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My Step 2 CK > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

What is considered late preterm delivery?

A

34 to 37 weeks gestation

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2
Q

What is the normal respiratory rate of a newborn?

A

40-60 breaths per minute

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3
Q

What is the normal heart rate of a newborn?

A

120-160 beats per minute

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4
Q

What is the purpose of the APGAR score?

A

quantifiable measurement for the need and effectiveness of resuscitation

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5
Q

What is the normal blood pressure for a newborn?

A

65/50 mmHg

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6
Q

What are the 5 aspects that go into an APGAR score?

A
  1. appearance (skin color= pink)
  2. pulse (>100)
  3. grimace (reflex irritability= crying)
  4. activity (muscle tone = active movement)
  5. respiration (quality of breathing)
    (max score is 10)
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7
Q

What does the APGAR score at 1 minute signify?

A

conditions during labor and delivery

whether baby needs resuscitation

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8
Q

What does the APGAR score at 5 minutes signify?

A
  1. represents effectiveness of resuscitation efforts

2. prognostic of survival

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9
Q

What should be done if the APGAR score is 0-3?

A

resuscitation (ventilation)

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10
Q

What should be done if the APGAR score is 4-6?

A

closely monitor newborn

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11
Q

What is the most common cause of red eyes (conjunctivitis) in a newborn at 1 day of life?

A

chemical irritation (usually due to silver nitrate drops in developing countries)

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12
Q

What is the most common cause of red eyes (conjunctivitis) in a newborn at 2-7 days of life and what is treatment?

A

Neisseria gonorrhoeae

tx: ceftriaxone

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13
Q

What is the most common cause of red eyes (conjunctivitis) in a newborn at more than 7 days of life and what is treatment?

A

Chlamydia trachomatis

tx: oral erythromycin

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14
Q

What is the most common cause of red eyes (conjunctivitis) in a newborn at more than 3 weeks of life?

A

Herpes simplex infection

tx: acycolvir and topical vidarabine

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15
Q

What is done at the time of birth to prevent ophthalmia neonatorum (due to Neisseria gonorrhoeae or Chlamydia trachomatis)?

A

erythromycin or tetracycline ointment with silver nitrate drops
(most effective against Neisseria gonorrhoeae)

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16
Q

What is a consequence of vitamin K deficient bleeding?

A

hemorrhagic disease of newborn

vitamin K used to produce factors 2, 7, 9, 10 and protein C and protein S

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17
Q

Why do newborns lack vitamin K at birth?

A

colon lacks normal bacterial flora that produces vitamin K

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18
Q

What is the treament used to prevent development of hemorrhagic disease of the newborn?

A

IM injection of vitamin K at birth

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19
Q

A neonate who did not receive routine newborn care presents with bright red blood in diaper, bleeding from belly button and lethargy most likely suffers from ….

A

Hemorrhagic Disease of the Newborn (vitamin K deficiency b/c did not receive prophylactic vitamin K shot)

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20
Q

What diseases are commonly tests in a newborn screen? (8)

A
  1. PKU (phenylketonuria)
  2. congenital adrenal hyperplasia (CAH)
  3. Biotinidase
  4. Beta thalassemia
  5. Galactosemia
  6. Hypothyroidism
  7. Homocysteinuria
  8. Cystic fibrosis
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21
Q

What vaccine is given to babies at the time of birth?

A

Hepatits B

give hep B immunoglobulin if mom was Hep B surface antigen positive

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22
Q

What causes transient polycythemia of a newborn?

A

hypoxia due to cord clamping at delivery stimulates erythropoeitin
(associated with splenomegaly)

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23
Q

A neonate is born via C-section with a respiration rate higher than 60 bpm without any other symptoms or signs most likely suffers from …

A

transient tachypnea of newborn

due to lack of fluid expulsion from the lung via vaginal delivery; lung immaturity; surfactant insufficiency

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24
Q

What is the next best step in a neonate with tachypnea (RR > 60) lasting more than 4 hours?

A

(evaluate for sepsis and start antibiotics)

  1. blood culture
  2. urine cultures
  3. lumbar puncture (if lethargy, temp irregular, feeding problems)
  4. CXR
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25
Q

What is respiratory distress syndrome 2?

A

transient tachypnea of newborn

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26
Q

What causes transient hyperbilirubinemia in a newborn (day 2-3)

A

spleen removing RBCs that carry hemoglobin F resulting in increased unconjugated bilirubin

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27
Q

….. is minute hemorrhages present in eyes of infant due to rapid rise in intrathoracic pressure as the chest in compressed while passing thru birth canal

A

Subjunctival Hemorrhage

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28
Q

…. is swelling of the soft tissues of the scalp of newborn that does cross suture lines

A

Caput succedaneum

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29
Q

…. is a subperiosteal hemorrhage in newborn that does not cross suture lines

A

Cephalohematoma

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30
Q

What is a complication associated with cephalohematoma?

