Pediatrics

Question 0

pathogenesis of atopic dermatitis (eczema)

Answer 0

• epidermal dysfunction due to improper synthesis of stratum corneum components. Allergens can enter the disrupted skin barrier and generate an inflammatory response
• excessive bathing, dry environments, stress, overheating, and irritating detergents can trigger flares

Question 1

Atopic dermatitis (eczema)

Answer 1

• in INFANCY presents w/ pruritis, and scaly erythematous lesions on the face, chest, and extensor surfaces of the extremities
• Flexural involvement is common in children and adults
• topical emollients are the first line treatment (+/- steroid ointment)
• risk factors: low humidity, relatives w/ eczema, allergies, or asthma
• complications: eczema herpeticum, cellulitis/abscess, discomfort interfering w/ daily activities and sleep

Question 2

Contact dermatitis

Answer 2

• itchy red rash w/ indistinct margins and occur only in areas of direct allergen contact
• common in older children and adults after sensitization to an allergen (eg poison ivy resin, nickel, neomycin/bacitracin)

Question 3

Eczema herpeticum

Answer 3

• potential complication of severe atopic dermatitis
• superinfection w/ herpes simplex virus can cause a vesicular eruption on preexisting inflamed skin
• these pts often have fever and pain

Question 4

Erythroderma (exfoliative dermatitis)

Answer 4

• erythema and scaling in > 90% of the body

- bright red patches coalesce and gradually peel

Question 5

Psoriasis

Answer 5

• characterized by well-demarcated erythematous plaques w/ silvery scales on the scalp, extensor surfaces, and back
• common in adults but not in children

Question 6

Scabies

Answer 6

• caused by Sarcoptes scabiei infection
• small pruritic papules in a linear arrangement (burrows) favor the web spaces, wrists and ankles, genitals, nipples, and waistline

Question 7

Seborrheic dermatitis (“cradle cap”)

Answer 7

-adherent greasy scales w/ a mildly erythematous base seen on the scalp

Question 8

Clubfoot (talipes equinovarus)

Answer 8

• initially managed w/ stretching and manipulation of the foot, followed by serial plaster casts, malleable splints, or taping
• surgical treatment is indicated if conservative management gives unsatisfactory results, and is preferably performed between 3 and 6 months of age
• remember that the tx of clubfoot should be started IMMEDIATELY
• Equinus and varus of the calcaneum and talus, varus of the midfoot, and adduction of the forefoot

Question 9

Meconium ileus

Answer 9

• virtually diagnostic for cystic fibrosis

- inspissated meconium is responsible for life-threatening obstruction at the level of the ileum

Question 10

what two disorders must be considered in any infant who has delayed passage of meconium?

Answer 10

• Meconium ileus and Hirschsprung disease (congenital aganglionic megacolon)
• these conditions can be differentiated by the level of the intestinal obstruction and consistency of the meconium
• Hirschsprung: rectosigmoid obstruction, normal consistency
• Meconium ileus: Ileum obstruction, inspissated consistency

Question 11

what is meconium ileus virtually diagnostic for?

Answer 11

• Cystic fibrosis
• although only 20% of pts w/ CF develop meconium ileus, almost all newborns w/ meconium ileus have CF
• should prompt SWEAT CHLORIDE TESTING to confirm diagnosis

Question 12

long QT syndrome

Answer 12

• pts are at risk of syncope, ventricular arrhythmias, and sudden cardiac death
• those w/ congenital QT prolongation should avoid electrolyte derangements and medications that block potassium channels
• beta blockers w/ pacemaker placement can prevent cardiac arrest

Question 13

developmental milestones for 3 year olds

Answer 13

• throw a ball overhead
• build a 6-8 block tower
• copy a circle
• ride a tricycle

Question 14

developmental milestones for 4 year olds

Answer 14

• hop on 1 foot
• copy a cross
• brush teeth

Question 15

developmental milestones for 5 year olds

Answer 15

• tie a knot, copy squares
• mature pencil grasp, print some letters and numbers
• skip, draw a person w/ 6 or more body parts

Question 16

Thiamine (vitamin B1) deficiency

Answer 16

• causes Beriberi or Wernicke-Korsakoff syndrome

- neurologic and psychiatric symptoms, and are often seen in alcoholics or pts who have had weight loss surgery

Question 17

Riboflavin (vitamin B2) deficiency

Answer 17

-cheilosis, glossitis, seborrheic dermatitis (often affecting the genital areas), pharyngitis, and edema and/or erythema of the mouth

Question 18

Pyridoxine (vitamin B6) deficiency

Answer 18

• irritability, depression, dermatitis, and stomatitis
• can cause elevated serum homocysteine concentration, which is a known risk factor for venous thromboembolic disease and atherosclerosis

Question 19

Cyanocobalamin (vitamin B12) deficiency

Answer 19

-macrocytic anemia and peripheral neuropathy

Question 20

Niacin (vitamin B3) deficiency

Answer 20

-Pellagra (diarrhea, dermatitis, dementia, death)

Question 21

pyloric stenosis

Answer 21

• most commonly seen in boys age 1-2 months w/ NON-bilious projectile vomiting
• visible peristaltic waves and a palpable abdominal mass
• abdominal US is the preferred imaging modality

Question 22

Hirschsprung disease and meconium ileus usually present w/ failure to pass meconium within the first 2 days of life and dilated loops of bowel on x-ray. These should be evaluated by CONTRAST ENEMA.

Answer 22

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Question 23

Malrotation w/ midgut volvulus

Answer 23

• usually presents in neonates w/ BILIOUS vomiting and abdominal distension
• untreated volvulus can progress to frank bowel ischemia, bloody stools, and perforation
• an upper GI contrast study is the gold standard for diagnosing malrotation

Question 24

The finding of the ligament of Treitz on the right side of the abdomen reflects MALROTATION, while contrast in a "corkscrew" pattern indicates VOLVULUS on upper GI series.

Answer 24

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Question 25

what is generally the normal duration of crying in an infant?

Answer 25

1-2 hours per day

Question 26

Colic

Answer 26

- excessive crying for 3 or more hrs a day, 3 or more days a week, over a period of 3 or more weeks in an otherwise healthy infant - usually presents in the first few weeks of life and resolves spontaneously by age 4 months - crying generally occurs at same time of day, usually early evening - cause is unknown, but may be overstimulation and parental unfamiliarity w/ alternate soothing methods - calming techniques include an infant swing, swaddling, minimizing environmental stimuli, and holding and rocking the baby - feeding patterns should also be reviewed to assess if there is overfeeding, underfeeding, or an inadequate burping technique

Question 27

Intussusception

Answer 27

- typically occurs at age 3-36 months and presents w/ recurrent episodes of severe abdominal pain - poor appetite and vomiting are common

Question 28

GERD in infants

Answer 28

- usually presents w/ excessive spitting up and crying after feedings - may arch back during or after feeding - meds are generally reserved for infants who are not gaining weight appropriately

Question 29

Infantile hypertrophic pyloric stenosis

Answer 29

- most common in first born boys age 3-5 weeks - protracted projectile, NONbilious vomiting causes a hypochloremic metabolic alkalosis - abdominal US confirms the diagnosis - tx is pyloromyotomy

Question 30

Milk protein allergy

Answer 30

- can present w/ vomiting, poor weight gain, and bloody stools - affected infants should be switched to a hydrolyzed formula and avoid cow's milk-based and soy-based formulas

Question 31

Bilious vomiting in the first 2 days of life and a "double bubble" sign on abdominal x-ray

Answer 31

- Duodenal obstruction | - duodenal atresia is strongly associated w/ Down syndrome

Question 32

infants w/ biliary atresia

Answer 32

- most are asymptomatic at birth and initially seem healthy | - jaundice and acholic (pale) stools typically develop by age 2 months

Question 33

meconium ileus

Answer 33

- pathognomonic for cystic fibrosis and typically presents as delayed passage of meconium (> 48 hrs), marked abdominal distension, and sometimes bilious emesis - obstruction is typically at the level of the terminal ileum, and abdominal x-ray shows multiple dilated loops of small bowel

Question 34

pyloric stenosis

Answer 34

-postprandial NONbilious emesis at ages 3-6 weeks

Question 35

Sigmoid volvulus

Answer 35

- abdominal pain, distention, and constipation due to torsion of the sigmoid colon - x-ray shows an inverted U-shaped appearance of the distended sigmoid loop ("coffee bean sign") - typically occurs in elderly pts and is exceptionally rare in children

Question 36

Gastroesophageal reflux (mild, NOT GERD) is common in infants due to their shorter esophagus, incomplete closure of the lower esophageal sphincter, and greater time spent in the supine position. Parents should be reassured about adequate weight gain and advised to hold the infant upright after feeds.

Answer 36

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Question 37

In contrast to physiologic reflux, pathologic features of GERD include failure to thrive or Sandifer syndrome (intermittent opisthotonic posturing). Thickened feeds and antacid therapy are the first steps in management of GERD.

Answer 37

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Question 38

Regurgitation caused by milk protein allergy is associated w/ eczema, poor weight gain, and bloody stools. Infants w/ milk protein allergy should be switched to a hydrolyzed formula. Hydrolyzed formulas are very expensive and unnecessary when no other symptoms are present.

Answer 38

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Question 39

Goat milk is deficient in folate and could result in macrocytic anemia.

Answer 39

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Question 40

Gastroschisis

Answer 40

- usually an ISOLATED defect lateral (right) to the umbilical cord w/ uncovered bowel herniating through the abdominal wall - maternal serum a-fetoprotein is typically elevated during pregnancy - after delivery, the exposed bowel should be covered w/ sterile saline dressings and plastic wrap. Immediate surgery is required.

Question 41

Omphalocele

Answer 41

- commonly has other major malformations associated w/ it such as cardiac disease, neural tube defects, or trisomy syndromes - have a covering sac of peritoneum over healthy bowel - need immediate surgery after birth by staged closure w/ a SILASTIC SILO

Question 42

Increased gastric residual volume, vomiting, and abdominal distention in a premature neonate

Answer 42

- Necrotizing enterocolitis - hallmark findings on x-ray include PNEUMATOSIS INTESTINALIS (intramural air) and portal venous air - leukocytosis and metabolic acidosis are common

Question 43

Infantile hypertrophic pyloric stenosis presents w/ projectile, NONbilious emesis and an olive-shaped mass in RUQ. Prolonged vomiting causes a hypochloremic, hypokalemic metabolic alkalosis. Tx consists of IV rehydration and normalization of electrolytes prior to pyloromyotomy to decrease the risk of post-op apnea.

Answer 43

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Question 44

US is the first-line modality for diagnosing intussusception. A positive "target sign" should prompt reduction w/ air or water-soluble contrast enema.

Answer 44

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Question 45

Intussusception

Answer 45

- telescoping of one bowel segment into another - most common cause of intestinal obstruction in children 6-36 months - ileocolic junction is most frequently involved - most children have no identifiable lead point (75%) - possible lead points: Peyer patches (inflammation from viral infection), Meckel's diverticulum, polyps, hematomas (from Henoch-Schonlein purpura) - intermittent pain - currant jelly stools are preceded by mucosal ischemia, occult bleeding - palpable tubular "sausage shaped" mass in RUQ - US is test of choice ("target sign") - tx is w/ AIR ENEMA

Question 46

Atopic dermatitis

Answer 46

- presents in INFANCY w/ pruritis, and scaly erythematous lesions on the face, chest, and extensor surfaces of the extremities - FLEXURAL involvement is common in children and adults - topical emollients are the first-line treatment

Question 47

Meconium ileus is virtually diagnostic of what?

Answer 47

- Cystic fibrosis | - Inspissated meconium is responsible for life-threatening obstruction at the level of the ileum

Question 48

family hx of sudden death, congenital sensorineural deafness, and QT interval prolongation

Answer 48

- Jervell and Lange-Nielsen syndrome | - autosomal recessive long QT syndrome caused by defects in potassium channels

Question 49

Pts w/ prolonged QT intervals are at risk for syncope, ventricular arrhythmias, and sudden cardiac death. Those w/ congenital QT prolongation should avoid electrolyte derangements and medications that block potassium channels. Beta blockers w/ pacemaker placement can prevent cardiac arrest.

