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Step 2 CK (primary set) > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

meningite and refractaire hypotension

A

waterhouse fredrichsen syndrome

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2
Q

hemiplegia in chidren after having seizures

A

Todd paralysis

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3
Q

4 forms of tetanos(2)

A

generalisee
localisee
cephalic
Neonatale

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4
Q

dx differentiel of Lytic lesion on bone puls hypercalcemia(4)

A

osteomyelitis
endocrine
neoplastic
idiopathic

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5
Q

clue for lytic lesion induced by osteomyelitis

A

brodie abcess

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6
Q

endocrine cause of lytic bone lesion(2)

A

hyperparathyroidie

osteoid fibrosa cystica

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7
Q

Neoplastic cause of bone lytic lesion(3)

A

erwing sarcoma
Langerhans hystiocystosis
Metastases

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8
Q

quid of cephalhematoma

A

hemmoragie sous periostee

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9
Q

clue for cephalhematoma

A

it doesn’t cross suture

limited to one cranial bone

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10
Q

clue caput succedaneum

A

it crosses suture

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11
Q

most common cause of functional asplenism in children

A

sickle cell disease

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12
Q

cause of sepsis in asplenia

A

encapsulated bugs

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13
Q

most common bug causing sepsis in asplenia

A

s pneumoniae

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14
Q

cyanosis in infant first 24 hours of life

A

transposition of great vessels

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15
Q

quid of transposition of great vessel

A

aorta in ventricule droit

artere pulmonaire in ventricule gauche

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16
Q

what to suspect in child with reccurrent sinopulmonary infection

A

cystic fibrosis

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17
Q

gold standard dx test for cystic fibrosis

A

sweat test for Na et CL-

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18
Q

consequence of cow milk consumption in infant

A

iron deficiency anemia

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19
Q

cyanosis in children less than 4 years

A

Fallot

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20
Q

tetralogie de Fallot(4)

A

overriding Aorta
VSD
Subpulmonary stenosis
right ventricular hypertrophy

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21
Q

Clue for PDA and VSD

A

no cyanosis

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22
Q

Prader willi syndrome(3)

A

binge eating
hypotonia
obesity

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23
Q

genetics of prader willi

A

paternal genetics deletion

15q11-q13

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24
Q

genetics problem in cat cry syndrome

A

5p deletion

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25
Q

genetics problem in angelman

A

15q11-q13

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26
Q

genetics in beckwith wiedman

A

11p15

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27
Q

clue for bweckwith

A

macroglossie

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28
Q

clue megaoblastic anemia

A

hypersegmentation of the nucleus of neutrophils and other blodd cells

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29
Q

most common cause of congenital hypothyroidism in the US

A

thyroid dysgenesis

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30
Q

quid of thyroid dysgenesis(3)

A

ectopie
aplasie
hypoplasia

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31
Q

Disease with Howell jolly bodies

A

sickle cell disease

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32
Q

Meaning of howell jolly bodies and why

A

no spleen

spleen normally removes nuclear rmnants of red blood cells

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33
Q

bite cells or heinz bodies(2)

A

G6PD deficiency

Thalassemia

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34
Q

Helmet cells(3)

A

DIC
HUS
TTP

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35
Q

cause of helmet cells

A

traumatic hemolysis

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36
Q

other finding in traumatic hemolysis

A

schistocytes

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37
Q

casue of basophilic stippling(2)

A

thalassemia

lead poisonning

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38
Q

quid diamond blackfan anemia(2)

A

macrocytic anemia

congenital malformation in baby

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39
Q

Mc cune albright syndrome(4) 3 P

A

femme
Puberte precoce
pigmentation
polyostotic fibrous dysplasia

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40
Q

what will happen in polyostotic fibrous dysplasia

A

fracture a repetition

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41
Q

casue of stroke in children(4)

A

internal carotid dissection
AF
homocystinuria
Todd paralysis

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42
Q

clue for homocystinuria(4)

A

Marfan’s features
thromboembolic event
downward dislocation of the lens
mental retardation

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43
Q

clue for marfans features(3)

A

long emaciated arms and legs
arachnodactily
hyperlaxity of the skin and joints

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44
Q

cause of homocystinuria

A

deficiency in cystathione synthetase

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45
Q

Dx test for homocystinuria(2)

A

high methionine

high homocysteine

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46
Q

Rx of homocystinuria

A

B6

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47
Q

failure of B6 in rx of homocystinuria

A

cysteine

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48
Q

quid of leucocoria in USMLE

A

white eye reflex

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49
Q

cause of leucocoria in kid

A

retinoblastoma until proven the contrary

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50
Q

occlusion in first 24 hr in infant(2)

A

hirsprung

meconium ileus

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51
Q

cause of meconium ileus

A

cystic fibrosis

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52
Q

cause of intestinal occlusion from 24 h to 1 month

A

volvulus of midgut

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53
Q

cause of intestinal occlusion > 1 month of age

A

stenose pylorique

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54
Q

cause of cyanosis from 24 h to 4 ans

A

tetralogy de Fallot

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55
Q

cause of osteogenesis imperfecta

A

deficiency in type 1 collagen synthesis

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56
Q

congenital disease with coarctation of aorta

A

turner syndrome

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57
Q

complication of congenital adrenal hyperplasia

A

puberte precoce

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58
Q

enzyme deficiency in congenital adrenal hyperplasia

A

21 hydroxylase(CYP21A2)

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59
Q

baby with cyanosis during feeding and relieved by crying

A

choanal atresia

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60
Q

Dx of choanal atresia(2)

A

tube nasal

ct scan

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61
Q

Dx test for hereditary spherocytosis

A

osmotic fragility study

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62
Q

when to perform coombs test

A

autoimmune hemolytic anemia

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63
Q

most common cause of nephrotic syndrome in children

A

minimal change disease

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64
Q

next step when dx nephrotic syndrome in adult

A

biopsy renale

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65
Q

calculate APGAR score

A 
A:appearance
P:pulse
G:grimace
A:activity
R:respiration
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66
Q

Monitoring Appearance in APGAR(3)

A

blue=0
blue pink=1
pink=2

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67
Q

Monitoring pulse in APGAR(3)

A

absent=0

,100=2

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68
Q

Monitoring grimace in APGAR(3)

A

absent=0
grimace,whimper=1
cough/cry=2

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69
Q

Monitoring activity in APGAR(3)

A

limp=0
flexion=1
spontaneous active=2

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70
Q

Monitoring respiration in APGAR(3)

A

absent =0
slow irregular=1
regular=2

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71
Q

Normal APGAR

A

7-9

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72
Q

abnormal APGAR

A

<7

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73
Q

patient with delayed separation of umbilical cord more than 30 days

A

leucocytes adhesion defect type 1

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74
Q

clue for leucocytes adhesion defect type 1

A

CD18 expression deficiency

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75
Q

risk in in baby whom mother taking cocaine during pregnancy

A

jejunal atresia

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76
Q

xray abdomen in jejunal atresia(2)

A

tripple bubble sign

gasless colon

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77
Q

xray showing double bubble sign

A

duodenal atresia

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78
Q

abdomen xray in hirsprung

A

dilated loops of bowel

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79
Q

how to diffenrenciate microcytic anemia caused by iron deficiency from thalassemia

A

RDW

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80
Q

Clue for Iron deficiency anemia using RDW

A

RDW>20 %

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81
Q

Normal RDW with microcytic anemia

A

thalassemia

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82
Q

cause arthropathy in hemophilic patient(2)

A

deposit of hemosiderrin

fibrosis

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83
Q

hemophilic patient cause

A

deficiency in factor 8
et
9

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84
Q

children between 4-10 with hip pain(2)

A

Legg calve Perthes disease

avascular necrosis of femoral head

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85
Q

Quid of measles

A

rubeola

rougeole en francais

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86
Q

quid of koplik spots

A

bluish white lesions on buccal mucous membranes next to first and second molars

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87
Q

gender in Mc cune albright syndrome

A

femme

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88
Q

pigmentation in Mc cune Albright syndrome

A

cafe au lait spot

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89
Q

gender in Lesh Nyhan syndrome

A

Male

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90
Q

clue for Lesh Nyhan Syndrome(3)

A

Male
dystonia
self mutilation

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91
Q

Gout in male children

A

Lesh Nyhan Syndrome

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92
Q

physiopatho in Lesh Nyhan Syndrome

A

hypoxanthine guanine phophoribosyl transferase

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93
Q

black stool in children

A

Meckel Diverticulum

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94
Q

difference between congenital adrenal hyperplasia and hyperandrogenism

A

virilization in women

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95
Q

Quid of macrosomia

A

> 4 kg

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96
Q

risk in macrosomia

A

clavicular fracture

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97
Q

how to recognize fetal alcoholic syndrome(3)

A

small palpebral fissures
absence philtrum
thin upper lip border= thin vermillon border

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98
Q

Quid of Edward’s syndrome(5)

A 
micrognatia
microcephaly
absent palmar creases
rocker bottom feet
overlapping fingers
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99
Q

heart complication of Edward’s syndrome

A

VSD

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100
Q

chromosome problem in Edward syndrome

A

trisomy 18

election age

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101
Q

Heart problem in trisomy 21

A

ASD

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102
Q

Heart problem in william’s syndrome

A

supravalvular aortic stenosis

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103
Q

Heart problem in congenital rubella

A

PDA

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104
Q

young kid with stomatitis and cheilitis sore throat andscaly pathes on eyebrows cheek and nose and photophobia dx?

A

ariboflavinose

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105
Q

cause ariboflvinose in the US(3)

A

Anorexia nervosa
Malabsorption syndrome
Inborn defect in B2 synthesis

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106
Q

pain articulation in young kid(3)

A

Legg calve
transient synovitis
hemophilic arthropathy

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107
Q

infant with stridor acute respiratory distress toxic appearrance and fever first dx to think

A

epiglotitis

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108
Q

first step in epiglotitis

A

intubation

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109
Q

what to avoid in epiglotitis

A

never try to watch the epiglotte

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110
Q

Bloody diarrhea plus IR plus low platelet

A

HUS

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111
Q

cause of HUS in children

A

E coli 0157h7

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112
Q

how E coli causes HUS

A

by producing verotoxin

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113
Q

young kid with scrotal pain ,purpura and arthralgia

A

Henoch shonlein purpura

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114
Q

complication of Henoch shonlein purpura

A

intussiception ileoileale

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115
Q

age to have henock shonlein purpura

A

<15 ans

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116
Q

seizure in afebrile children with wide qrs complex dry oral mucosa and dilated pupils and hypotension

A

TCA intoxication to rule out

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117
Q

Rx of TCA intoxication

A

sodium bicarbonate

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118
Q

action of Hydroxyurea

A

Increase HB F

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119
Q

importance of hydroxyurea in sickle cell disease

A

prevention of painful crisis

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120
Q

clue for cystic fibrosis(2)

A

diarrhea

probleme respiratoire a repetition

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121
Q

breastfeeding contraindication(9)

A 
herpes mammaire
HIV
TB
varicella
drug
alcohol
fetal galactosemia
chemotherapy
radiation
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122
Q

for TB when the mother can be allowed to breastfeed

A

2 weeks after debut of treatment

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123
Q

patient with blue eye and susceptibility to fracture

A

osteogenesis imperfecta

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124
Q

quid opalescent teeth

A

yellow teeth

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125
Q

disease with opalescent teeth

A

osteogenesis imperfecta

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126
Q

red eyes in children in the first 24 h(2)

A

iatrogenic

nitrate d’argent

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127
Q

red eyes in children in 2-5 days of birth

A

gonoccoque

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128
Q

rx of conjunctivitis caused by gonoccoque

A

ceftriaxone

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129
Q

red eyes in children 5- 24 jours of birth

A

chlamydia

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130
Q

rx for conjuctivitis induced by chlamidya

A

oral erythromycin

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131
Q

finding in severe combined immunodeficiency

A

low Lympho B and T

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132
Q

cause of post vermis syndrome(2)

