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Kaplan Shelf prep > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

APGAR Scoring

A 
Appearance 
Pulse
Grimace
Activity 
Respiration
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2
Q

1point on APGAR means

A 
A- Pale blue extremities 
P- <100/min
G- grimace on suction/stimulation 
A- some flexion
R- irregular, shallow gasps
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3
Q

2 points on APGAR means:

A 
A- pink
P- > 100
G- cry on stimulation
A- flexion that resists extension 
R- robust crying
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4
Q

What does the one minute APGAR Score tell?

A

How labor was tolerated by the newborn

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5
Q

5 mins APGAR score tells …….

A

Response of the newborn to resuscitation

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6
Q

Moro response on a LGA (Large gestational age) newborn: R arm remains limply adducted, medially rotated.

Diagnosis?

A

Erb- Duchenne palsy (C5-C6)

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7
Q

Moro response on a LGA (Large gestational age) newborn: R arm remains limply adducted, medially rotated.

Management?

A
  • Physical therapy

- Surgery for severe cases

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8
Q

Paralysis of newborn hand +/- Horner syndrome

A

Klumpke palsy (C7 - C8 + T1)

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9
Q

Palpate the clavicle on LGA newborn- Crepitus and discontinuity on L.

Diagnosis?

A

Clavicular fracture

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10
Q

In a newborn: edema crosses suture lines

A

Caput succedaneum

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11
Q

In a newborn:
Fluctuance does not cross suture lines.

Diagnosis?

A

Cephalohematoma

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12
Q

Lacy, reticulated vascular pattern over most of body when baby is cooled; improves over first month; abnormal if persists

Diagnosis?

A

Cutis marmorata

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13
Q

White papules, retention of keratin and sebum in hair follicles

Diagnosis?

A

Milia

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14
Q

Inflammatory papules and pustules

Diagnosis?

A

Neonatal acne

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15
Q

Pale, pink vascular macules; found in nuchal area, glabella, eyelids; usually disappears

Diagnosis?

A

Salmon patch (Nevus simplex)

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16
Q

Blue to slate-gray macules; seen on presacral, back, posterior thighs; > in on white infants; arrested melanocytes; usually fade over first few years;

Diagnosis? And differential?

A

Mongolian spots

Child abuse

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17
Q

Firm, yellow-white papules/pustules with erythematous base; peaks on second day of life; contains eosinophils; benign

A

Erythema toxicum neonatorum

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18
Q

Vomiting,seizures, developmental delay (1st few months), intellectual disability + fair hair, eyes, skin, musty smell

Diagnosis?

A

Phenylketonuria

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19
Q

Jaundice, vomiting, HSM, FTT, poor feeding+ liver dysfunction, susceptibility to infection/ sepsis (E.coli), cataracts

Most common deficiency?

A

Galactose-1-phosphate uridyl transferase (GALT)

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20
Q

Diseases screened in new born: 8

A 
Phenylketonuria 
Galactosemia
Cystic fibrosis 
Hypothyroidism 
21- hydroxylase deficiency 
Tyrosinemia
Hb SS
Hb C
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21
Q

Thick, yellow/white oily scale on inflammatory base

Management ?

A

Gently clean with mild shampoo (seborrheic dermatitis)

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22
Q

Area of alopecia, with orange-colored modular skin

Management?

A

Remove before adolescence (nevus sebaceous)

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23
Q

5 advantages of breast milk

A
  • maternal-infant bonding
  • premixed, right temperature and concentration
  • less diarrhea, intestinal hemorrhage, chronic illnesses later in life
  • maternal weight loss and faster return of uterus to preconception size
  • decreased allergies accompanied to formula fed
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24
Q

Holds head steadily; rolls from prime to supine; coos

Age?

A

4 months

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25
Q

Sits with support (tripod); unilateral reach; transfers object; recognizes that someone is a stranger

Age?

A

6 month

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26
Q

“Mama”, “dada”; crawls well; pulls to stand; immature pincer grasp;

Age?

A

9 months

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27
Q

50 words; 2-word sentences; follows 2-step commands; parallel play

Age?

A

24 months

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28
Q

Alternates feet going up the stairs; pedals tricycle; >/= 250 words; 3 word sentences; group play;

Age?

A

3 years

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29
Q

Hops and skips; dresses completely; knows colors; play cooperatively

Age?

A

4 years

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30
Q

Prints first name; asks what a word means; knows alphabet; skips alternating feet; abides by rules

Age?

A

5 years

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31
Q

Infant ______ birth weight by 6 months and _______ by 1 year

A

Doubles

Triples

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32
Q

Bone age=chronological age

Normal cause

A

Ideal

Genetic (familial) short stature

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33
Q

Bone age= chronological age

Abnormal cause?

A
  • Genetic

- Chromosomal

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34
Q

Bone age < chronological age

Normal cause?