A

elevated unconjugated bilirubin from RBC breakdown in hematoma

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31
Q

What is the next best step in management for any hyperbilirubinemia that happens in the first 24 hours of a newborn’s life?

A

evaluation for cause

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32
Q

What is the next best step in management for any conjugated hyperbilirubinemia in newborn at any time in life?

A

Evaluation for cause

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33
Q

An infant presents with waiter’s tip appearance in which they are unable to abduct the shoulder and unable to externally rotate and supinate the arm after shoulder dystocia during birth most likely suffers from …

A

Duchenne Erb Paralysis

due to damage to C5-C6 nerves

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34
Q

What is treatment for Duchenne Erb Paralysis and Klumpke paralysis?

A

immobilization

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35
Q

An infant presents with claw hand and lack of grasp reflex in association with or without Horner’ syndrome (ptosis, miosis, anhydrosis) after shoulder dystocia during birth most likely suffers from …

A

Klumpke Paralysis

due to damage to C7, C8, and T1 nerve

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36
Q

What is the most common newborn fracture as a result of shoulder dystocia during birth?

A

Clavicular fracture

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37
Q

An infant presents with paralysis of facial muscles after forcep use in delivery most likely suffers from …

A

Facial nerve palsy (facial nerve runs behind ear)

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38
Q

What is the most common brachial plexus injury in newborn?

A

Duchenne-Erb Paralysis

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39
Q

What are the two common causes of polyhydramnios? (3)

A
  1. Werdnig Hoffman syndrome
  2. intestinal atresia
  3. CNS malformations
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40
Q

What nerves are innervated by roots C5 and C6 of brachial plexus and affected in Duchenne-Erb Paralysis? (2)

A
  1. musculocutaneous nerve (supination of arm)

2. axillary nerve (abduction of arm)

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41
Q

What is the nerve that are innervated by roots C7, C8, and T1 and affected in Klumpke paralysis?

A

Ulnar nerve (extensor muscles of hand)

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42
Q

What is Werdnig Hoffman syndrome?

A

neurological disorder in which newborn is unable to swallow

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43
Q

What is considered early sepsis of neonate?

A

sepsis develops within 1 week of birth

perinatal infection

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44
Q

What is considered late sepsis of neonate?

A

sepsis develops after 1 week of life

environmental infection

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45
Q

What are the common causes of early sepsis?

A
  1. Group B strep (most common)
  2. E. Coli
  3. Listeria
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46
Q

What are the common causes of late sepsis?

A
  1. coag negative Staph (most common)
  2. E. Coli
  3. Group B strep
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47
Q

What is the first step in management in presumed sepsis in neonate?

A
  1. obtain IV line and start fluids

2. start antibiotics

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48
Q

What antibiotics are used for presumed sepsis in the neonate?

A

ampicillin (listeria), gentamicin, cefotaxime

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49
Q

What is the best initial test for toxoplasmosis infection in baby?

A

IgM antibodies to Toxo

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50
Q

An infant presents with chorioretinitis, multiple ring enhancing lesions on CT and hydrocephalus most likely suffers from …

A

Toxoplasmosis

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51
Q

An infant presents with cataracts, deafness, patent ductus arteriosis, blueberry muffin rash, thrombocytopenia and hyperbilirubinemia most likely suffers from …

A

Rubella

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52
Q

An infant presents wiht rash on palms and soles, frontal bossing, hutchinson eighth nerve palsy and saddle nose most likely suffers from …

A

Syphillis

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53
Q

What is the most accurate test for toxoplasmosis infection in newborn?

A

PCR

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54
Q

What is treatment for toxoplasmosis infection in newborn?

A

Pyrimethamine and sulfadiazine

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55
Q

What is the treatment for syphillis infection in newborn?

A

penicillin

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56
Q

What is the treatment for rubella infection in newborn?

A

supportive

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57
Q

An infant presents with periventricular calcifications with microcephaly, chorioretinits, hearing loss and petechiae most likely suffers from …

A

CMV infection

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58
Q

What is the best initial test for CMV infection in newborn?

A

urine or saliva viral titers

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59
Q

What is the most accurate test for CMV infection in newborn?

A

urine or saliva PCR for viral DNA

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60
Q

What is the treatment for CMV infection in newborn?

A

Ganciclovir (with signs of end organ damage)

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61
Q

An infant presents with shock and DIC or vesicular lesions or encephalitis after being born to a mother with history of active lesions during labor most likely suffers from ..

A

Herpes infection

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62
Q

What is the best initial test for herpes infection in newborn?

A

Tzanck smear

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63
Q

What is the most accurate test for herpes infection in newborn?

A

PCR for viral DNA

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64
Q

What is treatment for herpes infection in newborn?

A

Acyclovir and supportive care

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65
Q

What are common causes of oligohydramnios (too little amniotic fluid)?

A
  1. post term pregnancy (placenta not producing)
  2. renal agenesis/ failure (not able to urinate)
  3. prune belly
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66
Q

What is a common complication of oligohydramnios?

A

increased risk of cord compression

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67
Q

What is prune belly?