Answer 49

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Question 50

Tay-Sachs disease

Answer 50

- progressive autosomal recessive condition - B-hexosaminidase A deficiency - Like Niemann-Pick disease, Tay-Sachs also presents w/ loss of motor milestones, hypotonia, and a "cherry-red" macula. However, pts w/ Tay-Sachs have HYPERREFLEXIA and NO hepatosplenomegaly

Question 51

Galactocerebrosidase deficiency

Answer 51

- Krabbe disease - autosomal recessive LYSOSOMAL storage disorder that presents in early infancy w/ developmental regression, hypotonia, and areflexia

Question 52

Gaucher disease

Answer 52

- Glucocerebrosidase deficiency | - anemia, thrombocytopenia, and hepatosplenomegaly

Question 53

Hurler syndrome

Answer 53

- one of the mucopolysaccharidoses - LYSOSOMAL storage disease due to lysosomal HYDROLASE deficiency - presents at age 6 months- 2 years w/ coarse facial features, inguinal or umbilical hernias, corneal clouding, and hepatosplenomegaly

Question 54

Niemann-Pick disease type A

Answer 54

- due to SPHINGOMYELINASE deficiency - presents at age 2-6 months w/ areflexia, hepatosplenomegaly, a "cherry-red" macula, and developmental milestone regression - Although Tay-Sachs disease presents in a similar manner, hepatosplenomegaly and areflexia are NOT seen

Question 55

Down syndrome (trisomy 21)

Answer 55

- hypotonia, flat face, upward and slanted palpebral fissures, epicanthal folds, Brushfield spots, dysplasia of the pelvis, cardiac malformations, simian crease, short and broad hands, hypoplasia of the middle phalanx of the 5th finger, intestinal atresia, and high arched palate - most common trisomy

Question 56

Patau's syndrome (trisomy 13)

Answer 56

-cleft lip, flexed fingers w/ polydactyly, ocular hypotelorism, bulbous nose, low-set malformed ears, small abnormal skull, cerebral malformation, microphthalmia, cardiac malformations, scalp defects, hypoplastic or absent ribs, visceral and genital anomalies

Question 57

Wolf-Hirschhorn's syndrome

Answer 57

- very low yield for USMLE - chromosome 4p deletion - "greek helmet" facies w/ ocular hypertelorism, prominent glabella and frontal bossing, ptosis, and strabismus

Question 58

Cri-du-chat syndrome

Answer 58

- microcephaly w/ protruding metopic suture - cat-like cry - hypotonia, short stature, moonlike face, hypertelorism, bilateral epicanthic folds, high arched palate, wide and flat nasal bridge - 5p deletion

Question 59

Edwards' syndrome (trisomy 18)

Answer 59

-low birth weight, clenched fists w/ index finger overlapping the 3rd digit and the 5th digit overlapping the 4th, microcephaly, prominent occiput, micrognathia, rocker-bottom feet

Question 60

The diagnosis of ADHD is based on clinical evaluation of symptoms and associated impairment in 2 different settings. Teacher evaluations are an important tool for assessing behavior in the school environment.

Answer 60

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Question 61

Complete AV canal defect

Answer 61

- strongly associated w/ Down syndrome - aka endocardial cushion defect - chest x-ray findings include increased pulmonary markings and cardiomegaly from excessive pulmonary blood flow and biventricular volume overload

Question 62

Ebstein's anomaly

Answer 62

- associated w/ maternal lithium use during pregnancy - displacement of a malformed tricuspid valve into the right ventricle - the droopy tricuspid valve results in severe tricuspid regurgitation and right atrial enlargement, resulting in tall P waves and right axis deviation on ECG - extreme cardiomegaly from heart failure can be seen on chest x-ray

Question 63

Tetralogy of Fallot

Answer 63

- can have paucity of vascular marking on CXR due to pulmonary outflow tract obstruction - "boot-shaped heart" - right axis deviation on ECG

Question 64

Total anomalous pulmonary venous return

Answer 64

- defect in which all 4 pulmonary veins fail to make their normal connection to the left atrium - the right atrium receives blood from both the pulmonary and systemic venous systems, resulting in right atrial and ventricular enlargement - ECG can show right ventricular hypertrophy and right axis deviation - CXR can show increased pulmonary markings due to pulmonary overcirculation

Question 65

Truncus arteriosus

Answer 65

- strongly associated w/ DiGeorge syndrome - ECG can be normal in neonate - CXR typically shows cardiomegaly and increased pulmonary vascular markings from heart failure and pulmonary overcirculation

Question 66

Left axis deviation on neonatal ECG is NEVER NORMAL.

Answer 66

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Question 67

Tricuspid valve atresia

Answer 67

-cyanotic congenital heart defect characterized by left axis deviation on ECG and decreased pulmonary markings on CXR due to hypoplasia of the right ventricle and pulmonary outflow tract

Question 68

IgA deficiency

Answer 68

- consider in pts w/ mild immunodeficiency consisting of recurrent sinopulmonary and GI infections, and anaphylactic transfusion reaction - Diagnosis may be confirmed by measurement of a low serum IgA concentration w/ normal serum IgM and IgG levels - Pts may form antibodies to IgA, predisposing them to anaphylactic transfusion reactions

Question 69

DiGeorge syndrome

Answer 69

- thymic aplasia and consequent T cell deficiency - susceptible to fungal infections - hypoparathyroidism w/ hypocalcemia, cleft palate, and congenital heart disease (truncus arteriosis) are also associated

Question 70

X-linked agammaglobulinemia (Bruton's)

Answer 70

- affects males - pts lack B cells and all classes of Ig - sinopulmonary infections and Pseudomonas are common

Question 71

Wiskott-Aldrich syndrome

Answer 71

- X-linked combined B and T cell disorder | - pts present w/ recurrent otitis media, eczema, and thrombocytopenia

Question 72

Cystic fibrosis

Answer 72

-recurrent respiratory infections, sinus disease, pancreatic insufficiency, meconium ileus, and infertility

Question 73

Hyper-IgM syndrome

Answer 73

- pts have elevated IgM and depressed IgG and IgA - they are susceptible to both Giardia and recurrent sinopulmonary infection - Lymphoid hyperplasia is common

Question 74

Osteogenesis imperfecta

Answer 74

-associated w/ blue sclerae, hearing loss, recurrent fractures, and OPALESCENT teeth (dentinogenesis imperfecta; due to discolored dentin shining through the translucent and weak enamel; both primary and permanent teeth are affected)

Question 75

Osteogenesis imperfecta

Answer 75

- associated w/ blue sclera, hearing loss, recurrent fractures, and opalescent teeth - Pts w/ OI have normal intelligence

Question 76

Full term infants are born w/ adequate iron stores to prevent anemia for the first 4-6 months of life regardless of dietary intake. Preterm infants are at significantly increased risk for iron deficiency anemia. Iron supplementation should be started at birth in exclusively breastfed preterm infants and continued until age 1 year. All exclusively breastfed infants should be started on Vitamin D 400 IU daily.

Answer 76

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Question 77

what factors increase risk of iron deficiency anemia in infants

Answer 77

- maternal iron deficiency - prematurity - early introduction of cow's milk before age 12 months

Question 78

what is the first step in management of a newborn w/ respiratory compromise and suspected congenital diaphragmatic hernia (CDH)?

Answer 78

- Endotracheal intubation! - note that bag-and-mask ventilation can exacerbate respiratory decline - a gastric tube should be placed immediately to decompress the stomach and bowel.

Question 79

Bilateral choanal atresia

Answer 79

-presents w/ cyanosis and respiratory distress during feeding that improve when the infant cries

Question 80

Congenital diaphragmatic hernia

Answer 80

- cyanosis w/ respiratory distress immediately after birth - polyhydramnios can occur as a result of esophageal compression - deviation of abdominal viscera into the thorax results in a scaphoid-appearing abdomen - x-ray shows a displaced cardiac silhouette, bowel in the thorax, and a gasless abdomen

Question 81

Duodenal atresia

Answer 81

- can cause polyhydramnios and vomiting w/ initial feeds but not respiratory distress - the abdomen would NOT be distended and intestinal gas would be absent on x-ray as air cannot pass the duodenum - gastric tubes can be inserted without resistance and x-ray would show air in the stomach and proximal duodenum ("double-bubble sign")

Question 82

Esophageal atresia without fistulous connection to the trachea is rare and would not cause sudden respiratory distress w/ feeding.

Answer 82

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Question 83

Anomalous vascular branches of the aortic arch (vascular rings)

Answer 83

-can cause stridor and dysphagia due to compression of the trachea and esophagus

Question 84

Esophageal atresia w/ TE fistula

Answer 84

- should be suspected when a newborn chokes and coughs during the first feeding - attempts at naso- or orogastric tube insertion will fail and x-ray will show the tube in the proximal esophageal pouch - most common is a PROXIMAL atresia with a fistula between the trachea and DISTAL esophagus - Polyhydramnios is typically seen - aspiration pneumonia and distended abdomen is common - half of pts have other anomalies; VACTERL (vertebral, anal atresia, cardiac, TE fistula, renal, limb)

Question 85

genetic B-lymphocyte deficiency

Answer 85

- begin to develop recurrent infections AFTER passing 6 months of age due to the decline of passive immunity from mom's Ig - The deficient humoral immune response in these pts impairs the body's ability to destroy ENCAPSULATED organisms (recurrent sinopulmonary infections w/ H. influenza and S. pneumo are common) - lack of IgA also predisposes to Giardia infection

Question 86

Chronic granulomatous disease (CGD)

Answer 86

- impaired oxidative metabolism - a defect in the NADPH-oxidase system of phagocytic cells results in defective intracellular killing - pts are prone to ABSCESSES secondary to catalase-producing organisms like ASPERGILLUS and STAPHYLOCOCCUS

Question 87

Complement deficiency results in common infections with what?

Answer 87

-Gonococcal and meningococcal infections (due to Neisseria species)

Question 88

Thymic hypoplasia associated w/ DiGeorge syndrome

Answer 88

-T-cell deficiency puts pts at high risk for viral and fungal infections

Question 89

Adenosine deaminase deficiency

Answer 89

- commonly the genetic defect underlying severe combined immunodeficiency (SCID) - pts w/ SCID have a deficiency of both B and T cells - T cell deficiency predisposis to viral and fungal infections and the B cell deficiency predisposes to infection by bacteria

Question 90

Meningococcal meningitis

Answer 90

- most common cause of bacterial meningitis in children and young adults - typically presents w/ fever, headache, neck stiffness, altered mental status, and a PETECHIAL OR PURPURITIC RASH - prompt diagnosis and treatment are critical given that it has a high morbidity and mortality rate even w/ appropriate treatment

Question 91

Borrelia burgdorferia

Answer 91

- causes Lyme disease - usually acquired in the late summer months after an Ixodes sp. tick bite - presents w/ rash (ie erythema chronicum migrans), headaches, fevers, chills, and malaise - skin rash is very characteristic and is large, annular, and erythematous, occassionally w/ central clearing

Question 92

Cytomegalovirus

Answer 92

-can cause infectious mononucleosis like illness, which presents w/ high fevers, fatigue, malaise, splenomegaly, and pharyngitis

Question 93

Group B strep

Answer 93

- most common cause of meningitis in infants | - usually acquired from the mother during childbirth

Question 94

Haemophilus influenza

Answer 94

- may cause meningitis but typically does NOT present w/ a rash - may also cause rhinorrea, fever, epiglottitis, and ear infections - the rate of infection has decreased dramatically since the vaccine was introduced

Question 95

Herpes simplex virus

Answer 95

-generally causes temporal lobe encephalitis in neonates and infants and typically presents w/ seizures

Question 96

Listeria monocytogenes

Answer 96

- transmitted vaginally - 1 of the 3 most common causes of meningitis in newborns but does NOT present w/ a rash - another mode of transmission would be ingestion of unpasteurized milk or cheese from infected cows

Question 97

Hemolytic Uremic Syndrome (HUS)

Answer 97

- suspect HUS in a child who recently recovered from a diarrheal illness and presents w/ acute renal failure, microangiopathic hemolytic anemia, fever, thrombocytopenia and characteristic peripheral smear finding of schistocytes - E. coli 0157:H7 is often the organism (can also be w/ Shigella, Salmonella, Yersinia, and Campylobacter)

Question 98

Thalassemia presentation

Answer 98

- hepatosplenomegaly - peripheral blood smear may reveal target cells, microcytosis, hypochromia, and anisopoikilocytosis, but NOT schistocytes - BUN and creatinine levels are normal

Question 99

B12/Folate deficiency

Answer 99

-macrocytosis and hypersegmented PMNs on blood smear

Question 100

Lead poisoning

Answer 100

- causes a MICROCYTIC anemia, w/ BASOPHILIC STIPPLING of RBCs on peripheral smear - pts typically also present with GI symptoms

Question 101

PT and aPTT are prolonged in pts w/ DIC

Answer 101

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Question 102

ITP

Answer 102

- characterized by an ISOLATED thrombocytopenia | - on peripheral smear, the morphology of red cells is normal

Question 103

Bleeding in renal failure is usually due to dysfunctional platelets from uremia.