A

Constitutional delay

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35
Q

Bone age < chronological age

Abnormal cause?

A
  • chronic systemic disease

- endocrine related

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36
Q

Bone age > chronological age

Normal cause?

A

Obesity (tall)

Familiar tall stature

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37
Q

Bone age > chronological age

Abnormal cause?

A
  • precocious puberty
  • congenital adrenal hyperplasia
  • hyperthyroidism
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38
Q

Immunization at birth?

A

HepB

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39
Q

Immunization at 2,4 and 6 months?

A

HepB, DTaP, Hib, PCV13, IPV

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40
Q

Immunization at 6 months and then yearly?

A

Influenza

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41
Q

Immunization at 12 months ?

A

MMR, Varicella HepA

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42
Q

Immunization at 4-6 yrs (before start of school)?

A

DTaP, IPV, MMR, Varicella

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43
Q

Immunization at 12 years?

A

Tdap, HPV, meningococcal meningitis

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44
Q

Upward slanting palpebral fissures; inner epicanthal folds; single palmar crease; hypotonia; hearing loss

Diagnosis?

A

Down syndrome (trisomy 21)

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45
Q

Most common cardiac anomalies seen in Down syndrome

A

Endocardial cushion deficiency

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46
Q

Most common cancer seen in Down syndrome

A

Acute lymphocytic leukemia

AML if in the first 3 yrs of life

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47
Q

Low-set, malformed ears, microcephaly, micrognathia, prominent occiput, clenched hands, rocker bottom feet, omphalocele.

Diagnosis?

A

Edwards syndrome (trisomy 18)

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48
Q

Holoprosencephaly, microcephaly, microphthalmia, cutis aplasia, single umbilical artery, severe cleft lip, palate, or both

Diagnosis?

A

Patau syndrome (trisomy 13)

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49
Q

Hypogonadism and hypogenitaliam; long limbs; decreased IQ; most common findings manifest at puberty

Diagnosis?

A

Klinefelter syndrome (XXY)

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50
Q

Large ears, dysmorphic facial features, large jaw, long face, intellectual disability, large testes

Diagnosis?

A

Fragile X syndrome

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51
Q

Macrosomia, macroglossia, pancreatic B cell hyperplasia, omphalocele

Diagnosis?

A

Beckwith- Wiedemann syndrome

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52
Q

Cafe at lait spots, soft tumors on nerves, seizures, CNS tumors, bone lesions

A

Neurofibromatosis

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53
Q

Micrognathia, retroglossia, cleft soft palate, associated with FAS or Edward’s

Diagnosis?

A

Pierre Robin sequence

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54
Q

Obesity, small puffy hands and feet, small genitalia, intellectual disability, hypothalamic-pituitary dysfunction

Diagnosis?

A

Angelman syndrome (happy puppet syndrome)

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55
Q

Short palpebral fissure, maxillary hypoplasia, short and smooth philtrum-vermillion border, symmetric IUGR

A

Fetal Alcohol Syndrome

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56
Q

When is hyperbilirubinemia pathologic?

A
  • appears on 1st day of life
  • Bili > 19.5mg/do (term baby)
  • Bili increases >5mg/dL/day
  • direct bili > 2 mg/dL (any time)
  • persists beyond 2nd week of life
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57
Q

Newborn- Hypoxemia then hypercarbia, respiratory acidosis, ground-glass appearance, air bronchogram

Management?

A

Oxygen then intubation then exogenous surfactant (respiratory distress syndrome)

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58
Q

Tachypnea after birth, slow absorption of fetal lung fluid

Best test and what are the findings?

A

CXR

Air trapping, fluid in fissures, perihilar streaking

(Transient tachypnea of the new born

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59
Q

Pulmonary hypoplasia, respiratory distress, scaphoid abdomen, bowel sounds in chest

Best test to confirm diagnosis?

A

CXR (diaphragmatic hernia)

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60
Q

Infant (<28 days) with fever > 100.4 F =? Until proven otherwise

A

Sepsis

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61
Q

Most common pathogens associated with sepsis

A

Group B strep
E.coli
Listeria monocytogenes

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62
Q

Empiric treatment when suspicious of sepsis in a newborn

A

Ampicillin + Gentamicin x 48

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63
Q

Sepsis in neonates + meningitis suspected?

A

Cefotaxime + ampicillin

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64
Q

TORCH meaning?

A 
Toxoplasmosis 
Others - syphilis, varicella, HIV, parvovirus B19
Rubella
CMV
Herpes
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65
Q

Maculopapular rash (palms+ soles), snuffles, periostitis, chorioretinitis

Diagnosis?

A

Congenital syphilis

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66
Q

Maculopapular rash (palms+ soles), snuffles, periostitis, chorioretinitis

Treatment?