A

fetus/neonate lacks abdominal muscles (so can’t bear down to urinate)

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68
Q

What is the treatment for prune belly?

A

serial Foley catheter placement

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69
Q

An infant with renal agenesis, pulmonary hypoplasia and abnormal facies and had oligohydramnios in utero most likely suffers from …

A

Potter’s syndrome

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70
Q

An infant is born in respiratory distress (grunting, nasal flaring, accessory muscle use), scaphoid abdomen (sucked in stomach), bowel sounds heard in chest, and air-fluid levels on CXR most likely suffers from ….

A

Congenital Diaphragmatic Hernia (mostly left sided)

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71
Q

What is the most common type of congenital diaphragmatic hernia?

A

Bochdalek (posterolateral defect)

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72
Q

What is the first step in management for an infant presenting with congenital diaphragmatic hernia?

A
  1. intubation (maintain airway)

2. surgery

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73
Q

….. is a midline wall defect in which intestines protruding out of abdominal cavity with a sac covering content

A

Omphalocele

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74
Q

What are the conditions associated with omphalocele? (5)

A
  1. imperforate anus
  2. congenital heart defects
  3. conjoined twins
  4. trisomy 18 (edwards syndrome)
  5. Beckwith-Wiedemann syndrome
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75
Q

…. is a lateral wall defect with intestines protruding out of the abdominal cavity without a sac covering

A

Gastroschisis

associated with multiple intestinal atresias

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76
Q

At what point is surgical intervention indicated for an umbilical hernia?

A

persistent presence of umbilical hernia at age 4 or older

want to prevent strangulation and necrosis

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77
Q

What is a sign of abdominal wall defect in triple/ quad screening during pregnancy?

A

elevated AFP levels

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78
Q

What is the most common primary renal malignancy in kids?

A

Wilm’s tumor

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79
Q

What is aniridia?

A

absence of an iris

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80
Q

A child presents with abdominal pain, constipation, aniridia, darkening of urine, hypertension and a large painless palpable flank mass most likely suffers from …

A

Wilm’s tumor

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81
Q

A child with Wilm’s tumor, aniridia, genitourinary malformations, and mental retardation most likely suffers from …

A

WAGR syndrome (due to deletion on chromosome 11)

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82
Q

What is the best initial test for Wilm’s tumor?

A

abdominal ultrasound

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83
Q

What is the most accurate test for Wilm’s tumor?

A

CT with contrast

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84
Q

What is the most common site of metastasis for Wilm’s tumor?

A

lungs

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85
Q

What is the treatment for Wilm’s tumor?

A

surgery, chemotherapy and radiation

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86
Q

A child presents with painful abdominal mass, opsoclonus (dancing, rapid eye movement), hypsarrythmia (dancing feet), diarrhea, and hypokalemia most likely suffers from …

A

Neuroblastoma (tumor of sympathetic ganglia)

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87
Q

What is the diagnostic test for neuoblastoma?

A

urine catecholamines (vanillyl mandelic acid and metanephrines)

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88
Q

A child presents with a painless sac in the scrotum that transilluminates most likely suffers from …

A

hydrocele

usually resolves within 6 months or drain

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89
Q

A child presents with an undescended testis that is usually found within inguinal canal most likely suffers from …

A

Cryptorchidism

increased risk of testicular cancer b/c of underlying cause of why testis did not descend

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90
Q

When is orchipexy indicated for the treatment of cryptorchidism?

A

no descent by 6 months-1 year

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91
Q

… is the opening of the urethra on the ventral surface of the penis and results in …. being contraindicated

A

hypospadias; circumcision

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92
Q

… is the opening of the urethra on the dorsal surface of the penis and is associated with …..

A

epispadias; bladder exstrophy (protrusion of bladder thru defect in abdominal wall)

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93
Q

A male presents with dull ache and heaviness in their scrotum and on exam a “bag of worms” is palpated most likely suffers from …

A

Varicocele

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94
Q

What is the most accurate test for varicocele?

A

ultrasound of scrotal sac (bilaterally) showing dilation of vessels in pampiniform plexus > 2 mm

95
Q

What is the rooting reflex?

A

if touch baby’s cheek, baby will turn head to that side

96
Q

What is the moro reflex?

A

arms spread symmetrically when the baby is scared

97
Q

What is the superman reflex?

A

when held facing floor, arms go out like flying)

98
Q

What is the most common cyanotic heart defect in children after neonatal period?

A

tetralogy of fallot

associated with chromosome 22 deletions

99
Q

What are the 4 characteristic heart defects that occur in tetralogy of fallot?

A
  1. overriding aorta
  2. VSD (ventricular septal defect
  3. pulmonary stenosis
  4. right ventricular hypertrophy
100
Q

A child presenting with cyanosis of lips/ extremities, holosystolic murmur heard best at LLSB, exercise intolerance (SOB w/ playing) and squatting relieves symptoms most likely suffers from …

A

Tetralogy of Fallot

101
Q

What is the characteristic finding on CXR for tetralogy of fallot?