Answer 103

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Question 104

Human milk is the ideal form of nutrition for term infants. The major protein source is whey, which is more easily digested than casein and helps to improve gastric emptying.

Answer 104

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Question 105

what is the most common type of brain tumor seen in pediatric patients?

Answer 105

- benign astrocytomas - in the pediatric population, infratentorial tumors are more common than supratentorial tumors, and benign astrocytomas are the most common histologic type in both groups

Question 106

Medulloblastoma

Answer 106

- second most common tumor of the posterior fossa in children - approximately 90% of cases arise from the vermis

Question 107

Glioblastoma multiforme

Answer 107

- highly malignant astrocytic tumor | - usually seen in adults

Question 108

Pinealoma

Answer 108

- develops in the dorsal aspect of the midbrain - symptoms consist of endocrine syndrome, intracranial hypertension, Parinaud's sign (paralysis of vertical gaze), and Collier's sign (retraction of the eyelid)

Question 109

Craniopharyngioma

Answer 109

- arise in the sella turcica, and symptoms usually include visual field defects and an endocrine syndrome - characterized by a cystic structure w/ calcifications

Question 110

Pediatric OCD

Answer 110

- repetitive mental and physical rituals that interfere w/ social and occupational functioning - Tx involves high-dose SSRI and psychotherapy - onset may be associated w/ recent streptococcal infection (PANDAS)

Question 111

Spondylolisthesis

Answer 111

- developmental disorder characterized by a forward slip of vertebrae (usually L5 over S1) that usually manifests in preadolescent children. - in the typical clincial scenario, back pain, neurologic dysfunction (ie urinary incontinence), and a palpable "step-off" at the lumbosacral area are present if the disease is severe

Question 112

Patients w/ sickle cell anemia

Answer 112

- anemia w/ a high reticulocyte count, previous admissions for pain, hematuria, african american - become functionally asplenic at an early age due to splenic autoinfarction, thus more susceptible to encapsulated organisms - pneumococcal vaccination plus penicillin prophylaxis (until 5 years of age; twice daily) can prevent almost all cases of pneumococcal sepsis in pts w/ sickle cell anemia

Question 113

live attenuated virus vaccines

Answer 113

-measles, mumps, rubella, and chicken pox (varicella)

Question 114

bacterial toxoid vaccines

Answer 114

-tetanus and diptheria

Question 115

Sickle cell anemia

Answer 115

- associated w/ functional asplenia due to recurrent splenic infarction, which puts these pts at risk of dangerous infection w/ encapsulated organisms (S. pneumo, H. influenza type B, N. meningitides, and Salmonella species) - Pneumococcus is the most common cause of sepsis in this population - vaccination and penicillin prophylaxis are extremely important infection prevention measures

Question 116

what vaccinations should sickle cell pts receive?

Answer 116

- both the 13 valent and 23 valent polysaccharide pneumococcal vaccines - meningococcal conjugate vaccines - H influenza type B vaccines

Question 117

common cause of bacteremia in pts w/ burn wound and neutropenia?

Answer 117

Pseudomonas aeruginosa

Question 118

most common causes of osteomyelitis in sickle cell pts in the U.S.

Answer 118

-Salmonella species and Staph aureus

Question 119

Brain abscess

Answer 119

- can present w/ fever, headache, focal neurologic deficits, and seizure - congenital heart disease (right-to-left shunts bypass the lungs, an important filter) and recurrent sinusitis (direct spread to frontal lobe) are important predisposing factors

Question 120

bacterial meningitis presentation

Answer 120

-headache, lethargy, fever, fast onset, photophobia, nuchal rigidity

Question 121

Carotid artery dissection

Answer 121

-typically occurs after trauma or spontaneously in pts w/ connective tissue disorders

Question 122

Systemic Lupus Erythematosus (SLE)

Answer 122

- often associated w/ false positive RPR test resuts - 1/5 of all SLE cases occur in children - confirmatory tests are a positive ANTI-SMITH antibody and/or ANTI-DOUBLE STRANDED DNA antibodies (highly specific)

Question 123

Neonatal abstinence syndrome

Answer 123

- caused by infant withdrawal to opiates and usually presents in the first few days of life - characterized by irritability, a high-pitched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, vomiting, and diarrhea - tx is symptomatic care such as swaddling, providing small frequent feeds, and keeping the infant in a low stimulation environment - pharmacologic tx should be used when supportive tx does not control the infant's withdrawal symptoms. Morphine can be administered and systematically weaned to help control opiate withdrawal

Question 124

fetal exposure to valproic acid

Answer 124

-risk of neural tube defects, may result in cardiac anomalies, and can produce dysmorphic facies, including a cleft lip, narrow bifrontal diameter, midface hypoplasia, broad and depressed nasal bridge, and long philtrum

Question 125

prenatal exposure to phenytoin

Answer 125

- fetal hydantoin syndrome, which is characterized by nail and digit hypoplasia, dysmorphic facies, and mental retardation - growth deficiency can also be seen

Question 126

fetal alcohol syndrome

Answer 126

- growth deficiency, presence of a long, smooth philtrum, small palpebral fissures, and a thin upper lip in addition to CNS abnormalities such as mental retardation - withdrawal symptoms are usually not seen unless the mother was drinking just prior to delivery

Question 127

Prenatal exposure to cocaine

Answer 127

- jitteriness, excessive sucking, and a hyperactive Moro reflex - withdrawal symptoms are usually not as severe as with opiates - long term effects on behavior, attention level, and intelligence may be seen

Question 128

Guillain-Barre syndrome

Answer 128

- most commonly presents w/ ASCENDING flaccid paralysis - involvement of respiratory and bulbar muscles puts pts at high risk for respiratory failure - serial measurements of FVC are the best means of monitoring respiratory function (use SPIROMETRY) - severe autonomic dysfunction, flaccid quadriparesis, inability to hold the neck erect, and bulbar palsy are other indications for critical care

Question 129

Botulism has DESCENDING progression of weakness!

Answer 129

.

Question 130

Congenital hypothyroidism

Answer 130

- infants initially appear normal at birth, but gradually develop apathy, weakness, hypotonia, large tongue, sluggish movement, abdominal bloating, and an umbilical hernia - for this reason, screening newborns for hypothyroidism, along w/ PKU and galactosemia, is standardly performed in all states - tx is levothyroxine - most common cause is thyroid dysgenesis (ie aplasia, hypoplasia, or ectopic gland)

Question 131

infant botulism

Answer 131

-occurs most commonly in infants whose diet includes honey or canned food

Question 132

Werdnig-Hoffman syndrome

Answer 132

- autosomal recessive disorder that involves degeneration of the anterior horn cells and cranial nerve motor nuclei - it is a cause of "floppy baby" syndrome (the other cause is infant botulism)

Question 133

Myotonic congenital myopathy

Answer 133

-autosomal dominant disorder characterized by muscle weakness and atrophy (most predominant in the distal muscles of the upper and lower extremities), myotonia, testicular atrophy, and baldness

Question 134

Myasthenia gravis

Answer 134

- presents w/ easy fatigability and weakness that improves w/ rest - the pediatric form occurs in late childhood or adolescence

Question 135

Galactosemia

Answer 135

- newborn or young infant w/ failure to thrive, bilateral cataracts, jaundice and hypoglycemia - caused by galactose-1-phosphate uridyl transferase deficiency - typically present w/ vomiting, poor weight gain, jaundice, hepatomegaly, convulsions, and cataracts - other common manifestations include aminoaciduria, hepatic cirrhosis, hypoglycemia, and mental retardation. Pts are at increased risk of E. coli neonatal sepsis - Early diagnosis and tx by elimination of galactose from the diet are mandatory

Question 136

Galactokinase deficiency

Answer 136

-present w/ cataracts only, and are otherwise asymptomatic

Question 137

Uridyl diphosphate galactose-4-epimerase deficiency

Answer 137

- rare disease compared to uridyl-transferase deficiency | - pts have hypotonia and nerve deafness

Question 138

Malrotation with midgut volvulus

Answer 138

- usually presents in neonates w/ bilious vomiting and abdominal distension - untreated volvulus can progress to frank bowel ischemia, bloody stools, and perforation - an upper GI contrast study is the gold standard for diagnosing malrotation - finding is Ligament of Treitz on the right side of the abdomen (malrotation) while contrast in a "corkscrew" pattern indicates volvulus - Ladd procedure consists of fixing the bowel in a non-rotated position to minimize recurrent volvulus risk

Question 139

Pyloric stenosis

Answer 139

- most commonly seen in boys age 1-2 months w/ NON-bilious projectile vomiting - finding can include a visible peristaltic waves and a palpable abdominal mass - abdominal US is the preferred imaging modality for pyloric stenosis

Question 140

Hirschsprung disease and meconium ileus

Answer 140

- both usually present w/ failure to pass meconium within the first 2 days of life and dilated loops of bowel on x-ray - these diagnoses should be evaluated by contrast enema

Question 141

Serial abdominal x-rays are used in infants to follow the progression of non-surgical conditions, such as ileus or mild cases of necrotizing enterocolitis.

Answer 141

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Question 142

Cri-du-chat syndrome

Answer 142

- due to 5p deletion and presents as microcephaly, hypotonia, short stature, and a cat-like cry - other features: protruding metopic suture, moonlike face, hypertelorism, bilateral epicanthal folds, high arched palate, wide and flat nasal bridge, and mental retardation

Question 143

Chronic constipation is a risk factor for what in toddlers?

Answer 143

- Recurrent cystitis - impacted stool can cause rectal distension, which in turn compresses the bladder, prevents complete voiding, and leads to urinary stasis

Question 144

any male adolescent who presents with epistaxis, a localized mass, and a bony erosion on the back of the nose has what?

Answer 144

-an ANGIOFIBROMA until proven otherwise (juvenile angiofibroma)

Question 145

Reactive nasal polyps

Answer 145

- normally do NOT cause bony erosions | - usually associated w/ chronic infections or allergies, and the main complaint is obstruction rather than bleeding

Question 146

Fragile X syndrome

Answer 146

- characterized by low to normal IQ w/ learning disabilities, generalized language disability, short attention span, autism, large head, prominent jaw, large low set ears and macroorchidism - results from full mutation in the FMR1 gene caused by an increased number of CGG trinucleotide repeats accompanied by aberrant methylation of the FMR1 gene

Question 147

Fetal alcohol syndrome

Answer 147

mild to moderate mental retardation, hypo-plastic maxilla, long philtrum, and microcephaly

Question 148

Immune Thrombocytopenia (ITP)

Answer 148

- should be suspected in children who develop isolated thrombocytopenia and petechia after a viral infection - children usually spontaneously recover within 6 months and require only observation, regardless of platelet count - children w/ bleeding should receive IVIG or glucocorticoids

Question 149

Risk factors for renal calculi

Answer 149

-diet high in animal protein and sodium and low in calcium and fluid

Question 150

risk factors for the development of renal cell carcinoma

Answer 150

-cigarette smoking, hypertension, and diabetes mellitus

Question 151

Vesicoureteral reflux (VUR)

Answer 151

- risk factor for recurrent UTIs, which can lead to progressive renal scarring - all children w/ a first febrile UTI at age 2-24 months should undergo a renal US to evaluate for anatomic abnormalities - those w/ recurrent UTIs should also undergo a voiding cystourethrogram to evaluate for VUR

Question 152

almost all infants w/ congenital toxoplasmosis are asymptomatic until adulthood, when they develop chorioretinitis

Answer 152

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Question 153

HIV infection in infants

Answer 153

- should be suspected when an infant has failure to thrive, lymphadenopathy, and thrush in the setting of maternal IV drug abuse - Pregnant pts w/ risky behavior should undergo HIV antibody testing in the 1st and 3rd trimesters as it can take up to 3 months to develop detectable antibody - diagnosis in infants consists of PCR testing

Question 154

Friedreich Ataxia

Answer 154

- autosomal recessive condition and genetic counseling is recommended for prenatal diagnosis for parents with one affected child - due to an excessive number of trinucleotide repeats, resulting in an abnormality of a tocopherol transfer protein - the disorder is progressive w/ a poor prognosis; wheelchair bound by 25 and death by 30-35 - unsteady gait, weakness in lower limbs, decreased vibratory and position sense in lower extremities, high plantar arches, atrophy of cervical spinal cord and minimal cerebellar atrophy

Question 155

Differential for T-wave inversion?

