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MCCQE1 > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

APGAR?

A
  • Appearance (Blue/pale, acrocyanosis, pink)
  • Pulse (absent, <100, >100)
  • Grimace (absent, with high stimulation, with normal stimulation)
  • Activity (none, flexion, resistance to extension)
  • Respiration (absent, irregular, strong)

Normal: 7-10

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2
Q

Baby with accrocyanosis, pulse 75, grimace with stimulation, resistance to extension and irregular respirations.

APGAR?

A

APGAR= 7

acrocyanosis= 1
pulse=1
Grimace=2
activity=2
respiration=1
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3
Q

Term baby with grunting. CxR: hyperextended and edema lungs.

Dx and tx?

A

Transient tachypnea of the newborn (TTN)

Tx: positive pressure ventilation (PPV)

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4
Q

Immature infant with difficutly breathing. CxR: hypo extended lung with atelectasis

Dx and tx?

A

Respiratory Distress Syndrome (RDS)

Tx: intubation + surfactant

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5
Q

Baby large for gestational age, the mother with DM. Baby with jitteriness, tremors, lethargy, poor feeding.

Dx, next step and tx?

A

Hypoglycemia

Next step: Look for cause (infection)

Tx: 2mL/kg of D10W and recheck

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6
Q

Ppx for eye infections in newborns?

A

Erythromycin drops

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7
Q

Screening for retinibastoma in new born?

A

Red reflex

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8
Q

Pre-term infant with increased demands of O2 for >28 days.
CxR: Ground glass opacity
Dx, tx?

A

Bronchopulmonary dysplasia (BPD)

  • Post-natal surfactant to baby
  • Ante-natal steroids to mom
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9
Q

Pre-mature infant with increased FIO2 requirements who undergoes eye exam, which shows neovascularization.
Dx, tx and long-term consequences?

A

Retinopathy of prematurity (ROP)

Tx: photoablation

F/U: early glaucoma

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10
Q

Pre-mature patients with bulging fontanels, seizure, coma.

Dx, next step, tx?

A

Intraventricular hemorrhage

Next step: Cranial doppler

Tx: Surgery (VP shunts, drains)

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11
Q

Pre-mature infant with bloody bowel movement.
Abdominal xR showing air in the wall of the bowel

Dx and tx?

A

Necrotizing enterocolitis

Tx:

  • NPO
  • IV antibiotics against gram negatives
  • Total parenteral nutrition
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12
Q

New-born who during the first exam you notice No anal opening.
Next step?

A 
Evaluate VACTREL syndrome
•	Vertebral anomalies: U/S of sacrum
•	Anus (imperforate): Cross table xR
•	Cardiac problems: Echocardiogram
•	Traqueo-esophageal fistula: Nasogastric tube down the nostril and take xR
•	Esophageal atresia: Nasogastric tube 
•	Renal: Voiding cystourethrogram
•	Limb: xR for wrist
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13
Q

New-born who during the first exam you notice No anal opening.
Cross table xR shows that blind end is near to the skin

Tx?

A

surgery right away

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14
Q

New-born who during the first exam you notice No anal opening.
Cross table xR shows that blind end is far from the skin

Tx?

A

Colostomy first, surgery once bigger (before toilette training)

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15
Q

New-born, no meconium 48 hrs after delivery. The mother is undocumented immigrant and didn’t have prenatal care.
Dx, next step, tx and f/u?

A

Meconium Ileus

Next step: xR with air-fluid levels with a gas-filled plug.

Tx: Water enema

F/U: Confirm Cystic Fibrosis dx with sweat chloride test
• If (+), supplement with Vitamins A, D, E, and K, give pancreatic enzymes, and recommend pulmonary toilet

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16
Q

New born with failure to pass meconium, palpable colon and explosive diarrhea on digital exam.

Dx, next step and tx?

A

Hirschsprung’s

Next steps:
o xR showing dilated proximal colon (normal) and a normal looking distal colon (abnormal)
o Contrast enema to see the transition point
o Gold standard: Bx showing no plexus

Tx: Resection of colon without plexus

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17
Q

Baby with chronic diarrhea and overflow incontinence.

