Pediatrics

Question 1

What diseases cause a rash of the palms of the hands and soles of the feet?

Answer 1

Enterovirus (cocksackie A - hand, foot, mouth disease)

Syphilis

Rocky Mountain Spotted Fever

Kawasaki disease

Toxic shock syndrome (also diffuse rash)

Question 2

2 month anticipatory guidance and screening

Answer 2

Parental well-being Infant behavior Infant-family synchrony Nutritional adequacy Safety Universal screening: metabolic and hemoglobinopathy, hearing Selective screening: blood pressure, vision

Question 3

12 month anticipatory guidance and screening

Answer 3

Family support Establishing routines Feeding and appetite changes Establishing a dental home Safety Universal screening: anemia, lead (high prevalence/Medicaid) Selective: oral health, blood pressure, vision, hearing, TB

Question 4

24 month anticipatory guidance and screening

Answer 4

Assessment of language development Temperament and behavior Toilet training Television viewing Safety Universal screening: autism, lead (high prevalence/Medicaid) Selective: oral health, blood pressure, vision, hearing anemia, TB, dyslipidemia

Question 5

5 year anticipatory guidance and screening

Answer 5

School readiness Mental health Nutrition and physical activity Oral health Safety Universal screening: vision, hearing Selective screening: anemia, lead, TB

Question 6

10 year anticipatory guidance and screening

Answer 6

School Development and mental health Nutrition and physical activity Oral health Safety Universal screening: vision, hearing Selective screening: anemia, TB, dyslipidemia

Question 7

15 year anticipatory guidance and screening

Answer 7

Physical growth and development Social and academic competence Emotional well-being Risk reduction Violence and injury prevention Universal screening: vision Selective: hearing, anemia, TB, dyslipidemia, STIs, pregnancy, alcohol or drug use

Question 8

2 month immunizations

Answer 8

Hepatitis B Rotavirus DTap Hib PCV IPV

Question 9

4 month immunizations

Answer 9

Rotavirus DTap Hib PCV IPV

Question 10

6 month immunizations

Answer 10

Hep B Rotavirus DTap Hib PCV IPV Influenza

Question 11

12 month immunizations

Answer 11

Hib PCV IPV Influenza MMR Varicella Hep A

Question 12

4-6 year immunizations

Answer 12

DTap IPV Influenza MMR Varicella

Question 13

11-12 year immunizations

Answer 13

Influenza Tdap HPV Meningococcal

Question 14

16 year immunizations

Answer 14

Influenza Meningococcal

Question 15

CXR findings of TTN vs. RDS

Answer 15

TTN: wet lungs (fluid in fissure), no bronchograms RDS: ground-glass appearance, bronchograms

Question 16

Treatment of pyelonephritis

Answer 16

IV ampicillin/gentamicin > IV ceftriaxone > IV pipperacilin/tazobactam > IV ciprofloxacin (only if child > 1) Oral cephalexin Renal ultrasound If abnormal ultrasound or recurrent UTI –> VCUC

Question 17

Criteria of Kawasaki disease

Answer 17

Fever > 5 days Changes in oral mucosa Extremity changes (redness/swelling) Unilateral cervical lymphadenopathy Rash Conjunctivitis

Question 18

SCFE

Answer 18

Knee pain Medially rotated foot Limited ROM of hip External rotation of hip upon raising leg Dx: lateral and AP xray Tx: internal fixation

Question 19

Transient synovitis

Answer 19

Recent URI Low-grade fever Tx: rest and ibuprofen; resolves in 3-10 days

Question 20

Reactive arthritis

Answer 20

A few weeks after recent bacterial gastroenteritis or genitourinary infection; antibodies attack joint a/w urethritis, conjunctivitis

Question 21

Septic arthritis

Answer 21

Fever Non weight-bearing Elevated ESR Elevated WBC

Question 22

Henoch-Schonlein Purpura

Answer 22

Non-thrombocytopenic pupura Hematuria Arthritis, esp. of knees and ankles Colicky abdominal pain Recent URI Tx: acetaminophen for pain; self-resolves Complications: chronic kidney disease, intestinal bleeding