A

medulloblastoma

astrocytoma

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133
Q

clue for scarlet fever(2)

A

sore throat

sand paper like appearrance

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134
Q

clue for 21 hydroxylase in children(newborn)(4)

A

high K+
low TA
Low NA+
high 17 hydroxyprogesterone

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135
Q

clue for 11 B hydroxylase

A

high 11 deoxycortocosterone

HTA

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136
Q

cause of HTA in 11 B hydroxylase

A

HTA

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137
Q

cause of HTA in 17 alpha hydroxylase

A

high corticosterone

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138
Q

substance produced by adrenal cortex

A

G,F,R
Aldoesterone=G
fascicule=F
reticule=androgen

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139
Q

clue for duchenne muscular dystrophy(2)

A

weakness in children before 5

wheelchair bound before 5

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140
Q

clue for Becker muscular dystrophy

A

weakness in children after 5

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141
Q

strawberry tongue in USMLE

A

kawasaki

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142
Q

clue for Kawasaki(5)

A 
Fever
adenopathy
extremities swelling
red eyes
skin erythema
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143
Q

syndrome coronarien in kid

A

kawasaki

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144
Q

rx of kawasaki(2)

A

aspirin and

immunoglobulin

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145
Q

genotype of turner

A

45 XO

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146
Q

gendre in turner

A

woman

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147
Q

complication of turner(2)

A

osteoprosis

coarctation of aorta

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148
Q

physiopatho in Marfan syndrome

A

mutation of the fibrillin -1 gene

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149
Q

vascular problem in Marfan

A

aortic root dilation

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150
Q

eye problem in marfan

A

upward dislocation of the lens

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151
Q

children with unsteady gait ,and myocarditis

A

friedrich ataxia

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152
Q

cause of T wave inversion(5)

A 
MI
Myocarditis
Pericarditis
digoxin toxicity
Myocardial contusion
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153
Q

EKG in friedrich ataxia

A

T wave inversion

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154
Q

CAT in club foot

A

treat immediately

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155
Q

clue hyper IGM syndrome(2)

A

Low neutophils
high IGM
low IGA and IGG
sinopulmonary infections and PCP pneumonia

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156
Q

Bruton’s agammaglobulinemia

A

Low IG M
Low IG G
Low IG A

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157
Q

finding in chronic pyelonephritis in children

A

focal parenchymal scarring and blunted calices

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158
Q

bugs in otite moyenne(3)

A

strep pneumo # 1
non typable H flu # 2
Moraxella catharalis # 3

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159
Q

consequence of vit D deficiency in children

A

rickets

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160
Q

epidemiology for rickets

A

black children

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161
Q

clue for Neuroblastoma in children(2)

A

high homovanillic acid

vanylilmandelic acid in urine

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162
Q

origin of neuroblastoma

A

neural crest cells

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163
Q

origin tumor de wills

A

metanephros

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164
Q

renal tumor in children(2)

A

neuroblastoma

tumor de wilms

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165
Q

murmeur in tetralogy of Fallot

A

squatting increases murmur

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166
Q

cardiac problem in Down syndrome(3)

A

endocardial cushion defect #1 or complete atrioventricular canal
VSD
ASD

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167
Q

clue for cyclic vomiting in children(2)

A

any cause can be found

history of migraine in the family

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168
Q

bug in rheumatic fever

A

strep group A

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169
Q

cause of NEC in baby

A

formula use

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170
Q

abdomen xray in NEC

A

pneumatosis intestinalis

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171
Q

quid of pneumatosis intestinalis

A

intramural air with dilated loops pof bowel

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172
Q

rx of prematurity anemia

A

fer

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173
Q

Lab for prematurity anemia(5)

A 
mormochromic
normocytic 
anemia
low reticulocytes
total normal bilirubin level
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174
Q

vasoocclusive manif in hand in sickle cell disease(2)

A

dactilytis

hand foot syndrome

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175
Q

early manif of vasooclusive crisis in SCD(2)

A

dactilytis

hand foot syndrome

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176
Q

quid of gastrochisis

A

no peritoneum covers the intestines

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177
Q

quid omphalocele

A

ombilic ring herniation covered by peritoneum

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178
Q

most common bugs causing pneumonia in cystic fibrosis(4)

A

Hi flu # 2
pseudomonas # 1
staph aureus # 4
strep pneumo #3

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179
Q

gram positive diplococci

A

strep pneumo

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180
Q

gram positive cooci in clusters

A

staph

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181
Q

gram negativ cocci

A

neisseria

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182
Q

gram positive rods

A

Lysteria monocytogenes

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183
Q

gram negative rods(4)

A

Pseudomonas
Hi flu
Klebsiella
legionella

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184
Q

cause # 1 of bronchiolitis

A

VSR

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185
Q

risk future in bronchiolitis

A

asthma

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186
Q

risk in use of erythromycin in baby

A

hypertrophis pyloric stenosis

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187
Q

clue for Kartagena syndrome(3)

A

situs inversus
reccurrent sinusitis
bronchiectasis

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188
Q

risk for patient having received inactivated vaccine in 1960

A

can develop atypical measles

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189
Q

gold standard test for Duchenne muscular dystrophy

A

genetic studies

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190
Q

number one cause of sepsis in sickle cell disease

A

Pneumococcus

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191
Q

important thing to do in premature baby

A

iron till 1 year old

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192
Q

consequence of cow milk consumption

A

anemia

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193
Q

red blood cells in intrauterine growth restriction

A

polycythemia

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194
Q

clue for congenital foot deformity

A

adduction of the foot

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195
Q

Rx for congenital foot deformity(2)

A

reassurrance

no cast

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196
Q

cardiac problem in congenital rubella(2)

A

PDA

ASD

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197
Q

clue for turner (3)

A

feme naine
coarctation of aorta
Miley cyrus concert

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198
Q

cardiac problem in Edward

A

VSD

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199
Q

bugs causing infection in chronic granulomatosis disease

A

catalase positive organism

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200
Q

quid of catalase positive organism(5)

A 
SPACE
S:STAPH AUREUS 
P:PSEUDOMANAS
A:SPERGILUS
CANDIDA
ENTEROBACTERIACEA
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201
Q

quid of enterobacteriacae

A

klebsiella

…..

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202
Q

other name of laryngotracheobronchitis

A

croup

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203
Q

indication of epinephrine in respiratory problem(2)

A

croup

asthma

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204
Q

rx of in infection caused by pseudomonas in cystic fibrosis(2)

A

ceftazidine + gentamycine
or
ticarcilin + gentamycin

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205
Q

rx of CGD

A

gamma interferon

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206
Q

quid of henoch shonlein purpura

A

IGA vasculitis

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207
Q

how to prevent sudden infant death syndrome

A

supine position while sleeping

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208
Q

meaning of non pitting edema

A

lymphatic problem

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209
Q

why people with turner has edema in feet

A

lymphedema

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210
Q

kidney appearance in turner

A

horse shoe kidney

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211
Q

disease with webbed neck

A

turner syndrome

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212
Q

meaning of barking cough

A

croup

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213
Q

cause of barking cough

A

parainfluenza type 1

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214
Q

risk during delivery of macrosomia(3)

A

clavicle fracture
brachial plexus injury
perinatal asphyxia

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215
Q

intestinal malformation associated with chromosomal abnormality

A

dudenal atresia

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216
Q

risk in premature infant

A

intraventricular hemorrage

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217
Q

what disease you can perform gutry test

A

phenylketonuria

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218
Q

cause of avascular necrosis in children(3)

A

sickle cell disease
corticosteroid
alcoholism

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219
Q

immune thrombocytopenia and viral infection < 30 000 rx

A

corticosteroid

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220
Q

immune throbocytopenia and viral infection platelet 30 000

A

observation

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221
Q

dx digeorge syndrome(5)CATCH

A 
conotruncal cardiac  defects
abnormal facies
thymic aplasia
cleft palate
hypocalcemia
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222
Q

anomaly chromosomal in Digeorge

A

22q11,2

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223
Q

facies abnormaly in Digeorge(2)

A

low set ears

micrognatia

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224
Q

waiters tip attitude and erb duchenne palsy

A

atteinte C5 C6 C7
extended elbow
pronated forearm
flexed wrist and fingers

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225
Q

kid with failure to thrive and metabolic acidosis with normal anion gap,high urine PH 7,9 cause of failure to thrive

A

renal tubular acidosis

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226
Q

kid with giardiasis in fection a repetition

A

genetic b cell deficiency

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227
Q

physiopatho in nieman pick disease

A

sphingomyelinase deficiency

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228
Q

quid of adrenarche

A

axillary hair growth

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229
Q

quid of pubarche

A

pubic hair growth

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230
Q

clue for bruton’s agamma globulinemia(2)

A

low IGM IGG and IGA

Lymphocytes B absent

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231
Q

how’s temperature in neonatal sepsis(2)

A

high 30 C

low <36 degree

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232
Q

jaundice in children cause(4)

A

breastmilk
breast feeding
sepsis
hematologic problem

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233
Q

peak in jaundice caused by breastmilk

A

2 weeks

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234
Q

complication of galactosemia(2)

A

E coli neonatal sepsis

cataract in newborn

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235
Q

enzyme deficiency in galactosemia

A

galactose 1 phosphate uridyl transferase

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236
Q

cause of cirrhosis in neonate

A

galactosemia

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237
Q

period of infantile colic

A

< 4 months

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238
Q

cause of alkali ingestion intox

A

liquid oven cleaner

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239
Q

management of alkali ingestion(4)

A

no charbon
no vinegar
no lavage gastrique
endoscopy

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240
Q

physiopatho od reye syndrome in aspirin ingestion in infant

A

hyperammonemia

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241
Q

advantage of breastfeeding in mother(7))

A 
decreased the risk of 
breast cancer
ovarian cancer
more rapid uterine involution and post partum bleeding
fastter return to prepartum weight
improved maternal  infant bonding
imp[roved child spacing
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242
Q

advantage of breastfeeding in kid(5)

A 
decreased risk of otite moyenne
improve immunity
prevention of respiratory illness
decreased risk of NEC childhood cancer and type 1 diabetes
prevent gastroenteritis
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243
Q

additionnal finding in atresia oesophagienne

A

tracheo esophageal fistula

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244
Q

clue for foreign body aspiration

A

wheezing in infant

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245
Q

best test in foreign body aspiration

A

bronchoscopy

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246
Q

enfant controle tete et cou a quel age

A

2 mois

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247
Q

controle du bassin(2)

A

4 mois

6 mois

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248
Q

pull to stand a quel age

A

9 mois

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249
Q

stand and marche a quel age

A

12 mois

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250
Q

can say papa mama

A

9 mois

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251
Q

language of baby in 12 months(3)

A

mama
papa
plus one word

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252
Q

fine motor development in baby a 2 mois

A

ferme les mains

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253
Q

fine motor development in baby a 4 mois

A

ouvre mains

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254
Q

fine motor development in baby a 6 mois

A

passe objet d’une main a une autre

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255
Q

fine motor development in baby a 9 mois

A

pince a 3 doigts

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256
Q

fine motor development in baby a 12 mois

A

pince a 2 doigts

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257
Q

skin rash and vasomotor collapse during meningoccemia cause of death in children

A

adrenal gland failure

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258
Q

meningoccemia and adrenal failure percentage of death

A

100%

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259
Q

hemiplegia in infant after seizures that usually improves within 24 hours

A

Todd paralysis

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260
Q

seizure description in infant in the USMLE

A

sudden loss of consciousness with following disorientationand slow gain of consciousness