A

Penicillin

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67
Q

Hydrocephalus, intracranial calcifications, chorioretinitis in neonates

Diagnosis

A

Toxoplasmosis

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68
Q

Hydrocephalus, intracranial calcifications, chorioretinitis in neonates

Treatment?

A

Pyrimethamine, sulfadiazine, leucovorin

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69
Q

Hydrocephalus, intracranial calcifications, chorioretinitis in neonates

Prevention?

A

Mother should not change at little

Spiramycin to decrease transmission

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70
Q

Cataracts, deafness, cardiac defects (PDA, VSD, etc), extra medullary hematopoiesis (“blueberry muffin spots”)

Diagnosis?

A

Rubella

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71
Q

Microcephaly, IUGR, periventricular calcification, decrease platelets, petechiae

Diagnosis?

A

Cytomegalovirus

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72
Q

Microcephaly, IUGR, periventricular calcification, decrease platelets, petechiae

Treatment?

A

Ganciclovir

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73
Q

Limb hypoplasia, scars, cataracts, chorioretinitis, cortical atrophy

Diagnosis?

A

Congenital varicella

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74
Q

Fever, seizure, bulging anterior fontanelle; mom has vesicles on perineum

Diagnosis ?

A

Congenital herpes simplex

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75
Q

1-3 DOL (day of Life): red conjunctivae, tearing

Diagnosis?

A

Chemical conjunctivitis

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76
Q

3-5 DOL: purulent conjunctivitis leading to corneal ulceration

Diagnosis?

A

Gonococcal conjunctivitis

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77
Q

3-5 DOL: purulent conjunctivitis leading to corneal ulceration

Treatment ?

A

IM ceftriaxone + saline irrigation

Gonococcal conjunctivitis

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78
Q

7-14 DOL: red tarsal conjunctivitis with mucoid discharge, lid swelling

Diagnosis?

A

Chlamydia conjunctivitis

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79
Q

7-14 DOL: red tarsal conjunctivitis with mucoid discharge, lid swelling

Treatment?

A

Erythromycin + saline irrigation

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80
Q

Early, systolic, soft, vibratory/ musical, heard best at lower sternum

A

Still’s murmur

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81
Q

Continuous murmur heard best in anterior neck which disappears when jugular vein is compressed

Diagnosis?

A

Venous hum

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82
Q

When is a murmur not benign

A

Diastolic murmur, holosystolic murmur, > II/VI, harsh or blowing quality

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83
Q

Common cyanotic heart diseases? 5 T’s

A 
Tetralogy of fallot
Truncus arteriosus
Tricuspid atresia
Transposition of Great vessels
Total anomalous pulmonary venous return
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84
Q

CXR: “egg on a string” appearance
Loud, single S2
PDA closes leads to cyanosis, tachypnea

Diagnosis?

A

Transposition of the Great arteries

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85
Q

Components of tetralogy of fallot

A
  • pulmonary stenosis and infundibular stenosis (obstructed RV outflow)
  • VSD
  • Overriding aorta (overrides VSD)
  • Right ventricular hypertrophy
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86
Q

Bipolar mom gives birth to infant with holosystolic murmur c/w tricuspid regurgitation

Diagnosis?

A

Ebstein anomaly

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87
Q

Newborn: continuous machine-like murmur, bounding pulses, wide pulse pressure

Diagnosis?

A

Patent ductus arteriosus

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88
Q

Infant with normal brachial pulses, weak femoral pulses, rib notching on CXR

Diagnosis?

A

Coarctation of the aorta

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89
Q

ASD: what do you hear on heart auscultation?

A

Loud S1, fixed Split S2

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90
Q

VSD: what do you hear on heart auscultation?

Diagnosis?

A

Holosystolic murmur among the LLSB with a palpable thrill

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91
Q

When is surgery indicated for VSD?

A

FTT in first year, pulmonary hypertension, pulmonary blood flow X2 systemic blood flow

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92
Q

15 y.o. athlete suddenly collapses on the football field

Management?

A

BB or CCB

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93
Q

6 y.o. female w/severe joint pain (elbows, wrists), fever x 1 week, sore throat 1 month ago, exam reveals new murmur

Diagnosis?

A

Acute rheumatic fever

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94
Q

Newborn Caucasian mail fails to pass meconium in first 24 hrs of life. Diagnostic test?

A

Sweat chloride test

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95
Q

Respiratory infection in cystic fibrosis:
Early-
Then-
Later-

A

Nontypeable H. influenza and S. aureus
Then colonization with P. aeruginosa
Later colonization with Burkholderia cepacia

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96
Q

Failure of umbilical ring closure in an infants

Diagnosis?

A

Umbilical hernia

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97
Q

Management of small umbilical hernia in an infant

A

Watch and wait- resolves in 1-2 years without treatment

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98
Q

When should surgery be considered for umbilical hernia?

