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USMLE Step 2 CK > Pediatrics > Flashcards

Pediatrics Flashcards

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USMLE® Step 1 flashcards
1
Q

When does neonatal conjunctivitis from Chlamydial infections occur? Treatment?

A

5-14 days after delivery?

Treatment: ORal erythromycin

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2
Q

Linear lesions with pruritus and erythematous streaks with edema and vesicles after camping?

A

Poison Ivy- Contact Dermatitis

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3
Q

Complications of hemophilia A and B

A

Hemophilic arhropathy -> iron/hemosiderin deposition leading to sunovitis and fibrosis

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4
Q

Todd paralysis

A

self-limited, focal weakness that occurs after focal or generalized seiure; presents in the postictal period with partial or compelte hemiplegia involving ipsilateral arm

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5
Q

Herpetic Gingitcostomatitis: Cause, Signs

A

Cause: HSV1

Signs: Fever, Pharngitis, Erythematous gingiva, Clusters of small vescicles on anerior oropharynx

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6
Q

Signs of Diamond-Blackfan syndrome?

A

Macrocytic anemia, low reticulocyte count, congenital anomalies

Average age of onset is 3 months

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7
Q

Painful vescibles with “punched out” erosions and hemorrhagic crusting superimposed on a child with atopic dermatitis?

A

HSV

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8
Q

Legg-calve-perthes disease

A

Average onset 4-10, incisious onset, antalgic gait (less time on one side), long-term pain

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9
Q

Most common bacterial infection in children with CF?

A

S. Aureus, especially with concurrent influenza.

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10
Q

Ehlers-Danlos syndrome

A

scoliosis, joint laxity, skin hyperelasticity

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11
Q

Signs on leukocyte adhesion deficiency?

A

Recurrent skin and mucosal infections, no pus, poor wound healing

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12
Q

Most common cause of sepsis in sickle cell patients?

A

S. pneumoniae

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13
Q

X-linked agammaglobulemia?

Alternative name?

A

Low B-cells, low Ig levels

AKA: Bruton’s agammaglobulinemia

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14
Q

First step in the evaluation of a neonate with emiesis?

A

Cessation of enteral feeds, NG tube decompression, IV fluids, XRay to rule out pneumoperitoneum

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15
Q

When should you suspect tricuspid atresia?

A

Cyanotic infant with left axis deviation, small or absent R waves,

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16
Q

Signs of vitamin D deficiency in an infant?

A

Delayed fontanel closure, enlarged skull, costochondral joints (achitic rosary), long-bone joint widening, genu varum (bowed legs)

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17
Q

Children under 8 years of age should be treated for erythema hronicum migrans from lyme disease with?

Over 8?

A

Under 8: Amoxicillin

Over 8: Doxycycline

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18
Q

What is spondylolisthesis? Signs?

A

Developmental disporder characterized by forward slip of vertebrae (L5 over S1)

Signs: Chronic back pain, neurological dysfunction, palpable step-off

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19
Q

Job syndrome?

A

Normal levels of B-cells, Ig, except with hyper IgE

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20
Q

Acute management of a sickle cell patient with signs of stroke?

A

Exchange transfusion, dilutes amount of sickled cells in blood

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21
Q

Developmental milestones at 12 months?

A

Stands well, walks first steps, 2-finger pincer, says first words, separation anxiety, comes when called

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22
Q

Early adolescent obese male that presents with hip or knee pain of insidious onset that causes limping? Treatment?

A

Slipped capital femoral epiphysis

x: surgical pinning

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23
Q

Fibrosarcoma

A

Malignant spindle cell neplasm found in patiens 30-60. Painful mass. Osteolytic lesion whose margins can be well-defined or ragged and moth-eaten

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24
Q

Congenitial CMV infections signs? Treatment?

A

Growth restriction, microcephaly, periventirular calcification, hepatosplenomegaly, thrombocytopenia

Treatment: Valganciclovir

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25
Q
A

Osteosarcoma

Findings: Soft tissue mass, “sunburst pattern”, periosteal elevation (Codman traingle)

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26
Q

Beckwith-Wiedemann syndrome: Cause? Clincal Manifestations? Complications? Surveillance?

A

Cause: Desregulation of imprinted gene expression on 11p15

Manifestations: Fetal meacrosomia, rapid growth, macroglossia, hemihyperplasia, medial abdominal wall defects

Complications: Wilms tumor, hepatoblastoma

Surveillance: Serum AFP, abdominal/renal US

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27
Q

Signs of sepsis?

A

Fever, chills, hypotension, leukocytosis, bandemia

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28
Q

How to diagnose Laryngomalacia?

A

Confirmation by flexible laryngoscopy for moderate-severe cases

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29
Q

VACTER

A

Vertebral, anal atresia, cardiac abnormalities, radial (skeletal) and renal

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30
Q

What findings of a pediatric burn would suggest child abuse?

A

Sparing flexor surfaces

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31
Q

Diagnostic test for Chronic Granulomatous disease?