Dx, next step and tx?

A

Hirschsprung’s

Next steps:
o xR showing dilated proximal colon (normal) and a normal looking distal colon (abnormal)
o Anal-rectal manometry showing increased tone (because of the lack of inhibitory neurons)
o Gold standard: Bx showing no plexus

Tx: Resection of colon without plexus

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18
Q

Child in toilet training or entering school who has constipation, overflow incontinence and encopresis.

Dx and tx?

A

Voluntary holding

Tx:
• Stool softeners and motility agents + behavioral intervention (tell the kid that is ok to poop)
• Desimpactation under anesthesia

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19
Q

Baby with projectile bilious vomiting. Normal pregnancy, no risk factors, no polyhydramnios.

xR showing double bubble with normal gas pattern beyond

Dx and tx?

A

Malrotation/volvulus

Tx:
o NG tube to decompress
o Surgery

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20
Q

Baby with down syndrome and projectile green vomit. In-utero had polyhydramnios.

xR showing double bubble without gas beyond

Dx?

A

Duodenal atresia or annular pancreas

Tx: surgery (during the surgery you differentiate with annular pancreas)

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21
Q

Baby with projectile green vomit. Mom with cocaine/tobacco use during pregnancy.

xR showing double bubble with multiple air-fluid levels

Dx?

A

Intestinal atresia

Tx: Surgery

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22
Q

Patient with projectile non-biliary emesis at day 1, gurgling and bubbling with respirations.

Dx, next step and tx?

A

Tracheoesophageal fistula

Next step: NG tube that coils on xR

Tx:
o Parenteral nutrition
o Surgery

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23
Q

Baby male who was eating normally but at weeks 2 to 8 has projectile non-biliary emesis. On physical exam, you feel and olive-shaped mass and see visible peristaltic waves.

Dx, next step and tx?

A

Pyloric stenosis

Next step:
o U/S showing a donut sign
o CMP showing hypochloremic, hypokalemic, metabolic alkalosis (↓Cl, ↓K, ↑pH, ↑HCO3)

Tx:
o IVF and correct electrolytes
o Surgery (pyloromyotomy)

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24
Q

Baby with jaundice. ↑ Conjugated bilirubin.

Next step?

A

HIDA scan, hepatic U/S, sepsis evaluation, metabolic evaluation.

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25
Q

Baby with jaundice. ↑ unconjugated bilirubin.

Next step?

A

Coombs test

If + –> isoimmuniazation

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26
Q

Baby with jaundice. ↑ unconjugated bilirubin. Coombs test negative, high hemoglobin.
Possible dx?

A

Twin-twin transfusion, maternal-baby transfusion, delayed cord clamping

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27
Q

Baby with jaundice. ↑ unconjugated bilirubin. Coombs test negative, normal hemoglobin, reticulocyte count +.
Possible dx?

A

Hemolysis (G6DP deficency, spherocitosis)

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28
Q

Baby day 4 with jaundice. ↑ unconjugated bilirubin. Coombs test negative, normal hemoglobin, reticulocyte count negative.
Dx and tx?

A

Breastfeeding jaundice (low quantity of milk)

Tx: Feed baby more (formula supplementation)

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29
Q

Baby day 12 with jaundice. ↑ unconjugated bilirubin. Coombs test negative, normal hemoglobin, reticulocyte count negative.
Possible dx?

A

Breast milk jaundice (low quality of milk)

Tx: Feed baby with hydrolyzed formula (formula replacement)

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30
Q

Baby with scaphoid abdomen.

Dx, next step and tx?

A

Diaphragmatic Hernia

Next step: Babygram

Tx:

  • Surgical repair
  • Supplemental surfactant may be needed
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31
Q

Abdominal wall defect right of midline and without a membrane.

Dx and tx?

A

Gastroschisis

Tx:

  • Cover viscera in a sterile bag and place saline-soaked gauze over extruded contents to prevent desiccation and infection.
  • Place NG tube
  • IVF
  • Covered silo to allow the extruded contents to gradually re-enter the abdomen.
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32
Q

Baby with abdominal wall defect in the midline and covered with a membrane.