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261
Q

importanse of todds paralysis

A

there ‘s a structural abnormality underlying the seizure

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262
Q

patient with spasms 14 yo and swollen and erythemastous ombilical cord dx

A

tetanus neonatal

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263
Q

major source of protein in milk

A

whey

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264
Q

advantage of human mlik

A

more easily absorbs

improves gastric emptying

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265
Q

evolution of cephalematoma

A

resorb spontaneously wuthin weeks to 3 months

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266
Q

clue for drinking cow milk in USMLE

A

whole milk

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267
Q

clue for tetralogy de fallot(2)

A

tet spell

cyanosis during tet

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268
Q

cause of tet spells

A

sudden spasm of the right ventricular outflow tract during exertion

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269
Q

murmur in Fallot

A

crescendo decrescendo systolic murmur over the left upper sternal border

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270
Q

complication of praderr willi syndrome(4)

A

sleep apnea
Type 2 diabetes mellitus
gastric distension and rupture
death by choking

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271
Q

howel jolly bodyes

A

nuclear remnant of red blood cell

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272
Q

congenital malformation in diamond blacfan diamond(4)

A

short stature
webbed neck
shieleded chest
triphalangeal thumbs

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273
Q

lens dislocation in marfan syndrome

A

upward

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274
Q

lens dislocation in homocystinuria

A

down ward

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275
Q

what to do devant leukocoria

A

refer to ophtalmologist

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276
Q

clue for midgut volvulus(3)

A

child less than 1 month with bilious vomiting
abdominal distension
passage of bloodstained stools

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277
Q

development of child of 2 years(3)

A

speak in 2 words
follow two steps command
two quarters of speech intelligible

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278
Q

development of child of 3 years(3)

A

use three word sentences
threequarters of speech intellible
ride tricycle

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279
Q

complicationin severe type 2 osteogenesis imperfecta(4)

A

death in utero
multiple intrauterine fracture
blue sclera
growth retardtion

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280
Q

patient with menigitidis requires urgent LP who must give consent for the procedure and why(2)

A

no consent is needed

it’s an emergency procedure

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281
Q

emergent act with no need of consent(2)

A

intubation for respiratory failure

LP

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282
Q

xray finding in coarctation of the aorta

A

rib notching

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283
Q

cause of rib nocthing in coarctzation of aorta in turner

A

dilatation of the collaterals between the hypertensive chest walls vessels

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284
Q

characteristics of coarctation of aorta(2)

A

hypertension in upper part of the body

hypoperfusion in the lower part of the body

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285
Q

why continuous murmur on chest in coarctation of aorta

A

development of collaterals betweenthe hypertensive and hypoperfused vessels

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286
Q

young boy with bitemoral hemianopsia,symptom of intracranial pressure calcified lesion above the sella dx

A

craniopharyngioma

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287
Q

MRI with cystic calcified parasellar lesion

A

craniopharyngioma

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288
Q

clue for congenital adrenal hyperplasia late onset(non classic)(4)

A

advanced bone age
coarse axillary and pubic hair
severe cystic acne
normal electrolytes

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289
Q

clue for peripheral precocious puberty(2)

A

low baseline levels of LH

no modification of LH after stimulation with a gonadotrophin releasing hormone agonist

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290
Q

clue for classic CAH(3)

A

neonatal period manifestation
adrenal insufficiency
ambiguous genitalia

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291
Q

hemolytic anemia characteristics(5)

A 
mild to moderate anemia
reticulocytosis
unconjugated bilirubinemia
low to absent serum haptoglobin
high lactate dehydrogenase
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292
Q

first step in children with meningitidis(2)

A

LP

followed by ceftriaxone plus vancomycine

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293
Q

when using imaging prior to LP(3)

A

focal neurologic finding
coma
history of neurosurgical surgery

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294
Q

local impetigo characteristics

A

vesiculopustular lesions golden yellow and encrusted

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295
Q

rx of impetigo

A

topical mupirocin

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296
Q

spherocytose hereditaire in new born(3)

A

hemolytic anemia
jaundice
splenomegaly
increased mean corpuscular hb concentration

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297
Q

problem in hereditary spherocytosis

A

defect of red blood cell membrane

ankyrin gene abnormality causes spectrin defivciency

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298
Q

dx of spherocytosis(2)

A

high osmotic fragility in acidified glycerol lysis test

abnormal eosin5 maleimide binding test

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299
Q

rx of hereditary spherocytosis(3)

A

folic acid supplementation
blood transfusions
splenectomy

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300
Q

complication of hereditary spherocytosis(2)

A

pigment gallstones

aplastic crisis from parvovirus B19

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301
Q

hemiplegia in child after accident with pencil penetration in mouth at school

A

traumatic carotid artery dissection

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302
Q

consequence of trauma in the soft palate

A

risk of stroke in children

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303
Q

rx of minimal change

A

prednisone

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304
Q

during apgar evaluation baby has HR< 80 and irregular respiration APGAR a 5 /10 next step(2)

A

pulse oxymetry monitoring

positive pressure ventilation

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305
Q

clue for impaired leucocytes adhesion type 1(5)

A

delayed separation od umbilical cord
reccurrent bacterial infections of skin and mucosal surfaces
necrotic perriodontal infection
no pus in inflamed or infected tissue
leucocytosis with neutrophil predominance

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306
Q

maternal I drug user , baby with failure to thrive,lymphadenopathy,thrush dx

A

HIV infection

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307
Q

hiv testing in hiv drug use during pregnancy(2)

A

1 trimestre

3e trimestre

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308
Q

xray in duodenal atresia

A

double bubble sign

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309
Q

cause of microcytic anemia in children

A

consumption of > 24 ounces per day of cow milk(700ml)

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310
Q

inheritance of hemophilia

A

Xlinked recessive

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311
Q

screening test of hemophilia(2)

A

coagulation studies

platelet count

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312
Q

rx of hemophilia

A

administration of factor 8 et 9

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313
Q

boy 4 -10 ans with hip and knee pain with insidious onset and antalgic gait.xray

A

legg calve perthes disease

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314
Q

adolescent with hip pain obese

A

slipped femoral capital epiphysis

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315
Q

when to suspect respiratory distress syndrome in premature infant(3)

A

premature infant with
grunting
flaring
retraction immediately after birth

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316
Q

dx in prematured infant with respiratory distress

A

hyaline membrane disease

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317
Q

xray in hyaline membrane disease

A

fine reticular granularity

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318
Q

treatment of hyaline membrane disease

A

continuous positive air pressure ventilation

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319
Q

charactheristics of acquired aplastic anemia

A

everything is low=pancytopenia

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320
Q

cause of acquired aplactic anemia(2)

A

drugs

infectiom

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321
Q

drug causing acquired aplastic anemia

A

chemo

chloramphenicol

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322
Q

toxins causing aplastic anemia(2)

A

benzene

carbon tetrachloride

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323
Q

mode de contamination of measles

A

infected droplets from respiratory secretions

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324
Q

rash characteristic in measles(2)

A

cephalocaudal and

centrifugal spread

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325
Q

confirmatory dx of measles

A

PCR

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326
Q

complication of measles(4)

A

otitis media
pneumonia
neurologic
gastroenteritis

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327
Q

neurologic complication of measles(2)

A

encephalitis within days

subacute sclerosing panencephalitis within years

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328
Q

premature child with seizures hypotension focal neurologic findings bulging and tense fontanel apna and bradychardia cause of symptoms

A

intraventricular hemmorage

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329
Q

what do to in any premature infant even if asymptomatic

A

transfontanel ultrasound

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330
Q

why gout in lesh nyhan syndrome

A

deficiency in hypoxanthine guanine phosphorybosil transferase

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331
Q

role of hypoxanthine guanine phosphorybosil transferase

A

purine metabolism

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332
Q

young boy with gout

A

lesh nyhan syndrome

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333
Q

clue for intussuception in USMLE

A

palpable cylindrical mass on the right side of the abdomen

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334
Q

patient with recurrent intussuception

A

rule out meckel

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335
Q

cause of intussuception(3)

A

recent viral illness
rotavirus vaccination
pathological lead point

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336
Q

quid of pathological lead point(5)

A 
congenital malformation of the intestines like meckel
henoch shonlein purpura
celiac disease
intestinal tumor
polyps
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337
Q

clue for meckel(3)

A

suden intermittent abdominal pain
currant jelly stools
sausage shaped abdominal mass

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338
Q

dx of Meckel(3)

A

target sign on ultrasound
technetium 99m pertechnetate scanning
explorative laparoscopy

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339
Q

rx of intussuception(2)

A

enema

surgery for removal of lead point

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340
Q

management of cyanosis in fallot(2)

A

knee chest positionning

inhaled o2

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341
Q

definitive rx of Fallot

A

surgery before age of 6

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342
Q

the most common cause of congenital adrenal hyperplasia

A

21 hydroxylase deficiency

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343
Q

what will happen in 21 hydroxylase deficiency(2)

A

hyeperandrogenism=hirsutism

Plus virilism

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344
Q

clue for congenital adrenal hyperplasia(2)

A

elevated 17 hydroxyprogesterone

certain degree of dsalt wasting

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345
Q

most common cause of hyperandrogenism and oligo ovulation

A

PCOS

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346
Q

cause of hyperandrogenism en dehors de PCOS(6)

A 
ovarian or adrenal tumors
late onset of adrnal hyperplasia
hyperprolactinemia
hyperprolactinemia
acromegaly
cushing disease
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347
Q

hyperandrogenism plus high 17 hydroxyprogesterone

A

CAH

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348
Q

clue for acromegaly

A

high insulin like growth factor

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349
Q

clue for clavicular fracture in baby(2)

A

crepitus

moro reflex asymetric

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350
Q

consequence of hyperinsulinism in macrosome(2)

A

viceromegaly

fat accumulation

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351
Q

cause of intellectual disability(3)

A

fetal alcohol syndrome
down syndrome
fragile X syndrome

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352
Q

clue fragile x syndrome(5)

A 
macroorchidism
macrocephaly
large ears
long narrow face
prominent forehead and  chin
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353
Q

face of patient with down syndrome

A

flat facial profile
slanted palpebral fissure
small low set ears

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354
Q

body of patient with Down(4)

A

excessive skin at nepe of the neck
single transvers palmar crease
clinodactyly
large space between the first 2 toes

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355
Q

2 yo kid with noisy breathing worsen when lying on his back or crying or feeding dx?