A

Neutrophil function testing

  • Dihydrohodamine 123 test
  • nitroblue tetrazolium test
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32
Q

Heinz bodies

A

Aggregates of denatured hemogobin, seen in patients with hemolysis due to G6PD deficiency and thalassemia

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33
Q

Total anomalous pulmonary venous return

A

4 pulmonay veins fail to make the normal connection to the left atrium. Righ atrium received blood from both pulmonary and systemic venous system.

Signs: right venticle hypertrophy, and right axis deviation

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34
Q

Pyridoxine (B6) deficiency

A

Cheilosis, stomatitis, glossitis, irritability, confusion, depression

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35
Q

Acute Rheumatic fever: Major and minor signs

A

Major: Migratory Arthritis, Carditis, Subcutaneous nodules, Erythema marginatum, Sydenham Chorea

Minor: Fever, arthralgias, Elevated ESR, CRP, Prolonged PR interval

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36
Q

condensed nuclear chromatin, small nucleoli with scant agranular cytoplasm

A

Lymphocytes

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37
Q

Herpangina: cause, signs

A

Cause: Coxachie A virus

Signs: Feverm pharyngitis, gray vesicles/ulcers on posterior oropharynx, hands, feet

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38
Q

Clincal signs of glucose-6-phosphatase deficiency?

Lab Findings?

A

Doll-like face, thin extremities, short stature, protuberant abdomen

Lab findings: Hypoglycemia, high blood uric acid, total cholesterol, triglymerides, lactic acid levels

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39
Q

What is the next step in management after capillary samples tested positive for increased lead?

A

Venous blood lead level

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40
Q

Tests used to diagnose DM type 1?

A

glytamic acid decarboxylase (GAD65), IGF-1, IGFBP

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41
Q

Aldolase B deficiency causes?

A

Fructose intolerance- vomiting, poor feeding, lethargy, serizures or enxephalopathy

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42
Q

Hemolytic uremic syndrome: Signs? Lab findings? Treatment?

A

Signs: Diarrhea, lethargy, irritability, pallor, bruising or petechiae, oliguria, edema

Lab findings: Hemolytic anemia, thrombocytopenia, Incresed hematuria, proteinuria, casts, increased bilirubin

Treatment: Fluid/electrolyte management, blood transfusion, dialysis

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43
Q

What is a small for gestations age newborns at risk for developing?

A

Hypoxia, perinatal asphyxia, meconium aspiration, hypoglycemia, hypothermia, hypocalcemia, and polycythemia (due to hypoxia)

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44
Q

What congenital heart defects are present in patients with Down syndrome? Presentation?

A

Complete atrioventricular septal defect

Signs: Loud S2 d/t pulmonary hypertension

Systolic ejection murmur (increased flow across pulmonary valve from left to right shunt)

Holosystolic murmur of VSD (soft or absent if defect is large)

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45
Q

When does alloimmune hemolytic disease occur?

A

“A” and “B” offspring of “O” mothers

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46
Q

What cardiovascular abnormalities are in turner’s syndrome?

A

Bicuspid aortic valve

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47
Q

Findings suggestive of hypertrophic adenosis?

A

Postnasal drip, elongated facial heatures, mucopurulent nasal discharge, loud mouth breathing

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48
Q

VSD murmur description?

A

Pansystolic murmur hear loudest at the left lower sternal border and a diastolic rumble at the apex due to increase flow across mitral valve

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49
Q

Hereditary spherocytosis

A

Inc. mean corpuscular hemoglobin concentration

Spherocytes on peripheral smear

Negatove coombs test

Increased osmotic gragility on acidiied glyceral test

Abnormal eosin-5-meleimide binding test

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50
Q

Child has a desire to kill his mother and must recite a prayer 10-12 times to overcome it. Diagnosis? Treatment?

A

Diagnosis: Obsessive-compulsive disorder- can be obsessive (symmetry), or compulsive (must hurt mother)

Treatment: First-line: SSRI (Fluoxetine) or CBT

Second-line: Clomupramine and antipsychotic augmentation

Third-line (refractory): Deep-brain stimulation

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51
Q

Severe combined innumodeficiency: Signs

A

lymphopenia, recurrent infections, and failure to thrive,

ADA deficiency

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52
Q

Defect in Prader-Willi syndrome

A

Deletion of the paternal copy of chromosome 15q11-q13

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53
Q

Most effective form of emergency comtraception?

A

Copper IUD

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54
Q

Tetralogy of Fallot murmur?

A

Harsh systolic ejection murmur over the left upper sternal border, single S2

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55
Q

Workup for a newborn with bilious vomiting without a bowel movement?

A

Abdominal Xray -> contrast enema

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56
Q

Methylphenidate-Use?

A

ADHD

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57
Q

High blast count with strongly positive periodic acid schiff (PAS) reaction, in a 2-10 year old?

A

Lymphoblastic leukemia

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58
Q

What type of vaccination prevents S. pneumoniae?

A

Conjugate capsular polysaccharide

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59
Q

Kallman Syndrome

A

X-linked recessive disorder of migration of fetal gonaotropin-releasing hormoes and olfactory neurons.
Clincal Signs: short stature, delayed or absent puberty, normal genotype and internal reproductive organs, anosmia/hyposmia

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60
Q

Red flags for type 1 DM

A

Polyuria, polydipsia, enuresis (increased urinary incontinence)

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61
Q

When should gonads be removed in complete androgen insensitivity?