Dx and tx?

A

Omphalocele

Tx:

  • Cover viscera in a sterile bag and place saline-soaked gauze over extruded contents to prevent desiccation and infection.
  • Place NG tube
  • IVF
  • Covered silo to allow the extruded contents to gradually re-enter the abdomen.
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33
Q

Midline defect, wet with urine, shiny and red, no bowel inside the sac.

Dx and tx?

A

Exstrophy of the Bladder

Tx: Surgery

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34
Q

Patient with worsening jaundice (direct hyperbilirubinemia) at about two weeks.
US shows no biliary treee.

Dx, next step and tx?

A

Biliary Atresia

Next step: HIDA scan 5-7 days after phenobarbital stimulation

Tx: Surgery

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35
Q

Complications of cleft palate/lip

A

Failure to thrive , otitis media, feeding difficulties, possible hearing difficulties, and speech pathology

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36
Q

How are Neural Tube Defects diagnosed in prenatal care?

A
  • ↑AFP
  • U/S
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37
Q

Complications Neural Tube Defects

A
  • Arnold Chiari malformation
  • Hydrocephalous
  • Learning difficulties
  • Focal neurological deficit below the level of the defect
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38
Q

Tuff of hair in the back of a baby.

Dx?

A

Occulta Neural Tube Defects

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39
Q

Failure to thrive affects (in order)

A
  • Weight
  • Height
  • Head circumference
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40
Q

Gross motor development milestones of a child

A 
2 mo	Lift head
4 mo	Roll over
6 mo	Sit up
1 yr	        Walk
2 yrs	Steps
3 yrs	Tricycle
4 yrs	Hop (jumping on one foot)
5 yrs	Skip
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41
Q

Fine motor development

A 
2 mo	
4 mo	
6 mo	 
1 yr	        
2 yrs	
3 yrs	Circle
4 yrs	Cross
5 yrs	Triangle
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42
Q

Speech development

A 
2 mo	
4 mo	
6 mo	 
1 yr	       1 word 
2 yrs	2 word
3 yrs	3 word
4 yrs	4 word
5 yrs	5 word
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43
Q

Social development

A 
2 mo	Social smile
4 mo	
6 mo	 Stranger danger
1 yr	        Separation anxiety
2 yrs	
3 yrs	
4 yrs	
5 yrs
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44
Q

An 8-month infant with an episode of change in colour, tone, breath or responsiveness. Duration was less than 1 min. No CPR performed. First time that this happens.

No findings or physical exam findings

Dx and next step?

A

Brief Resolved Unexplained Event (BRUE)

Next step: No further investigations required, just reassure parents

If findings on history or physical exam, monitor and investigation accordingly

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45
Q

Prevention of Sudden infant death syndrome (SIDS)

A
  • Back to sleep: lay the infant on their back on a firm mattress. Turn their head to each side each night to prevent flatten occiput
  • Front play: supervised play)
  • Don’t share the bed
  • Smoking cessation
  • Avoid overheating and overdressing
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46
Q

7 y-o patient who has a strike to the side of the head during baseball practice. The patient has loss of consciousness, then seem fine, but then go into a coma.
CT scan shows lens-shaped hematoma

Dx?

A

Epidural Hematoma

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47
Q

Baby with loss of consciouness after she “fell from her crib” according to her dad.
CT showing crescent-shaped hematoma.
Dx?

A

Subdural Hematoma

Shaking baby syndrome (abuse)

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48
Q

Patient with deceleration truma.
Ct showing punctate intracerebral hemorrhages

Dx?

A

Contusion

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49
Q

Prevention of head trauma in children?

A 
Car safety 
•	Car seats (0-2 years)
•	Booster seat (until 4’9” and 8-12 years old)
•	Seat belts
Helmets: 
Trampolines: eliminate them
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50
Q

Boy with helmet-to-helmet football injury. LOC < 60 sec, mild headache that is improving, no amnesia. no FND on physical exam.
Dx and next step and follow-up?