A
  • enlarging after 1-2 years
  • symptoms (strangulation, incarceration)
  • persistent after age 4 years
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99
Q

Defect in abdominal wall with bowel outside laterally with no sac; high maternal AFP; not usually associated with other disorders

Diagnosis?

A

Gastroschisis

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100
Q

Bowel midline outside the abdominal cavity in a sac; associated with other disorders

Diagnosis?

A

Omphalocele

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101
Q

4- weeks old non-bilious vomiting + palpable “olive”

Diagnosis?

A

Pyloric stenosis

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102
Q

2- wk old w/ bilious vomiting (polyhydramnios in pregnancy)

Diagnosis?

A

Intestinal atresia (annular pancreas)

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103
Q

Premature infant presents with bloody stools, apnea, lethargy and abdominal distention (after perforation)

Diagnosis?

A

Necrotizing enterocolitis

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104
Q

Pathognomic finding on X-ray for necrotizing enterocolitis is

A

Pneumatosis intestinalis ( air in bowel wall)

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105
Q

Premature infant presents with bloody stools, apnea, lethargy and abdominal distention (after perforation)

Management?

A

Cessation of feeds
Gut decompression
Systemic antibiotics
Supportive care

106
Q

6-12 months old; colicky abdominal pain, currant jelly stool, sausage shaped palpable mass in RUQ

Diagnosis and treatment?

A

Intussusception

Barium or air enema, surgery if recurs

107
Q

Bright red blood per rectum (BRBPR) +/- RUQ (mimics appendicitis)

Diagnostic test?

A

Technetium scan

Meckel’s diveriticulum

108
Q

12 years old Male presents with edema,
HTN, hematuria with colored urine, reports diagnosis of impetigo 1 month ago. U/A shows dysmorphic RBCs + RBC casts

Renal biopsy reveals?

A

Lumpy-bumpy Ig and complement deposits on GBM

109
Q

12 y.o. Male wi th bloody urine; U /A shows dysmorphic RBCs +RBC casts + just started runny nose, sore throat and cough yesterday

A

IgA nephropathy (Berger’s disease)

110
Q

12 y.o. Male wi th bloody urine; U /A shows dysmorphic RBCs +RBC casts + has hemoptysis

Diagnosis?

A

Anti-GBM Antibody disease (Goodpasture’s)

111
Q

12 y.o. Male wi th bloody urine; U /A shows dysmorphic RBCs +RBC casts + bilateral sensorineural hearing loss + ocular abnormality

A

Alport’s syndrome (hereditary nephritis)

112
Q

What mutation is seen in Alport syndrome?

A

Genes encoding for type IV collagen

113
Q

Kidney stones <5mm

Management?

A

Hydrate- most pass spontaneously

114
Q

Stones 5mm- 2cm

Management?

A

Extracorporeal shock wave therapy)

115
Q

Stones > 2 cm

A

Endoscopic or open surgical removal

116
Q

> 3.5g protein/ 24hrs., hypoalbunimemia, edema, hyperlipidemia (fatty/ waxy casts)

Most common cause in children?

A

Minimal change disease

117
Q

Electron microscopy of minimal change disease shows?

A

Foot process fusion (effacement)

118
Q

Newborn Male, no palpable testes

Diagnosis?

A

Cryptorchidism

119
Q

Newborn Male, no palpable testes

Next best test?

A

Ultrasound

120
Q

Newborn Male, ventral urethral opening

A

Hypospadias

121
Q

Newborn Male, ventral urethral opening

Contraindication

A

Circumcision

122
Q

Newborn w/ ambiguous genitalia at 1 mo with vomiting, decreased Na, increased potassium, acidosis

Diagnosis?

A

Congenital adrenal hyperplasia

123
Q

Newborn w/ ambiguous genitalia at 1 mo with vomiting, decreased Na, increased potassium, acidosis

What is deficient?

A

21-hydroxylase

124
Q

Newborn w/ ambiguous genitalia at 1 mo with vomiting, decreased Na, increased potassium, acidosis

Definitive test

A

17- OH progesterone before and after ACTH bolus

125
Q

Newborn w/ ambiguous genitalia at 1 mo with vomiting, decreased Na, increased potassium, acidosis

Treatment?

A

Hydrocortisone + fludrocortisone

126
Q

Teenage boy, Acute pain, swelling, tenderness, testicle in transverse lie

Diagnostic test?

A

Doppler color flow ultrasound

127
Q

Acute painful scrotal swelling in sexually active male;

A

Epididymitis

128
Q

Palpable, hard mass, does not trans-illuminate, usually painless

A

Testicular tumors

129
Q

Pharmacotherapy for primary enuresis?