Answer 155

- Myocardial infarction - Myocarditis - Old pericarditis - Myocardial contusion - Digoxin toxicity

Question 156

language development of a 2 year old

Answer 156

- vocabulary of several hundred words and be able to combine words into short sentences - in addition, half of their speech should be understandable to a stranger

Question 157

language development of a 1 year old

Answer 157

- "mama" and "dada", and one other word | - should be able to follow simple commands w/ gestures

Question 158

language development of 15 month old

Answer 158

- ''mama", "dada", and 3-5 other words | - can understand simple commands even without a gesture

Question 159

language development of 18 month old

Answer 159

-vocabulary of approx. 5-20 words

Question 160

language development of 3 year old

Answer 160

- vocab of close to 1000 words, and about 75% of child's speech can be understood by a stranger - they speak in 3-4 word sentences and use pronouns correctly

Question 161

Pyloric stenosis

Answer 161

- presents at age 3-5 weeks w/ projectile, nonbilious vomiting that occurs after each feed - protracted vomiting produces a hypochloremic, hypokalemic metabolic alkalosis that should be corrected prior to pyloromyotomy to decrease risk of postoperative apnea

Question 162

normal acid-base status

Answer 162

- pH of 7.35-7.45 - PaCO2 of 35-45 - Bicarb of 22-26

Question 163

Nephrotic syndrome

Answer 163

- edema, fatigue, proteinuria, absence of hematuria, hypoalbuminemia - MINIMAL CHANGE DISEASE in peds - FSGS, Membranous nephropathy, Membranoproliferative glomerulonephritis in adults

Question 164

Nephritic syndrome

Answer 164

- hypertension, oliguria, hematuria, proteinuria, casts - HUS, Poststrep glomerulonephritis in peds - IgA nephropathy, Crescentic glomerulonephritis, Membranoproliferative glomerulonephritis in adults

Question 165

Membranous nephropathy

Answer 165

- common cause of nephrotic syndrome (edema, proteinuria, and hypoalbuminemia) in adolescents and adults - active hepatitis B infection is an important risk factor, and vaccination reduces the risk

Question 166

FSGS

Answer 166

- common cause of nephrotic syndrome in adults and adolescents - HIV is the most commonly associated infection

Question 167

Membranoproliferative glomerulonephritis

Answer 167

-can cause Nephrotic syndrome or nephritic syndrome, most commonly in adults, and has been associated with hepatitis B infection. However, it is significantly less common than membranous nephropathy in hepatitis B infection

Question 168

Minimal change disease

Answer 168

-most common cause of nephrotic syndrome in preadolescent children

Question 169

Poststreptococcal glomerulonephritis

Answer 169

-most common cause of nephritic syndrome in children

Question 170

Whooping cough

Answer 170

- aka 100 days cough - Bordetella pertussis (gram negative coccobacillus) - 3 phases: catarrhal, paroxysmal, and convalescent - the paroxysmal phase is characterized by severe paroxysms of coughing and posttussive emesis - Macrolide antibiotics are the first-line treatment - may have lymphocytosis on CBC - infants

Question 171

Adenovirus

Answer 171

-common URI in children and is often accompanied by fever, pharyngitis, rhinitis, conjunctivitis, and diarrhea

Question 172

Chlamydophila pneumoniae and Mycoplasma pneumoniae

Answer 172

- causes of ATYPICAL pneumonias, which present w/ a gradual onset of symptoms, mild cough, and low-grade fevers

Question 173

Mycobacterium TB

Answer 173

-causes TB, a serious illness that presents w/ prolonged fever, night sweats, chronic cough, and weight loss

Question 174

Nontypeable Haemophilus influenza

Answer 174

-common cause of community-acquired pneumonia

Question 175

Parainfluenza

Answer 175

- very common cause of laryngotracheobronchitis (croup) in children - croup presents w/ fever, a "barky" cough, and inspiratory stridor

Question 176

Respiratory syncytial virus

Answer 176

-most common cause of bronchiolitis in children age

Question 177

Streptococcus pneumoniae

Answer 177

-most common cause of community-acquired pneumonia in children and presents w/ fever, cough, and tachypnea

Question 178

Acute Iron Poisoning

Answer 178

- disrupts basic cell processes from free radical production and lipid peroxidation - abdominal pain, hematemesis, shock and metabolic acidosis - commonly occurs in children of pregnant women taking pre-natal vitamins because children often confuse brightly colored iron pills for candy - tx of iron poisoning involves DEFEROXAMINE, which binds ferric iron, allowing urinary excretion

Question 179

antidote to TCA and aspirin overdose

Answer 179

Sodium Bicarbonate

Question 180

antidote to Torsades de Points induced by a prolonged QT interval?

Answer 180

Magnesium sulfate

Question 181

Tx for lithium toxicity?

Answer 181

Hemodialysis (most dialyzable toxin)

Question 182

tx for moderate to severe lead poisoning?

Answer 182

- Calcium EDTA (a lead chelator) | - children present w/ irritability, poor appetite, headaches, abdominal pain and anemia

Question 183

tx for hypercalemia?

Answer 183

Calcium gluconate (cardio-protective)

Question 184

Tx for mild to moderate lead poisoning?

Answer 184

-Oral succimer (chelating agent)

Question 185

tx for acetaminophen toxicity?

Answer 185

N-Acetylcysteine

Question 186

Osgood-Schlatter disease

Answer 186

- traction apophysitis of the tibial tubercle - Radiographic findings include anterior soft tissue swelling, lifting of tubercle from the shaft, and irregularity or fragmentation of the tubercle - common in adolescent male athletes - worsened by sports that involve repetitive running, jumping, or kneeling, and it improves with rest - 1/4 have bilateral disease - PE: edema and tenderness over the tibial tubercle - pain can be reproduced by extending the knee against resistance - tx is activity restriction, stretching exercises, and NSAIDs

Question 187

Prepatellar bursitis

Answer 187

- occurs w/ chronic irritation of the anterior knee | - symptoms include pain w/ direct pressure and superficial swelling over the patella

Question 188

Patellar tendonitis

Answer 188

- overuse syndrome resulting from repetitive jumping or kicking - pts present w/ anterior knee pain after exercise - pts have point tenderness at the inferior pole of the patella

Question 189

Tibial osteomyelitis

Answer 189

- bone infection, usually bacterial in origin - sx include pain, swelling, tenderness, and erythema - pts classically present w/ refusal to bear weight on the affected extremity. systemic symptoms may also be present - the pain from osteomyelitis does not remit with rest

Question 190

Patellofemoral stress syndrome

Answer 190

- overuse injury commonly seen in runners - pts present w/ anterior knee pain that worsens upon descending steps or hills - pain is localized to the patella and radiographs do not demonstrate separation at the tibial tubercle

Question 191

Intussusception

Answer 191

- risk factors: recent viral illness or rotavirus vaccine - pathological lead points: Meckel's diverticulum, Henoch-Schonlein purpura, Celiac disease, Intestinal tumor, Polyps - Presentation: episodic, crampy abdominal pain; currant jelly stools, sausage shaped abdominal mass - diagnosis: "target sign" on US - Tx: enema (air or water soluble contrast), surgical removal of lead point if present

Question 192

Recurrent intussusception

Answer 192

- a pathological lead point should be suspected in older children w/ recurrent intussusception - Meckel's diverticulum is the most common anomaly of the GI tract and can be asymptomatic between episodes of telescoping - Surgical resection is required to treat and prevent complications of obstruction

Question 193

Inspissated stool in cystic fibrosis may lead to intussusception.

Answer 193

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Question 194

Henoch-Schonlein purpura

Answer 194

- increases risk of intussusception due to small-bowel hematoma formation from the autoimmune vasculitis - palpable purpura and joint point are usually the first manifestations

Question 195

Hereditary angioedema

Answer 195

- rapid-onset edema of the face, acral extremities, genitals, trachea, and abdominal organs without urticaria - due to a deficiency or dysfunction in C1 inhibitor, which results in elevated levels of the edema-producing factors C2b and bradykinin

Question 196

Antibody-mediated (type 2) hypersensitivity

Answer 196

- can be seen in immune hemolytic anemia and Rh hemolytic disease of the newborn - involves specific rxns of IgG or IgM antibodies w/ cell bound antigens leading to complement activation and cell destruction - note that type 1 (immediate hypersensitivity) also involve the antibody IgE but result in mast cell and basophil degranulation w/ associated urticaria and pruritis

Question 197

Immune complex mediated (type 3) hypersensitivity

Answer 197

- can be seen in serum sickness - antibodies form complexes w/ allergens that are present in tissues, leading to activation of the complement cascade wherever the immune complexes deposit

Question 198

cell-mediated (type 4) hypersensitivity

Answer 198

- common examples are the TB skin test and allergic contact dermatitis - in allergic contact dermatitis, the allergen causes dermal inflammation following direct contact w/ the skin after a latent period of 1-2 days

Question 199

Low C1q levels

Answer 199

-associated w/ acquired angioedema, which usually presents in patients age > 30 (most common cause is ACE-inhibitor use)

Question 200

Circumstances in which minors do not require consent

Answer 200

- Medical: emergency care, STI's, substance abuse, Prenatal care - Emancipated minor: Homeless, Parent, Married, Military, Financially independent, High school graduate

Question 201

In general, parents who are themselves minors can give consent for medical treatment of their child. However, challenges in obtaining consent should not delay potentially life-saving, emergent procedures such as intubation for respiratory failure or emergent surgery.

Answer 201

.

Question 202

Homocystinuria

Answer 202

- autosomal recessive disorder caused by CYSTATHIONINE SYNTHASE DEFICIENCY - in addition to Marfanoid body habitus, pts w/ homocystinuria also have intellectual disability, downward lens dislocation, and hypercoagulability - tx involves vitamin B6, folate, and vitamin B12 to lower homocysteine levels, as well as antiplatelet or anticoagulation to prevent thromboembolic events - fair hair and eyes, developmental delay, and cerebrovascular accident are virtually pathognomic for homocystinuria

Question 203

Ehlers-Danlos syndrome

Answer 203

- collagen disorder | - scoliosis, joint laxity, and skin hyperelasticity

Question 204

Fabry disease (a-galactosidase deficiency)

Answer 204

- angiokeratomas, peripheral neuropathy, and asymptomatic corneal dystrophy - pts may also develop renal and heart failure and are at risk for thromboembolic events

Question 205

Krabbe disease

Answer 205

- autosomal recessive lysosomal storage disorder caused by galactocerebrosidase deficiency - intellectual disability, blindness, deafness, paralysis, neuropathy, and seizures

Question 206

PKU

Answer 206

- inborn error of metabolism that results from a deficiency of phenylalanine hydroxylase - intellectual disability, fair complexion, eczema, and a musty body odor

Question 207

Tay-Sachs disease

Answer 207

- autosomal recessive GANGLIOSIDOSIS caused by a deficiency of B-hexosaminidase A - intellectual disability, weakness, seizures, and presence of a cherry-red macula on exam

Question 208

Theophylline

Answer 208

- methylxanthine that may be used to treat asthma - has numerous side effects, must be given IV, and levels must be closely monitored - NOT indicated in the tx of acute status asthmaticus

Question 209

Tracheostomy

Answer 209

- surgical procedure performed to relieve upper airway obstruction - almost always an elective procedure and is never done to treat asthma, which is a disease process of the lower airways

Question 210

Racemic epinephrine

Answer 210

-should always be tried prior to endotracheal intubation in pts w/ CROUP

Question 211

Endotracheal intubation and mechanical ventilation are indicated in pts w/ severe asthma unresponsive to medications who have fatigue, altered mental status, CO2 retention, worsening hypoxemia, and poor air movement on exam

Answer 211

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Question 212

Hemolytic-uremic syndrome

Answer 212

- clinical syndrome of hemolytic anemia, thrombocytopenia, and acute renal failure - most often caused by Shiga-toxin mediated endothelial cell damage, after infection w/ E. coli O157:H7 or Shigella - Tx is supportive; approx. 50% of children w/ HUS require dialysis

Question 213

Henoch-Schonlein purpura

Answer 213

- presents w/ purpura on the legs and buttocks in the setting of a NORMAL platelet count - often presents as joint and abdominal pain

Question 214

Rocky mountain spotted fever (RMSF)

Answer 214

- can cause a vasculitis, including petechiae, anemia, thrombocytopenia, and hematuria - children are almost invariably febrile - tick borne infection

Question 215

Coarctation of the aorta

Answer 215

- hypertension in the upper part of the body and relative hypoperfusion in the lower part of the body - a mild, continuous murmur heard all over the chest is due to the development of collaterals between the hypertensive and hypoperfused vessels - rib notching, caused by the dilatation of the collateral chest wall vessels, is specific for coarctation

Question 216

supracondylar humerus fracture

Answer 216

- Compartment syndrome is a potential complication; severe pain, pallor, poikilothermia, paresthesias, and the late findings of pulselessness and paralysis - brachial artery injury is another concern; monitor pulses frequently - tx of compartment syndrome includes removal of any bandages, measurement of compartment pressures, and emergent orthopedic evaluation for possible fasciotomy

Question 217

blue-grey macule on infant

Answer 217

-congenital dermal melanocytosis ("Mongolian spots"); benign birthmarks prevalent in asian babies

Question 218

All neonates and infants should be screened for developmental dysplasia of the hip. How so?

