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Pediatrics Flashcards

1
Q

Underlying defect in fragile X

A

Increased number of CGG repeats

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2
Q

Next best option for venous access in pediatric patient in whom you cant get a peripheral IV

A

Intraosseous

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3
Q

First step in workup of an ill-appearing jaundiced infant after 3rd day and within first week of life

A

Blood cultures and LP to search for sepsis (even if picture seems like FTT)

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4
Q

Test of choice for pyloric stenosis

A

Abdominal ultrasound

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5
Q

In what age group is doxycycline not the treatment of choice for lyme and in this age group what is the treatment of choice?

A

Younger than 9. Amoxicillin

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6
Q

Treatment of choice for strep pharyngitis

A

Oral penicillin. If allergic use a macrolide (azithromycin)

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7
Q

Fever, pharyngitis, sandpaper rash, strawberry tongue

A

Scarlet fever (Group A strep)

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8
Q

Test of choice for muscular dystrophy

A

Muscle biopsy

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9
Q

Treatment of choice for a birth related clavicle fracture

A

Reassurance

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10
Q

Treatment of choice for neonatal chlamydial conjunctivitis

A

Oral erythromycin (topical erythromycin should not be used as it leaves a risk of chalmydial pneumonia)

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11
Q

At what age should you be concerned about hearing and speech development if a child does not respond to his or her own name?

A

Around 9 months

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12
Q

Difference in mechanism between infantile and adult botulism

A

Adult is due to ingestion of toxin, whereas infantile is due to ingestion of the organism itself. Honey is usually the food of transmission

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13
Q

Muscle weakness with temporal wasting, thin cheeks, emaciated extremities, testicular atrophy, and involvement of cardiac and smooth muscle

A

Myotonic muscular dystrophy (Steinert disease)

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14
Q

Inheritence of myotonic muscular dystrophy (Steinert disease)

A

Autosomal dominant

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15
Q

In what infection do patients frequently develop a rash after amoxicillin or other antibiotics are administered?

A

EBV mono

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16
Q

Close contact prophylaxis for pertussis

A

Erythromycin for 14 days to all contacts (regardless of age, immunizations, or symptoms)

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17
Q

Fever, conjunctivitis, extremity changes, cervical lymphadenopathy, oral changes, rash

A

Kawasaki

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18
Q

Treatment of an unimmunized child exposed to varicella

A

Vaccinate within 3-5 days of exposure, if high risk provide VZIG within 96 (preferably 72) hours. If you miss these times from just reassurance and supportive management

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19
Q

Deficiency in Gauchers

A

Enzyme acid beta-glucosidase

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20
Q

At what age should you treat persistent bedwetting and what is the treatment of choice?

A

After about age 5. DDAVP or imipramine (if behavioral therapy has failed)

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21
Q

Self-limiting episodes of vomiting and nausea in children without other symptoms or signs of a cause

A

Cyclical vomiting

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22
Q

Fever, headache, focal neurologic changes, seizure, spacticity, in a child

A

Suspect brain abscess

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23
Q

RDW in iron deficiency anemia and thalassemia respectively

A

Increased in IDA, normal in thalassemias

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24
Q

Abdominal distention, bloody diarrhea, leukocytosis in a formula feeding infant

A

Necrotizing enterocolitis

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25
Q

Cough with subcutaneous emphysema or subconjunctival hemorrhage

A

Pertussis. The cough can be so severe it can cause things like pneumothorax, subconjunctival hemorrhage, or rectal prolapse

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26
Q

Defect in galactossemia

A

Galactose-1-phosphate uridyl transferase

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27
Q

Time frame in infants when chlamydial and gonococcal conjunctivitis respectively are most common

A

Gonococcus - days 2 to 5, Chlamydia - days 5 to 15 (also usually less purulant than gonococcal)

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28
Q

Test of choice for child with increasing head circumference and signs of increased ICP

A

CT Head

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29
Q

Congenital heart defect with a normal S1 and a single loud S2 with no murmur

A

Transposition of the great vessels

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30
Q

Congenital heart defect with a normal S1, single S2 and systolic murmur

A

Tetralogy

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31
Q

What causes edema in turners patients?