A

Oral desmopressin (DDAVP)

130
Q

9.5 lb. newborn, jittery, ruddy with heart murmur

A

Infant of a diabetic mother

131
Q

Metabolic abnormalities seen in infants of a diabetic mother

A

Hypoglycemia, hypocalcemia, hypomagnesemia

132
Q

12 y.o. female w/ vomiting, wt. loss over the last month despite polyphagia and polydipsia + polyuria

Most likely diagnosis?

A

Type 1 DM

133
Q

First line management of diabetic keto acidosis

A

IVF + insulin drip

134
Q

Diagnosis of DM 1 made by symptoms + elevated glucose

FBG ?
2hrs OGTT ?
Random BG ?

A

FBG > 126
OGTT > 200 after 2hrs
RBG > 200

135
Q

Renal threshold for glucose reabsorption =?

A

180mg/dL

136
Q

In DM 1, there are antibodies against ________, __________, _________ or ________

A

Insulin, glutamine acid decarboxylase, tyrosine phosphatase or zinc transporter 8

137
Q

8 y.o. African American boy w/ fever, chest pain, SOB, wheezing, hypoxemia

A

Acute chest syndrome (sickle cell disease)

138
Q

In sickle cell disease blood smear shows what?

A

Sickled cells, increased reticulocytes, Howell jolly bodies (nuclear remnants), targets cells (Hb SC)

139
Q

How do you monitor for risk of stroke in a patient with sickle cell disease?

A

Transcranial doppler

140
Q

Progressive decrease in Hb over first 2-3 months (to Hb of 9-11g/dL)

A

Physiologic anemia of infancy

141
Q

18 mo- old female “picky eater” who drinks a lot of cow’s milk, Hb = 6.5 g/dL, Hct = 20%, MCV = 65fL

A

Iron deficiency anemia

142
Q

Iron study changes seen in iron deficiency anemia

A

Decrease ferritin, increase TIBC

143
Q

Short stature, craniofacial deformities, upper extremities defects (triphalangeal thumbs), profound anemia by 2-6 mos is consistent with

A

Blackfan-Diamond

144
Q

18 mos old w/ pancytopenia, cafe-au-lait spots, microcephaly and absent thumbs

Most likely diagnosis?

A

Fanconi anemia

145
Q

2 y.o. w/ hyperactivity, impaired growth, abdominal pain, constipation, microcytic, hypochromic anemia, basophilic stippling of RBCs

Most likely diagnosis?

A

Lead poisoning

146
Q

Treatment of lead poisoning

A

Chelation

147
Q

4 y.o. w/petechiae, purpura, and excessive bleeding from oral mucosa

A

Immune thrombocytopenic purpura

148
Q

15 y.o. female w/ heavy menses, petechiae but normal plts, increased bleeding time, prolonged PTT

Most likely diagnosis?

A

von Willebrand disease

149
Q

Treatment of von willebrand disease

A

DDAVP, vWF replacement

150
Q

1 week old born at home with bleeding from umbilical stump

Likely diagnosis?

A

Vit K deficiency

151
Q

Treatment for vit K deficiency

A

Fresh frozen plasma

152
Q

3 y.o. w/bloody diarrhea Nd decreased urination;5 days ago; fever & vomiting after a family picnic; patient appears pale and lethargic

A

Hemolytic uremic syndrome

153
Q

Etiologies of hemolytic uremic syndrome

A

E.coli 0157:H7, shigella, salmonella, campylobacter, viruses, drugs

154
Q

6 y.o. Male with palpable purpura, abdominal pain and knee pain

Most likely diagnosis?

A

IgA vasculitis Henoch-Schonlein purpura)

155
Q

Panhypopituitarism, growth failure, visual field defects

Tumor?

A

Craniopharyngioma

156
Q

3 y.o. with abdominal mass noted by mother + HTN

Most likely ________

A

Nephroblastoma (wilms tumor)

157
Q

3 y.o. with periorbital ecchymosis, proptosis, bluish skin nodules and tender abdominal mass

Most likely diagnosis?

A

Neuroblastoma

158
Q

4 y.o. female with limp and rash; exam: fever, HSM, petechiae

Most likely diagnosis?

A

Acute lymphoblastic leukemia

159
Q

16 y.o. male w/ fever, wt loss, drenching sweats, nontender cervical LNs

A

Hodgkin lymphoma

160
Q

7 y.o. female with persistent cough and mediastinal mass…

Suspect?

A

Non-hodgkin lymphoma

161
Q

3 y.o. girl with “grape-like masses” growing from her vagina, per mom

Suspect?

A

Rhabdomyosarcoma (botryoid variant)

162
Q

X-ray:-Sclerotic destruction: “sunburst”

A

Osteogenic sarcoma

163
Q

X-ray:-Lytic with laminar periosteal elevation: “onion skin”

A

Ewing sarcoma

164
Q

X-ray:-small round central lucency with sclerotic margin

A

Osteoid osteoma

165
Q

Cough, cough, coryza, conjunctivitis, high fever, koplik spots, morbilliform rash

Diagnosis?