Question 23

Idiopathic thrombocytopenic purpura

Answer 23

Often follows URI Asymptomatic petechiae Thrombocytopenia

Question 24

Intussusception

Answer 24

Invagination of bowel Lead point may be peyers patch (viral infection), Meckel’s diverticulum, tumor Paroxysms of severe abdominal pain Currant jelly stool Sausage-shaped mass in right abdomen Dx: target sign on ultrasound Tx: air or barium enema

Question 25

Scarlet fever

Answer 25

Group A strep infection Fever Fine, sandpaper rash that starts in the groin, axillae, and neck but spreads rapidly Pastia’s sign (linear petechiae in body folds) Tx: abx within 9 days to prevent rheumatic fever (tx will not prevent PSGN)

Question 26

Pyloric stenosis

Answer 26

Projectile, non-bilious vomiting after feeds Palpable olive-shaped epigastric mass Hypochloremic, hypokalemic metabolic alkalosis Dx: pyloric ultrasound Tx: IVF for rehydration, pyloromyotomy

Question 27

Bordetella pertussis

Answer 27

Triphasic: catarrhal, paroxysmal (whooping cough), convalescent

Question 28

Laryngotracheobronchitis (croup)

Answer 28

Caused by parainfluenza virus More common in the winter URI symptoms Barking cough Inspiratory stridor

Question 29

Roseola

Answer 29

Caused by HHV-6 Maculopapular rash that starts on the trunk and spreads outward Rash preceded by fever

Question 30

Parvovirus B19

Answer 30

Erythema infectiosum Slapped-cheek rash, lacy appearance Pain and swelling of joints May precipitate aplastic anemia

Question 31

Measles

Answer 31

Prodrome fever Cough, coryza, conjunctivitis Rash spreads downward Koplik spots on buccal mucosa

Question 32

DKA

Answer 32

Nausea, vomiting, altered mental status, polyuria, abdominal pain, hyperglycemia, hyponatremia, elevated BUN and creatinine (dehydration pre-renal azotemia), normal potassium Dx: random blood glucose > 200, pH

Question 33

What is associated with a port-wine stain in the distribution of CNV1?

Answer 33

Sturge-Weber syndrome Check for vascular abnormalities in the brain

Question 34

What is associated with port-whine stains of the face?

Answer 34

von Hippel-Lindau Check for vascular lesions of the retina and brain

Question 35

Caput succedaneum vs. cephalohematoma

Answer 35

Caput is edema above the periosteum and thus crosses sutures Cephalohematoma is fluctuance below the periosteum and thus doesn’t cross sutures

Question 36

Infant growth guidelines

Answer 36

Weight should triple and length should increase by 50% by 12 months

Question 37

Contraindications to rotavirus vaccine

Answer 37

Anaphylaxis to vaccine ingredients

History of intussusception

History of uncorrected congenital malformation of GI tract (e.g. Meckel’s diverticulum)

SCID

Question 38

Juvenile arthritis

Answer 38

Autoimmune, symmetric arthritis for at least 6 weeks

Labs: elevated ESR and CRP, hyperferritinemia, hypergammaglobulinemia, thrombocytosis, anemia

Question 39

Presentation and management of Tetrology of Fallot

Answer 39

Clinical features: RVOT obstruction, RV hypertrophy, overriding aorta, VSD

S&S: hypercyanotic, hypoxic “tet” spell, crescendo-decrescendo systolic ejection murmur with agitation or exertion (e.g. feeding, crying, hyperventilation)

Pathophysiology: agitation or exertion → infundibular spasm → increased RVOT obstruction → R to L shunt

Management: knee-chest positioning (kinks femoral arteries → increased systemic vascular resistance → L to R shunt), inhaled oxygen, IV fluids

Question 40

Holosystolic murmur with late diastolic rumble in children

Answer 40

VSD

Question 41

Continuous machine like murmur in newborns

Answer 41

PDA

Question 42

Wide fixed and split S2

Answer 42

ASD