A

Lymphatic dysgenesis. Dont be suckered into picking the horsehoe kidney

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32
Q

Neonate with bloody diarrhea, eosinophils in stool, and FH of atopy

A

Milk protein intolerance

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33
Q

What can be a long term complication of Henoch-Schonlein purpura?

A

Intussusception

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34
Q

Scrotal swelling, hematuria, and abdominal pain in a child

A

Henoch-Schonlein purpura. Will also have palpable pupura

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35
Q

Most common finding on MRI of brain and spinal cord in Frederichs ataxia

A

Marked atrophy of cervical spine with minimal cerebellar atrophy

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36
Q

Hand paralysis and ipsilateral Horners in an infant

A

Klumpke paralysis (injury to C7, C8, and T1 during birth)

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37
Q

Most common organisms in otitis media

A

Strep pneumo (40 percent), H flu (25-30 percent), Moraxella catarrhalis (10-15 percent)

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38
Q

What features make a partial seizure with secondary generalization more likely than a complex partial seizure in someone who had aura and LoC?

A

Tongue biting and bowel or bladder incontinence

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39
Q

Classic prenatal ultrasound finding in TORCH infections

A

Non-head sparing IUGR (i.e. body and head are both small)

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40
Q

Most likely long-term complication of vesicoureteral reflux with UTIs and pyelo

A

Renal scarring

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41
Q

Deficiency in Lesch-Nyhan

A

HGPRT

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42
Q

Fever, lethargy, new murmur in a child after a viral illness

A

Myocarditis

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43
Q

Physical exam findings in patients with a PDA

A

Usually unremarkable. You may have mildly accentuated peripheral pulses, however

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44
Q

Newborn male with oliguria and midline mass in the lower abdomen. Most likely diagnosis?

A

Posterior urethral valves (urethral obstruction)

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45
Q

Typical age of presentation and most common risk factor for slipped capital femoral epiphysis (SCFE)

A

10-16. Obesity

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46
Q

3-4 month old with hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia

A

Von Gierkes (Glucose-6-Phosphate deficiency)

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47
Q

Next step in management of a stable child who swallowed liquid alkali

A

Upper GI endoscopy (do not attempt to neutralize or lavage)

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48
Q

Most common presentation of sickle cell trait

A

Painless hematuria

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49
Q

Abdominal pain, hematemesis, shock, and metabolic acidosis in a child who may have ingested something

A

Iron poisoning

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50
Q

Child with Downs syndrome who presents with upper motor neuron findings

A

Atlantoaxial instability (a complication of Downs which involves spinal cord compression)

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51
Q

Indications for surgery in umbilical hernias

A

Persistence beyond 3-4 years, exceeding 2 cm in diameter, causing symptoms, strangulation, or progressive enlargement after age 1-2 years

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52
Q

Barking cough, hoarseness, respiratory distress

A

Croup (parainfluenza infection). Typically children younger than 3

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53
Q

What normal finding can be mistaken on CXR for cardiomegaly, lung infiltrate, or atelectasis in infants and how is it differentiated?

A

Thymic shadow. Sail sign (shape of a sail on right edge) suggests its the thymus youre seeing

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54
Q

Infant presenting with cyanosis aggrevated by feeding and relieved by crying

A

Choanal atresia

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55
Q

Adverse reactions to the DTaP vaccine are usually thought to be caused by which component?