A

laryngomalacia

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356
Q

2 yo kid with noisy breathigh worset when lying on his back or crying way to confirm the dx

A

flexible laryngoscopy

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357
Q

flexible laryngoscopy of laryngomalacia(2)

A

collapse of supraglottic structures with inspiration

omega shape epiglottis

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358
Q

evolution of laryngomalacia

A

spontaneous resolution by age of 18 months

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359
Q

inspiratory stridor in laryngomalacia

A

noisy breathing

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360
Q

peak for laryngomalacia

A

4-8 mois

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361
Q

clue for hypothyroidism in infant(6)

A 
baby normal at birth 
later apathy
hypotonia
sluggish movement
abdominal bloating 
umbilical hernia
362
Q

screening test in baby in the US(3)

A

hypothyroidism
Phenylketonuria
galactosemia

363
Q

murmur in VSD

A

holosystolic murmur at the left sternal border

364
Q

most common cause of congenital abnormality

A

VSD

365
Q

best tes if you suspect VSD

A

echocardiography

366
Q

evolution of vSD

A

75% des cas close spontaneously by age 2

367
Q

blood stained odorless vaginal discherger in kid < 3 months next step

A

reassurrance

368
Q

cause of vaginal discherge in infant

A

effect of maternal estrogen

369
Q

how many doses a kid from 6 weeks to 6 years should receive

A

5 doses

370
Q

patient in the past has febrile seizure when receiving DTP acellular can we give this patient hs 4 th dose and why (2)

A

yes

febrile seizure is not a contrindication for acellular pertussis

371
Q

contrindication for further administration of pertussis(3)

A

immediate anphylaxia
unstable neurologic disorder
encephalopathy
wthin a week administration of pertussis containing vaccines

372
Q

child from 3-10 year old develops hip pain following rhinorrhea and intermittent cough xrayu is normal no history of fever is noted dx

A

transient synovitis

373
Q

rx of transient synovitis(3)

A

Ibu
rest
follow up in 1 week

374
Q

indicator to look at in dx septic arthritis

A 
fever > 38.5
inability to bear weight
wBC> 12000
ERS > 40
CRP>2.0 mg/dl
375
Q

normal CRP

A

20 mg/l

376
Q

why you should ask bilateral hip xray even if you suspect transient synovitis

A

to rule out leg calve perthes disease

377
Q

patient presenting in consultation a 24 mois d’age with .cover test reveals moderate deviation of the left eye dx

A

strabismus

378
Q

complication of strabismus

A

amblyopia

379
Q

what to do in dx of strabismus

A

occlusion of the normal eye

380
Q

cause of amblyopia(3)

A

strabismus
errors of refraction
opacity of the media along the visual axis

381
Q

can you see a patient with epiglotittis like out patient

A

no because it’s a medical emergency

382
Q

patient dx with epiglotitis with respiratory distress next step

A

endotracheal intubation with a set up for tracheostomy

383
Q

why you can ‘t encounter epiglotitis caused by HIB

A

because of vaccination

384
Q

after bloody diarrhea patient develops anemia
low platelet
and renal insufficiency dx?

A

SHU

385
Q

cause of SHU

A

E coli producing verotoxin

386
Q

patient between 2-12 ans with bilateral lower extremities pain occurring at night bilateral with normal physical exam with normal activity leveldx?

A

growing pain

387
Q

cause of growing pain

A

unknown

388
Q

rx of growing pain(4)

A

observation
parental reassurance
massage
over the counter pain medications

389
Q

quid of purpura in USMLE

A

non blanching rash

390
Q

pathogenesis of Henoch shonlein purpura(2)

A

IG A deposit in affected organs

immune mediated leukocytoclastic vasculitis

391
Q

role in sodium bicarb in the rx of TCA intoxication(2)

A

correct the acidosis

narrow the qrs complex prolongation

392
Q

patient presenting with microcephaly,hypotonia

short stature and cat like cry

A

cri du chat syndrome

393
Q

weight loss in baby

A

up to 7% in the first 5 days

394
Q

baby comes by the day five with weight loss of < 7% next step

A

continue exclusive breast feeding

395
Q

baby comes by the day five with weight loss of > 7% next step(4)

A

assess for oromotor dysfunction
assess for lactation failure
daily weights
consider formula supplementation

396
Q

in vignette diaper with brick dust appearance or pink stains in baby with dehydration why

A

it’s caused by uric acid crystals

397
Q

when should a babay regain weight after losing weight during the 5 first days

A

entre 10 a 14 jours

398
Q

cause of growth failure in cystic fibrosis

A

pancreatic insufficiency

399
Q

cause of pancreatic insufficiency in cystic fibrosis(2)

A

inspissation

obstructionof pancreatic ducts

400
Q

tests for cystic fibrosis(3)

A

Sweat chloride test
genotyping
fecal elastase

401
Q

kid with growth failure and reccurrent respiratory infection

A

cystic fibrosis

402
Q

contrindication of breast feeding maternal conditions(8)

A 
active unrx TB
maternal hiv infection
herpetic breast lesions
varicella infection < 5 days earlier or  2 dyas  after delivery
specific maternal medications
chemo
ongoing radiation
active abuse of street drug or alcohol
403
Q

when a mother on anti TB can begin to breast feed baby

A

2 weeks after beginning anti TB drugs

404
Q

infants condition with contrindication of breastfeeding

A

galactosemia

405
Q

clue for osteogenesis imperfecta(5)

A 
autosomal dominant
osteopenia
blue sclerae
hearing loss
dentinogenesis imperfecta
406
Q

quid of dentinogenesis imperfecta

A

opalescent blue gray to yellow brown discoloration caused by discolored dentin shining through the transluscent and weak enamel

407
Q

what about intelligence in patient with osteogenesis imperfecta

A

normal intelligence

408
Q

rx of neonatal conjunctivitis induced by gonoccoque

A

parenteral ceftriaxone
or
cefotaxime

409
Q

rx of neonatal conjunctivitis induced by chlamydia trachomatis

A

oral erythromycin

410
Q

characteristic of chlamydial neonatal conjunctivitis(2)

A

blood stained eye discharge

mucoid discharge

411
Q

patient with reccurent sinopulmonary infections oral candidiasis persistent diarrhea absent lymp nodes Low B and T cells and natural killer absent thymic shadow dx

A

severe combined immunodeficiency

412
Q

most 2 common tumor of posterior fossa(infratentorial tumor) in children(2)

A

astrocytoma

medulloblastoma

413
Q

if a kid has a medulloblastoma what area of the brain will be most likely affected

A

cerebellar vermis

414
Q

post vermis syndrome(4)

A

unbalanced gait
trunk dystaxia
horizontal nystagmus
papilledema

415
Q

vaginal discharge and enlargement of mammary glands in newborn infants next step?

A

observation

416
Q

bugs causing scarlet fever

A

Group A streptococcus producing exotoxins

417
Q

kid with sore throat ,fever sand paper rash stawberry tongue and circumoral pallor dx

A

scarlet fever

418
Q

rx of choice of scarlet fever

A

penicillin V

419
Q

first born boy 3 a 5 semaines de naissance with projectile nonbilious vomiting after feed
physical exam reveals palpable olive shaped mass in the RUQ

A

pyloric stenosis

420
Q

metabolic problem in pyloric stenosis(3)

A

hypochloremic
hypokalemia
metyabolic acidosis

421
Q

dx of pyloric stenosis (2)

A

abdominal US

elongated and thickened pylorus

422
Q

rx of choice of pyloric stenosis

A

pylotomyotomy

423
Q

what to do before surgical rx of pyloric stenosis and why(2)

A

correct metabolic problem

sinon risque of post op apnea

424
Q

characteristics in 21 hydroxylase deficiency(5)

A 
anbiguous genitalia in  girl
salt  wasting
hypotension 
low NA+
high K+
425
Q

hormone abnormality in 21 hydroxylase deficiency(3)

A

low cortisol and aldosterone
high testo
high hydroxyprogesterone

426
Q

characteristics in 11 B hydroxylase deficiency(3)

A

ambiguous genitalia in girls
fluid and salt retention
hypertension

427
Q

hormone abnormality in 11 B hydroxylase deficiency(4)

A

low cortisol and aldosterone
high testo
high 11-deoxycorticosterone
high deoxycortisol

428
Q

characteristics in 17 @ hydroxylase deficiency(3)

A

all patients are female
fluid and salt retention
hTA

429
Q

hormone abnormality in 17 2 hydroxylase deficiency(3)

A

low cortisol and testo
high mineralocorticoids
high corticosterone

430
Q

first step in the management of choanal atresia(2)

A

placing oral airway

lavage feeding

431
Q

definitive rx of choanal atresia(2)

A

repairing obstruction with surgery
or
with endoscopy

432
Q

child less than 5 years with proximal muscles weakness gower sign and bilateral calf pseudohypertrophy dx

A

duchenne muscular dystrophy

433
Q

quid of gower sign

A

patient uses hands to walk up the legs in order to stand up

434
Q

cause of DMD

A

dystrophin gene deletion on XP 21

435
Q

cause of death in DMD(2)

A

respiratory failure
or
heart failure

436
Q

clue for kawasaki disease(6)

A

fever > ou egal a 5 jours plus > ou egal a 4 findings
bilateral non exsudative conjunctivitis
mucositis
cervical lymph node with at least one > 1,5 in diameter
erythematous polymorphous rash
extremity changes( edema or erythema)

437
Q

mucositis in kawasaki disease(3)

A

strawberry tongur
injected or fissured lips
injected pharynx

438
Q

complication of kawasaki(2)

A

coronary artery aneurism

myocardial infarction and ischemia

439
Q

rx of kawasaki(2)

A

aspirin
plus
IV immunoglobulin

440
Q

role of aspirin and immunoglobulin in kawasaki

A

to reduce incidence of complications such as coronary artery aneurisms

441
Q

clue for turner(4)

A

short height
high arched palate
widely spaced nipples
45 X0 karyotype

442
Q

why osteoporosis in turner(2)

A

low estrogen levels

only one X chromosome involved in bone metabolism

443
Q

patient with an autosomal dominant disorder presenting with tall stature,long and emaciated extremities,arachnodactyly hypermobility of joints upward lens dislocation aortic root dilation dx

A

Marfan syndrome

444
Q

patient at risk for transposition of great vessels(2)

A

diabetic mother

males

445
Q

physical examination in transposition of great vessels(2)

A

loud second heart sound

cyanosis

446
Q

patietn with history of diabetes mellitus type 1 presents with conjonctival pallor and micrcytic anemia but no blood in feces examination.skin with vesicule erythemateuses symmetrically distributed over the extensor surfaces of elbows and knees .dx

A

celiac disease

447
Q

extraintestinal manifestation on celiac disease in the vignette(3)

A

diabete type 1
dermatitis herpetiforme
iron deficiency anemia

448
Q

skin problem in celiac disease(2)

A

dermatite herpetiforme

vitiligo

449
Q

endocrine problem in celiac disease(2)

A 
diabete type 1
autoimmune thyroiditis (hypo ou hyper)
450
Q

psychiatric problem in celiac disease(2)

A

depression

psychosis

451
Q

musculoskeletal problem in celiac disease(2)

A

osteopenia/osteoporosis

osteomalacia

452
Q

dx of celiac disease

A

upper GI andoscopy with biopsy of small intestine

453
Q

marker of celiac

A

IG A antitissue transglutaminase

454
Q

9 yo girl with unsteady gait and weakness in the lower limbs .On examination widebased gait and constant shifting of position to maintain her balance.you have decreased vibratory and position sense in lower extremities

A

friedrich ataxia

455
Q

MRI in friedrich ataxia(2)

A

marked atrophy of cervical spinal cord

minimal cerebellar atrophy

456
Q

what you should advise to mother with kid suffering from friedrich ataxia

A

prenatal counselling if the mother desires any future pregnancy

457
Q

quid of friedrich ataxia(2)

A

autosomal recessive

abnormality in tocopherol transfer protein

458
Q

infectious protection by sickle cell trait

A

severe complication of malaria

459
Q

differenciate hyper IGM syndrome from xlinked agammaglobulinemia(3)

A

in hyper IgM syndrome
opportunistic infection+++
neutropenia
high IGM levels

460
Q

risk factor for chronic pyelonephritis

A

vesicoureteral reflux

461
Q

clinical feature of media otitis(2)

A

middle ear effusion\

bulging tympannic membrane

462
Q

complication of otitis media(3)

A

conductive hearing loss
mastoiditis
meningitis

463
Q

rx of otitis media(2)

A

amox
or
amox clavulanate

464
Q

risk factor for media otitis in children(4)

A

age 6-36 months
formula intake
exposure to cigarette smoke
upper respiratory infection

465
Q

Ct for mastoiditis(2)

A

no air in mastoid air cells

they are opacified

466
Q

patient 11 months with pliable skull bones,bony prominences of costochondral junctions genu varum cause of these findings(2)

A

nutritionnal deficiency

vit D

467
Q

costochondral joint hypertrophy in rickets quid?