A

After puberty, the benefits of gonad-stimulated puberty outweigh the risk of malignancy

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62
Q

Alternative name for laryngotracheititis?

A

Croup

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63
Q

Signs of increased intracranial pressure?

A

Morning vomiting and noctural headaches

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64
Q
A

Erythema marginatum of Rheumatic fever

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65
Q

What disorders are commonly associated with mitral valve prolapse?

A

Connective tissue disorders (Marfan, Ehlers-Danlos sundrome, osteogenesis imperfecta, etc)

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66
Q

Infants born to diabetic mothers are at risk for?

A

Hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia

Cardiomyopathy, GI atresia, urinary malformations, hyaline membrane disease

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67
Q

Most common cause of abnormal uterine bleeding in adolescents?

A

Immature hypothalamic-pituitary-ovarian axis -> anovulation cycles

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68
Q

Signs of pinworm infections?

A

Perianal puritus, especially at night, may extend into the volvula in pre-pubertal women

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69
Q

Cyanotic when stressed and asymptomatic at rest?

A

Tetralogy of Fallot

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70
Q

Chediak-Higashi syndrome

A

AR disorder characterized by oculocutaneous albinism and recurrent cutaneous infections

Staph. aureus and Strep pyogenese are most common

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71
Q

Components of DiGeorge’s Syndrome?

A

Conotruncal cardiac defects

Abnormal Facies

Thymic aplasia/hypoplasia

Cleft palate

Hypocalcemia

(t-cell lymphopenia is present)t

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72
Q

Burton agammaglobulinemia- Lab findings

A

Normal T-cells, absent B cells, low serum immunoglobulin, absent lymphoid tissue

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73
Q

When is a murmur benign?

A

Normal activity levels, early of mid-systolic, Grade I or II, low-putched muscicle or squeaky tone at LLSB (still’s murmur) or high-pitched at LUSB (pulmonary flow murmur)

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74
Q

Signs of botulisism?

A

Bilateral bulbar palsies (ptosis, sluggish pupillary response to light, poor sucking), constipation, drooling, and summetric descending flaccid paralysis

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75
Q

Caput seccedaneum

A

diffuse, sometimes ecchymotic swelling of the scape. Usually involved the portion of the head presenting during vertex delivery. May extend across midline and suture lines

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76
Q

Most common cause of orbital cellulitis?

A

Bacterial sinusitis

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77
Q
A

OsGood-Schlatters Disease; traction apophysitis

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78
Q

What are pink stains or “brick dust” in neonatal diapers?

A

Uric Acid crystals

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79
Q
A

Seborrheic dermatitis:

Erthematous plques and/or yellow, greasy scales

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80
Q

What are turner’s syndrome at increased risk for?

A

Osteoporosis- they lack protective estrogen production -> increased bone reabsorption

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81
Q

Cause of intussusception in children younger than 2? Older?

A

< 2: recent viral illness or rotavirus vaccination

>2: Meckel’s diverticulum, HSP, Celiac disease, intestinal tumor, polyps

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82
Q

Non-classical congenital adrenal hyperplasia (late-onset)

A

Premature adrenarche/pubarche, sever cystic acne (resistent to treatment), accelerated linear grwoth, advanced bone age

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83
Q

In a child less than 24 months, what should occur after the treatment of her first febrile UTI?

A

Renal and bladder ultrasound

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84
Q

Signs of fetal alcohol syndome

A

Small head, small palebrl fissures (eyes), smooth philtrum, thin vermilion border (lip)

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85
Q

What gross motor milestones should occur at 18 months?

A

Run, kicking a ball

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86
Q

Adolescent male

A

Benign bone tumor, osteoid osteoma

Pain is relieved by NSAIDS

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87
Q

Treatment for Impetigo?

A

Oral cephalexin (widespread)

mupirocin (topical, localized)

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88
Q

Fetal exposure to cocaine

A

Jitteriness, excessive sucking, hyperactive moro reflex

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89
Q

What should all sexually active women under 24 be screened for?

A

Chlamydia trachomatis and neisseria gonorrhoeae

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90
Q

Risks of maternal diabetes?

A

Macrosomic getus, shoulder dystocia (crepitus, asymmetric moro reflex), clavicle fracture, brachial nerve palsies, perinatal asphyxia, neonatal hypoxic encephalopathy, polycythemia

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91
Q

Heroin intoxication in a fetus, signs?

A

Interuterine growth retadation, irritability, high-pitched cry, poor sleeping, tremors, sweating, sneezing, diarrhea

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92
Q

What type of vasculitis is Henoch-Schlnlein purpura? Complications?

A

Immunoglobulin A-mediated

Complications: renal involvement; microscopic or macroscopic hematuria, red cel casts, mild to moderate proteinuria, with normal-slightly elevated serum creatinine

**Can lead to nephrotic syndrome, HTN, acute renal failure

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93
Q

Heart defect associated with Edwards Syndrome? Murmur description?

A

VSD

Holosystolic murmur that is heard beast at the lower left sternal border

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94
Q

Purpose of the CH50 test?

A

Determines total complement levels

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95
Q

Risk of gonad-derived cancer in turners syndrome compared to general population?