A

Mild concussion

Next step: no CT needed. Discharge and observe

F/U:
Stepwise Return to Play
Sleep–> go to school–> homework–> practice–> play

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51
Q

Boy with helmet-to-helmet football injury. LOC > 60 sec, headache that is worsening, retrograde amnesia. FND on physical exam.
Dx and next step and follow-up?

A

Severe concussion

Next step: CT and admit

F/U:
Stepwise Return to Play
Sleep–> go to school–> homework–> practice–> play

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52
Q

Prevention of drowning

A
  • Limiting access (gates, fences)
  • Supervision
  • Flotation: life jackets, not arm floaties
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53
Q

Gun safety in a house with kids

A

o Get rid of the gun if possible
o Store up high
o Locked in a safe cabinet
o Amo stored separately from gun

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54
Q

Child with mental retardation, son of a single young parent from a low socio-economical background. The child presents to the ER with a femur fracture. In the physical you see brises in different stages of healing. The child does not cry when the parent is present.
Dx and next steps?

A

Abuse

Next steps:
o Report to Child Protective Services
Certainty is NOT required
Tell the family why you’re doing it (patient safety) and that you’re required by law to do so
o Patient safety
Separate abuser from child if obvious
Separate parent-child unit from a common abuser
Hospitalize child if no safe alternative exists
o Offer resources and support that allows families and care givers to understand disease process, provide emotional economic, and physical support

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55
Q

Fractures associated with abuse

A
  • Skull, clavicle
  • Femur, especially spiral
  • Rib factures
  • Different stages of healing
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56
Q

Bruises associated with abuse

A
  • Different stages of healing
  • Weird places
  • Subdural hematoma (shaking baby syndrome)
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57
Q

Burns associated with abuse

A
  • Feet, ankles (dunk)
  • Buttocks only (dunk)
  • Punctate circular burns (cigarette)
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58
Q

Child behaviour associated with abuse

A
  • Not crying in the presence of caregiver
  • Running from caregiver
  • Receiving comfort from healthcare provider rather than caregiver
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59
Q

Child with slapped-cheek appearance, fever, and rash.

Dx and f/u?

A

Erythema infectious/ slapped-cheek disease/ fifth disease (parvovirus B19)

F/U:

  • Watch out for aplastic crisis (especially if sickle cell disease)
  • Separate from their mom if she’s pregnant (risk of hydrops)
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60
Q

Patient who had Cough, coryza (runny nose), conjunctivitis, and Kolpik Spots. Then fever and rash starts on the face and it spreads to the body. The rash spreads and clears from head to toe.
Dx?

A

Measles

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61
Q

Child with periorbital/postauricular tender lymphadenopathies. Then fever and rash starts on the face and it spreads to the body.
Dx?

A

Rubella

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62
Q

Child with prodrome of a high fever (>40 C). Then, macular rash that begins on trunk and spreads to the face.
Dx?

A

Roseola

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63
Q

Child with rash that starts on the trunk and head followed by outward spread to extremities. The vesicles are on an erythematous base and are in different stages (eruption, ulceration, crusting).
Dx?

A

Chickenpox

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64
Q

Pubertal males with parotid slewing and orchitis.

Dx?

A

Mumps

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65
Q

Child with vesicles on erythematous base involving hands, feet and mouth.
Dx?

A

Hand-foot-mouth disease

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66
Q

Baby with bulging fontanelle, irritable, then has a seizure.

Dx, next steps, tx?

A

Meningitis

Next steps:
Evaluate FAILS (FND, altered mental status, lesion on spine, seizure)
Since FAILS (+)
- Blood Culture –> Abx –> CT scan –> LP

Tx: Vancomycin + cefotaxime + ampicillin + steroids

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67
Q

Patient with itching in webs of hands.

Dx, next step and tx?

A

Scabies

Next step: scrape the skin to see eggs on a scope

Tx: Cover head-to-toe in permethrin or lindane

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68
Q

Patient with itchy scalp. You see eggs in comb when brushing.

Dx and tx?

A

Lice

Tx: Permethrin, or malathion

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69
Q

Patient with itchy butt.

Dx, next step and tx?

