6)
fetal macrosomia during delivery rapid growth until late childhood omphalocele or ombilical hernia macroglossia hemihyperplasia hypoglycemia
complications of beckwith wiedmann(2)
wilms tumor
hepatoblastoma
surveillance in beckwith wiedmann
serum alpha fetoprotein
abdominal and renal ultrasound
serum alpha protein surveillance of beckwith wiedman
every 3 months from birth to 4 years for
abdominal ultrasound in surveillance ofbeckwith wiedman
every 3 months from age 4-8
renal ultrasound surveillance in beckwith wiedmann
from age 8 years to adolescent
patient who is particular at risk for hepatoblastoma or wilms tumor in wiedmann beckwith
patient with hemihyperplasia
example of hemihyperplasia
right upper and lower extremities are significantly larger in circumference than the left extremities
pathogenesis of wiedman beckwith
deregulation of imprinted gene expression in chromosome 11p15
quid of parinaud syndrome
paralysis of vertical gaze =paralysis of downward and upward gaze
quid of collier sign
poor pupillary reaction to light and eyelid retraction
meaning of parinaud syndrome and collier’s sign
rostral midbrain lesion
cause of rostral midbrain lesion(2)
germinoma
pinealoma
why you can have development of dark facial hair ,deeping voice and rapid croissance in lesion pinealoma(2)
interruption of hypothalamic inhibiting pathways
bhcg secretion and consequent leydig’s cells stimulation
why eye problem in pinealoma
the lesion is located at the level of superior colliculus and CN3
patient with multiple skin infection and recurrent pneumonia.In the last bout of skin infection cultures of secretions reveals S aureus Dx probable
CGD
problem in CGD(2)
impaired metabolism within phagocytes
a mutation causes loss or inactivation of the NADPH oxidase responsible for oxydation
main pathogenesis in CGD
intracellular killing deficiency
clue for CGD
gram stain of fluid aspirated from the affected lymph nodes reveals numerous bacteria filled segmented neutrophils
most common infection in CGD(2)
pneumonia
suppurative adenitis
5 yo Mexican girl is seen for nocturnal vulvar itching next step
do a scotch tape test
5 yo Mexican girl is seen for nocturnal vulvar itching dx
pinworms infection
rx of pinworms
mebendazole
clue for ombilcal hernia(2)
abdominal swelling
more pronounced when crying or coughing
3 yo girl with ombilical hernia next step
refer to pediatric surgeon for operative management
indication of surgery in ombilical hernia(5)
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
evolution of ombilical hernia
disappear spontaneously by age of 1
patient with severe coughing develops subcutaneous emphysema over the anterior chest most appropriate next step
chest xray
why chest xray in case of emphysema secondary to severe coughing
to rule out pneumothorax
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
club foot
management of clubfoot(3)
stretching
manipulation of the foot
followed by serial plaster casts
indication of surgery in clubfoot(2)
failure in conservative management
surgery is performed within 3 and 6 months of age
why polycythemia in small gestational age
increased erythropoietin secretion in response to fetal hypoxia
rx of Lyme disease in children less than 8 years
oral amox
anal pruritis in kid dx
enterovermicularis infection
rx of enterovermicularis infection(2)
albendazole/mebendazole
or
pyrantel pamoate
dx of enterovermicularis infection
scotch tape
the most common causes of viral meningitis(2)
echoviruses
coxsakievirus
brudzinsky ????????
you flexe the neck lower leds are flexed too
quid of non-polio viruses
echoviruses
coxsakievirus
clue for meningococcal meningitis(3)
fever
neurologic finding
petechial or purpuric rash
most common cause of neonatal sepsis
GBS
prevention of GBS(2)
maternal testing and
rx with intrapartum IV antibiotics
antibio used in prevention of GBS sepsis
PNC