A

Measles

166
Q

Complications of measles (4)

A

Otitis media
Pneumonia
Encephalitis
Subacute sclerosing panencephalitis

167
Q

Mild constitutional symptoms, forchheimer spots, posterior cervical and auricular nodes, rash spreads from face to trunk and extremities

Diagnosis ?

A

Rubella

168
Q

Headache, fever, malaise, muscle pain, glandular swelling

Complications ?

A

Encephalitis
Orchitis
Pancreatitis

169
Q

Low grade fever, malaise, URI symptoms, crops of papules, vesicles that crusts at the same time, central to peripheral

Diagnosis?

A

Varicella

170
Q

Low grade fever, malaise, URI symptoms, crops of papules, vesicles that crusts at the same time, central to peripheral

Complications?

A 
Superinfection
Zoster
Pneumonia 
Encephalitis 
Hepatitis 
Congenital varicella
171
Q

Mild URI symptoms, slapped cheek -> trunk -> central clearing-lacey

Diagnosis?

A

Erythema infectiosum

Parvovirus B19

172
Q

Complications of parvovirus B19 infection

A

Aplastic anemia

Dangerous for pregnant mothers

173
Q

URI symptoms, abrupt onset, high fever then breaks -> macular rash on trunk and spreads to extremities

Diagnosis?

A

Roseola

174
Q

Sore throat, exudative pharyngitis, strawberry tongue, fine maculopapular rash (like sandpaper, esp antecubital and in GUI make areas), pastia lines

Diagnosis?

A

Scarlet fever (streptococcal infection)

175
Q

Complications of scarlet fever

A

Acute rheumatic fever

Glomerunephritis

176
Q

Usually absent (maybe fussiness, low-grade fever); oral macule -> vesicle w/halo of erythema; macular, maculopapular or vesicular; hands, feet and buttocks common

Diagnosis?

A

Hand-foot-mouth disease (coxsackie-virus)

177
Q

Treatment of Lyme disease?

A

Doxycycline

178
Q

Treatment of carditis and meningitis complications of Lyme disease ?

A

Ceftriaxone

179
Q

7 y.o. w/fever, headache, rash that started on extremities (lives in wooded area of N. Carolina)

A

Rocky Mountain spotted fever

180
Q

3 y.o. with honey-colored crusted plaques on face

A

Impetigo

181
Q

Treatment for impetigo

A

Topical mupirocin

182
Q

10 y.o. male w/ multiple excoriations and linear burrows in webs of fingers, ++pruritis

A

Scabies

183
Q

1 week old infant w/ conjunctivitis, blisters on skin, + Nikolsky’s sign

A

Staphylococcal scalded skin syndrome

184
Q

2-12 mos; fever lethargy, irritability, anorexia, N/V, meningeal irritation (photophobia, neck & back pain, rigidity, brudzinski, kernig or bulging fontanelle in infant)

A

Meningitis

185
Q

6 yo male fromPA returns from camping with fever, headache and rash

Most likely diagnosis?

A

Lyme disease (borrelia burgdorferi)

186
Q

Treatment for Lyme disease?

A

Doxycycline

187
Q

Treatment for Lyme disease in a child < 8y.o.

A

Amoxicillin

188
Q

Treatment for carditis or meningitis complication of Lyme disease

A

Ceftriaxone

189
Q

New born; cluck on Barlow; Positive ortolani

Management?

A

Pavlik harness (developmental dysplasia of hips)

190
Q

5 y.o. with progressive limping (initially painless now anterior thigh pain)

Management?

A

Casting or orthoses, rest, exercises, surgery

Legg- Calve- Perthes disease

191
Q

Obese 14y.o. with knee pain and decrease range of motion of hip

Management?

A

Surgical stabilization

Slipped Capital femoral epiphysis

192
Q

Complications of slipped capital femoral epiphysis

A

Osteonecrosis

Chrondolysis

193
Q

6 y.o. male had URI 2 wks ago, now: limp, pain in groin and knee; non-toxic appearing kid, X-rays of hip and knee WNL, slight increase in ESR

Diagnosis?

A

Transient synovitis

194
Q

10 y.o. basketball player with knee pain and swelling

Most likely …

A

Osgood-Schlatter disease

195
Q

2-12 mos; fever lethargy, irritability, anorexia, N/V, meningeal irritation (photophobia, neck & back pain, rigidity, brudzinski, kernig or bulging fontanelle in infant)

Etiologies?