A

Pertussis

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56
Q

Treatment for asymptomatic VSDs in infants

A

Reassurance and surveillence (usually close spontaneously)

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57
Q

First step in management of suspected congenital diaphragmatic hernia

A

Placement of an OG tube

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58
Q

Cyanosis, poor air entry, and shifting of cardiac sounds to the right in a newborn

A

Congenital diaphragmatic hernia

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59
Q

Nidus of infection most common in patients with chronic granulomatous disease

A

Pneumonia and Suppurtative Adenitis

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60
Q

Bluish white lesions on erythematous buccal mucosa opposite the first and second upper molars

A

Koplik spots (Measles)

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61
Q

Treatment of choice for increasingly unstable patient with croup

A

Racemic epinephrine. Should be tried before attempting intubation if possible

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62
Q

HSV infection associated with atopic dermatitis

A

Eczema herpeticum. Vesicles over the area of atopic dermatitis, can be life-threatening, treat with acyclovir

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63
Q

Cardiac defect in Edwards syndrome

A

VSD

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64
Q

Most common heart defect in Downs

A

Endocardial cushion defect (can lead to pulmonary hypertension)

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65
Q

Manifestations of polycythemia in newborns

A

Respiratory distress, poor feeding, neurologic signs

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66
Q

Fluid of choice for initial resuscitation in severe hypovolemic hypernatremia

A

Normal saline

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67
Q

New onset hearing loss or chronic ear drainage despite antibiotic therapy in kids

A

Cholesteatoma (destructive and expanding growth of keratinizing and squamous epithelium in the middle ear)

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68
Q

Child with noisy breathing and epiglottal abnormalities on laryngoscopy

A

Laryngomalacia

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69
Q

Management of laryngomalacia

A

Child should be held upright for 30 mins after feeding and never fed while laying down. Usually resolves within first 18 months of life

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70
Q

Bone marrow failure, poor growth, morphologic abnormalities, and macrocytic anemia

A

Fanconis anemia

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71
Q

A congenital cause of macrocytic anemia

A

Fanconis anemia (caused by chromosomal breaks)

72
Q

Management of child who refuses potty training initially

A

Stop training attempts for a few months until he or she is more motivated

73
Q

Thrombocytopenia, eczema, recurrent bacterial infections

A

Wiskott-Aldrich (thrombocytopenia is most common feature and is due to decreased platelet production)

74
Q

Most common predisposing factor for acute bacterial sinusitis

A

Viral URI

75
Q

Seizures of multiple types starting in childhood, impaired cognitive function, slow spike and wave activity on EEG

A

Lennox-Gastaut

76
Q

Age of an infant who sits well unsupported, enjoys looking around, babbles, and has a raking grasp

A

6 months

77
Q

Treatment of choice for adenitis in kids

A

Dicloxacillin

78
Q

Criteria which prompt workup for septic arthritis

A

Any three of the four. 1) WBC over 12k, 2) Temp over 102, 3) ESR over 40, 4) Refusal to bear weight. If three or four are true workup for septic arthritis

79
Q

Infant with poor suckling, fatigue, umbilical stumpitis then rigidity, spasms, and hyperextension

A

Tetanus (happens in first two weeks of life to children of unimmunized mothers)

80
Q

Indications for treatment (steroids or IVIG) in ITP

A

PC less than 30 thousand, or symptoms

81
Q

Treatment for cat bite

A

Amox-Clav for 5 days (most concerning pathogen is Pasteurella multocida)

82
Q

Criteria for Kawasakis

A

Fever for over 5 days and any four of the following. 1) Bulbar conjunctival injection, 2) Desquamation and edema of fingers and toes, 3) Erythema, fissuring, crusting of lips, strawberry tongue, oral mucosal injection, 4) Morbilliform truncal exanthem, 5) Cervical lymphadenopathy

83
Q

How long after birth is vaginal bleeding normal in newborn girls?