A

10-30 times higher (15-30%). Gonad development should be closely monitored and an earlier gonadectomy could be required.

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96
Q

Clinical manifestations of Prader-Willi? Common complications?

A

Poor suck and feeding problems in infancy, compulsive binge-eating and obesity-related problems

Complications: Sleep Apnea, DM type II

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97
Q

What can cause flaccid paralysis? How?

A

Infant botulism- ingestion of C. botulinum spores from dust

Foodborne- C. botulinum toxin from food

Guillain-Barre syndrome- Autoimmune peripheral nerve demyelination

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98
Q
A

Tinea Capitis, dermatophyte infection

Tx: Oral terbinefine, friseofulvin, itraconazole, fluconazole

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99
Q

Measles vs Rubella

A

Measles: High fever (>104), cephalocaudal rash over multiple days , cervical adenopathy

Rubella: maculopapular cephocaudal rash over 24 hours (sparing palms and soles), polyarthralgia

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100
Q

Patient with meningitis and petechial rash?

A

Neisseria meningtides

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101
Q

What solutions should be used to resusitate an infant that is hypovolemia, but hypernatremia?

A

0.9% NS

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102
Q

Niacin (b3) deficiency

A

Pellegra (dermatitis, diarrhea, delusions, glossitis)

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103
Q

Riboflavin deficiency signs:

A

Angular choelosis, stomatitis, glossitis, normocytic anemia, seborheic dermatitis

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104
Q

Treatment for migraines in pediatric populations?

A

Acetaminophen or NSAID and supportive mangement (dark room, etc)

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105
Q

Clinical features of medulloblastomas?

A

Ataxia and truncal instability

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106
Q

Alternative name for Wilms tumor?

A

Nephroblastoma

107
Q

Henoch-Schonlein purpura: Signs?

A

transient migratory arthritis (lower extremities) and rash (puritic)

108
Q

What is the generic name for the plan B pill? MoA

A

Levonorgestrel

MoA: Delays ovulation

109
Q

Primary dusmenorrhea? Treatment?

A

Lower abomdinal cramping with menses in the absense of other pathology

**pain during the first few days of menses is cause ny uterine contractions triggered by prostaglandins

Treatment: NSAIDS

110
Q

Wiskott-Aldrich syndrome: Clincal manifestations? Defect? Problem?

A

Eczema, recurrent infections, thrombocytopenia

Defect: WASP protein

Conequence: Impaired cytoskeleton changes in leukocyte, platelet

111
Q

How to treat a patient with a “barky” cough?

A

Racemic epinephrine and corticosteroids

112
Q

What signs should suggest possible child abuse

A

Abrupts onset of mood changes, bedwetting, and/or academic difficulties

113
Q

Erythrocte CD55 and CD59 are present in which disease?

A

Paroxysmal noctural hemoglobinuria

114
Q

What diseases can lead to a vitamin K deficiency?

A

Cystic fibrosis, IBS, Celiac, biliary atresia, frequent Abx use, malnutrition

115
Q

Signs on Gonadotropin-independent precocious puberty?

A

Boy under 9 with severe facial ance, advanced pubic and axillary hair, normal testicular volume

116
Q

Signs of refeeding syndrome? Cause?

A

Arrhythmia, congestive heart failure, seizures, wenicke encephalopathy

Cause: Increased insulin secretion -> decreased phosphorus, magnesium, potassium, thiamine, with increased water and sodium

117
Q

Galactosemia

A

“mouse-like” odor, hyperbilirubin, elevated liver function tests, low glucose, cataracts, ascities

Increased risk for E. Coli sepsis

118
Q

Signs of hemophilia?

A

Hemarthrosis and Deep tissue hematomas

Increased aPTT

119
Q

2 days fever and facial swelling with delayed vaccination schedule? Most common complication?

A

Mumps

Common complication: Aseptic meningitis, orchitis, parotitis

120
Q

Howell Jolly bodies?

A

nucleated remnant of red blood cells

121
Q

What are the catecholamines?

A

homovanilic acid and vanillylmandelic acid

122
Q

Aeur rods are found in which type of cancer/

A

Acute myelocytic leukemia`

123
Q

What factors increase the risk for intraventricular hemorrhages?

A

Preterm and loss birth weight

124
Q

How to diagnose intraventicular hemorrhage?

A

transfontanel ultrasound

125
Q

Myotonic musculodystrophy-Onset? Inheritance? Comorbidies? Prognosis?

A
126
Q

What increases the murmur n Hypertrphic cardiomyopathy? Decreases?

A

Increases: Decreased preload: Valsava, abrupt standing, nitroglycerine

Decreases: Increased afterload/preload: Sustained hand grip, squatting, passive leg raises

127
Q

In which population in the cyclic vomiting syndrome the highest?

A

Children of parents who have a history of migraines

128
Q

abdominal pain, palpable mass, jaundice

A

Biliary cyst

129
Q

47 XXY

A

Klinefelter syndome, male phenotype with small testicles.

130
Q

What is the most common event prior to a seizure? During?

A

Prior: Aura

During: Tongue Laceration

131
Q

What type of CT should be ordered for head trauma?