A

S. pneumonia, N. meningitidis, HiB

196
Q

Meningitis in 0-2 months most likely organisms

A

GBS, E.coli, L. monocytogenes

197
Q

Meningitis in 0-2 months, empirical antibiotics

A

Ampicillin + cefotaxime

198
Q

Meningitis in 2-3 months; most likely organisms

A

GBS, E. coli, L. monocytogenes +
Some S. pneumoniae +
very little H. influenza type B

199
Q

Meningitis in 2-3 months; empiric antibiotics

A

Ampicillin + caefotaxime/

Ceftriaxone + vancomycin (assume resistant S. pneumoniae)

200
Q

Meningitis 3 months- 2 years; most likely organisms

A

S. pneumoniae + N. meningitides

201
Q

3 months - 2 years with meningitis; empiric antibiotics

A

Vancomycin + cefotaxime/ ceftriaxone

202
Q

2-18 years with meningitis; most likely organisms

A

N. meningitides +

203
Q

2-18 years with meningitis; empiric antibiotics

A

Vancomycin + cefotaxime / ceftriaxone

204
Q

19 y.o. male with roommate at college with bacterial meningitis and a petechial rash. What does this patient need?

A

Rifampin po x 2days

205
Q

Treatment for otitis media

A

Amoxicillin

206
Q

8 y.o. female with sore throat and fever over 1 day; exam: enlarged, erythematous tonsils with exudate, cervical lymphadenopathy

A

Acute pharyngitis

207
Q

Complications of acute streptococcal pharyngitis

A
  • Acute rheumatic fever
  • Post streptococcal glomerulonephritis
  • Reactive arthritis
208
Q

Treatment of acute pharyngitis in a patient with allergy to penicillin

A

Erythromycin

209
Q

Sore throat, “hot potato “ muffled voice, trismus, ipsilateral ear pain, uvula displacement

Most likely _____

A

Peritonsillar abscess

210
Q

16 y.o. with sore throat, fever, fatigue, generalized adenopathy, splenomegaly

A

Infectious mononucleosis

211
Q

3 y.o. with barking cough, hoarseness, inspiratory strider

A

Croup

212
Q

Management of different severity of croup

A

Mild- sg dose dexamethasone
Mod- nebulized epinephrine + corticosteroid
Severe- nebulized epi + corticosteroid + admission

213
Q

2 y.o. with fever of 102 F, tugging on ear; TM bulging and red

Most sensitive test

A

Pneumatic insufflation

Otitis media

214
Q

Otitis media treatment in a patient with penicillin allergy

A

Azithromycin

215
Q

Most common cause of croup?

A

Parainfluenza

216
Q

3 y.o. with fever, tripod position, drooling

A

Epiglottis

217
Q

3 y.o. with fever, tripod position, drooling

First line management

A

Intubation

218
Q

9-mo-old infant w/runny nose, cough, wheezing, ↑work of breathing; RR = 60, + retractions, O2sat = 91%

Most common cause

A

RSV

Bronchiolitis

219
Q

Prevention of bronchiolitis for premature patients, those with chronic lung disease or congenital heart disease

A

Palivizumab

220
Q

6-mo-old infant w/coughing spells (loud inspir whoops) f/b vomiting

Confirm diagnosis by ________

A

Nasopharyngeal cx or PCR

Whooping cough; Bordetella pertussis

221
Q

Treatment of cystitis in young children

A

amox, TMP/SMX, nitrofurantoin

222
Q

Treatment for pyelonephritis in children

A

3rdgen cephalosporin 10-14 days

223
Q

2 y.o. male with multiple episodes of otitis media, pneumonia and diarrhea. On exam, no tonsils seen

A

X-linked (Briton) Agammaglobulinemia (XLA)

224
Q

17 y.o. female with ↓IgG, IgM, IgE, IgA but normal B cells

A

Common Variable Immunodeficiency (CVID)

225
Q

2 y.o. female with giardiasis, PMH: pneumonia and UTI; Anaphylaxis with blood transfusion

A

IgA deficiency

226
Q

3-day-old male with hypertelorism, thin upper lip, small mandible, notched ears presents with seizures and cyanosis

A

DiGeorge syndrome (thymic hypoplasia)

227
Q

Infant with severe infections, no thymus, no tonsils, severe lymphopenia

A

Severe Combined Immunodeficiency (SCID)

228
Q

18-mo-old male with severe eczema, petechiae, recurrent ear infxns.

A

Wiskott-Aldrich Syndrome

229
Q

2 y.o. male with 4thepisode of otitis media; mom remembers his umbilical cord stump separated around 2 mos.

A

Leukocyte Adhesion Deficiency

230
Q

3 y.o. male, recurrent swollen, infected LNs in groin

Test of choice

A

Dihydrorhodamine 123

Chronic granulomatous disease

231
Q

7 y.o. girl w/L wrist and R knee pain (off and on x 3 mos.), pain is worst in morning (improves through day); R knee has effusion and ↓ROM

A

Juvenile Idiopathic Arthritis (JIA) (synovitis of peripheral joints)

232
Q

Juvenile Idiopathic Arthritis (JIA) (synovitis of peripheral joints) treatment options

A

NSAIDs, methotrexate, azathioprine, cyclophosphamide, biologicals, steroids

233
Q

2 y.o. female w/2-wk h/o fevers to 102°F, conjunctivitis, very red tongue, cracked lips, desquamating rash, swollen hands and feet

A

Kawasaki disease

234
Q

Treatment for Kawasaki disease?