Answer 218

- Barlow and Ortolani maneuvers - a palpable clunk should prompt referral to an orthopedic surgeon - a soft click, leg-length discrepancy, or asymmetric inguinal skin folds require diagnostic imaging with US (age 4-6 months) - the tx of choice for age

Question 219

Clinical manifestations of neonatal sepsis (including meningitis)

Answer 219

-Present in > 50% of cases: Temperature instability (> 38C or

Question 220

Neonatal sepsis

Answer 220

- untreated neonatal sepsis can result in significant morbidity and mortality, and there should be a very low threshold for evaluation and empiric treatment - clinical manifestations are often nonspecific and include temperature instability (low or high), poor feeding, lethargy, and jaundice - preterm infants are more likely to present w/ hypothermia than with fever - antibiotics should be administered immediately after blood cultures in ill-appearing infants without waiting for a lumbar puncture - workup includes a CBC, BLOOD CULTURE, LUMBAR PUNCTURE, URINALYSIS, AND URINE CULTURE

Question 221

Procalcitonin

Answer 221

-acute phase reactant similar to C-reactive protein and is released in response to bacterial toxins; in contrast, levels are reduced in viral infection

Question 222

Breast milk jaundice

Answer 222

- caused by a factor in human breast milk, and results from increased intestinal absorption of bilirubin and generally peaks around age 2 weeks - even infants w/ breast milk jaundice should continue to be breastfed as hyperbilirubinemia from breast milk rarely requires intervention

Question 223

Wiskott-Aldrich syndrome

Answer 223

- X-linked disorder characterized by the triad of thrombocytopenia, eczema, and recurrent bacterial infections - the thrombocytopenia is caused by decreased platelet production, and the few platelets that exist are typically quite small

Question 224

Childhood leukemias

Answer 224

- can cause anemia, leukopenia, and thrombocytopenia by infiltrating the bone marrow - an abnormal leukocyte differential w/ a high percentage of blast cells would be seen on the lab studies in children w/ leukemia

Question 225

Idiopathic thrombocytopenic purpura (ITP)

Answer 225

- immune-mediated disorder caused by antibodies that bind to platelets and facilitate their removal from the circulation - affected children typically present w/ easy bruisability or bleeding

Question 226

Thrombocytopenia as a result of increased activation, aggregation, and consumption can occur in pts w/ DIC, TTP, or HUS

Answer 226

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Question 227

Measles (rubeola)

Answer 227

- presentation: prodrome- fever, malaise, anorexia, CONJUNCTIVITIS, CORYZA, COUGH, KOPLIK SPOTS; exanthem- blanching, reddish-brown maculopapular rash, cephalocaudal and centrifugal spread, usually spares palms/soles - diagnosis: PCR, acute and convalescent serology for anti-measles IgM and IgG - Prevention: live attenuated measles vaccine - Tx: supportive care, VITAMIN A for hospitalized children - Complications: otitis media, pneumonia, encephalitis (within days), acute disseminated encephalomyelitis (within weeks), subacute sclerosing panencephalitis (within years), gastroenteritis

Question 228

Measles

Answer 228

- prodrome of Cough, Coryza, Conjunctivitis, and Koplik spots followed by a maculopapular rash that spreads in a cranial-caudal pattern - the disease affects only humans and is transmitted by respiratory droplets that can remain airborne for hours - prevention is best achieved by vaccination with the live attenuated measles vaccine - people are most contagious when they have coryza and cough, but can spread disease from 5 days before the appearance of the rash to 4 days after the rash resolves - manifests 1-3 weeks after inhalation of respiratory droplets

Question 229

Medulloblastoma

Answer 229

- second most common infratentorial tumor in children (after cerebellar astrocytoma) and arises from the cerebellar vermis - recognize posterior vermis syndrome (truncal dystaxia) - it is highly radiosensitive and can metastasize through the CSF tract

Question 230

Cerebellar hemispheric syndrome

Answer 230

- consists of arm, leg, and gait dystaxia, with ipsilateral cerebellar signs - cerebellar hemispheres are the site of astrocytoma and cerebellar abscess rather than medulloblastoma

Question 231

peripheral smear of sickle cell anemia

Answer 231

- sickled red cells, polychromasia (due to reticulocytosis), and Howell-Jolly bodies (due to splenic infarction) - acute pain crises due to vasoocclusion and ischemia are the most common manifestations of sickle cell anemia

Question 232

sickle cell anemia

Answer 232

- pathophys: autosomal recessive inheritance of B globin mutation in blacks and hispanics - features: hemolytic anemia, dactylitis, acute vasoocclusive pain crises - labs: decrease hematocrit, increased reticulocytes, serum LDL, and unconjugated bilirubin; peripheral smear shows sickled red cells, Howell-Jolly bodies - management: maintenance- vaccination, penicillin until age 5, folic acid, hydroxyurea; acute pain crises- hydration, analgesia, +/- transfusion

Question 233

radial head subluxation (nursemaid's elbow)

Answer 233

- common in preschool children - the classic mechanism is swinging or pulling a child by the arm - full recovery after closed reduction by forearm hyperpronation confirms the diagnosis - arm is classically held EXTENDED AND PRONATED and there is no swelling, deformity, or focal tenderness - tx: supination of forearm and flexion of elbow, OR hyperpronation of forearm (preferred); no post-reduction films are needed when the pt resumes full use of extremity

Question 234

in patients with apparent subcutaneous emphysema secondary to severe coughing paroxysms, chest x-rays must be obtained first to rule out pneumothorax!

Answer 234

-sever coughing paroxysms may result in subcutaneous emphysema, wherein air leaks from the chest wall due to high intraalveolar pressure provoked by the cough; by a similar process, pneumothorax can occur

Question 235

Remember to always evaluate precocious puberty (girls

Answer 235

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Question 236

Gonadotropin-dependent (central) precocious puberty

Answer 236

- characterized by premature adrenarche, premature thelarche, and advanced bone age - LH is elevated at baseline or after stimulation w/ GnRH agonist - tx consists of GnRH agonist therapy to maximize adult height - GnRH agonist therapy should NOT be initiated until after MRI has been performed, as idiopathic GDPP is a diagnosis of exclusion. Surgical resection would be the appropriate tx for certain tumors.

Question 237

Danazol

Answer 237

- testosterone derivative w/ progestin-like effects | - used for the treatment of endometriosis

Question 238

Pts w/ gonadotropin-independent (peripheral) precocious puberty

Answer 238

- have low basal LH levels with no response to GnRH - US of the adrenal glands, ovaries, and testes should be performed to look for a peripheral source of excessive sex hormone secretion

Question 239

Slipped capital femoral epiphysis

Answer 239

- common hip disorder seen in OVERWEIGHT adolescents age 10-16 - urgent surgical fixation is required to prevent avascular necrosis of the hip - additional risk factors: endocrinopathies (hypothyroidism, GH deficiency), renal failure, and radiation hx - always check for BILATERAL disease - insidious onset of dull hip or referred knee pain and altered gait w/ no preceding trauma - pts tend to hold the affected hip in passive external rotation, and exhibit decreased internal rotation, abduction, and flexion - gold standard for tx is IMMEDIATE SURGICAL SCREW FIXATION

Question 240

Developmental hip dysplasia

Answer 240

- caused by abnormal development of the hip in utero | - leg length discrepancy is present and radiographs show a poorly formed femoral head

Question 241

Legg-Calve-Perthes disease

Answer 241

-idiopathic AVN of the hip that most commonly affects boys age 5-7 years

Question 242

Anemia in sickle cell disease

Answer 242

- suffer from chronic extravascular and intravascular hemolysis - lab findings include mild to moderate anemia w/ reticulocytosis and unconjugated hyperbilirubinemia, increased LDH, decreased haptoglobin - an acute worsening of anemia can occur from splenic sequestration, which manifests as splenomegaly and increasing fatigue

Question 243

Respiratory distress syndrome

Answer 243

- should be suspected when a premature infant presents w/ grunting, flaring, and retractions immediately after birth - CXR includes characteristic fine reticular granularity of the lungs - tx includes early CONTINUOUS POSITIVE AIR PRESSURE VENTILATION - due to surfactant deficiency in most cases of preterm infants

Question 244

Congenital diaphragmatic hernia

Answer 244

- loops of bowel in the hemithorax, a displaced cardiac silhouette, and a gasless abdomen - pts worsen w/ noninvasive positive-pressure ventilation as air pumped into the GI tract can compress the lungs and should be intubated instead

Question 245

Meconium aspiration syndrome

Answer 245

- occurs in term or post-term infants born through meconium stained fluid - meconium obstructs the airways and causes respiratory distress - x-ray would show patchy infiltrates, coarse streaking of both lung fields, and flattening of the diaphragm

Question 246

Persistent pulmonary hypertension of the newborn

Answer 246

- should be suspected in all term and post-term neonates w/ cyanosis - high pulmonary vascular resistance results in right-to-left shunting of deoxygenated blood through the foramen ovale and ductus arteriosus, resulting in hypoxia

Question 247

Transient tachypnea

Answer 247

-most common cause of respiratory distress in full-term infants and has no long-term sequelae

Question 248

neonatal displaced clavicular fracture

Answer 248

- babies who are large for gestational age are at increased risk for birth injuries such as clavicular fractures - most clavicular fractures heal rapidly without complications - risk factors: fetal macrosomia (maternal diabetes, post-term pregnancy), instrumental delivery (vacuum or forceps), shoulder dystocia - features: crying/pain w/ passive motion of affected extremity, crepitus over clavicle, asymmetric Moro reflex - diagnosis: x-ray - tx: reassurance, gentle handling, analgesics (NOT aspirin), place affected arm in a long-sleeved garment and pin sleeve to chest w/ elbow flexed at 90 degrees - heals in 7-10 days

Question 249

Newborns w/ DiGeorge syndrome

Answer 249

- must be assessed immediately for potentially life-threatening hypocalcemia - the diagnosis should be suspected in the setting of craniofacial anomalies, thymic hypoplasia, and congenital heart disease - CATCH-22 (conotruncal cardiac defects, abnormal facies, thymic hypoplasia, cleft palate, hypocalcemia, chromosome 22)

Question 250

Todd's paralysis

Answer 250

- represents a postictal condition that usually rapidly improves w/ restoration of motor function within 24 hours - may follow generalized as well as focal seizures - usually indicates that a structural abnormality underlying the seizure is present

Question 251

Cholesteatomas

Answer 251

- in children can either be congenital or acquired secondary to chronic middle ear disease - new-onset hearing loss or chronic ear drainage despite antibiotic therapy are typical presenting symptoms of cholesteatomas, and granulation tissue and skin debris may be seen within retraction pockets of the tympanic membrane on otoscopy - complications: hearing loss, cranial nerve palsies, vertigo, brain abscesses or meningitis - refer to ENT for dedicated otologic exam

Question 252

Meniere's disease

Answer 252

-accumulation of fluid in the inner ear that leads to hearing loss, vertigo, and tinnitus

Question 253

Craniopharyngioma

Answer 253

- tumor that can occur in children | - derived from Rathke's pouch, which is in the suprasellar space

Question 254

Otosclerosis

Answer 254

-condition in which there is bony overgrowth of the stapes footplate that results in conductive hearing loss

Question 255

osteoma

Answer 255

-benign, solitary area of bony overgrowth that can form in the outer ear and lead to heard loss

Question 256

Refeeding syndrome

Answer 256

- potentially fatal complication of nutritional rehabilitation in anorexia nervosa - carb intake stimultes INSULIN activity, which in turn promotes cellular uptake of phosphorus, potassium, and magnesium - clinical manifestations include arrhythmias and cardiopulmonary failure - phosphorus is the primary deficient electrolyte as it is required for energy (ATP) - potassium and magnesium deficiency can cause arrhythmias

Question 257

muscle degeneration in the muscular dystrophies releases muscle enzymes into the blood, resulting in markedly elevated serum creatine phosphokinase and aldolase

Answer 257

.

Question 258

Myotonic dystrophy

Answer 258

- autosomal dominant disease that generally presents in the teenage yrs w/ muscle weakness, myotonia, cataracts, and cardiac conduction abnormalities - the muscular groups that are most affected include the facial muscles, intrinsic hand muscles, and ankle dorsiflexors - myotonia, or delayed muscle relaxatioin, is a prominent feature of the disease and manifests as a myoTONIC pattern on EMG; in contrast, a myoPATHIC pattern would be seen in DMD and BMD.