A

boot shaped heart

and decreased pulmonary vascular markings

102
Q

What are the 3 causes of a holosystolic murmur?

A
  1. mitral regurgitation (heard best at apex)
  2. tricuspid regurgitation (heard at LLSB, right side endocarditis or carcinoid syndrome, adult, radiate to back)
  3. VSD (head best at LLSB, kid)
103
Q

A neonate presents with cyanosis of lips/ extremities, a single S2 heart sound, and an “egg on a string” on CXR most likely suffers from ….
(must have PDA, VSD, ASD)

A

Transposition of Great Vessels (aorta originates off from RV and pulmonary artery originates from LV)

104
Q

What is a pharmacologic treatment used for transposition of great vessels?

A

prostaglandin E1 (to maintain patent ductus arteriosis)

105
Q

What pharmacologic agents should be avoided in a neonate with transposition of great vessels?

A

NSAIDs (specifically indomethacin) which cause closure of ductus arteriosus

106
Q

What is the most common cyanotic heart defect in neonates?

A

Transposition of the great vessels

107
Q

An infant presents with gray colored lips/ extremities, increased right ventricular heave from RV hypertrophy and absent pulses with a single S2 most likely suffers from …
(dependent on PDA so give prostaglandin E1)

A

Hypoplastic Left Heart Syndrome (LV hypoplasia, mitral valve atresia, aortic valve lesions)

108
Q

What is the characteristic finding on CXR for hypoplastic left heart syndrome?

A

globular shaped heart

109
Q

A neonate presents within first few days with severe dyspnea and mild cyanosis with early and frequent respiratory infections, VSD, single S2 heart sound, systolic ejection murmur and bounding peripheral pulses most likely suffers from ….

A

Truncus Arteriosus (1 great vessel overriding VSD)

110
Q

What is the major complication of truncus arteriosus?

A

Pulmonary hypertension (due to increased load on right ventricle)

111
Q

…. is a congenital heart defect in which there is no venous return between the pulmonary veins and the left atrium; instead oxygenated blood from pulmonary veins returns to the superior vena cava and is dependent on patent foramen ovale to get oxygenated blood to left side of heart

A

Total Anomalous Pulmonary Venous Return (TAPVR)

dx: ECHO

112
Q

What is the difference between total anomalous pulmonary venous return with obstruction versus without obstruction?

A

obstruction: early respiratory distress and severe cyanosis

no obstruction: present at age 1-2 y/o with right heart failure and tachypnea

113
Q

What does a CXR of a child with total anomalous pulmonary venous return without obstruction?

A

snowman signs or figure 8 sign

114
Q

What are the 2 cyanotic heart diseases that are PDA (patent ductus arteriosus) dependent?

A
  1. Transposition of great vessels
  2. Hypoplastic Left Heart Syndrome

(must get prostaglandin E1 and avoid NSAIDs)

115
Q

What are the 2 cyanotic heart diseases that have VSD present?

A
  1. Tetralogy of Fallot

2. Truncus Arteriosus

116
Q

…. is the process by which a left to right shunt caused by a VSD reverses into a right to left shunt due to right ventricle hypertrophy

A

Eisenmenger syndrome

117
Q

A child presents with dyspnea with respiratory distress, high pitched holosystolic murmur at LLSB, loud pulmonic S2, and symptoms of failure to thrive without cyanosis most likely suffers from …

A

Ventricular Septal Defect

VSD

118
Q

What is the most likely finding on EKG of a child with VSD?

A

Right ventricular Hypertrophy

blood flows from high pressure left side to low pressure right side causes right side volume overload

119
Q

What pharmacologic treatment can be used as conservative treatment for ventricular septal defect (VSD)?

A

diuretics and digoxin

120
Q

What is the most likely cause of stroke in a child who has a history of recent travel resulting in DVT?

A 
Paradoxical emboli
(emboli from DVT goes through ASD to bypass lung)
121
Q

A child presents with a fixed wide splitting of S2 and history of stroke secondary to DVT most likely suffers from…

A

atrial septal defect (ASD)

risk of paradoxical embolic , atrial enlargment leading to dysrhythmia

122
Q

A child presents with machine like murmur with wide pulse pressure and bounding pulses most likely suffers from …

A

Patent Ductus Arteriosus (PDA)

123
Q

What is the treatment for patent ductus arteriosus that is not needed to live in a concurrent condition (tetralogy of fallot, hypoplastic left heart syndrome)?

A

Indomethacin

(NSAIDs inhibit prostaglandins causing closure of PDA)

124
Q

What is the best initial test for acyanotic congenital heart defects (VSD, ASD, PDA)?

A

ECHO

bubble study for ASD

125
Q

What is the most accurate test for acyanotic congenital heart defects (VSD, ASD, PDA, coarctation of aorta)?

A

cardiac catheterizations

126
Q

What is physiologic splitting of S2?