A

rachitic rosary

468
Q

genu varum in rickets

A

femoral and tibial bowing

469
Q

risk factor for Vit D deficiency(4)

A

increasd skin pigmentation(black)
exclsive breastfeeding
inadequate sun exposure
maternal vit D deficiency

470
Q

pliable skull bones with step offs in rickets or ping pond ball skull

A

craniotabes

471
Q

xray in rickets

A

metaphysal cupping and fraying of long bones

472
Q

rx of rickets

A

Vit D 1000-2000 UI daily

473
Q

most common form of cerebral palsy seen in premature infants

A

spastic diplegia

474
Q

quid of spastic displegia(4)

A

hypertonia
hyperreflexia
involving lower extremities
clasp knife

475
Q

quid of clasp knife in cerebral palsy

A

resistance to passive muscle movement increases with more rapid movement of the affected extremity

476
Q

leading cause of cerebral palsy

A

prematurity

477
Q

other causes of cerebral palsy(7)

A 
intrauterine growth restriction
intrauterine infection
antepartum hemorrage
placental pathology
multiple gestation
maternal alcohol consumption
maternal tobacco use
478
Q

rx of cerebral palsy in spasticity(2)

A

baclofen and

botulinum toxin

479
Q

comorbidities associated with cerebral palsy(4)

A

intellectual disability
epilepsy
strabismus
scoliosis

480
Q

localisation of neuroblastoma(2)

A

adrenal gland

any location along the paravertebral sympathetic chains

481
Q

quid of neural crest cells

A

precursor cells of the sympathetic chains and adrenal medulla

482
Q

CT or Xray in neuroblastoma(2)

A

calcifications

hemorrage

483
Q

quid of metanephros

A

embryologic precursor of renal parenchyma

484
Q

quid of metabolites of cathecholamines found in neuroblastoma(2)

A

HVA

VMA

485
Q

key physical exam for down syndrome(5)

A 
upslanting palpebral fissures
epicanthal folds
brushfield spots
single transverse crease
sandal gap toes
486
Q

GI problem associated with Down(2)

A

duodenal atresia

hirshprung disease

487
Q

neurocognitive problem associated with Down syndrome(2)

A

intellectual disability

early onset alzheimer

488
Q

hematologic problem associated with Down syndrome

A

acute leukemia

489
Q

endocrine problem associated with Down syndrome(2)

A

hypothyroidism

type 1 diabetes mellitus

490
Q

musculoskeletal problem associated with Down syndrome(2)

A

atlantoaxial instability

491
Q

porcentage of down with heart problem

A

50%

492
Q

what age down syndrome patient will have heart failure

A

around 6 weeks

493
Q

auscultation finding in heart failure in patient with down

A

S2 due to pulmonary hypertension

494
Q

patient with circular rash after trip in connecticut dx

A

lyme disease

495
Q

prevention of lyme in lyme endemic area(2)

A

wear permethrin treated pants

long sleeved shirts

496
Q

7 yo girl comes for vomiting,this is the 3 episode the last two were self limiting .Physical exam is ok dx

A

cyclical vomiting

497
Q

parental antecedent for children with cyclical vomiting

A

migraine in parents

498
Q

patient with severe dehydration IV line can be found next step

A

intraosseous access

499
Q

how long can you use an intraosseous access

A

24 a 48 heures

500
Q

patient with difficulty writting and jerky movements,days later he has sore throat but now has low grade fever.pericardial friction,a subcutaneous nodules over the hands dx?

A

rheumatic fever

501
Q

cause of rheumatic fever

A

Group A streptococus

502
Q

5 major criterai in jones criteria(5)

A 
polyartritis
carditis
chorea
subcutaneous nodules
erythema marginatum
503
Q

3 minor criteria for jones

A

fever
athralgia
previous rheumatic fever

504
Q

dx of rheumatic fever(3)

A

one major pour 2 minor
or
two major
plus detection af antistreptolysin antibodies or cultures or varrious antigens detection

505
Q

rx of rheumatic fever

A

PNC G

506
Q

2 day old baby is seen with irritabilioty,high pithed cry,poor sleeping tremors,seizures sweating sneezing tachypnea poor feeding vomiting and diarrhea dx

A

neonatal abstinence syndrome

507
Q

drug involved in neonatal abstinence syndrome(2)

A

heroin

methadone

508
Q

time of apparition of neonatal abstinence syndrome(2)

A

48 h after birth for heroin withdrawal

48 a 72 h for methadone withdrawal

509
Q

clue for NEC(5)

A 
newborn with 
abdominal distension 
bloody diarhea
 and leucocytosis 
after introduction of formula feeding
510
Q

clue for craniopharyngyoma(3)

A

young boy with increased intracranial pressure
bitemporal hemianopsia
calcified lesion above the sella

511
Q

clue for cranyopharyngioma

A

cystic clcified parasellar lesion on MRI

512
Q

cause of anemia in premature infant(4)

A

transition in the erythropoiesis sites of the neonate
shorter red blood cells in neonates
diminished fetoplacental transfusion
blood loss

513
Q

black child 9 month old with augmentation de volume des pieds et mains et douleur dx

A

dactylitis caused by sickle cell anemia

514
Q

pathophysiology of dactilytis

A

vaso occlusive phenomena

515
Q

what the earliest manif of vasoocclusive disease in sickle

A

dactylitis

516
Q

neonate seen in with matted mass of edematous bowel loops protruding from the abdomen .There is no covering ovr the bowel loops dx

A

gastrochisis

517
Q

gastrochisis next step after the DX

A

sterile saline dressing and wrapping of exposed bowel

518
Q

characteristics of gastrochisis(4)

A

bowel protrude through a defect on the right side of the ombilical cord
bowel is not covered by protective membrane
bowel looks angry and matted
no other abnormalities associated

519
Q

characteristics of omphalocele(3)

A

intera abdominal contents through the umbilical ring
bowel is covered with amnioperitoneal membrane
associated with other abnormalities(heart ,kidney)

520
Q

patient with omphalocele what other organ to look at(2)

A

heart

kidney

521
Q

why you should wrap and dress bowel in gastrochisis(2)

A

to minimize heat loss

and fluid loss

522
Q

most common cause of pneumonia in cystic fibrosis

A

Pseudomonas aeruginosa

523
Q

mode de transmission de cystic fibrosis CF

A

autosomal recessive

524
Q

why bronchiectasia in CF

A

recuurrent pneumonia

525
Q

quid of clubbing

A

bulbing enlargement of the tips of digits

526
Q

cause of clubbing in CF

A

chronic hypoxia

527
Q

appearance of thorax in CF

A

barrel chest

528
Q

3 phases in developping bordetella pertussis(3)

A

catarrhal phase
paroxysmal phase
convalescent phase

529
Q

whooping chronic cough in kid with delayed immunization with posttussive emesis

A

bordetela pertussis infection

530
Q

clue for catarrhal phase in pertussis(2)

A

mild cough

rhinitis

531
Q

clue for paroxysmal phase in pertussis(4)

A

coughing paroxysm lasting 20 a 30 mn
inspiratoty whoop
staccato cough
posttussive emesis

532
Q

clue for convalescent phase in pertussis(2)

A

cough

posttussive emesis resolve

533
Q

duration of paroxysmal phase

A

4-6 weeks

534
Q

dx pf pertussis(2)

A

PCR

pertussis culture

535
Q

hemogramme in pertussis

A

lymphocyte predominant leukocytosis

536
Q

complication of pertussis(6)

A 
pneumonia
weight loss
subconjonctival hemorrage
pneumothorax
respiratory failure 
death
537
Q

rx of pertussis

A

macrolides

538
Q

macrolides used in pertussis(3)

A

azythromycin
erythromycin
clarythromycin

539
Q

what age you can have death in infant with pertussis

A

less than 6 months

540
Q

the only way to prevent chlamydial conjunctivitis in neonates

A

maternal prenatal testing

541
Q

clue for duchenne muscular dystrophy(3)

A

bilateral calf pseudohypertrophy
gower sign
mx weakness

542
Q

transmission of Duchenne

A

x linked recessive transmission

543
Q

screening of Duchenne muscular dystrophy(2)

A

elevated serum creatine phosphokinase

elevated aldolase levels

544
Q

dx support of duchenne(2)

A

fibrosis

fatty infiltration in biopsy

545
Q

gold standard to confirm the dx of DMD

A

genetic studies

546
Q

risk factor for iron deficiency anemia in kid(3)

A

cow’s milk before 12 months
prematurity
maternal iron deficiency

547
Q

why you should introduce vit D to all chldren exclusively breastfed during first month of life

A

human milk does not contain enough VIT D to meet daily requirement of the infant

548
Q

dose of VIT D to give in infant exclusively breast fed

A

400 UI

549
Q

quid of small for gestationnal age infant for age

A

weight under 10 th percentile for gestationnal age at birth

550
Q

complication of small gestationnal age child(5)

A 
hypoxia
polycythemia
hypoglycemia
hypothermia
hypocalcemia
551
Q

classification of intrauterine growth restriction(2)

A

symmetrical

assymetrical

552
Q

clue for symmetrical intrauterine growth restriction

A

head weight and head are equally affected

553
Q

clue for asymmetrical intrauterine growth restriction

A

weight is affected more than height and head circumference

554
Q

quid of metatarsal adductus(2)

A

deformity of foot

adduction of the anterior aspect of the foot with convex lateral border and concave medial border

555
Q

rx of metatarsal adductus

A

reassurrance

556
Q

rx of internal torsion of tibia in infant

A

reassurrance

557
Q

baby 4 months old with blue macules on buttocks and and lower back (2)

A

mongolian spot

also called congenital dermal melanocytosis

558
Q

epidemiology of mongolian spots(4)

A

african
asian
hispanic
native american

559
Q

evolution of mongolian spots

A

fades spontaneously in the first decade of life

560
Q

is mongolian spot dangerous

A

no its benign

561
Q

triad for congental rubella(german measles)(3)

A

sensorineural deafness
cardiac defects
cataracts

562
Q

complication of first trimaester rubella(2)

A

spontaneous abortion

congenital rubella syndrome

563
Q

clue cataract in USMLE

A

leukokoria

564
Q

cardiovascular anomaly in turner

A

bicuspid aortic valve

565
Q

face and neck of turner patient(3)

A

narrow high arched palate
low set ears
low hairline
webbed neck

566
Q

chest of turner(3)

A

broad chest with widely spaced nipples
coarctation of aorta
bicuspid aortic valve

567
Q

abdomen of turner

A

horse shoe kidney

568
Q

limbs of turner(2)

A

cubitus valgus

short stature

569
Q

pelvis of turner(3)

A

streak ovaries
amenorrhea
infertility

570
Q

why echo coeur should be done in patient with turner(3)

A

to dx
bicuspid aortic valve
coarctation of aorta
aortic root dilation

571
Q

dx of chronic granulomatus disease(3)

A

nitro blue tetrazolium slide test
flow cytometry
cytochrome c reduction

572
Q

Rx of CGD(2)

A

daily TMS

gamma inrterferon 3 f jour

573
Q

patient with recurrent or unusual lymphadenitis hepatic abcess or osteomyelitis at multiple sites or infection with catalase positive organisms

A

CGD

574
Q

patient seen in emergency with barking cough and difficulty respiratoire DX

A

croup

575
Q

first thing to do in croup

A

racemic epinephrine before any invasive procedure

576
Q

pneumonia plus influenza in young children with CF, bugs in cause

A

staphyloccocus aureus

577
Q

medication to use in patient with cystic fibrosis in a context of influenza

A

vancomycin

578
Q

most common cause of pneumonia in cystic fibrosis in young children

A

staph aureus

579
Q

most common cause of pneumonia in cystic fibrosis in adult

A

pseudomonas aeruginosa

580
Q

Henoch shonlein purpura clue(4)HSP

A

lower extremity purpura
athralgias and arthritis
coliky abdominal pain
reenal involvement