Question 259

Becker's vs Duchenne muscular dystrophy

Answer 259

- BMD is a similar but milder version of DMD, in which the dystrophin gene deletion preserves the reading frame for dystrophin, resulting in decreased (but not absent) dystrophin and muscle weakness later in childhood - DMD should be suspected in a boy age

Question 260

Neuroblastoma

Answer 260

- 3rd most common cancer in the pediatric population (after leukemia and CNS tumors) - the tumor arises from neural crest cells, which are also the precursor cells of the sympathetic chains and adrenal medulla - the most common site is the abdomen - calcifications and hemorrhages are seen on plain x-ray and CT scan - the levels of serum and urine catecholamines and their metabolites (HVA and VMA) are usually elevated

Question 261

embryologic precursor of the renal parenchyma

Answer 261

-Metanephros

Question 262

embryologic structure that gives rise to the seminal vesicles, epididymis, ejaculatory ducts, and ductus deferens?

Answer 262

-MeSonephros (S = sperm)

Question 263

Paramesonephron gives rise to what?

Answer 263

-fallopian tubes, uterus, and part of the vagina

Question 264

Strabismus

Answer 264

- strabismus after age 4 months is usually abnormal and requires treatment to prevent amblyopia - Asymmetric corneal light reflections and deviation on cover test are concerning findings - the standard tx is occlusion (patching) or penalization (blurring) of the normal eye

Question 265

New onset of strabismus

Answer 265

- can be a sign of retinoblastoma if accompanied by a white eye reflex - acute onset can also result from intracranial hemorrhage, brain abscess, or encephalitis

Question 266

Hand-foot syndrome or dactylitis

Answer 266

- the earliest manifestation of vaso-occlusion in sickle cell anemia, thereby warranting a complete workup for previously asymptomatic sickle cell patients - usually present between 6 months - 2 yrs of age w/ an acute onset of pain and symmetric swelling of the hands and feet - pathophys involves vascular necrosis of metacarpals and metatarsals

Question 267

mutation in sickle cell disease

Answer 267

-point mutation which results in the substitution of VALINE for GLUTAMIC ACID on the surface of the HbS molecule in the sixth codon of the beta globin chain

Question 268

Impetigo

Answer 268

- initially presents as papules which rapidly become pustules that rupture into honey-colored crusted exudates - Staphylococcus aureus and Streptococcus pyogenes are the most common causes of this contagious infection

Question 269

Chickenpox

Answer 269

- starts as a pruritic vesicular rash that eventually ruptures to leave scabs - usually, several stages of lesions are present simultaneously throughout the body

Question 270

Eczema herpeticum

Answer 270

- a superinfection of HSV in areas of severe eczema | - the rash can progress rapidly and is accompanied by fever

Question 271

Erysipelas

Answer 271

- begins as a small erythematous patch that progresses to a red, indurated, tense, and shiny plaque - the presence of a raised, sharply demarcated margin is a classic feature - overlying skin streaking and regional lymphadenopathy indicate lymphatic involvement - these pts usually have fever and chills

Question 272

Hand-foot-mouth disease

Answer 272

- characterized by vesicles on the posterior oropharynx, hands, and/or feet - the rash is not typically present on the face and does not crust

Question 273

Fibromuscular dysplasia

Answer 273

- can present as new onset hypertension in children - bruit or venous hum may be heard at the costovertebral angle - angiogram reveals the "string of beads" sign - it is the most common cause of secondary hypertension in children - the right renal artery is more affected than the left

Question 274

Conn's syndrome

Answer 274

- due to an aldosterone secreting adenoma or bilateral adrenal hyperplasia - usually presents in older pts as hypokalemia and hypertension

Question 275

Primary amenorrhea evaluation

Answer 275

- defined as absence of menarche by age 15 yrs - first do a pelvic exam or US to determine if uterus is present or absent - if uterus is PRESENT, get a serum FSH; if FSH increased, get a karyotype; if FSH decreased, get a cranial MRI - if uterus is ABSENT, get a karyotype and serum testosterone - Turner syndrome is one of the most common causes of primary amenorrhea

Question 276

Primary amenorhea, delayed puberty, short stature, and bicuspid aortic valve

Answer 276

- strongly suggestive of Turner syndrome - one of the most common causes of primary amenorrhea - Pelvic US should be performed to evaluate internal female anatomy

Question 277

Erb-Duchenne palsy

Answer 277

- excessive traction on the neck during a difficult delivery can result in this and the characteristic "waiter's tip" posture - fortunately, most infants recover arm function spontaneously within a few months - african american boys are at increased risk for fetal macrosomia, which in turn is a risk factor for shoulder dystocia and brachial plexus injury - involves C5, C6, and sometime C7

Question 278

Cephalohematoma

Answer 278

- subperiosteal scalp swelling that can occur in any delivery but is more common in the setting of instrumental delivery - usually resolves spontaneously w/o any sequelae - on the other hand, intracranial hemorrhage is a potential complication of vacuum use that can cause upper motor neuron injury leading to decreased arm movement, hyperreflexia, and hypertonia

Question 279

Vitamin K deficiency in newborns

Answer 279

- the body derives vitamin K from the diet and from gut flora synthesis - deficiency in newborns is the result of poor placental transfer, absent gut flora, immature liver function, and inadequate levels in breast milk - all newborns should receive a vitamin K injection to prevent vitamin K deficient bleeding (ie intracranial hemorrhage) - severe vitamin K deficiency typically causes prolonged PT and PTT, but mild deficiency may present w/ a prolonged PT and a normal PTT

Question 280

pts w/ impaired platelet function present w/ mucocutaneous bleeding and petechiae in the setting of normal PT, aPTT, and platelet count. Some causes include medications (aspirin, clopidogrel), metabolic problems (uremia, liver disease), and congenital disorders (Glanzmann thrombasthenia).

Answer 280

.

Question 281

affected individuals w/ von Willebrand disease will have a normal PT interval but may have a prolonged aPTT due to decreased factor VIII activity

Answer 281

.

Question 282

Osteosarcoma

Answer 282

- most common primary bone tumor in children and young adults and typically involves the metaphyses of long bones (distal femur, proximal tibia, proximal humerus) - physical exam typically shows a large and tender mass - classic x-ray findings include "sunburst" periosteal reaction and Codman triangle - constitutional symptoms are usually absent

Question 283

Ewing sarcoma

Answer 283

- second most common primary bone malignancy - incidence is highest in adolescent males and up to 20% may have systemic symptoms - x-ray shows an OSTEOLYTIC lesion w/ a periosteal reaction that produces layers of reactive bone, known as "ONION SKIN" appearance

Question 284

Osteoid osteoma

Answer 284

- appears as a sclerotic, cortical lesion on imaging w/ a central nidus of lucency - typically causes pain that is worse at night and unrelated to activity - pain is quickly relieved by NSAID medications

Question 285

Absence (petit mal) seizures

Answer 285

- suspect absence seizures in a 4 to 8 year old child w/ frequent daydreaming episodes, brief staring spells, decline in school performance, and no post-ictal phase - the preferred tx is ETHOSUXIMIDE or VALPROATE - classic EEG pattern is generalized, symmetrical 3-Hz spike and wave activity on a normal background (this finding is provoked by hyperventilation of the patient during EEG)

Question 286

APGAR score

Answer 286

- helpful in assessing the status of a neonate and response to neonatal resuscitation - routinely measured at 1 and 5 minutes of life - scores of

Question 287

Rabies

Answer 287

- transmission of neurotropic virus typically involves exposure to infected saliva; rare cases may be from contact w/ mucous membranes, infected aerosol particles, and corneal and organ transplantations - raccoons are the most prevalent rabid animal in the US, especially on east coast - post-exposure prophylaxis can be life-saving and should be initiated after a bite wound from a wild carnivore; IVIG and rabies vaccine - hydrophobia and aerophobia are pathognomonic for encephalitic rabies, and affected pts typically die within weeks of illness onset - ascending flaccid paralysis - almost all pts die within weeks

Question 288

Epiglottitis

Answer 288

- life-threatening cause of airway obstruction that is most commonly caused by bacterial infection - the first priority is to secure the patient's airway with endotracheal intubation in a controlled environment (eg operating room)!

Question 289

epiglottitis

Answer 289

- organisms: H. flu type B, nontypable H. flu, Strep, Staph - presentation: Distress ("tripod" positioning, inspiratory stridor), Dysphagia, Drooling - x-ray findings: "Thumbprint" sign (enlarged epiglottis), loss of vallecular space - management: keep child calm and comfortable, emergency ENDOTRACHEAL INTUBATION in the operating room

Question 290

Cricothyroidotomy in children

Answer 290

- should be avoided in pre-pubescent children | - the upper portion of the trachea is incompletely developed and children age

Question 291

Croup

Answer 291

- viral laryngotracheobronchitis - nebulized racemic epinephrine can provide relief - barky cough and inspiratory stridor - "steeple" sign

Question 292

Laryngomalacia

Answer 292

-inspiratory stridor that WORSENS IN THE SUPINE POSITION and w/ crying and feeding 2 and peaks at age 4-8 MONTHS -diagnosis is confirmed w/ flexible laryngoscopy, which shows collapse of the supraglottic structures during inspiration and OMEGA-shaped epiglottis -self-resolves by age 18 months -increased laxity of supraglottic structures -reassurance for most cases; supraglottoplasty for severe symptoms (poor weight gain, apnea, cyanosis, rapidly worsening stridor)

Question 293

common causes of pediatric stridor

Answer 293

-croup, foreign body aspiration, anatomic abnormalities such as laryngomalacia or vascular rings

Question 294

Vascular rings

Answer 294

- BIPHASIC STRIDOR and feeding difficulties if an anomalous branch of the aortic arch encircles the trachea and esophagus - workup consists of screening w/ barium swallow followed by confirmation w/ MRI w/ angiography

Question 295

Spirometry is used to diagnose VOCAL CORD PARALYSIS and ASTHMA in children age > 6 yrs.

Answer 295

.

Question 296

Prevertebral soft-tissue thickening

Answer 296

-retropharyngeal abscess

Question 297

subglottic edema

Answer 297

-croup

Question 298

All sexually active women age

Answer 298

.

Question 299

Neonatal tetanus

Answer 299

- generally seen in infants born to unimmunized mothers, frequently following umbilical stump infection - affected infants initially present in the first two weeks of life w/ poor suckling and fatigue, followed by rigidity, spasms and opisthotonus

Question 300

Fanconi anemia

Answer 300

-autosomal recessive disorder that causes congenital marrow failure, poor growth, morphologic abnormalities, and usually macrocytic anemia

Question 301

recurrent intussusception

Answer 301

- a pathological lead point should be suspected in older children w/ recurrent intussusception - Meckel's diverticulum is the most common congenital anomaly of the GI tract and can be asymptomatic between episodes of telescoping - Surgical resection is required to treat and prevent complications of obstruction - most cases of intussusception (~75%) occur before age 2 following a viral illness and have no identifiable lead point

Question 302

most common cause of nephrotic syndrome in pre-adolescent children?

Answer 302

- Minimal Change Disease (80%) | - renal biopsy shows normal kidney architecture but is not routinely obtained in pts age

Question 303

Focal segmental glomerulonephritis

Answer 303

- crescent formation is typical finding - most common cause of nephrotic syndrome in adults - may be rapidly progressive

Question 304

Thickened basement membrane and subEPITHELIAL "spikes"

Answer 304

- Membranous glomerulonephritis | - second most common cause of nephrotic syndrome in adults (behind FSGS)

Question 305

Masangial hypercellularity

Answer 305

- suggestive of membranoproliferative glomerulonephritis - commonly presents w/ NEPHRITIC syndrome rather than nephrotic syndrome - uncommon in young children

Question 306

nephrotic syndrome

Answer 306

-edema, fatigue, abdominal pain (from rapid fluid accumulation), and proteinuria

Question 307

Indications for renal and bladder US in children

Answer 307

-infants and children age

Question 308

indications for voiding cystourethrogram

Answer 308

- can be considered if hydronephrosis or scarring is seen in renal US - newborns age

Question 309

Children age

Answer 309

.

Question 310

common cause of childhood stroke?