A

Up to 3 months

84
Q

Age of presentation of ToF

A

30 percent in first year. Most between ages 1 and 5

85
Q

Most common cause of neonatal sepsis

A

Group B strep

86
Q

Testicular size in normal prepubertal males

A

2 cm in length and 3 mL in volume

87
Q

Most common cause of subarachnoid hemorrhage in premature infants

A

Intraventricular hemorrhage

88
Q

Most common cause of communicating hydrocephalus in infants

A

Subarachnoid hemorrhage

89
Q

Common injury in kids who are lifted or pulled by the hand or arm

A

Nursemaids elbow (radial head subluxation)

90
Q

First step in management of gastroschisis

A

Sterile wrapping of exposed bowel

91
Q

Type of genetic mutation in CF

A

Deletion

92
Q

New onset hypertension in child with bruit at costovertebral angle

A

Fibromuscular dysplasia. Angiogram will show string of beads sign

93
Q

Scaly, mildly pruritic rash with central clearing on preteen who just took up swimming

A

Tinea corporis (treat with antifungals)

94
Q

Treatment for clubfoot

A

Stretching, manipulation, followed by serial casting. Do not delay treatment

95
Q

IVP findings in chronic pyelonephritis

A

Focal parenchymal scarring and blunting of calices

96
Q

Normal baby who develops apathy, weakness, hypotonia, large tongue, sluggish movement, abdominal bloating, and umbilical hernia

A

Congenital hypothyroidism (most common cause is thyroid dysgenesis)

97
Q

Coagulopathy in CF patient

A

Vitamin K deficiency due to malabsorption. Leads to deficiency of 2, 7, 9, 10, and proteins C and S

98
Q

Type of hypersensitivity in allergic contact dermatitis (eg poison ivy)

A

Type 4 (delayed, cell-mediated)

99
Q

Prophylaxis for patients with history of rheumatic fever

A

IM benzathine penicillin G every 4 weeks (limits the progression of rheumatic heart disease by preventing reinfection)

100
Q

In preterm infants should vaccines be given according to gestational or chronological age?

A

Chronological (except that children need to be 2 kg before receiving first HepB vaccine)

101
Q

Most common cause of congenital hypothyroidism in US

A

Thyroid dysgenesis (around 85 percent of cases)

102
Q

Treatment of choice for child who has spells of losing consciousness after crying with no cyanosis or incontinence

A

Reassurance (breath holding spells are normal)

103
Q

Treatment of choice for pinworm

A

Albendazole or mebendazole

104
Q

Blue sclera, hearing loss, joint hypermobility, dental imperfections

A

Osteogenesis imperfecta

105
Q

Knee pain in preteen worsened by sports

A

Osgood-Schlatter (traction apophysitis of the tibial tubercle). Caused mostly by rapid growth. Will see anterior soft tissue swelling, lifting of tubercle from shaft, and irregularity or fragmentation of the tubercle on XR.

106
Q

Stroke in a child after trauma to the soft palate

A

ICA dissection

107
Q

Excessive crying for more than 3 hours a day, more than 3 days a week, and more than 3 weeks a month, usually resolving by 4 months of age

A

Colic

108
Q

Epistaxis, localized mass, bony erosion on the back of the nose in a male adolescent

A

Angiofibroma

109
Q

Solitary, painful, lytic long bone lesion with overlying swelling and hypercalcemia in a child

A

Langerhans cell histiocytosis (or other neoplastic process). Other causes are possible as well

110
Q

Long term neurologic sequelae of bacterial meningitis

A

Hearing loss, Loss of cognitive functions (due to neuronal loss in hippocampal dentate gyrus), Seizures, Mental Retardation, Spasticity or paresis

111
Q

Forward slip of vertebrae (usually L5 over S1) in preadolescent children accompanied by a Cauda Equina type syndrome

A

Spondylolisthesis

112
Q

How do you differentiate tricuspid atresia from tetralogy of fallot?