581
Q

why coliky abdominal pain in HSP

A

local vasculitis

582
Q

dx of HSP

A

clinical

583
Q

dx of HSP in atypical presentation

A

renal biopsy

584
Q

renal biopsy in HSP

A

deposition of IGA in the mesangium by immunofluorescence

585
Q

peak of incidence sudden infant death syndrome

A

1 month and 1 year in the US

586
Q

cause of edema in turner syndrome

A

lymphedema

587
Q

cause of lymphedema in turner

A

dysgenesis of the lymphatic network

588
Q

kid with with ascending symmetric flaccid paralysis in both legs absent deep tendon treflexes and decreased superficial touch and vibratory senses.dx

A

guillain barre

589
Q

structures affected in guillain barre

A

peripheral motor nerves

590
Q

albumino cytologic dissociation dx

A

guillain barre syndrome

591
Q

rx of Guillain barre(2)

A

plasmapheresis
or
human immunoglobulin

592
Q

cause of GBS

A

most of the time follows viral infection

593
Q

macrosome with clavicle fracture next step

A

reassurrance and gentle handling

594
Q

period of time for healing clavicle fracture

A

7-10 jours

595
Q

prema with neurologic symptoms

A

intraventricular hemorrage

596
Q

risk for intracerebral hemorrage in prema(2)

A

< 30 semaines de gestation

or <1500 g

597
Q

screening test for intracerebral hemorrage in prematurity

A

serial head ultrasounds

598
Q

clue for intracerebral hemorrage(4)

A

rapidly increasing head circumference
bulging fontanel
hypotonia
lethargy

599
Q

cranial ultrasound of intraventricular hemorrage in prema(2)

A

bilateral IVH

dilated ventricles

600
Q

why communicating hydrocephalus in intracerebral hemorrage

A

accumulation of blood in subarachnoid space impaitr the ability of the arachnoid villi to absorb cerebrospinal fluid

601
Q

main problem in phenylketonuria(2)

A

deficiency in phenylalanine hydroxylase

accumulation of phenylalanine in the blod and body tissues

602
Q

screening test for phenylketonuria

A

gutrie test

603
Q

clue for phenylketonuria(4)

A

faitr hair and skin
blue eyes
eczematous changes
urine with mousy odor

604
Q

what to avoid in phenylketonuria

A

protein

605
Q

12 yo with back pain with or without incontinence ,physical exam reveals step off of lumbosacral area dx

A

spondylisthesis

606
Q

physiopatho of spondylisthesis

A

developmental disorder with forward slip of vertebra usually L5 over S1

607
Q

6 yo with down syndrome presents urinary incontinence,hyptonic and hyperreflexia wit positive babinski

A

atlanto axial instability

608
Q

cause of atlanto axial instability in down syndrome

A

excessive laxity in the post transverse ligament causing increased mobility between atlas C1 ant the axis C2

609
Q

upper motor neuron findings in patient presenting with down syndrome

A

atlantoaxial instability

610
Q

children with inattention impulsivity and hyperactivity in 2 or more settings dx

A

deficit hyperactivity syndrome disorder

611
Q

patiuetn with sickle cell disease presents with pain in his right hip that started several days ago dx

A

avascular necrosis

612
Q

cause of avascular necrosis(6)

A 
sickle cell disease
SC hemoglobin disease
corticosteroid therapy
SLE
alcoholism'
Gaucher disease
613
Q

physiopatho of aeptic necrosis in sickle cell disease(3)

A

occlusion of end arteries supplying the femoral head
bone necrosis
colapse of the periarticular bone and cartilage

614
Q

children with isolated thrombocytopenia and petechiae after viral infection dx

A

immune thrombocytopenia

615
Q

children with isolated thrombocytopenia and petechiae after viral infection next step

A

observation regardless the level of platelet

616
Q

children with isolated thrombocytopenia and petechiae after viral infection ,experiencing bleeding next step(2)

A

IV glucorticoids
or
IV immunoglobulin

617
Q

physiopatho of immune purpura(2)

A

antibody binds to platele

destruction of complex antibody-platelet-in spleen

618
Q

period of time to recover from immune purpura

A

6 months

619
Q

hemogram in measles(2)

A

leukopenia(T cell cytopenia)

thrombocytopenia

620
Q

what seem to decrease the morbidity and mortality in measles

A

vit A

621
Q

regression of milesstones after meningitis cause of that

A

meningitis

622
Q

neurologic sequelae associated with bacterial meningitis(5)

A 
hearing loss
loss of cognitive functions
seixures
mental retardation
spasticity or paresis
623
Q

principal risk in Digeorge

A

hypocalcemia

624
Q

tests to ask if youb suspect Digeorge(2)

A

serum calcium levels

echocardio

625
Q

risk associated with hypocalcemia(3)

A

tetany
seizures
arrythmia

626
Q

complication of absent thymus in Digeorge

A

T cell lymphopenia

627
Q

complication of T cell lymphopenia(2)

A

viral

fungal infection

628
Q

bay born with cyanosis,tremulation,low set ears,micrognatia and cleft palate.No thymic shadow in chest xray DX

A

Digeorge syndrome

629
Q

macrome presenting with right upper extremity held in adduction and rotation interne,with the elbow pronated and wrists and fingers flexed,moro and biceps reflexes absent bilateraly next step in the management in the patient and dx

A

Erb Duchenne

reassurance about prognosis

630
Q

maternal risk factor for macrosomia

A 
advanced age
diabetes
excessive weight gain during pregnancy
preexisting obesity
multiparity
631
Q

fetal risk factor for macrosomia(3)

A

african american or hispanic ethnicity
male sex
post term pregnancy

632
Q

evolution of erb duchenne

A

80 % spontaneous recovery within 3 months

633
Q

quid of renal tubular acidosis

A

inability for renal tubules to reabsorb bicarb or excrete hydrogen

634
Q

quid of type 1 renal tubular acidosis

A

defect in hydrogen secretion

635
Q

cause of type 1 renal tubular acidosis

A

genetic disorder

636
Q

metabolic problem in type 1 renal tubular acidosis(4)

A

acidotic
hypokaliemic
high PH urinaire
nephrolithiasis commonly develops

637
Q

quid of type 2 renal tubular acidosis

A

decreased bicarb reabsorbtion in proximal tubule

638
Q

cause of type 2 renal tubular acidosis

A

Fancony syndrome

639
Q

quid of type 4 renal tubular acidosis

A

defect in sodium potassium exchange in the distal tubule

640
Q

metabolic problem in type 4 renal tubular acidosis(2)

A

hyperkaliemie

hyperchloremie

641
Q

cause of type 4 renal tubular acidosis(3)

A

obstructive uropathy
renal disease
multiplastic dysplastic kidneys

642
Q

patient with less than 3 yo with impairment of social interaction and communication delayed language and stereotypical behaviors

A

autism

643
Q

what will need patient with autism

A

behavioral and educationnal programs

644
Q

patient with respiratory distress ,examination reveals nasal falring grunting,and barre shaped chest.auscultation reveals absent breath sounds in the left abdomen is scphoid .chest xray shows devation pf the heart in the right and gasless abdomen dx ?

A

congenital diaphragmatic hernia

645
Q

next after dx of congenital diaphragmatic hernia

A

endotracheal intubation

646
Q

complication of diaphragmatic hernia(2)

A

pulmonary hypoplasia

pulmonary hpertension

647
Q

sites of diaphragmatic hernia in the chest(2)

A

85% in the left

15 % in the right

648
Q

why polyhydramnios in congenital diaphragmatic hernia

A

esophageal compression

649
Q

consequence of abdominal viscera in the chest(2)

A

concave abdomen

barrel shaped chest

650
Q

congenital diaphragmatic hernia with respiratory distress

A

emergency intubation

651
Q

why you cannot use blow by oxygen and bag and mask ventilation in congenital diaphragmatic hernia

A

you will pump air in the intestines ,and further compromise the pulmonary function

652
Q

why after intubation in diaphragmatic hernia ,gastric tube should be used

A

to decompress the stomach and bowel

653
Q

in vignette patient after 6 months of age with reccurrent sinopulmonary infections and giardiaisis, DX

A

abnormal B lymphocyte maturation

654
Q

problem with genetic B cells deficiency(2)

A

ressurrent infections after 6 months with encapsulated organisms
lack of IGA predisposes to infection

655
Q

clue for Nieman pick disease(5)

A 
cherry red macula
protruding abdomen
hepatosplenomegaly
lymphadenopathy
regression of developmental milestones
656
Q

complication of sphingomyelinase deficiency in Nieman pick

A

sphingolipidosis

657
Q

risk of premature adrenarche(2)

A

obesity

hispanic and black ethnicities

658
Q

risk in patient with isolated premature adrenarche(3)

A

PCOS
Diabete type 2
metabolic syndrome

659
Q

cause of premature adrenarche

A

early activation of adrenal androgen relaease

660
Q

characteristics premature (5)

A 
pubic hair
axillary hair
acne 
body odor  in girls
before 8 for girl before 9 for boy
661
Q

role of adipocytes during obesity(2)

A

increase secretion of insulin

increase secretion of leptin

662
Q

consequence of increased insulin secretion in obesity(2)

A

increase adrenal production—->periphera activation of adrenarche
increase ovarian estrogen production——->peripheral activation of thelarche

663
Q

consequence of leptin secretion in obesity

A

axctivation of the axis hypothalamus pituitary gonadal axis——->central activation of puberty—–> LH ans FSH release —>ovarian stimulation and estrogen production

664
Q

patient with reccurrent sinopulmonary infection with deceased IGA,IGM IGD and IGG absence circulating B cells Dx

A

bruton’s agammaglobulinemia

665
Q

transmission of Bruton agammaglobulinemia

A

X linked recessive

666
Q

differenciation between Bruton and common varable immunodeficiency(3)

A

CVID occurs later 15-35 ans
CVID no decrease or no absence of Lymphocytes B circulant
in CIVD all gender can be touched by the disease

667
Q

male 6-9 ans with recurrent sino pulmonary infection

A

Brutons agammaglobulinemia

668
Q

most common cause of neonatal jaundice

A

breastfeeding jaundice
breast milk jaundice
sepsis

669
Q

when to suspect neonatal sepsis(3)

A

fever or hypothermia
ictere
neurologic symptom

670
Q

patient with ictere and neurologic symptom and hypothermia next step(2)

A

PL

blood culture

671
Q

patient with ingestion battery plain xray shows battery in esophagus next step?

A

immediate endoscopic removal

672
Q

why you should remove battery in esophagus

A

to prevent mucosal damage and esophageal ulceration

673
Q

patient with ingestion battery plain xray shows battery in distal to esophagus next step?