Answer 310

Sickle cell anemia

Question 311

Electromyography (EMG)

Answer 311

- procedure that tests peripheral nerve function | - can be helpful in distinguishing nerve disease from muscle disease

Question 312

Neuroblastoma

Answer 312

- 3rd most common pediatric cancer after leukemia and brain tumors, but the most common cancer in the FIRST YEAR OF LIFE - can arise anywhere in the sympathetic nervous system but typically involves the adrenal glands and presents as an abdominal mass that CROSSES THE MIDLINE w/ systemic symptoms

Question 313

Posterior urethral valves

Answer 313

- can cause bilateral obstructive uropathy and are usually diagnosed prenatally - boys who present later in life typically have frequent UTI and signs of renal failure - associated hydronephrosis

Question 314

Renal cell carcinoma

Answer 314

- most common PRIMARY renal neoplasm | - occurs predominantly in men age 50-80 years and is rare in children

Question 315

Wilms tumor (nephroblastoma)

Answer 315

- most common pediatric renal malignancy - should be suspected in a toddler w/ a firm, smooth, unilateral abdominal mass and hematuria - fourth most common childhood cancer - peak age 2-5 years - does NOT CROSS THE MIDLINE - very high 5 year survival rate

Question 316

Biliary atresia

Answer 316

- newborns w/ conjugated (direct) hyperbilirubinemia and hepatomegaly should be evaluated for biliary atresia - the first step in evaluation is abdominal US, which may show an absent or abnormal gallbladder - early tx w/ a Kasai procedure (hepatoportoenterostomy) dramatically improves outcomes

Question 317

Breast milk jaundice

Answer 317

- generally appears in the second week of life - INDIRECT hyperbilirubinemia that may rise as high as s10-30 mg/dL - generally is benign, but in rare cases phototherapy may be indicated

Question 318

Crigler-Najjar and Gilbert's syndrome

Answer 318

- inherited deficienies of UDP-glucuronyl transferase that result in UNCONJUGATED hyperbilirubinemia - in Gilbert's, the deficiency is mild and pts are asymptomatic or have mild jaundice particularly during times of stress - in Crigler-Najjar, the enzyme is ABSENT and so pts present early in life and require liver transplant

Question 319

Erythroblastosis fetalis

Answer 319

- unconjugated hyperbilirubinemia and Coombs-positive hemolytic anemia - caused by mismatch between infant and maternal blood types (Rh disease, ABO incompatibility, minor blood group antigens)

Question 320

Physiologic jaundice

Answer 320

- UNCONJUGATED hyperbilirubinemia that appears after the first 24 hours of life and resolves within the first week - remember that CONJUGATED hyperbilirubinemia is always pathologic

Question 321

Primary humoral immune deficiency syndromes present w/ recurrent or severe sinopulmonary infections

Answer 321

- X-linked (bruton's) agammaglobulinemia - Common variable immunodeficiency - IgA deficiency - Hyper IgM syndrome - IgG subclass deficiency

Question 322

Hyper-IgM syndrome

Answer 322

- caused by a defect in the CD40 ligand (allows for class switching from IgM to others and formation of plasma cells) - high IgM levels, low or absent IgG and IgA, and normal lymphocyte populations

Question 323

Bruton agammaglobulinemia (X-linked)

Answer 323

- low IgG, IgM, and IgA | - low or absent B-lymphocytes

Question 324

Common variable immunodeficiency

Answer 324

- low levels of IgG, IgM, and IgA | - NORMAL B-lymphocyte levels

Question 325

Selective IgA deficiency

Answer 325

- relatively common - most pts are asymptomatic but some have recurrent respiratory, GI, and UG infections - IgA is low while IgM is normal

Question 326

Selective IgG subclass deficiency

Answer 326

-recurrent infections, low total IgG, normal IgM

Question 327

Transient hypogammaglobulinemia of infancy

Answer 327

- low serum IgG levels after age 6 months due to the waning maternal derived antibody from birth - usually resolves by 12 months of age - B and T cells and IgA and IgM levels are all normal

Question 328

Cystic fibrosis

Answer 328

- autosomal recessive - recurrent sinopulmonary infections, nasal polyps, digital clubbing - bilateral nasal polyps exacerbate nasal obstruction and chronic rhinosinusitis - sweat testing and QUANTITATIVE PILOCARPINE IONTOPHORESIS are gold standard for diagnosis

Question 329

ALL

Answer 329

- most common cause of childhood cancer - can present w/ numerous infections and weight loss - hepatosplenomegaly, lymphadenopathy, and petechiae are often seen

Question 330

Primary ciliary dyskinesia (immotile-cilia syndrome)

Answer 330

- autosomal recessive disorder of mucociliary clearance | - recurrent sinopulmonary infections, nasal polyposis, and digital clubbing

Question 331

Sturge-Weber syndrome

Answer 331

- neurocutaneous syndrome that is characterized by a congenital unilateral cavernous hemangioma along the trigeminal nerve distribution and radiographic evidence of intra-cranial calcifications that resemble a tramline - focal or generalized seizures, mental retardation, port wine stain or nevus flammeus, hemianopia, hemiparesis, hemisensory disturbance, ipsilateral glaucoma - tx is aimed at controlling the seizures and reducing IOP - argon laser therapy is successful in removing skin lesions

Question 332

Tuberous sclerosis

Answer 332

- initial presentation w/ seizure | - cutaneous manifestation is called adenoma sebaceum, which appears between 5-10 years of age

Question 333

capillary hemangioma

Answer 333

- usually presents at birth or appears by 6 months of age - small capillaries and presents as in irregular, raised lesion that blanches on pressure - approximately 75% regress by age 7

Question 334

Meningiomas

Answer 334

- non-invasive tumors derived from arachnoid cap cells, and consist of concentric whorls and calcified psammoma bodies - these may indent the brain and cause hyperostosis

Question 335

empty sella syndrome

Answer 335

- sella turcica is often enlarged and contains no discernible pituitary gland - syndrome may be primarily due to an incompetent sellar diaphragm w/ compression of the pituitary gland by the herniating arachnoid, or secondary to surgery or radiotherapy

Question 336

ependymomas are gliomas and are benign.

Answer 336

.

Question 337

a young boy w/ symptoms of increased intracranial pressure, bitemporal hemianopsia, and a calcified lesion above the sella?

Answer 337

- Craniopharyngioma - presence of a cystic calcified parasellar lesion on MRI is almost diagnostic - tx of choice is surgical removal

Question 338

Serum creatinine phosphokinase and aldolase levels are elevated in screening for muscular dystrophies. Fibrosis and fatty infiltration on calf muscle biopsy support the diagnosis. Genetic studies are the gold standard for confirmation.

Answer 338

.

Question 339

contraindications to rotavirus vaccine

Answer 339

- anaphylaxis to vaccine ingredients - hx of intussusception - hx of uncorrected congenital malformation of the GI tract (eg, Meckel's diverticulum) - SCID

Question 340

The administration of multiple vaccinations in a single office visit is safe and increases vaccine compliance and optimal protection at a young age. The exception is live-virus vaccines, which should be administered 4 weeks apart due to a possible interference of immune response.

Answer 340

.

Question 341

Live virus vaccinations can be safely administered to household contacts of pregnant women because the virus is weak and not contagious. Vaccination of household contacts reduces the potential spread of infection to pts who cannot receive vaccinations.

Answer 341

.

Question 342

Physiologic jaundice of the newborn

Answer 342

-total bilirubin

Question 343

Breastfeeding jaundice

Answer 343

- "lack of breast milk jaundice" - happens early in first week of life when the milk supply is low, resulting in limited enteral intake - low intake causes decreased GI motility and in turn retention of meconium - the B-glucuronidase in meconium deconjugates bilirubin and the unconjugated bilirubin is reabsorbed via the enterohepatic circulation, causing elevated serum levels - improves once milk let-down occurs - often difficult to distinguish from that of physiologic jaundice

Question 344

Breast-milk jaundice

Answer 344

- begins in first 4 to 7 days of life, but may not peak until about 10-14 days - NOT the result of low breast milk volume - possibly due to B-glucuronidase in breast milk deconjugating bilirubin in GI tract, allowing for increased reabsorption via enterohepatic circulation - can persist for up to 12 weeks, but total bilirubin concentrations rarely, if ever, get to concerning levels

Question 345

Biliary atresia

Answer 345

- healthy-appearing infant who develops jaundice, dark urine, and acholic (pale) stools between 3 and 6 weeks of age - any infant who develops jaundice after 2 weeks of age must be evaluated w/ fractionated bilirubin - tx is w/ Kasai procedure

Question 346

Kernig's sign

Answer 346

-resistance to extension of the knee

Question 347

Brudzinski's sign

Answer 347

-flexion of hip and knee in response to flexion of the neck by the examiner

Question 348

Difference between "fever without source" and "fever of unknown origin"?

Answer 348

- FWS: time of presentation (2-3 days) after onset of fever, which there is not a clearly identified source - FUO: 7-10 days after onset and workup has been negative and viral infections should have run their course. more likely to have unusual infections, malignancies, or collagen vascular disorders

Question 349

Simple vs Complex seizures

Answer 349

-simple: more common, 15 minutes, more than once in a 24 hr period, focal

Question 350

Causes of altered mental status

Answer 350

- A,E,I,O,U and TIPS - Alcohol, ingested toxins - Epilepsy, encephalitis, endocrine, electrolytes - Infection, insulin - Overdose, opiates, oxygen deprivation - Uremia (renal failure) - Trauma, temperature - Insulin, infection - Psychosis - Stroke, shock, space occupying lesion

Question 351

Acute iron poisoning

Answer 351

- abdominal pain, hematemesis, and metabolic acidosis - iron is radiopaque, and ingested tablets can be seen on x-ray - chelation therapy w/ deferoxamine should be provided for moderately to severely ill pts

Question 352

acute aspirin poisoning

Answer 352

-tinnitus, fever, hyperpnea (respiratory alkalosis), and metabolic acidosis

Question 353

acute overdose of vitamin A

Answer 353

- nausea, vomiting, and blurry vision | - chronic toxicity result in increased intracranial pressure (pseudotumor cerebri)

Question 354

meds used for tx of absence seizures

Answer 354

Ethosuximide and valproic acid

Question 355

Lamotrigine

Answer 355

first line agent for mixed seizures

Question 356

phenytoin and carbamazepine

Answer 356

-first line drugs for the tx of primary generalized tonic-clonic seizures or partial seizures w/ or w/o secondary generalization

Question 357

Diamond-Blackfan syndrome

Answer 357

-macrocytic pure red aplasia associated w/ several congenital anomalies such as short stature, webbed neck, cleft lip, shielded chest and triphalangeal thumbs

Question 358

Wiskott-Aldrich syndrome

Answer 358

-X linked disorder w/ eczema, thrombocytopenia, and hypogammaglobulinemia

Question 359

Fanconi's anemia

Answer 359

- autosomal recessive - progressive pancytopenia and macrocytosis - 8 yrs average age at diagnosis - cafe-au-lait spots, microcephaly, microphthalmia, short stature, horseshoe kidneys and absent thumbs

Question 360

Celiac disease

Answer 360

frequent cause of malabsorption and can lead to iron deficiency anemia -common associations w/ celiac disease include type 1 DM and dermatitis herpetiformis

Question 361

Enterobius vermicularis

Answer 361

- infection is highly contagious and manifests as nocturnal perianal pruritis - ALBENDAZOLE and PYRANTEL PAMOATE are first-line tx options (the latter is best for pregnant women) - "pinworms"

Question 362

Chagas disease (Trypanosoma cruzi)

Answer 362

- primarily affects the heart (cardiomyopathy, right BBB) and GI tract (megacolon, megaesophagus) - BENZNIDAZOLE is the first-line treatment

Question 363

Strongyloidiasis

Answer 363

- IVERMECTIN is the first-line tx - presents w/ urticaria, abdominal pain, and respiratory symptoms (dry cough, dyspnea, wheezing) - Onchocerciasis "river blindness" causes ocular lesions and dermatitis and is also tx w/ ivermectin - these are the worms that live in soil and penetrate the bottoms of your feet

Question 364

Reye syndrome

Answer 364

- seen exclusively in children less than 15 years old who were tx w/ salicylates for a viral infection - vomiting, agitation, irrational behavior, lethargy, stupor, restlessness - hyperammonemia, prolonged PT, severe elevations in AST, ALT, and LDH - microvesicular steatosis

Question 365

Sunscreens are rated by the strength of their SPF. The amount of UVB radiation filtered by SPF 15, 30, and 50 sunscreens is 93%, 97%, and 98%, respectively. Sunscreens w/ SPF > 50 provide a neglibible increase in UV protection (eg, SPF 100 sunscreen filters 99% of UVB rays).

Answer 365

.

Question 366

Sun avoidance is the best form of photo-protection. Sunscreen w/ SPF 15-30 or higher should be applied 15-30 minutes prior to sun exposure to allow time for development of a protective film.