A

Non-contrast

132
Q

What substance maintains the PDA? Closes it?

A

Maintains: Prostoglandin E2

Closes: Indomethicine

133
Q

Clincal manifestations of medulloblastoma?

A

increased intracranial pressure, trucal and gait ataxia

134
Q

How to assess pulmonary function in a guilllain-barre patient?

A

Spirometry, peak flow could be used as an alternative

135
Q

What prophylaxis should be used for cat bites in children?

A

Amoxicillin/Clavulanate due to activity again pasteurella multocida

136
Q

Primary vs.Secondary dysmenorrhea

A

Primary- normal physical examination

Secondary - abnormal physical examination

137
Q

Signs of congenital CMV?

A

pericentricular calcifications (microcephaly, if severe)

138
Q

What infections are common in sickle cell patient?

A

H influenza, N meningitidis, S. pneumoniae

Al

139
Q

Signs of Turner’s Syndrome?

A

Narrow, high arched palate, low hairline, webbed neck , broad chest, coarctation of the aorta, bicuspid aortic valve, horse-shoe kidney, streak ovaries, amenorrhea, infertility

140
Q

Signs of Tetralogy of Fellot?

A

Tet spells-sudden hypoemia and cyanosis during exertion or agitation

141
Q

What are risk facors of Henoch-Schonlein purpura?

A

Gastrointestinal hemorrhage or intussusception: Cause by bowel edema and hemorrhage

142
Q

Common complication of individuals with sickle cell trait?

A

Hematuria

143
Q

Cephalohematoma

A

subperiosteal hemorrhage, not visable until several hours after birth

144
Q

Triad of brain abscesses

A

Headaches (noctural and/or morning), focal neurologic changes, fever

145
Q

Maple syrup urine disease

A

dystonia, poor feeding, lethargy, vomiting, ketouria

146
Q

What is the treatment for mild lead levels?

Moderate lead levels?

Severe lead levels?

A

Mild: No medication, retest in <1 month (5-44mcg/dL)

Moderate: DMSA (Meso-2,3-demercapto-succinic), (45-69mcg/dL)

Severe: Dimercaprol (British anti-lewisite) plus EDTA (>69mcg/dL)

147
Q

Aplastic anemia vs aplastic crisis?

A

Aplastic anemia: pancytopenia due to bone marrow failure

Aplastic crisis: Chronic anemia with compensatory reticulocytosis

148
Q

Signs of syphilis in a newborn?

A

Profuse rhinorrhea, desquamating skin rash, abnormal long-bone radiographs (metaphyseal lucencies)

149
Q

How should a urine sample be collected in infants with diapers?

A

Urethral catheterization, urinalysis, urine culture

150
Q

Mental retardation, pronounced startle reflex, serizures, hyperacusis, loss of vision, macrocephaly

A

Tay sachs disease, beta-hexosaminidase A

151
Q

Cause of chronic nasal obstruction refractory to conventional treatment?

A

Adenoid hypertrophy

152
Q

How to follow-up an incidental urine proteinuria in an adolescent?

A

Repeat dipstick testing on two subsequent occaisions to determine orthostatic, persistent, or transient proteinuria

153
Q

Alternative name for strawberry hemoangiomas?

A

Superficial infantile hemangioma

154
Q

Phenttoin exposure in-utero

A

Fetal hydantoin syndrome- nail and digit hypoplasia, dysmorphic facies, mental retardation

155
Q

Celiac disease risk factors?

A

First-degree relative

Autoimmune thyroiditis

Type 1 DM

Down syndrome

Selective IgA deficiency

156
Q

What is the squirt sign?

A

Explosive gas and stool associated with Hirsprung Disease

157
Q

Biliary atresia

A

Obstructive jaundice, acholic stools, presents early in infancy

158
Q

Inability to extend the beck and widened prevertebral space suggests?

A

Retropharyngeal abscess

159
Q

Gold standard for confirming muscular dystrophies?

A

Genetic analysis

160
Q

Cough, coryza, conjunctivitis with subsequent exanthema?

A

Measles

161
Q

Why are menstral cycles in pubertal girls irregular?

A

Immaturity of the hypothalamic-pituitary-honadal axis -> decreased gonadotropin secretion

162
Q
A

Mongolian spots, beling flat, blue-grey patches

Fade spontaneously, reassure parents

163
Q

recurrent sinusitis, point of maximal impulse displaced to the left, bronchiectasis?

A

Primary ciliary dyskinesia (Kartagener syndrome,

164
Q

How do you confirm the type of leukemia?

A

Bone marrow biospy

165
Q

Meconium obstruction at th level of the ileum and narrow, underdeveloped colon?

A

Cystic fibrosis

166
Q
A

Tinea Corporis

167
Q

Ornithine transcarbamylase deficiency

A

vomiting and poor feeding, seizures, increased ammonia, altered mental status

168
Q
A

Ewing Sarcoma

“onion skin”, “moth eaten”, extension into soft tissue

169
Q

Selective mutism

A

Refusal to speak in a specific social situation, but engaged in normal communications where she feels comfortabe.

Diagnosis required 1 month or more in situations where they are required to talk (school), despite speaking in other situations

170
Q

Characteristics of oppositional defiant disorder?

