Pediatrics

Question 1

What are the important elements of the newborn exam?

Answer 1

• Red reflex
• Fontanelles
• Primitive reflexes
• Hips: Barlow & Ortolani manoeuvres
• Spine
• Genitalia
• Measurements

Question 2

What are the components of the Apgar score?

Answer 2

A = Apparence (coloration)

P = Pouls (fréquence cardiaque)

G = Grimace (réactivité aux stimuli)

A = Activité (tonus musculaire)

R = Respiration (efforts respiratoires)

Question 3

What Apgar score is worrisome?

Answer 3

7 and under

Question 4

What are the short-term complications of prematurity?

Answer 4

• Hypothermia
• Respiratory abnormalities: respiratory distress syndrome (RDS), bronchopulmonary dysplasia, apnea and pulmonary hemorrhage
• Cardiovascular abnormalities: patent ductus arteriosus (PDA) and systemic hypotension
• Intraventricular hemorrhage
• Glucose abnormalities: hypo or hyper
• Necrotizing enterocolitis (NEC)
• Infection
• Retinopathy or prematurity

Question 5

• 3 day old premature baby
• Poor feeding
• Abdominal distension
• Blood in stools

What’s your diagnosis?

Answer 5

Necrotizing enterocolitis (NEC)

Question 6

You suspect foreign body aspiration in a child. He has an EXPIRATORY wheeze. Where is the object?

Answer 6

Intrathoracic

Question 7

A baby tastes like salt. What’s your diangosis?

Answer 7

Cystic Fibrosis

Question 8

What is the medication for absence seizures?

Answer 8

Ethosuximide

Question 9

What are the characteristics of a simple febrile seizure?

Answer 9

1. Only one in 24 hours
2. Short (< 15 minutes)
3. Generalized

Question 10

How do you treat simple febrile seizure?

Answer 10

1. Benzodiazepine if actively seizing
2. Acetaminophen
   * *NEVER GIVE NSAIDS BECAUSE IT CAN CAUSE REYE’S SYNDROME**

Question 11

What is the hallmak of atrial septal defect on physical exam?

Answer 11

Fixed Split S₂

Question 12

What is the hallmak of patent ductus arteriosus on physical exam?

Answer 12

Continuous machine-like murmur (multiphasic)

Question 13

How do we call a left to right shunt that becomes a right to left shunt?

Answer 13

Eissenminger’s syndrome

Question 14

What are the types of left to right shunts seen in children?

Answer 14

L –> R = D

1. Atrial Septal Defect
2. Ventricular Septal Defect
3. Patent Ductus Arteriosus

Question 15

What are the types of right to left shunts seen in children?

Answer 15

R –> L = T

1. Transposition of the great vessels
2. Tetralogy of Fallot

Question 16

What are the elements of the tetralogy of Fallot?

Answer 16

1. VSD
2. Overriding aorta
3. Pulmonic stenosis
4. Right ventricular hypertrophy

Question 17

Clicking hip at birth and at 4 weeks, what’s your diagnosis?

Answer 17

Developmental hip dysplagia (DHD)

Question 18

Insidious onset of antalgic gait in a 6 y/o, what’s your diagnosis?

Answer 18

Legg Calve Perthes disease: Osteonecrosis (avascular necrosis of bone)

Question 19

13 y/o fat boy with hip pain, what’s your diagnosis?

Answer 19

Slipped Capital Femoral Epiphyis (SCFE)

Question 20

Hip pain of a 10 y/o post viral illness, what’s your diagnosis?

Answer 20

Transient synovitis (self-limited)

Question 21

Teenage athlete with knee pain and tibial swelling, what’s your diagnosis?

Answer 21

Osgood-Schlatter disease (osteochondritis of the tibial tubercle)

Question 22

Unilateral focal atraumatic bone pain in a child, what do you suspect?

Answer 22

Ewing’s sarcoma or Osteosarcoma

Question 23

What are the possible causes of neonatal conjunctivitis?

Answer 23

1. Chemical (silver nitrate) ⇒ we use topical erythromycin now
2. Gonnorhea ⇒ erythromycin prevents it
3. Chlamydia ⇒ oral
4. HSV
5. Baterial

Question 24

Absent red light reflex in a new born (white in the back of the eye), what’s your diagnosis?

Answer 24

Retinoblastoma

Question 25

You see a child with Salmonella osteomyelitis, what’s the underlying diagnosis?

Answer 25

Sickle Cell disease

Explanation: the sickle cells block capillaries ⇒ ischemia of the bone ⇒ opportunistic infections

Question 26

• Wide-spaced eyes
• Low-set ears
• Absent thymic shadow
• Small face
• Recurrent fungi and PCP infections

What’s your diagnosis?

Answer 26

DiGeorge Syndrome (22q11.2 deletion ⇒ T-cell disease)