A

Pinworm (oxyuriasis)

Next step: Put tape on the butt in the AM to catch some eggs

Tx: Albendazole

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70
Q

Patient with general urticaria (rash), hypotension and Wheezing after exposition to a trigger.

Dx and tx?

A

Anaphylaxis

Tx:
• Epinephrine 1:1,000 IM
• Diphenhydramine, Cetirizine
• Steroids

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71
Q

Wheal (roncha) and erythema and rash
after exposition to a trigger, but no hypotension.

Dx and tx?

A

Urticaria

Tx:
• Usually self-limited
• Observe and topical anti-histamine
• Rule-out anaphylaxis

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72
Q

Swelling in airway and wheezing after exposition to a trigger, but no hypotension.

Dx and tx?

A

Angioedema

Tx:
• Secure the airway
• Diphenhydramine, Cetirizine
• Steroids

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73
Q

Patient with shiners under the eyes, pale, boggy mucosa, polyps.

Dx and tx?

A

Allergic rhinitis

Tx:
• Intranasal steroids!! (the good answer)
• Avoidance of trigger

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74
Q

Patient with shiners under the eyes, conjunctival injection and chemosis (inflammation).

Dx and tx?

A

Allergic conjunctivitis

Tx: 
•	Avoidance of trigger 
•	Artificial tears
•	Mast cell stabilizers in drops 
•	Antihistamines in drops
•	Oral antihistamines 
•	Leukotriene antagonists
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75
Q

Child with nausea, vomiting and diarrhea. The patient has eczema, atopic dermatitis and asthma

Dx, next step and tx?

A

Food allergy

Next step: Food trial (take out all potential triggers and introduce them one at a time)

Tx:
• Avoid trigger
• EpiPen

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76
Q

Baby, 6 months of age with failure to thrive despite feeding adequate amount. The parents report feeding intolerance, vomiting and occasional bloody stool.

Dx and tx?

A

Milk protein allergy

Tx:
• Avoid cow’s milk protein until 2-3 years
• Hydrolyzed formula

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77
Q

Unilateral ear pain relieved with pulling of the pinna, swelling of tympanic membrane, loss of light reflex, bulging erythematous tympanic membrane.

Dx and next step?

A

Otitis media

Next step: pneumatic insufflation (membrane doesn’t move with air)

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78
Q

1st line tx of otitis media

A

Amoxicillin

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79
Q

Tx of recurrent otitis media

A

amoxicillin-clavulanate

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80
Q

Indication for tympanostomy if otitis media

A

3 recurrences in 6 months or 4 in a year

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81
Q

Patient with ottis media and pen allergy. How to treat?

A

Pen allergy with no anaphylaxis: cefdinir

Pen allergy with anaphylaxis: azithromycin

82
Q

Unilateral ear pain which is worse with pulling of the pinna and erythematous canal.
Dx and tx?

A

Otitis Externa

Resolves spontaneously , but if severe infection: cipro drops + steroid drops

83
Q

Paitent with otitis media and swelling behind the ear, and anteriorly rotated ear.
Dx, next step and tx?

A

Mastoiditis

Next step: no images, it’s a clinical dx

Tx: surgical decompression

84
Q

Congestion, bilateral purulent discharge, painful facial tap.
Dx and tx?

A

Sinusitis

Tx: supportive
- If fever, duration of > 10 days or worsening; amoxicillin-clavulanic

85
Q

Centor criteria for pharingituis?

A
  • no Cough +1
  • Exudates +1
  • Nodes +1
  • Temperature +1
  • Age <14 -1; >14 +1

Tx:

  • < 1: nothing it’s viral
  • 2-3: rapid strep test
  • > 4: treat with amoxicillin-clavulanic
86
Q

Homeless with scratching and buzzing in the ear.

A

Foreign body (insect) in ear

DON’T LIGHT!! Instead use lidocaine to paralyze the insect

87
Q

Baby cyanotic when eating, pink when crying, or snoring in a child.

Dx, next step and tx?

A

Choanal Atresia

Next step: failure to pass a catheter or fiber-optic

Tx: surgery

88
Q

2-y-o patient who had a viral prodrome and now has barking or seal-like cough, inspiratory stridor.