A

inspiration causes pulmonic valve to close later (due to increase return to right side of heart) and aortic valve closes soon (due to decreased return to left heart)

127
Q

What does a pear shaped heart on CXR suggest?

A

Pericardial effusion

128
Q

What does a boot shaped heart on CXR suggest?

A

Tetralogy of Fallot

129
Q

What does a jug handle appearance on CXR suggest?

A

Primary Pulmonary artery hypertension

130
Q

What does “3” like appearance or rib notching suggest?

A

Coarctation of aorta

131
Q

A child presents with syncope in the setting of normal vital signs and exam, history of hearing loss, and family history of sudden cardiac death most likely suffers from …

A

Long QT syndrome

132
Q

What disease is associated with coarctation of aorta?

A

Turner’s syndrome

133
Q

A child presents with hypertension, elevated blood pressure in arms, lower blood pressure in legs, reduced pulses in feet, rib notching on CXR and development of CHF and respiratory distress within first few months of life most likely suffers from …

A

Coarctation of the Aorta

134
Q

A girl presents with short stature, webbed neck, shield chest, broad spaced nipples, streak gonads, horseshoe kidneys and shortened fourth metacarpal most likely suffers from …

A

Turner’s syndrome

135
Q

An infant presents with hypotonia, seizures, choreoathetosis, and sensorineural hearing loss in the setting of hyperbilirubinemia most likely suffers from …

A

kernicterus (deposition of bilirubin in basal ganglia)

136
Q

When is hyperbilirubinemia considered pathologic?

A
  1. appears in 1st day of life
  2. rise > 5mg/dl/day
  3. > 19.5 mg/dl in term baby
  4. direct bilirubin > 2 mg/dl at any time
  5. persists after second week of life
137
Q

What is the initial treatment for pathologic hyperbilirubinemia?

A

phototherapy (converts bilirubin into excretable form)

138
Q

When is exchange transfusion indicated for hyperbilirubinemia?

A

bilirubin > 20-25 mg/dl

139
Q

An infant presents with vomiting/choking/ cyanosis with first feeding with milk exhaled through nose, respiratory distress with feeds and recurrent aspiration pneumonia with associated history of polyhydramnios most likely suffers from …

A

Esophageal Atresia

blind esophagus

140
Q

What are the diagnostic tests for esophageal atresia?

A
  1. CXR (air bubble in esophagus without gas pattern in rest of GI tract)
  2. coiling of NG tube on CXR and inability to pass into stomach
141
Q

What is a major complication of esophageal atresia?

A

aspiration pneumonia due to tracheoesophageal fistula

142
Q

An infant presents with cyanosis during feeding and rest while pink when crying most likely suffers from …

A

Choanal Atresia
(membrane btw the nostrils and pharyngeal)
(pink with crying b/c are mouth breathers during crying)

143
Q

What is the best initial test for choanal atresia?

A

NG tube (does not pass thru nose into pharynx)

144
Q

What is the most accurate test for choanal atresia?

145
Q

An infant presents with bilious vomiting within 12 hours of birth and has a double-bubble on abdominal X-ray most likely suffers from …

A

Duodenal Atresia

146
Q

What conditions are associated with duodenal atresia? (2)

A
  1. Down’s syndrome (trisomy 21)

2. annular pancreas

147
Q

What is the treatment for duodenal atresia?

A
  1. IV fluids and replace electrolyte (potassium)
  2. NG tube decompression of bowel
  3. surgical duodenostomy
148
Q

What is the initial step in management of an infant with choanal atresia?

A

intubation (maintain airway)

149
Q

A male infant presents with forceful vomiting that projects across a room, the vomitus is nonbloody and nonbilious, hypochloremic, hypokalemic metabolic alkalosis and a palpable olive sized mass at epigastric most likely suffers from …

A

Pyloric stenosis (hypertrophy of pyloric sphincter)

150
Q

What is the best initial test for pyloric stenosis?

A

abdominal ultrasound

151
Q

What are the 4 signs seen on upper GI series that suggest pyloric stenosis?

A
  1. string sign (thin column of barium leaking thru tightened muscle)
  2. shoulder sign (filling defect of antrum)
  3. mushroom sign (hypertrophic pylorus against duodenum)
  4. railroad track sign (excess mucosa in pyloric lumen resulting in 2 columns of barium)
152
Q

What is the most common electrolyte disturbance that occurs due to extreme vomiting>

A

Hypochloremic, hypokalemic metabolic alkalosis

vomit H+ and Cl-, increase aldosterone due to volume loss leads to hypokalemia b/c increases K excretion

153
Q

What is the treatment for pyloric stenosis?

A
  1. IV fluids and electrolyte replacement (potassium)
  2. NG tube decompression
  3. surgical myotomy
154
Q

An infant presents with failure or delayed (> 48 hours) passage of meconium, constipation, inability to pass flatus, large bowel obstruction and tight rectal sphincter most likely suffers from …

A

Hirschsprung disease

lack of Auerbach plexus innervation of distal bowel

155
Q

What is the most accurate test for Hirschsprung disease?