A

Angry/urrutale mood and argumentative/defiant behavior towards authority figures

171
Q

Diagnosis?

A

Eczema Herpeticum-complication of atopic dermatitis

172
Q

Short statute, primary amenorrhea, abscent thelarche

A

Turner’s Syndrome

173
Q

Treatment for Tinea Corporis?

A

First line (localized): Topical (clotrimazole, terbinafine)

Second-line (generalized): Oral antifungals (terbinafine, griseofulvin)

174
Q

Cafe au lait spots, precocious pubert, multiple bone defects (polyostotic fibrous dysplasia)?

A

McCune Albright syndrome, remember the 3 P’s: Precocious puberty, pigmentation, polyostotic fibrous dysplasia

175
Q

Neimann-Pick vs. Tay sachs

A

Neimann-pick: Sphingomyelinase deficiency with hyporeflexia/areflexia and hepatosplenomegaly

Tay Sachs: beta-hexosaminidase A with hyperreflexia without hepatosplenomegaly

176
Q

Whem should PEEP be employed in a newborn? Chest Compressions?

A

Heart rate less than 100, irregular breathing

Chest compressions: Less than 60bpm

177
Q

Treatment for vaicella zoster exposure in an individual without complete immunity?

A

Postexposure prophylais with VAV vaccines (if within preceeding 5 days)

If unable to receive live vaccine: varicella immunoglobulin (includes individuals less than 1 year of age)

178
Q

Signs of Meckel’s diverticulum? Diagnosis? Treatment?

A

Asymptomatic incidental finding, painless hematochezie, intussusception, intestinal obstruction, volvulus

Diagnosis: Technetium-99m pertechnetalte scan

Treatment: Surgey for symptomatic patients

179
Q

Difference between iron deficiency anemia and thalassemia?

A

Iron deficiency: Increaed RDW, decreased MCW, RBC #

A-thalassemia: Normal RDW, RBC #; decreased MCV, normal hemoglobin electrophoresis

B-thalassemia: Normal RDW, RBC #; decreased MCV, increased hemoglobin A2 with electrophoresis

180
Q

What is a patient with recurrent infections and congenital heart disease at risk for?

A

Brain abscess

181
Q

Edema, hypoalbuminemia, markedly elevated urine protein in a teen with Hep. B? Pathogenesis

A

Membranous nephropathy (nephrotic syndrome)

Pathogenesis: Deposition of HbeAb and its corresponding antibody in the glomeruli

182
Q

How to granulosa cell tumors present in children?

Post-menopausal woman?

Diagnostic findings?

A

Children: Precocious puberty, Large adnexal mass

Post-menopausal: bleeding/endometrial hyperplasia

Diagnostic findings: Inc. estrogen,

Pelvic US: ovarian mass, thickened endometrium

183
Q

Signs of hypothyroidism? Lab?

A

Decreased activity, horse cry, jaundice

*However, majority are asymptomatic at birth

Lab: Increased TSH, decreased T4

184
Q

Clincal manifestation of Edwards Syndrome?

A

Trisomy 18

Signs: Closed fists, with overlapping fingers, micrognathia, prominent occiput, rocker-bottom feet, severe intellectual disability

185
Q

Early onset puberty iwth high basal LH? Next step?

A

Gonadotropin-dependent precocius puberty

Next step: Brain MRI wtih contrast

186
Q

Signs of HIV in infancy?

A

Failure to thrive, chronic diarrhea, lymphadenopathy, pneumocystis pneumonia

187
Q

Breath-holding spells

Types?

A

Episodes of apnea precipitated by frustration, anger, pain.

Types

Cyanotic: crying followed by breath-holding, cyanosis and loss of consciousness

Pallid: Minor trauma followed by breath-holding, pallor, diaphoresis, and loss of consciousness

188
Q

Signs of breastfeeding faliure jaundice?

A

1st week of life,

Filaure of transition to yellowish or green stools (inadequate milk ingestion), decreased wet diapers

189
Q

Cyanosis that is aggrevated by feeding and improved by crying

A

Choanal Atresia

190
Q

Urinary in ontinence in children over 5?

A

Workup: Urinalysis, urological imaging

Management: Avoid caffeine, void regularly, drink fluids early, reward system, enuresis alarm (1st line after behavioral, pharmocotherapy (desmopressin, tricyclic antidepressants)

191
Q
A
192
Q

What causes the trendelenburg sign?

A

Weakness of the gluteus medius and gluteus minimus muscles, where are innervated by the superior gluteal nerve

193
Q

What type of rash spares the palms and soles? What type of precaution should be used for this infection?

A

Measles, should use airborne precaution

194
Q

ill-appearing neonate with bilious emesis and poor apetite?

A

malrotation with mid-gut volvulus

195
Q

What is the defect in duchenne and becker muscular dystrophy?

A

Deletion of dystrophin on chromosome Xp21

196
Q

What complications are CF patients at risk for?

A

Infertility (95% of men, 20% of womeN)

Pancreatitis (~10%)

197
Q

Clincal features of pineal gland masses?

A

Limited upward gaze, upper eyelid retraction, puils non-reactive to light, reactive to accomidation

198
Q

Signs of ADHD?