A

TA has LEFT axis deviation on EKG, whereas ToF has RIGHT axis deviation

113
Q

Most common predisposing factor for acute bacterial rhinosinusitis

A

Viral URI

114
Q

Treatment for uncomplicated acute bacterial rhinosinusitis

A

Amox-clav

115
Q

Procedure of choice for foreign body aspiration with respiratory distress

A

Rigid bronchoscopy

116
Q

Complications of SGA babies

A

Hypoxia, polycythemia, hypoglycemia, hypothermia, hypocalcemia

117
Q

Treatment for metatarsus adductus

A

Reassurance. Usually correct spontaneously

118
Q

Apgar categories

A

Appearance (color), Pulse, Grimace (reflex irritability), Activity (tone), Respiration

119
Q

Treatment of choice for the Long QT of Jervell-Lange-Nielson

A

Propanolol

120
Q

Two main risk factors for RDS

A

Prematurity and diabetic mother

121
Q

What causes hematuria in Henoch-Schonlein Purpura?

A

Mesangial deposition of IgA

122
Q

Tetrad of Henoch-Schonlein purpura

A

Rash, Arthralgias, Abdominal Pain, Renal Disease (usually hematuria and proteinuria)

123
Q

What neonatal rash usually spares the diaper region?

A

Atopic dermatitis

124
Q

Most common causes of acquired torticollis in children

A

URI, minor trauma, cervical lymphadenitis, retropharyngeal abscess. Do a C-spine x-ray to rule out c-spine fracture or dislocation

125
Q

Where does medulloblastoma arise from?

A

Cerebellar vermis. Presents with headaches, vomiting, visual disturbance, TRUNCAL DYSTAXIA, horizontal nystagmus, papilledema

126
Q

Macrosomia, macroglossia, visceromegaly, omphalocele, hypoglycemia, hyperinsulinemia

A

Beckwith-Wiedemann

127
Q

Male pseudohermaphrodysm, early onset renal failure with mesangial sclerosis, and Wilms tumor

A

Denys-Drash

128
Q

Differences between congenital hypothyroidism and Beckwith-Wiedemann

A

1) CH has umbilical hernia whereas BW has omphalocele. 2) Head circumference inc in CH, down in BW. 3) No hypoglycemia or hyperinsulinemia in CH

129
Q

Fine reticular granularity of the lung parenchyma on CXR

A

Hyaline Membrane Disease

130
Q

Stridor, wheezing, coughing, and SOB which are worse while supine and relieved with neck extension in baby

A

Vascular ring

131
Q

Hepatosplenomegaly, cutaneous lesions, jaundice, anemia, rhinorrhea in baby

A

Congenital syphilis

132
Q

Short stature, webbed neck, cleft lip, shield chest, triphalangeal thumbs, macrocytic pure red cell aplasia

A

Diamond-Blackfan syndrome (congenital hypoplastic anemia). Is a defect in erythroid progenitor cells

133
Q

Most common cause of diffuse bronchiectasis in children

A

Cystic fibrosis

134
Q

Skin manifestations of Marfan

A

Striae (do not confuse with Cushings)

135
Q

Most common complication of mumps in prepubertal children

A

Meningoencephalomyelitis

136
Q

Sharply circumscribed, verrucous plaque on a child

A

Nevus sebaceous (a type of hamartoma). Present at birth, may enlarge during puberty. Excise (may become malignant)

137
Q

Immunoglobulins deficient in ataxia-telangiectasia

A

IgA and IgE

138
Q

What organism is notorious for leading to brain abscess when it causes meningitis?

A

Citrobacter Koseri

139
Q

Test of choice in suspected entamoeba histolytica liver abscess

A

Serum antibody testing (and metronidazole if positive)

140
Q

Hypotonia, upslanting palpebral fissures, epicanthal folds, excess nuchal skin, enlarged tongue, deflection of fifth fingers, simian crease

A

Downs

141
Q

Which vaccination is a common cause of postviral synovitis?