Next step?

A

Administration of racemic epinephrine

If improvement -> Croup
If not -> Bacterial tracheitis

89
Q

2-y-o patient who had a viral prodrome and now has barking or seal-like cough, inspiratory stridor. Improvement after the administration of racemic epinephrine.

Dx and tx?

A

Croup (laryngotracheobronchitis)

Tx:

  • Mild: mist (agua nebulizada)
  • Moderate: racemic epinephrine, IM steroids, O2
  • Severe: Admit
90
Q

2-y-o patient who had a viral prodrome and now has barking or seal-like cough, inspiratory stridor. The patient doesn’t improve after the administration of racemic epinephrine.

Dx and next step?

A

Bacterial Tracheitis (superinfection of cropu with staph aureus)

Next step: Tracheal culture (get ENT to do a scope)

91
Q

5-y-o patient No history of vaccinations, Very toxic, Rapid onset high spiking fever, Tripoding, Drooling , Accessory muscles use, Talking with a hot potato voice.

Dx and next step?

A

Epiglottitis

Next step: Get endotracheal tube (ET) in the OR

92
Q

10-y-o patient with toxic appearance , Rapid onset high spiking fever, Drooling, Talking with a hot potato voice, Anterior chain unilateral lymphadenopathy, Tender unilateral neck mass.

Dx, next step and tx?

A

Retropharyngeal Abscess

Next step: CT scan of neck

Tx: Drainage + Abx

93
Q

Adolescent talking with a hot potato voice, Sore throat, Drooling, Odynophagia, dysphagia , Uvular deviation.

Dx and tx?

A

Peritonsillar Abscess

Tx: drainage + IV Abx

94
Q

3-y-o patient, with sudden onset of dyspnea after parents left unattended. On phsysical: expiratory wheeze.

Dx, next step, tx?

A

Intrathoracic foreign body

Next step: CxR:

Tx: Bronchoscopy if intrathoracic (call respirology)

95
Q

3-y-o patient, with sudden onset of dyspnea after parents left unattended. On phsysical: inspiratory stridor.

Dx, next step, tx?

A

Extra thoracic foreign body

Next step: 2-view CxR

Tx: Laryngoscopy if extrathoracic (call ENT)

96
Q

Patient with suspiction of foreign boddy in trachea vs esophagus.

2-view CxR showing (+) coin sing in lateral view. (-) coin sing in the AP

Where is the foreign body?

A

Trachea

97
Q

Patient with suspiction of foreign boddy in trachea vs esophagus.

2-view CxR showing (-) coin sing in lateral view. (+) coin sing in the AP

Where is the foreign body?

A

Esophagus

98
Q

Tx of asthma in kids

A
  • Avoid triggers (pets, carpets)
  • Smoking cessation on parents
  • Progressive use of SABA + Low-dose ICS + high-dose ICS +LABA + oral steroids

Before adding more meds, make sure they are using the inhalers right.

99
Q

1-y-o pateitn with Wheezing and Dyspnea.

Dx, tx?

A

Bronchiolitis

Tx: O2, IVF, observation
F/U: Watch out for respiratory failure and ARDS

100
Q

Child who is foreign born. With recurrent pulmonary infectious and failure to thrive.

Dx, next step and tx?

A

Cystic Fibrosis

Next step:

  • Screen
  • Sweat chloride to confirm( > 40 is confirmatory in infant)

Tx:

  • Replacement of pancreatic enzymes
  • Replacement of fat-solute vitamins (ADEK)
  • Pulmonary toilet
101
Q

Patient with dx of cystic fibrosis who has now pneumonia. What’s the most common bug to having caused it?

A

Pseudomonas

102
Q

Child with fever and one seizure in 24 hrs that lasted < 15 mins with loss of consciousness.

Dx, next step and tx?

A

Simple febrile seizure

Next step: no imaging needed

Tx:
• BZD to abort active seizure
• Acetaminophen

103
Q

Patient with fever and several seizures in 24 hrs that lasted > 15 mins with loss of consciousness.