A

Inattentive, hyperactive/impulsive symptoms, prior to age 12

199
Q

Marfan syndrome vs Homocystinurea

A

Marfan: AD, normal intellect, Aortic root dilation,

upward lens dislocation

Homocystinurea: AR, intellectual disability, thrombosis, downward lens dislocation, megaloblastic anemia, fair complexion

200
Q

Extraintestinal signs of Celiac disease?

A

Short stature, weight loss, iron deficiency anemia, dermatitis herpetiformis

201
Q

Risk factors for ARDS in a newborn?

A

Prematurity, maternal diabetes, male sex, perinatal asphyxia, c-secton without labor

202
Q

Clincal features of Epiglottitis?

A

Abrupt onset Distress (“tripod”, stridor), dysphagia, drooling, thumbprint sign on Xray

203
Q

What can cause isolated adrenarche? Clincal manifestations? Lab findings?

A

Adrenal angrogen secretion in obese individuals

Signs: oily hair/skin, acne, pubic hair, axillar hair

Lab findings: Increased DHEA-S, low testosterone

204
Q

How do you management Autism spectrum disorders?

A

Early diagnosis and intervention (speech, behavioral), adjunct pharmacotherapy for psychiatric comorbities

205
Q

Clinincal manifestations of PNH?

A

hemolytic anemia, cytopenias, and hypercoagulability

206
Q

Family history of sudden death, congenital sensorineural deafness, and QT interval of 600ms?

A

Jervell and Lange-Nielsen syndrome

207
Q

Signs of cardiac temponade?

A

Distant heart sounds, distended jugular veins, (scalp veins in infants) and hypotension

208
Q

Glomus tumor triad

A

severe intermittent pain, tenderness, sensitivity to touch

benign tumor of vascular system

209
Q

When should formula supplementation be considered?

A

Greater than 7% loss of birth weight

210
Q

Varicella immunization protocol

A

2 doses, 1st at 1 year, 2nd at 4 years

211
Q

Signs of intraventricular hemorrhage?

A

Hypotension, cyanosis, seizures, focal neurological signs, bulding or tense hontamel, anpea, and bradycardia; however, may be asymptomatic

212
Q

Most common cause of pneumonia in children?

Adults?

A

Children: S. aureus

Adults: Pseudomonas

213
Q

Hemiparesis, aphasia after injury tot he posterior pharync

A

Cervical internal cartid artery

**Can occur when falling with an object in mouth

214
Q

Murmur in Tetralogy of Fallor?

A

crescendo-decreasendo systolic murmur with a single S2 in left upper sternal border

215
Q

How to diagnose hereditary spherocytosis?

A

Osmoti gragility on acidified glycerol lysis test

216
Q

Clinical manifestations of congenital diaphragmatic hernia? Managemtn?

A

Pulmonary hypertension, polyhydramnios, barrel-shaped chest, concave abdomen

Management: Emergency intubation with caution ventilation

217
Q

Signs of hyper-IgM syndrome?

A

Normal B cells, decreased IgG/IgA, increased IgM

218
Q

Cause of edema in a child with turners syndrome? Type of edema?

A

Dysgenesis of the lymphatic network

Type: Non-pitting

219
Q

Pyloric Stenosis: Onset age? Characteristics?

A

Onset: 3-5 weeks

Clinical presentatin: Nonbilious, hugry vomiter, poor weight gain, dehydrated, “olive-shaped” abdominal mass

220
Q

Congenital Toxoplasmosis infection signs?

A

Macrocephaly, diffuse parenchymal calcifications

221
Q

Signs on defective intracellular killing?

A

No neutrophilia, infections with catalse-positive organisms

222
Q

Signs on Shigella infection?

A

Rapid onset, high fever, abdominal pain, watery diarrhea with mucous +/- blood, +/- seizures in children

223
Q

Type 1 RTA?

A

Defect: Poor hydrogen secretion into urine

pH: > 5.5

Potassium: Low-normal

Cause: Genetic disorder, medication toxitiy, autoimmune

224
Q

Trachoma? Signs?

A

Chlamydia trachomatis serotype A-C, major cause of blindness

Signs: follicular conjunctivitis and pannus (neovascularization) of the cornea

225
Q

What are cholesteatoma? Cause? Complications?

A

retraction pocket in the tympanic membrane that fills with granulation tissue and skin debris

Cause: Chronic middle ear infections or congenital in nature

Complications: Hearing loss, cranial nerve palsies, vertigo, brain abscesses or meningitis

226
Q

Infectious mononucleosis, signs?

Test?

A

Fever, Tonsillitis/pharyngitis, psterior or diffuse cervical lympadenopathy, significant fatigue, hepatosplenomegaly

Test: Heterophile antibody test

227
Q

Focal Serizures

A

Originated from 1 cerebral hemisphere +/- loss of consciousness

Cannot respond to stimuli during episodes with confusion afterwards

>2-3 minutes in length

228
Q

Severe combined immunodeficiency- lab findings? Treatment?

A

Failure of T-cell development, b-cell dysfunction due to low T-cells, absence oflymphoid tissues

Treatment: Stem cell transplant

229
Q

Causes of aplastic anemia?