A

Full thickness biopsy (rectal suction biopsy) showing lack of ganglionin cells in submucosa

156
Q

What are findings on abdominal Xray and manometry associate with Hirschsprung disease?

A

Xray: distended bowel loops w/ lack of air in rectum
Manometry: high pressures in anal sphincter

157
Q

What are the congenital defects characteristic of CHARGE syndrome?

A
  1. coloboma of eye (cleft in iris), CNS anomalies
  2. heart defects
  3. atresia of choanae
  4. retardation of growth/ development
  5. genital/ urinary defects
  6. ear anomalies/ deafness
158
Q

What are the congenital defects characteristic of VACTERL syndrome?

A 
V: vertebral anomalies
A: anal atresia
C: cardiovascular anomalies
T: transesophageal fistula
E: esophageal atresia
R: renal anomalies
L: limb anomalies
159
Q

An infant presents with a history of complete failre to pass meconium and no evidence of an anus on physical exam most likely suffers from …

A

Imperforate anus (rectum ends in blind pouch)

160
Q

An infant (1 y/o or younger) presents with bilious vomiting, colicky abdominal pain, abdominal distension, failure to pass flatus/ stool with multiple air fluid levels on abdominal X-ray and bird’s beak on upper GI series most likely suffers from …

A

Volvulus (bowel twisted on itself due to malrotation of gut)

161
Q

What is the treatment for volvulus?

A
  1. IV fluids and NG tube decompression
  2. endoscopic or surgical untwisting
  3. antibiotics (if signs of sepsis from bowel necrosis and perforation)
162
Q

A child (w/in 1st year of life) presents with colicky abdominal pain, bilious vomiting, currant jelly (purple colored) stool, and a firm sausage shaped mass (usually at RUQ) after having a viral illness most likely suffers from …

A

Intussusception (telescoping of bowel)

163
Q

What is the best initial test for Intussusception?

A

ultrasound (donut sign or target sign)

164
Q

What is the most accurate test for intussusception?

A

air contrast/ barium enema (diagnostic and therapeutic)

avoid if signs of peritonitis, shock, perforation

165
Q

What is the treatment for intussusception?

A
  1. IV fluids and electrolyte replacement
  2. NG tube decompression
  3. barium enema
166
Q

What are the 3 causes of bilious vomiting in infants?

A
  1. duodenal atresia (1st day of life, double bubble)
  2. volvulus
  3. intussusception (currant jelly stool, sausage shaped mass, donut sign)
167
Q

A male boy (2 y/o or younger) presents with episodes of painless rectal bleeding that is massive in quantity and possibly a palpable mass in the left side of abdomen most likely suffers from …

A

Meckel’s Diverticulum

outpouching of bowel that contains ectopic tissure

168
Q

What is the most accurate test for Meckel’s Diverticulum?

A

technetium 99m scan (Meckel scan)

169
Q

What are the rules of 2 for Meckel’s diverticulum? (5)

A
  1. 2% prevalence
  2. 2 y/o or younger
  3. 2 ft proximal to ileocecal vale
  4. 2 inches long
  5. 2 type of ectopic tissue (gastric, pancreatic)
170
Q

What is the best initial step in a child presenting with gastroenteritis?

A

IV fluid resuscitation

obtain stool for blood, leukocyte, toxins; culture for ova & parasites

171
Q

A child presents with profuse watery diarrhea that is foul smelling after camping, hiking or swimming in lake most likely suffers form …

A

Giardia infection

tx: metronidazole

172
Q

A child presents with watery nonbloody diarrhea, fever, and vomiting in winter time that lasts less than 1 week with a history of recent URI prodrome most likely suffers from ….

A

Rotavirus

most common cause

173
Q

A child presents with watery nonbloody diarrhea, fever, and vomiting that lasts for longer than 1 week with a history of recent URI prodrome most likely suffers from…

A

Adenovirus

174
Q

A child presents with explosive diarrhea, cramping abdominal pain that lasts 1-2 days and history of being on cruise or in area with diarrhea outbreak most likely suffers from …

A

Norwalk (small, round viruses)

175
Q

A severely premature infant with low birth weight presents with vomiting, abdominal distention, blood in stool and fever most likely suffers from …

A 
Necrotizing Enterocolitis
(bowel necrosis with bacteria invading intestinal wall)
176
Q

What is the characteristic finding on abdominal X-ray for necrotizing enterocolitis?

A

pneumatosis intestinalis (air within bowel wall)

177
Q

What are common complications of a fetus born to a diabetic mother? (8)

A
  1. macrosomia & enlarged organs
  2. polycythemia & hyperviscosity
  3. shoulder dystocia & brachial plexus injuries
  4. small left colon syndrome
  5. asymmetric septal hypertrophy
  6. renal vein thrombosis
  7. electrolyte abnormalities (low glu, Ca, Mg)
  8. hyperbilirubinemia (indirect)
178
Q

A infant born to a diabetic mother presents with shakiness, jittery and seizures most likely suffers from ..