Answer 366

.

Question 367

Intraventricular hemorrhage

Answer 367

- common complication in premature and underweight neonates - accumulation of blood in subarachnoid space can impair the ability of the arachnoid villi to absorb CSF, resulting in communicating hydrocephalus - affected neonates are at risk for permanent neurodevelopmental problems and death

Question 368

Hemophilic arthropathy

Answer 368

- delayed consequence of recurrent hemarthrosis (often seen in hemophilia A or B) - associated w/ hemosiderin deposition leading to synovitis and fibrosis within the joint - risk can be significantly reduced by prophylactic tx w/ factor concentrates

Question 369

idopathic avascular necrosis of the femoral head

Answer 369

- Legg-Calve-Perthes disease - limp or hip pain and is most common in children age 4-12 - note that sickle cell can also cause avascular necrosis of femoral head

Question 370

Allergic contact dermatitis

Answer 370

- erythema, edema, pruritis, tiny vesicles and weepy or crusted lesions 24-48 hours after contact w/ the allergen - due to CELL-MEDIATED (DELAYED, TYPE IV) HYPERSENSITIVITY - remember that type IV requires the host be sensitized before a reaction will develop, so a pt must have had prior exposure to the allergen before developing a reaction

Question 371

type I hypersensitivity

Answer 371

- IgE-mediated - occurs when an allergen binds and cross-links two IgE molecules attached to the mast cell - Atopy, urticaria, and anaphylaxis are examples - immediate

Question 372

type II hypersensitivity

Answer 372

- antibody-mediated hypersensitivity - CYTOTOXIC reactions involve specific reactions of IgG or IgM to cell-bound antigens. The antibodies then activate complement resulting in cell damage - examples are immune hemolytic anemia and Rh hemolytic disease in the newborn

Question 373

type III hypersensitivity

Answer 373

- immune complex-mediated hypersensitivity - antibodies of IgG or IgM form complexes w/ antigens and nonspecifically active the complement cascade and other inflammatory processes - examples are serum sickness and the Arthus reaction

Question 374

6 month developmental milestones

Answer 374

gross motor: sits momentarily propped on hands (unsupported by 7 months) fine motor: transfers objects hand to hand, raking grasp language: responds to name, babbles social/cognitive: stranger anxiety

Question 375

12 month developmental milestones

Answer 375

gross motor: stands well, walks first steps independently, throws ball fine motor: 2-finger pincer grasp language: says first words social/cognitive: separation anxiety, comes when called

Question 376

By age 4 months, primitive reflexes (Moro, grasp) have either already disappeared, or are starting to disappear as the infant initiates purposeful movement of the extremities. The Babinski reflex is the only primitive reflex that may persist in healthy children up to age 2 years, but can disappear as early as age 12 months.

Answer 376

.

Question 377

what age does stranger anxiety develop?

Answer 377

6 months

Question 378

what is the most common cause of bacterial pneumonia in young children with cystic fibrosis?

Answer 378

- Staph aureus (especially w/ coexisting influenza infection) - pts w/ CF suffer from life-threatening, recurrent sinopulmonary infections due to accumulation of viscous airway secretions - IV VANCOMYCIN is the drug of choice for severe pneumonia - (switches from S. aureus to P. aeruginosa at about age 20)

Question 379

antibiotics effective for Pseudomonas?

Answer 379

- Amikacin, ceftazidime, and ciprofloxacin | - most common cause of pneumonia in ADULTS w/ CF, but is less common in young children

Question 380

drug of choice for outpatient tx of community-acquired pneumonia for coverage of Strep pneumo?

Answer 380

High dose oral amoxicillin

Question 381

what vitamin has been shown to reduce the morbidity and mortality rates of pts w/ measles?

Answer 381

Vitamin A | -immune enhancement and helps GI and respiratory epithelium to regenerate

Question 382

what lab values might you see in measles?

Answer 382

-Leukopenia (T-cell cytopenia) and thrombocytopenia

Question 383

Lesch-Nyhan syndrome

Answer 383

- secondary to a deficiency in hypoxanthine-guanine phosphoribosyl transferase (HGPRT) - self-mutilation, neurologic features (mental retardation, dystonia, choreoathetosis, spasticity), gouty arthritis, and tophus formation - gout is usually seen in pts above 50 yrs of age; therefore, suspect Lesch-Nyhan if you see a BOY with gout - X-linked recessive - accumulation of uric acid due to enzyme deficieny involving purine metabolism; give ALLOPURINOL

Question 384

A large thymic silhouette is a normal finding on frontal chest x-ray in children age

Answer 384

"Sail sign"

Question 385

Cradle cap

Answer 385

- seborrheic dermatitis - papular, scaly rash tends to affect the eyebrows, nasolabial folds, and scalp - tx consists of moisturizers, antifungals, anti-dandruff shampoos, and topical steroids

Question 386

Atopic dermatitis

Answer 386

- recurrent, pruritic, eczematous eruption that tends to affect flexural and extensor surfaces - scaling red papules and plaques

Question 387

Trisomy 18 (Edward's syndrome)

Answer 387

- micrognathia, microcephaly, rocker bottom feet, overlapping fingers, and absent palmar creases - congenital heart disease occurs in > 50%; VENTRICULAR SEPTAL DEFECT IS THE MOST COMMON - 90% die in first year of life, the rest are mentally retarded

Question 388

heart disease in Trisomy 21

Answer 388

- Endocardial cushion defects | - Atrial septal defects

Question 389

heart disease in Williams' Syndrome

Answer 389

supravalvular aortic stenosis

Question 390

heart disease in DiGeorge syndrome

Answer 390

-Conotruncal abnormalities (Truncus arteriosus, Tetralogy of Fallot, interrupted aortic arch) (CATCH-22 syndrome)

Question 391

heart disease in neonatal lupus

Answer 391

Congenital heart block

Question 392

Neonatal polycythemia

Answer 392

- defined as hematocrit >65% in term neonates - risk factors: delayed cord clamping, maternal HTN, and maternal DM - symptomatic neonates generally have a combination of respiratory distress, hypoglycemia, and neurologic manifestations

Question 393

Tetralogy of Fallot

Answer 393

- varying degrees of cyanosis depending on the degree of RIGHT VENTRICULAR OUTFLOW TRACT OBSTRUCTION - squatting decreases right-to-left ventricular shunting, which improves cyanosis and increases the intensity of systolic murmur due to increased blood flow across the right ventricular outflow tract

Question 394

D-transposition of great arteries is a CYANOTIC congenital heart disease

Answer 394

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Question 395

Hypertrophic cardiomyopathy

Answer 395

- fatigue, dyspnea, chest pain, palpitations, or syncope; NO CYANOSIS - systolic murmur that DECREASES in intensity with INCREASING AFTERLOAD (squatting, handgrip)

Question 396

heart sound in atrial septal defect?

Answer 396

wide and fixed splitting of the second heart sound

Question 397

What are the most common causes of viral meningitis?

Answer 397

the non-polio enteroviruses, such as echoviruses and coxsackieviruses

Question 398

A type 1 collagen assay is used to diagnose osteogenesis imperfecta, or "brittle bone disease". Common findings include numerous fractures in multiple stages of healing, presence of blue sclerae, and short stature.

Answer 398

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Question 399

Hemarthrosis after minor trauma in a young child is suspicious for what?

Answer 399

bleeding disorder - screening should include coagulation studies and a CBC - nonaccidental trauma should be suspected in children w/ injuries inconsistent w/ the hx or developmental stage

Question 400

Bacterial meningitis in infants and children > 1 month

Answer 400

- lethargy, fever, poor oral intake, vomiting - its CRUCIAL to administer empiric antibiotics (CEFTRIAXONE and VANCOMYCIN) FIRST, and then perform a lumbar puncture as soon as possible - Imaging should be performed before the lumbar puncture in infants and children in coma, w/ focal neurologic findings, or w/ a hx of a neurosurgical procedure - note that in neonates

Question 401

Vaginal discharge in the newborn is due to the effects of maternal estrogens. In such cases, reassurance of the mother is all that is required. Female infants less than 3 months of age.

Answer 401

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Question 402

Chlamydial infection in the newborn

Answer 402

-may cause pneumonia or conjunctivitis

Question 403

Contraindications for further administration of pertussis-containing vaccines

Answer 403

- immediate anaphylaxis, unstable neurologic disorders, and encephalopathy within a week of administration of the DTaP vaccine - immunization against pertussis should be provided in the absence of these conditions

Question 404

Acetaminophen and ibuprofen can be administered after vaccination for fever or discomfort; they have NOT been shown to prevent fever or febrile seizures. In addition, prophylactic antipyretics may reduce antibody response to vaccines.

Answer 404

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Question 405

Complex partial seizure

Answer 405

- brief episodes of impaired consciousness, failure to respond to various stimuli during the episode, staring spells, automatisms, and post-ictal confusion - the EEG pattern is usually normal or may show brief discharges; unlike in absence seizures, hyperventilation during the EEG cannot simulate a complex partial seizure

Question 406

typical absence seizure

Answer 406

- brief (lasting for a few seconds) periods of imparied consciousness - pts may also have automatisms, but do NOT have a post-ictal state - hyperventilation during the EEG reveals a gerneralized 3 Hz spike and wave pattern on a normal background

Question 407

Lennox-Gastaut syndrome

Answer 407

-usually presents in childhood as seizures of multiple types, impaired cognitive function, and slow spike and wave activity on EEG

Question 408

Henoch-Schonlein purpura

Answer 408

- IgA mediated vasculitis of the small vessels that is most common in children - classic manifestations include palpable purpura, arthralgias, abdominal pain, and renal disease - Immunofluorescence microscopy shows IgA deposition in the kidney

Question 409

Minimal change disease

Answer 409

- most common form of idiopathic nephrotic syndrome in children and often presents w/ edema and hematuria - EM findings include fusion or flattening of the podocytes ("foot processes")

Question 410

Retropharyngeal abscess

Answer 410

-should be suspected in children who present w/ fever, dysphagia, inability to extend the neck, muffled voice, and lateral x-ray showing a widened prevertebral space

Question 411

what does Diphtheria pharyngitis look like on exam?

Answer 411

Grey-colored pseudomembrane formation

Question 412

Healthy infants normally lose up to 7% of birth weight in the first 5 days of life. No treatment is required, and exclusive breastfeeding should be continued. Birth weight should be regained by age 10-14 days. Pink discoloration in neonatal diaper is common and usually represents URIC ACID CRYSTALS, which is a NORMAL finding.

Answer 412

.

Question 413

Infants have immature kidneys that cannot reabsorb sodium effectively. Plain water should never be given to infants age

Answer 413

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Question 414

Lyme arthritis

Answer 414

- most common late manifestation of untreated Lyme disease | - the diagnosis should be suspected in pts w/ hx of travel to the northeastern or upper midwestern US

Question 415

Reactive arthritis

Answer 415

- typically an acute and asymmetric oligoarthritis that occurs 1-4 weeks after urethritis or diarrheal infection - malaise and fever can be present

Question 416

Simple febrile seizures

Answer 416

- do NOT require any workup | - pts can be discharged home from the ED w/ reassurance about a good prognosis

Question 417

Brain imaging should be considered in a child w/ COMPLEX febrile seizures, with a persistently abnormal neuro exam, macrocephaly, or signs/symptoms of elevated intracranial pressure.

Answer 417

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Question 418

Congenital hypothyroidism

Answer 418

- associated w/ neurodevelopmental injury if not recognized and treated early - decreased activity, hoarse cry, and jaundice are commonly associated w/ congenital hypothyroidism, but the majority of infants are asymptomatic - THYROID DYSGENESIS is the most common cause of congenital hypothyroidism worldwide

Question 419

Routine neonatal ophthalmic prophylaxis w/ topical erythromycin is NOT effective against chlamydial conjunctivitis. Maternal prenatal testing and treatment is the only effective strategy for the prevention of this condition. Typically presents 5-14 days after birth w/ chemosis, mild eyelid swelling, and watery or mucopurulent discharge. Tx is w/ ORAL ERYTHROMYCIN for 14 days despite the risk of hypertrophic pyloric stenosis w/ oral erythromycin use.

Answer 419

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Question 420

TOPICAL erythromycin ointment is only effective against gonococcal conjunctivitis (ophthalmia neonatorum), which presents 2-5 days after birth.

Answer 420

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Question 421

All immunoCOMPETENT pts who are asymptomatic and NONimmune should receive the varicella vaccine for post-exposure prophylaxis within 3-5 days of exposure. ImmunoCOMPROMISED hosts who are asymptomatic and NONimmune should receive varicella zoster immune globulin.

Answer 421

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