A

Rubella vaccination

142
Q

Child aged 1-8 weeks with mass in sternocleidomastoid

A

Congenital torticollis. Usually regress over 4-8 months

143
Q

Indication for audiometry testing in chronic otitis media with effusion

A

Recommend audiometry testing if pt has had chronic otitis media with effusion for 3 months or longer

144
Q

Treatment of choice for tinea capitis

A

Oral griseofulvin

145
Q

What test should be done upon diagnosis of juvenile rheumatoid arthritis to prevent a serious complication

A

Slit lamp exam (to prevent iridocyclitis which can lead to blindness)

146
Q

Anemia, thrombocytopenia, granulocytopenia, hepatosplenomegaly, bone pain in a child

A

ALL

147
Q

CHARGE defects

A

Coloboma (hole in eye structure), Heart defects, choanal Atresia, Retardation (growth and or mental), Genitourinary abnormalities, Ear anomalies

148
Q

X-ray finding of aortic coarctation

A

Erosion of posterior ribs

149
Q

Age of a child who needs some help dressing, can copy a circle but not a square, has mostly understandable speech, knows 4 colors, balances on each foot for 2 seconds but cannot for 5 seconds

A

4 Years

150
Q

Blount disease

A

Bowlegedness. Aggressive treatment necessary (bracing, surgery).

151
Q

Age of a child who can walk but is wobbly, has neat pincer grasp, can release cube into cup, builds tower of 2 cubes with variable success

A

1 Year

152
Q

Major contraindication to DTaP vaccine

A

Encephalopathy (coma, AMS, seizure) within 7 days of previous administration

153
Q

Which meningitis would be most likely to have a course lasting several weeks?

A

Tuberculous meningitis

154
Q

An adolescent comes in and is due for a tetanus booster (10 years), what shot should you give?

A

TDaP (incorporating pertussis protection is good as its incidence has increased)

155
Q

Treatment for heat stroke

A

IV fluids, aggressive cooling, oxygen, lab eval and consider ICU admission

156
Q

Flat vesicular lesions on back of neck or eyelids worsened by crying, activity or exercise

A

Salmon patches (nevus simplex or nevus flammeus)

157
Q

Erythematous, ulcerative lesions on fingertips from cold exposure that are painful and itchy

A

Chilblain

158
Q

Blistering, peeling areas that start as firm, cold, white areas and are sensitive. From cold exposure

A

Frostnip

159
Q

Megaloblastic anemia, growth failure, paresthesias, sensory defects, developmental regression, weakness, fatigue

A

B12 deficiency

160
Q

Name of Vitamin B2

A

Riboflavin

161
Q

Irritability, convulsions, hypochromic anemia

A

B6 deficiency

162
Q

Drug of abuse which causes extrapyramidal symptoms, which can be treated with benadryl

A

Phenothioazine

163
Q

The two first line treatments for trichomonas

A

Metronidazole and tinidazole

164
Q

Treatments of choice for giardiasis

A

Tinidazole or metronidazole

165
Q

Treatment of choice for cyclospora infection

A

Bactrim (cipro is second line)

166
Q

Most common heart lesion of infants born to mothers with SLE

A

Heart block

167
Q

Quick test for suspicion of a T-cell deficiency such as DiGeorge

A

Intradermal skin test using candida albicans

168
Q

Main deficiencies of goats milk

A

Iron and folate

169
Q

Most common configuration of TE fistula

A

Blind esophagus and distal esophagus connected to trachea

170
Q

Newborn with acute increase in head circumference, tachycardia, squishy scalp, fluid wave over scalp

A

Subgaleal or subaponeurotic hemorrhage

171
Q

Complications of cleft lip palate

A

Recurrent otitis media, hearing loss, speech defects

172
Q

Which TORCH infection most commonly includes structural heart defects?

A

Rubella

173
Q

Triad of neonatal toxoplasmosis

A

Hydrocephalus, chorioretinitis, intracranial calcifications

174
Q

What feature is most common in congenital CMV infection versus other TORCH infections?

A

Hearing loss

175
Q

Lateral displacement of medial canthi, broad nasal bridge, medial hyperplasia of eyebrows, partial albinism, deafness

A

Waardenburg syndrome (AD congenital defect)

176
Q

Most common cardiac abnormality in infants of diabetic mothers

A

Asymmetric septal hypertrophy

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