A

hypoglycemia (secondary to hyperinsulinemia for exposure to high glucose inutero)

179
Q

What is considered macrosomia?

A

weight > 4500 grams (9 pounds 14 ounces)

180
Q

What is the treatment for an infant of a diabetic mother with shakiness, jittery, and seizures?

A

glucose and monitoring

181
Q

What other electrolyte disturbances are associated with hypocalcemia?

A
  1. hypomagnesium

2. hyperphosphatemia

182
Q

A pt presenting with flank mass, abdominal bruit, hematuria and thrombocytopenia most likely suffers from …

A

Renal Vein thrombosis

183
Q

A pt presents with hypotension, hyperkalemia, hypoglycemia, normal males and ambiguous genitalia in females most likely suffers from ….

A

Congenital Adrenal Hyperplasia due to 21 hydroxylase deficiency
(high androgens, low cortisol/ aldosterone)

184
Q

A pt presents with hypertension, hypokalemia, hypoglycemia, pseudohemaphrodite in males (female organs externally, male organs internally) and amenorrhea & lack of pubic hair in females most likely suffers from …

A

CAH due to 17 hydroxlase deficiency

high aldosterone, low cortisol/ androgens

185
Q

A pt presents with hypertension, few electrolyte abnormalities, normal males and ambiguous genitalia in females most likely suffers from ….

A

CAH due to 11 beta hydroxylase deficiency

high androgens & 11 deoxycorticosterone, low cortisol/ aldosterone

186
Q

A child presents with abnormal gait, bowed leggs and beading (rachitic rosary) of ribs on CXR in the setting of living in sunlesss environment and minimal milk drinking most likely suffers from …

A

Rickets (due to lack of vitamin D, calcium or phosphate)

187
Q

What is the complication associated with rickets?

188
Q

What supplement should breast fed infants be given starting at 2 months of age?

A

Vitamin D (to prevent rickets)

189
Q

Rickets associated with normal/ decreased Ca, decreased phosphate, decreased 1,25(OH) vit D, decreased 25 (OH) vit D, elevated PTH, elevated alk phos is due to ……

A

vitamin D deficient Rickets

190
Q

Rickets associated with decreased Ca, normal phospate, decreased 1,25 (OH) vit D, normal 25 (OH) vit D is due to …

A

Vitamin D dependent Rickets (inability to convert 25 (OH) vit D to 1,25(OH) vit D)

191
Q

Rickets associated with normal Ca, decreased phosphate, normal 1,25 (OH) vit D, and normal 25 (OH) vit D is due to …

A

X-linked hypophosphatemia (kidney defect leading to inability to retain phosphate)

192
Q

What are the TORCH infections?

A 
T: toxoplasmosis
O: other (syphilis)
R: rubella
C: CMV
H: herpes
193
Q

An child presents with cough, coryza (rhinitis), and conjunctivits with Koplik spots (grayish macule on buccal surface) most likely suffers from …

194
Q

A child presents with fever and URI that progresses to rash on the cheeks (“slapped cheek appearance”) most likely suffers from …

A

Fifth disease (erythema infectiosum due to Parvovirus B 19)

195
Q

A child presents with fever and URI that progresses to diffuse rash most likely suffers from …

A

Roseola (due to Herpesvirus type 6 and 7)

196
Q

A child presents with fever preceeding parotid gland swelling and possible orchitis (in males) most likely suffers from …

197
Q

A child presents with fever, pharyngitis, sandpaper rash over trunk and extremities, strawberry tongue and cervical lymphadenopathy most likely suffers from …

A

Scalet Fever (due to Strep pyogenes)

198
Q

A child presents a seal-like barking cough, URI symptoms (fever, runny nose), inspiratory stridor, worsening dyspnea when lying flat, peripheral cyanosis, accessory muscle use and constant hypoxia most likely suffers from …

A

Croup
(inflammation of upper airway due to parainfluenza virus type 1 and 2, RSV)
(aka laryngotrachitis, laryngotracheal bronchitis)

199
Q

What is the characteristic finding on CXR for Croup?

A

steeple sign (narrowing of air column in the trachea)

200
Q

What is the treatment for moderate to severe croup (respiratory distress, inability to lay flat, accessory muscle use, steeple sign)?

A

racemic epinephine

201
Q

What is the treatment for mild croup (no respiratory distress)?

202
Q

A child with a hx of vaccination deliquency presents with speaks with muffled words (hot potatoe voice), fever, drooling in tripod position, refusal to lean back/ lay flat and cherry red epiglottis most likely suffers from …

A

Epiglottitis
(swelling of epiglottis and arytenoids due to H. influenza type B)
(if pt has had vaccinations, due to strep)

203
Q

What is the initial best step of management for a child with epiglottitis?

A

Intubate (in OR just in case need to tracheostomy)

204
Q

What is the treatment for epiglottitis after intubation?

A
  1. ceftriaxone (for 7- 10 days)

2. Rifampin to close contacts

205
Q

What is the characteristic finding on CXR for epiglottitis?