A

observe stool

674
Q

newborn with failure to thrive,bilateral cataracts,jaundice and hypoglycemia DX

A

galactosemia

675
Q

whta to do after dx galactosemia

A

elimination of galactose in from the diet

676
Q

healthy infant crying for than three hours a day, more than three days a week and more than 3 weeks a month

A

colic

677
Q

rx of infantile colic

A

simethicone
or
probiotics

678
Q

steatorrhea in USMLE

A

oily and nasty smelling stools

679
Q

gold standard test for cystic fibrosis

A

swaet testing by quantitative pilocarpine iontophoresis

680
Q

why you can have ADEK deficiency in cystic fibrosis(2)

A

because of pancreatic insufficiency

no absorption of fat soluble vit

681
Q

consequence of ADEK deficiency

A

A=Night blindness
D=ricket
E=neuropathy
K=coagulapathy

682
Q

value of chloride to confirtm the DX of CF

A

> ou egal a 60 mmol /l on 2 separate occasions

683
Q

organ always involved in Cystic fibrosis(2)

A

respiratory tract
and
Pancreas

684
Q

problem in cystic fibrosis

A

defective chloride transport results in inpissated secretions in multiple organs

685
Q

clue for CF(3)

A

steatorrhea
failure to thrive
respiratory infections

686
Q

step in management of children after ingestion of oven cleaner liquid(4)

A

ABC assessment
remove contaminated clothing
chest xray if respiratory symptom
endoscopy within 24 hours

687
Q

when to perform upper endoscopy after alkali ingestion

A

within 24 hours

688
Q

risk for delay in performing upper endoscopy in alkali ingestion

A

risk of perforation during procedure

689
Q

quid of alkali ingestion

A

oven cleaner liquid

690
Q

complication of alkali ingestion(5)

A 
uppper airway compromise
perforation
stricture /stenosis(2-3 weeks)
ulcers
cancer
691
Q

what to not do if alkali ingestion

A

try to neutralize the alkali with vinegar or lavage

692
Q

symptom in reye syndrome and lab finging(6))

A 
vomiting
increased AST and ALT
PT prolonged 
Normal bilrubin
hyperammonemia
hypoglycemia
693
Q

context for reye syndrome

A

chil less than 15 years treated with salycilates after viral infection

694
Q

Ct scan in reye syndrome

A

cerebral edema

695
Q

viral infection and fever

A

no salycylates

696
Q

biopsy of liver in reye syndrome

A

microvesicular steatosis

697
Q

newborn with choking spell and coughing after first feeding

A

atresia oesophagienne with possible fistule tracheo esophagienne

698
Q

what will happen in attempting to pass a nasogastric tube in case of esophageal atresia

A

xray will show the tube in proximal esophageal pouch

699
Q

why you can have pneumonia par aspiration in esophageal atresia

A

gastric reflux can go into the distal esophagus through the fistula and into trhe trachea and lungs

700
Q

prenatl clue for osophageal atresia

A

polyhydramnios

701
Q

toddler with sudden onset respiratory istress bwith focal findings in auscultation

A

foreign body aspiration

702
Q

why chest xray is limited in foreihn body aspiration

A

because most object are radioluscent

703
Q

next step in foreign body aspiration

A

bronchoscopy

704
Q

most common aspirated foreign body*3)

A

peanuts
popcorn
pieces of toys

705
Q

physical exam in foreign body aspiration(2)

A

focal monophonis wheezing on affected side

diminished aeration on affected side

706
Q

gross motor in 2 months

A

lift head/chest in prone position

707
Q

gross motor in 4 months(12)

A

sits with trunk suppotrt

begins rolling

708
Q

gross motor in 6 months

A

sits momentarilypropped on hands( unsupported by 7 months)

709
Q

gross motor in 9 months(2)

A

pull to stand

cruises

710
Q

gross motor in 9 month(3)

A

stands well
walks first steps independently
throws ball

711
Q

fine motor in 2 months(2)

A

hands unfisted 50 % of the time

track past midline

712
Q

fine motor in 4 month(2)

A

hands mostly open

reaches midline

713
Q

fine motor in 6 month(2)

A

transfers objects hand to hand

raking grasp

714
Q

fine motor in 9 month(2)

A

3 finger pincer grasp

hold bottle or cup

715
Q

fine motor in 12 month

A

2 finger pincer grasp

716
Q

language in 2 month(2)

A

alerts to voice and sound

coos

717
Q

language in 4 month(2)

A

laughs

turn to voice

718
Q

language in 6 month(2)

A

responds to name

babble

719
Q

language in 9 month

A

say dada mama

720
Q

language in 12 month

A

say first words

721
Q

social cognitive in 2 months(2)

A

social smile

recognizes parents

722
Q

social cognitive in 4 months

A

enjoys looking around

723
Q

social cognitive in 6 months

A

stranger anxiety

724
Q

social cognitive in 9 months(2)

A

wave bye

plays pat a cake

725
Q

social cognitive in 12 months(2)

A

separation anxiety

comes when called

726
Q

what a 6 month baby can do(4)

A

should be able to sit momentarily
transfer objects from hand to hand
respond to name
stranger anxiety

727
Q

language development in 2 yo child(3)

A

vocabulary of hundred words
able to combine words into short sentences
half of the baby speech should be understood by stranger

728
Q

neonate with painless bloody stools dx

A

milk or soy protein proctocolitis

729
Q

what to do in soy protein proctocolits(2)

A

elimination of soy and dairy product in mama diet

initiation of hydrolysed formula in formula fed children

730
Q

symptoms of soy protein proctocolitis(3)

A

severe reflux or vomiting
painless bloody stools
eczema

731
Q

peak of apparition of soy protein proctocolits and prognosis(2)

A

2 a 8 semaines

resolution by age of one

732
Q

neonatal jaundice with conjugated bilirubinemia DX

A

neonatal cholestasis

733
Q

indication for further evaluation of jaundice(6)

A

conjugated hyperbilirubinemia > 2 mg/dl
jaundice that apperas in the first 24-36 hours of life
serum bilirubin greater than 12 mg/dl in full term infantor 10-14 in preterm infant
jaundice persist after 10-14 days of life
the presence of sign and symptom
serum bilirubin rising at a rate faster than 5 mg/24 hours

734
Q

cause of neonatal cholestasis in infant

A

biliary atresia

735
Q

quid of friedrich ataxia

A

the most common spinocerebellar ataxia

736
Q

triad of friedrich(3)

A

neurologic (atxia and dysarthria)
skeletal(scoliosis, foot deformities
cardiac(concentric hypertrophic cardiomyopathy)

737
Q

cause of death in friedrich(2)

A

cardiomyopathy
respiratory
failure

738
Q

speech difficulty in USMLE

A

dysartria

739
Q

hammer toe

A

friedrich

740
Q

quid of overlapping finger s in edwards

A

third and the 5 th overlaping the 4 th

741
Q

dx diffrentiel of flaccid pralysis in kid(3)

A

infant botulism
foodborne botulism
guillain barre syndrome

742
Q

pathogenis of infant botulism

A

ingestion of clostridium spores from environmental dust

743
Q

pathogenis of food borne botulism

A

ingestion of preformed C botuinum toxin

744
Q

pathogenis of Guillain barre syndrome

A

autoimmune peripheral nerve demyelination

745
Q

differentiate GBS and botulism(2)

A

descending flaccid paralysis in botulism

ascending flaccid paralysis in GBS

746
Q

rx of infant botulism

A

human derived botulism immune globulin

747
Q

rx of food borne botulism

A

equine derived botulism immune globulin

748
Q

rx of GBS

A

pooled human immune globulin

749
Q

clue for infant botulinism(4)

A

constpation
hypotonia
bulbar palsies
no honey feeding

750
Q

what to do in neonates in term of screening

A

hip dysplasia

751
Q

maneuver to screen hip dysplasia(2)

A

barlow
and
‘orthelani

752
Q

next step if you feel palpable clunk during maneuvers in screening of hip dysplasia

A

referral to orthopedic surgeon

753
Q

hip dysplasia suspected soft click during barlow and orthelani or asymmetric inguinal skin folds or leg lenght discrepancy (2)

A

Ultrasound in < 6 mois

Xrays > ou egal a 4 a 6 mois

754
Q

rx of choice for hip dysplasia in kid >< 6 months

A

pavlik hip harness

755
Q

complication of hip discrepancy

A

limp=trndelenburg gait

756
Q

risk in supracondylar fracture

A

brachial artery injury

757
Q

consequence of brachial artery injury

A

loss of radial artery pulse

758
Q

what to in household with one person with pertussis even if the contact has received immunizations

A

prescribe macrolide antibiotic for all households contacts

759
Q

pertussis rx and post exposure prophylaxis in person < 1 an

A

azytromycin for 5 days

760
Q

pertussis rx and post exposure prophylaxis in person > 1 an(3)

A

azytromycin for 5 days
clarythromycin for 7 days
erythromycin for 14 days

761
Q

basics in post exposure prophylaxis for pertussis(3)

A

rx regardless of age
statut immunitaire
symptoms

762
Q

clue for nursemaid’s elbow

A

infants or children whenare lifted or pulled by the hand or arm you have rasdial head subluxation

763
Q

clue for nursemaids elbow

A

child keeps hand in a pronated position and refuses attempted forearm supination

764
Q

clue for fragile X syndrome(6)

A 
low to normal IQ
generalised language disability
short attention span large head
prominent jaw
large low set ears 
macroorchidism
765
Q

cause of mental retardation in fragile X syndrome

A

increased number of CGG trinucleotide repeats

766
Q

overweight adolescent 10-16 yo with hip pain dx

A

slipped capital femoral epiphysis

767
Q

rx of slipped femoral capital epiphysis

A

immediate surgical screw fixation

768
Q

complication untreated slipped capital femoral epiphysis

A

avascular necrosis

769
Q

xray slipped capital femoral epiphysis

A

glissement du reste de la tete humeral asur l’epiphyse

770
Q

xray slipped legg calve

A

lyse of the head of femur

771
Q

developmental milestone in child by age of 12 months(6)

A 
they should triple weight
height should be increased by 50%
walk  independently
using 2 pincre grasps
saying few words like mama dada 
imitate action of others
772
Q

Ct scan finding in congenital toxo(3)

A

inflammatory lesions
hydrocephalus
intracranial calcificaions

773
Q

triad for congenital toxo(3)

A

chorioretinitis
hydrocephalus
intracranial calcifications

774
Q

clue for von gierke(8)

A 
hypoglycemia
lactic acidosis
hyperuricemia
hyperlipidemia
doll like facies
thin extremities
short stature
protuberant abdomen
775
Q

Age for von gierke

A

3 -4 month

776
Q

why seizure in von gierke

A

hypoglycemia

777
Q

why protuberant abdomen in von gierke (*2)

A

enlarged liver
and
kidney

778
Q

physiopatho for von gierke

A

glucose 6 phosphatase deficiency

779
Q

quid of von gierke

A

type 1 collagen storage disease

780
Q

what to do if apgar is 8 in infant (3)

A

removal of airway secretions
drying and keeping him warm
early preventive measures

781
Q

first thing to do in neonates

A

APGAR calculation

782
Q

quid of early preventives measure in newborn(2)

A

gonococcal ophtalmia prevention

vit K supplementation

783
Q

first step in children with speech delay

A

audiology evaluation

784
Q

confirmatory test for SLE(2)

A

anti SM

anti DsDNA

785
Q

risk factor for pyloric stenosis(3)

A

first born boy
erythromycin
formula feeding

786
Q

why peak of incidence of infantile hypertrophic pyloric stenosis

A

age 3-5 weeks

787
Q

dx of pyloric stenosis clinic(2)

A

projectile nonbilious vomiting

olived shaped presentation

788
Q

lab finding in infantile pyloric stenosis

A

hypochloremic metabolic alkalosis

789
Q

paraclinic dx in infantile pyloric stenosis

A

abdominal ultrasound

790
Q

finding in infantile pyloric stenosis

A

thick and elongated pylorus

791
Q

physiopatho of formula feeding inducing pyloric hypertrophy(2)

A

slower gastric emptying

increase burden stimulates growth of the pylorus muscle

792
Q

2 day baby with jaundice mother A positive and negative screening for GBS during pregnancy.lab show 7 mg/dl bilirubin with 0.4 conjugated bilirubin Dx

A

physiologic jaundice

793
Q

peak of incidence of physiologic jaundice

A

2-4 days of life

794
Q

resolution of physiologic jaundice

A

1-2 weeks

795
Q

physiopatho of physiologic jaundice(3)