Most common in children?

A

Acquired causes: Drugs (NSAIDS, sulfonamides)

Toxic chemicals (benzene, glue)

Idiopathic

Viral infecitions (HIV, EBV)

Immune Disorders

Thymoma

Most comon in children: Fanconi anemia (chromosomal break)

230
Q

How to determine B lymphocytes from total lymphocytes?

A

Subtract T-lymphocytes from total lymphocytes

231
Q

How to manage epiglottitis?

A

Endotracheal intubation, antibiotics

232
Q

Croup vs Epiglottitis

A

Croup: Bark-like cough, stridor, hoarse voice

Epiglottitis: Unvaccinated children, sore throat, dysphagia, drooling, tripod position

233
Q

Signs of pancreatic deficiency?

A

Bruises (vitamin K), Vitamin D deficiency, poor growth

234
Q

Head tilt to one side with chin deviation away

A

Congenital muscular torticolis

235
Q

Most common cause of otitis externa?

A

P. Aeruginosa, S. aureus

Tx: Fluoroquinolone

236
Q

When should IV ceftriaxone be used to treat lyme disease?

A

Lyme meningitis and heart block

237
Q

Diagnosis?

Treatment?

A

Diagnosis: Atopic dermatitis

Treatment: Emolients +/- steroid topicals

238
Q

Medication treatment of abnormal uterine bleeding?

A

High-dose IV or oral estrogen

High-dose combined oral contraceptive pills

High-dose progestin pills

Tranexamic acid

239
Q

Presentation of immune throbocytopenic purpura?

A

Thrombocytopenia and purpura, no anemia or renal invovlement

240
Q

Tests used to screen for DM Type 2?

A

Hemoglobin A1c, fasting glucose, 2 hour oral glucose, 1,5-anhydroglucitol

241
Q

First step in management for a harsh, holosystolic murmur best heart at the left lower sternal border?

A

Echocardiogram to evaluate ventricular septal defect

242
Q

Signs on congenital rubella infection?

A

Sensorineural hearing loss

cataracts

PDA

243
Q

Meniere’s disease?

A

Ear condition associated with fluid in the inner ear that leads to hearing loss, vertigo, tinnitus

244
Q

Drugs used to treat Tourette disorder?

A

Haloperidol, pirmozide, risperidone (preferred), clonidine, guanfacine

245
Q

Signs of renal tubular acidosis?

A

Normal anion gap acidosis, failure to thrive, alkalotic urine without known etiology of acidosis, low serum bicarb and hypercalemia

246
Q

Eczema, regurgitation/vomiting, and painless bloody stools

A

Milk protein-induced enterocolitis

247
Q

What homronal imbalances causes polycystic ovary syndrome?

A

Excess LH secretion

248
Q

Differences in blood pressure in coarctation of the aorta?

A

Hypertension in the upper body and hypotension in the lower

249
Q

Signs of hydrocephalus

A

Tense and bulging fontanelle, prominent scalp veins, poor feeding, irritability, rapidly increasing head size

250
Q

What is the management of an adolescent with suspected fibroadenoma?

A

Observation and reassurance (follow-up shortly after next menses

251
Q

Neuroblastoma?

A

Most common extracranial tumor of childhood

  • Adrenal gland or retroperitoneal ganglia
  • Calcifications and hemorrhages are seen on xray/ct
252
Q

How does a person with a volvulus present?

A

vomiting (often bilious)

253
Q

Signs of orbital cellulitis?

A

Abrupt onset of fever, proptosis, restriction of extraocular movements and swollen, red eyelids

254
Q

Signs of foreign body ingestion?

A

Difficulty swallowing, feeding refusal, vomiting

255
Q

When should chilren be toilet trained?

A

daytime: around 3

Nighttime: Any time up until 5 is considered normal

256
Q

How to manage a hydrocele in a newborn? 2 year old?

A

Newborn: Observation

2 year old: Surgical correction

**Most spontaneously recover within 12 months

257
Q

What is the first step in evaluating primary absence of menarche by age 15?

A

Pelvic US, to detect ovaries, uterus, and vagina

258
Q

When legal guardians of a patient deny a life-saving procedure, how do you proceed?

A

Obtain a court order to force compliance

259
Q

Adolescent with nasal obstruction, visible nasal mass, frequent nosebleeds, and bony erosions on hte back of the nose, suspect?

A

Angiofibroma

260
Q

Lennox-Gastaut syndrome

A

Presents by age 5, intellectual disability and sever seizures of varying types. EEG demonstrated a slow spike-wave pattern

261
Q

What are signs of turner syndrome?

A

Coarctation of aorta, broad chest, short stature, horse-shoe kidney, streak overies

262
Q

Baby that is cyanotic when feeding, pink when crying? Associated abnormalities?

A

Choanal atresia

Associated: CHARGE: Coloboma, heart defects, retarded growth, GU abnormalities, ear abomalies, deafness

263
Q

Big tongue, umbilical hernia?

A

hypothyroidism

264
Q

Tetralogy of Fallot components?

A

VSD + RA hypertrophy + over riding aorta, pulmonary stenosis

USMLE Step 2 CK (12 decks)

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