A

thumbprint sign

206
Q

A child presents with nasal congestion and rhinorrhea for 2 weeks progressing to cough episodes with extreme air gasping during inspiration followed by vomiting most likely suffers from …

A

Whooping cough/ Pertussis

bronchitis due to Bordetella pertussis

207
Q

What is the characteristic finding on CXR for whooping cough (pertussis)?

A

Butterfly pattern

208
Q

What are the 2 stages of whooping cough (pertussis)?

A
  1. catarrhal stage (congestion, rhinorrhea, most contagious)
  2. paroxysmal stage (inspiratory whooping cough w/ vomiting)
  3. convalescent stage (decrease frequency of cough)
209
Q

When should a child with pertussis (whooping) be given antibiotics (erythromycin, azithromycin)?

A
  1. catarrhal stage (first 14 days of disease)

2. paroxysmal stage (to prevent transmission)

210
Q

What are the sequeale of strep throat (group A strep pharygitis)? (2)

A
  1. rheumatic fever

2. glomerulonephritis

211
Q

A child presents with a gray pseudomembranous plaque on pharyngeal wall with URI symptoms most likely suffers from ..

A

Diphtheria (due to corynebacterium diphtheriae)

212
Q

What is the treatment for Diphtheria?

A

anti-toxin

213
Q

What is the prophylactic treatment of close contacts of kids with pertussis?

A

macrolides

214
Q

An infant is found to have a click or clunk in their hip with Ortolani and Barlow maneuver most likely suffers from …

A

Congenital hip dysplasia

215
Q

What is the treatment for congenital hip dysplasia?

A

Pavlik harness

216
Q

What vitamin deficiency is associated with poor night vision and hypoparathyroidism?

A

Vitamin A deficiency

217
Q

What vitamin deficiency is associated with beriberi and wernicke’s encephalopathy?

A

thiamine (vitamin B1) deficiency

218
Q

What vitamin deficiency is associated with angular chelosis, stomatitis and glossitis?

A

vitamin B2 (riboflavin) deficiency

219
Q

What vitamin deficiency is associated with diarrhea, dermatitis, dementia and eventually death?

A

Niacin (vitamin B3) deficiency

220
Q

What vitamin deficiency is associated with burning feet syndrome (numbness, tingling)?

A

Panthothenic acid (vitamin B5) deficiency

221
Q

What vitamin deficiency is associated with peripheral neuropathy?

A

pyridoxine (vitamine B6) deficiency

222
Q

What vitamin deficiency is associated with megaloblastic anemia and hypersegmented neutrophils with normal level a methylmalonic acid?

A

Folate (vitamin B9) deficiency

223
Q

What vitamin deficiency is associated with megaloblastic anemia, hypersegmented neutrophils, peripheral neuropathy of the dorsal column tracts, and elevated methylmalonic acid?

A

Vitamin B12 (cyanocobalamin) deficiency

224
Q

What vitamin deficiency is associated with echymoses, bleeding gums, and petechiae?

A

vitamin C deficiency

225
Q

What vitamin deficieny is associated with increased PT (prothrombin time), increased INR, and signs of bleeding?

A

Vitamin K deficiency

similiar to warfarin therapy

226
Q

A yound child presents with painful limp with joint effusions and widening on Xray most likely suffers from …

A

Legg-Calve-Perthes disease (avascular necrosis of femoral head)

227
Q

An obese adolescent presents with painful limp and leg externally rotated, and widening of joint space on X-ray most likely suffers from …

A

Slipped capital femoral epiphysis

228
Q

What is the treatment for slipped capital femoral epiphysis?

A

internal fixation with pinning

229
Q

An infant with fair hair and skin, blue eyes presents with projectile vomiting, musty odor, chorea and progressive mental retardation most likely suffers from ..

A

Pheynlketoniuria (PKU)

tx: low phenylalanine in diet

230
Q

An infant presents with jaundice, direct bilirubinemia, hypoglycemia, cataracts, liver dysfunction, poor feeding, seizures and mental retardation most likely suffers from ….

A

Galactosemia (gal-1-P uridylyltransferase)

tx: no lactose

231
Q

A premature infant develops tachypnea, nasal flaring, grunting, and hypoxemia followed by hypercarbia and respiratory acidosis most likely suffers from ..

A

Respiratory distress syndrome

due to deficiency in surfactant

232
Q

What is the most accurate test for respiratory distress syndrome?

A

lecithin/ sphingomyelin ratio (of amniotic fluid prior to birth)

233
Q

An otherwise healthy infant presents with jaundice and indirect hyperbilirubinemia at 2 weeks of life most likely suffers from ..

A

Breast-milk jaundice

(tx: postpone breast-feeding until resolves_

234
Q

A newborn presents with poor feeding, jaundice, indirect hyperbilirubinemia and signs of dehydration during first few days of life most likely suffers from …

A

(poor) Breast-feeding jaundice

tx: lactation consultation and hydration

My Step 2 CK (21 decks)

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