A

increased bilirubin production due to high Hb turn over
decreased bilirubin clearance
increased enterohepatic cycling

796
Q

why in newborn you can have decreased bilirubin clearance

A

decreased hepaticuridine diphosphoglucuronate transferase activity until age 2 weeks

797
Q

why in asian newborn you can have decreased bilirubin clearance

A

Asian have decreased UGT activity

798
Q

why enterohepatic cycling is increased in new born

A

because sterile newborn gut

799
Q

possible complication of physiologic jaundice

A

kernicterus

800
Q

indication of exchange transfusion in physiologic jaundice

A

total bilirubin levels > 20-25 mg/dl

801
Q

phototherapy for physiologic jaundice

A

gold standard rx for rapidly increasing hyperbilirubinemia to prevent kernicterus

802
Q

quid of bitot spots

A

gray silver plaques on the bulbar conjunctiva

803
Q

manif of vit A deficiency(7)

A 
impaired adaptation to dryness
photophobia
dry scaly skin
xerosis conjonctiva
xerosis cornea
keratomalacia
bitot spots 
hyperkeratosis
804
Q

localization of hyperkeratosis in vit A deficiency(3)

A

shoulders
buttocks
extensor surfaces

805
Q

microscopy light finding in nephrotic syndrome

A

normal findings

806
Q

immunofluorescence finding in SN

A

no abnormality

807
Q

electron microcopy finding in SN

A

difuse effacement of foot process of podocytes

808
Q

quid of podocytes

A

renal epithelial cells

809
Q

kids seen with seizures EP reveals decreased muscle strength of the left side of the body with brisk deep tendon reflexes in the left arm and leg.MRI reveals space occupying lesions of the parietal lobe droit dx

A

benign astrocytoma

810
Q

the most common solid tumors in kids

A

CNS tumors

811
Q

the most common malignancy in kid

A

leukemia

812
Q

the second most common malignancy in kid

A

CNS tumor

813
Q

most common localization of CNS tumor

A

supratentorial

814
Q

the most common tumon which could be found infratentorial and supratentorial localization in kid

A

astrocytoma

815
Q

most common complication of E coli 0157h7

A

renal damage

816
Q

mortality in renal damage in HUS

A

5 a 10%

817
Q

the organ system with higher mortality and morbidity after HUS

A

kidneys

818
Q

complication of shoulder dystocia(5)

A 
fractured clavicle
fractured humerus
erb duchenne
klumpke paralysis
perinatal asphyxia
819
Q

clue for clavicular fracture in macrosome(4)

A

clavicular crepitus
bony irregularity
decreased Moro reflexe due to pain on affected side
intact biceps and grasp reflexes

820
Q

clue for humerus fracture in macrosome(4)

A

upper arm crepitus crepitus
bony irregularity
decreased Moro reflexe due to pain on affected side
intact biceps and grasp reflexes

821
Q

moro and biceps reflexes in erb duchenne

A

decreased on affected side

822
Q

clue for klumpke palsy(3)

A

claw hand
ipsilateral horner syndrome
intact moro and bicep reflexes

823
Q

claw hand in klumpke(4)

A

extended wrist
hyperextended metacarpophalangeal joints
fixed interphalangeal joints
absent grasp reflexes

824
Q

clue for horner syndrome(2)

A

ptosis

miosis

825
Q

manif of perinatal asphyxia(4)

A

altered mental status
poor tone
seizure
difficulte respiratoire

826
Q

nerve fibers involved in Klumpke(2)

A

c8

T1

827
Q

rx for klumpke(2)

A

controverse

physical therapy to prevent contracture

828
Q

klumpke with no improvement after 3-9 months

A

surgery

829
Q

clue for myotonic muscular dystrophy type 1(8)

A 
grip myotonia=delayed muscle relaxation
facial weakness
foot drop
dysphagia
cardiac conduction abnormalities
cataracts
testicular atrophy/infertility
baldness
830
Q

transmission of muscular dystrophy type 1

A

autosomal dominant

831
Q

other name of muscular dystrophy type 1

A

steinert disease

832
Q

why dysphagia is the most dangerous smooth muscle manif in steinert disease

A

because of risk of aspiration pneumonia

833
Q

reflexes in steinert disease

A

normal

834
Q

quid of sturge weber

A

neurocutaneous syndrome characterized by

congenital unilateral hemangioma along the trigeminal nerve

835
Q

xray in sturge weber

A

intracranial calcifications that resemble a tramline

836
Q

usual neurological symptom in sturge weber

A

seizures

837
Q

other neurological finding in sturge weber(4)

A

hemianopsia
hemiparesis
hemisensory disturbance
ipsilateral glaucoma

838
Q

skin problem in sturge weber

A

port wine stain or nevus flammeus along the trigeminal nerve

839
Q

rx of sturge weber

A

controlling seizures

reducing intraocclualr pressure

840
Q

how to remove skin lesions in sturge weber

A

argon laser

841
Q

7 yo boy with decreased urine output and lethargy and high creat and BUN appropriate next step in this patient

A

urinalysis

842
Q

first test to di in all patient with renal disease

A

urinalysis

843
Q

14 yo boy is seen in the clinic for fire setting in the neigbor’s house.months later he has been arrested by police for stealing,parents say one time he steals money and tries to hurt the pets dx

A

conduct disorder

844
Q

quid of conduct disorder

A

disruptive behavioral patterns that violate basic social norms for at least one year in patients less than 18 years

845
Q

19 yo boy is seen in the clinic for fire setting in the neigbor’s house.months later he has been arrested by police for stealing,parents say one timeone year he steals money and tries to hurt the pets dx

A

antisocial personality disorder

846
Q

5 year old boy born at home developed bruises and prolonged PT> 15 cause of that

A

vit K deficiency

847
Q

origin of vit K in the body(2)

A

gut flora

diet

848
Q

why can you have Vit K deficiency in baby(3)

A

poor placental transfer
absent gut flora
inadequate levels in breast milk

849
Q

what to do to avoid hemorrhagic disease of newborn

A

all new born babies must receive vit K injection

850
Q

mild vit K deficiency

A

prolonged PT

normal PTT

851
Q

barking cough in patient less than 3 years hoarseness and varying degree of respiratory distress DX

A

croup

852
Q

lateral neck xray in croup

A

subglottic narrowing

853
Q

bug causing croup

A

parainfluenza virus

854
Q

quid of chickenpox

A

varicella

855
Q

Manif in chicken pox

A

pruritic vesicles appearing in different stages across the face and the body and usually fully crusted within a week

856
Q

child > ou egal a 1 an asymptomatic who never received varicella vaccine is exposed to chickenpox what to do

A

administer varicella vaccine

857
Q

contagiosity in chikenpox

A

patient is contagious 2 days prior to rash

858
Q

child > ou egal a 1 an immunodeprime asymptomatic who never received varicella vaccine is exposed to chickenpox what to do

A

givevaricella zoster immunoglobulin

859
Q

physical examination in beckwith wiedemann syndrome(6)

A 
fetal macrosomia during delivery
rapid growth until late childhood
omphalocele or ombilical hernia
macroglossia
hemihyperplasia
hypoglycemia
860
Q

complications of beckwith wiedmann(2)

A

wilms tumor

hepatoblastoma

861
Q

surveillance in beckwith wiedmann

A

serum alpha fetoprotein

abdominal and renal ultrasound

862
Q

serum alpha protein surveillance of beckwith wiedman

A

every 3 months from birth to 4 years for

863
Q

abdominal ultrasound in surveillance ofbeckwith wiedman

A

every 3 months from age 4-8

864
Q

renal ultrasound surveillance in beckwith wiedmann

A

from age 8 years to adolescent

865
Q

patient who is particular at risk for hepatoblastoma or wilms tumor in wiedmann beckwith

A

patient with hemihyperplasia

866
Q

example of hemihyperplasia

A

right upper and lower extremities are significantly larger in circumference than the left extremities

867
Q

pathogenesis of wiedman beckwith

A

deregulation of imprinted gene expression in chromosome 11p15

868
Q

quid of parinaud syndrome

A

paralysis of vertical gaze =paralysis of downward and upward gaze

869
Q

quid of collier sign

A

poor pupillary reaction to light and eyelid retraction

870
Q

meaning of parinaud syndrome and collier’s sign

A

rostral midbrain lesion

871
Q

cause of rostral midbrain lesion(2)

A

germinoma

pinealoma

872
Q

why you can have development of dark facial hair ,deeping voice and rapid croissance in lesion pinealoma(2)

A

interruption of hypothalamic inhibiting pathways

bhcg secretion and consequent leydig’s cells stimulation

873
Q

why eye problem in pinealoma

A

the lesion is located at the level of superior colliculus and CN3

874
Q

patient with multiple skin infection and recurrent pneumonia.In the last bout of skin infection cultures of secretions reveals S aureus Dx probable

A

CGD

875
Q

problem in CGD(2)

A

impaired metabolism within phagocytes

a mutation causes loss or inactivation of the NADPH oxidase responsible for oxydation

876
Q

main pathogenesis in CGD

A

intracellular killing deficiency

877
Q

clue for CGD

A

gram stain of fluid aspirated from the affected lymph nodes reveals numerous bacteria filled segmented neutrophils

878
Q

most common infection in CGD(2)

A

pneumonia

suppurative adenitis

879
Q

5 yo Mexican girl is seen for nocturnal vulvar itching next step

A

do a scotch tape test

880
Q

5 yo Mexican girl is seen for nocturnal vulvar itching dx

A

pinworms infection

881
Q

rx of pinworms

A

mebendazole

882
Q

clue for ombilcal hernia(2)

A

abdominal swelling

more pronounced when crying or coughing

883
Q

3 yo girl with ombilical hernia next step

A

refer to pediatric surgeon for operative management

884
Q

indication of surgery in ombilical hernia(5)

A 
persistence to the age of 3 and 4 years
exceeds 2 cm in diameter
causes symptom
becomes strangulated
progressively enlarges after the age 1 and 2 years
885
Q

evolution of ombilical hernia

A

disappear spontaneously by age of 1

886
Q

patient with severe coughing develops subcutaneous emphysema over the anterior chest most appropriate next step

A

chest xray

887
Q

why chest xray in case of emphysema secondary to severe coughing

A

to rule out pneumothorax

888
Q

patient newborn seen with mild atrophy of the calf,clcaneum and talus are in equinus and varus positions his midfoot is in varus position and his forefoot in adduction dorsiflexion and plantar flexion is limited dx

A

club foot

889
Q

management of clubfoot(3)

A

stretching
manipulation of the foot
followed by serial plaster casts

890
Q

indication of surgery in clubfoot(2)

A

failure in conservative management

surgery is performed within 3 and 6 months of age

891
Q

why polycythemia in small gestational age

A

increased erythropoietin secretion in response to fetal hypoxia

892
Q

rx of Lyme disease in children less than 8 years

A

oral amox

893
Q

anal pruritis in kid dx

A

enterovermicularis infection

894
Q

rx of enterovermicularis infection(2)

A

albendazole/mebendazole
or
pyrantel pamoate

895
Q

dx of enterovermicularis infection

A

scotch tape

896
Q

the most common causes of viral meningitis(2)

A

echoviruses

coxsakievirus

897
Q

brudzinsky ????????

A

you flexe the neck lower leds are flexed too

898
Q

quid of non-polio viruses

A

echoviruses

coxsakievirus

899
Q

clue for meningococcal meningitis(3)

A

fever
neurologic finding
petechial or purpuric rash

900
Q

most common cause of neonatal sepsis

A

GBS

901
Q

prevention of GBS(2)

A

maternal testing and

rx with intrapartum IV antibiotics

902
Q

antibio used in prevention of GBS sepsis

A

PNC

Step 2 CK (primary set) (22 decks)

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