A

IVIG +high dose aspirin

235
Q

Complication of Kawasaki disease

A

Aneurysm

236
Q

feeding difficulty, choking,stridor, apnea, vocal cord paralysis,UE spasticity + spina bifida oculta/ meningocele/ myelomeningocele

Next step?

A

Head Ct : look for Arnold Chiari malformation

237
Q

Presents: head circum > 95%ile, bulging fontanelle, distended scalp veins, “setting sun” eyes, ↑DTRs, vomiting

A

Hydrocephalus

238
Q

↑ing head size, prominent occiput, spasticity, hyperreflexia, ataxia delayed motor development; Diagnosis?

A

Dandy-Walker malformation (agenesis or hypoplasia of cerebellar vermis, cystic dilation of 4thventricle, enlarged post fossa)

239
Q

Treatment for simple partial seizures

A

Phenytoin

240
Q

18-mo-old male w/first time tonic-clonic seizure lasting 3 mins. He has had a viral illness with temp up to 103.8°F

A

Febrile seizure

241
Q

Management for febrile seizure

A

Acetaminophen

242
Q

10 y.o. female with falling grades in school and many episodes of ”staring into space” with eye flickering; EEG shows 3 Hz spike

A

Absence (petit mal )seizure

243
Q

Management for absence seizure

A

Ethosuximide *drug of choice) or valproic acid

244
Q

6-mo-old w/symmetric contractions of neck, trunk and extremities; EEG: hypsarrhythmia (asynchronous, chaotic spike-wave pattern)

A

Infantile spasm

245
Q

6-mo-old w/symmetric contractions of neck, trunk and extremities; EEG: hypsarrhythmia (asynchronous, chaotic spike-wave pattern)

Treatment?

A

ACTH, prednisone, +/- anticonvulsant

246
Q

10 y.o. male w/ataxia, explosive speech that is difficult to understand, kyphoscoliosis

A

Friedreich ataxia

247
Q

10 y.o. male w/ataxia, explosive speech that is difficult to understand, kyphoscoliosis

Most common cause of death

A

HOCM—>

CHF, arrhythmia, death

248
Q

13 y.o. male w/dystonia, tremors, Kayser-Fleischer rings in his eyes, and recent behavioral changes

Best test?

A

Serum ceruloplasmin

249
Q

13 y.o. male w/dystonia, tremors, Kayser-Fleischer rings in his eyes, and recent behavioral changes

Diagnosis

A

Wilson disease

250
Q

13 y.o. male w/dystonia, tremors, Kayser-Fleischer rings in his eyes, and recent behavioral changes

Treatment?

A

Chelation with penicillinamine

251
Q

10-mo-old Jewish male w/seizures, hypotonia, cherry-red macula

A

Tay-Sachs disease

252
Q

What is deficient in Tay-Sachs disease

A

Beta-hexosaminidase A

253
Q

9 y.o. male w/choreoathetosis and spasticity + h/o renal calculi

A

Lesch-Nyhan disease

254
Q

Newborn lying in frog-leg position w/subdiaphragmatic retractions, absent DTRs

A

Spinal Muscle Atrophy (SMA) (AR degenerative dz of motor units)

255
Q

11 y.o. male w/clumsiness (dropping items) and frequent falls; LEs are “stork like” + pes cavus

A

Charcot-Marie-Tooth (HMSN I)

256
Q

3 y.o. male w/clumsiness and big calves;

A

Duchenne Muscular Dystrophy

257
Q

Cause of becoming wheel bound in duchenne muscular dystrophy

A

Calf pseudohypertrophy (deposits of fat and collagen) + thigh muscle wasting

258
Q

What is seen on muscle biopsy for Duchenne muscular dystrophy

A

Abnormal or absent dystrophin

259
Q

Initial best for diagnosis of duchenne muscular dystrophy

A

CPK (Increased)

260
Q

Presents: facial wasting (“inverted V” upper lip, thin cheeks, scalloped temporalis, narrow head, high arched palate) + hypotonia (progressive wasting: distal →proximal) + poor speech, difficulty swallowing, EOM weakness, slow GI emptying + heart block + endocrine probs + half w/intellectual disability

A

Myotonic dystrophy (CTG trinucleotide expansion)

261
Q

Disorders that are associated with omphalocele (2)

A

Beckwidth-Weidemann syndrome, trisomy 18

Kaplan Shelf prep (11 decks)

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