Dx, next step and tx?

A

Complex febrile seizures

Nex steps:
• EEG
• LP
• MRI

Tx:
• BZD to abort active seizure
• Antiepileptic meds (e.g., Levetiracetam, phenytoin, valproate, lamotrigine)

104
Q

1-y-o patient with bilateral and symmetrical limb jerking. No fever.

Interictal EEG showing hypsarrhythmia (chaotic and disorganized brain electrical activity with no recognizable pattern)

Dx and tx?

A

West Syndrome (infantile spams)

Tx: ACTH

105
Q

2-y-o patient with angiofibroma and ash leaf spots identified under wood’s lamp

Dx and next step?

A

Tuberous Sclerosis

Next step: CT or MRI showing cortical tubers

106
Q

Boy who is “troublemaker”, and has bad performance at school.

Next step?

A

EEG to differentiate between ADHD and absence Seizures

107
Q

Tx of absence Seizures?

A

Ethosuximide

Valproic acid as 2nd option

108
Q

Premature baby with GI bleed. Babygram showing pneumatosis intestinalis (air in the wall of the bowel) or air under the diaphragm.

Dx and tx?

A

Necrotizing Enterocolitis

Tx:

  • NPO
  • IVF
  • Total parenteral nutrition (TPN)
  • Abx against gram negatives and anaerobes
109
Q

1-y-o patient with abrupt colicky abd pain, knee-chest position relief the pain and Currant jelly diarrhea
On physical you fee a sausage-shaped mass.

Dx. next step and tx?

A

Intussusception

Net steps:

  • KUB to r/o air under de diaphragm
  • U/S showing target sig

Tx:

  • Air enema
  • Surgery if enema fails, peritonitis or perforation
110
Q

2 yr patient with Painless, intermittent hematochezia, fecal occult blood test (+), and iron deficiency anemia.

Dx, next step and tx?

A

Meckel’s

Next step: Technetium 99 radionucleotide scan

Tx: Resection

111
Q

Newborn with melena.

Next step?

A

Apt test (negative means blood comes from the mother)

112
Q

Watery diarrhea with weight loss, EGD and colonoscopy showing skipped lesions.
Dx and tx?

A

Chron’s

Tx: immunomodulation, surgery for fistulas

113
Q

Bloody diarrhea, colonoscopy showing continuous lesion only in colon.

Dx and tx?

A

Ulcerative colitis:

Tx: surgery is curative

114
Q

Patient with history of sickle cell disease who goes to the ER with stroke, acute chest, pulmonary edema, or SOB.
Tx?

A

EMERGENT exchange transfusion!!!

115
Q

Chronic consequences of sickle cell disease at the spleen

A

Auto infraction of the spleen (prone to infection from encapsulated bugs)

  • PPx with PNC until age 5
  • Pneumococcal vaccine
116
Q

Chronic consequences of sickle cell disease at the bone

A

o Osteomyelitis produced by S. Aureus (most common) or Salmonella
o Avascular necrosis of hip (Tx: 1st conservative, then Sx)

117
Q

Patient with history of sickle cell disease with acute worsening of joint pain

↑Reticulocytes and Bilirrubin (greater than patient’s baseline)
Sickles on smear

Dx and next step?

A

Vaso-occlusive crisis

Tx:
•	IVF
•	O2
•	Pain control
•	Treat infection if present
118
Q

Patient with history of sickle cell disease with acute worsening of joint pain

Reticulocytes and Bili equal to patient’s baseline
No Sickles on smear

Dx nad next step?

A

Factitious disorder

Give the patient psychosocial help as s/he is faking it.

119
Q

How to prevent a patient with sickle cell disease from having Vaso-occlusive crisis?

A

hydroxyurea (increases production of HgbF–fetal)

120
Q

1-y-o patient with fixed split S2 on auscultation

Dx, next step and tx?

A

Atrial septal defect (ASD)

Next step: Echo

Tx: Closure via catheter-directed device closure.

121
Q

Down’s associated with which cardiac deffects

A

Tetralogy of Fallot

Ventricular septal defect (VSD)

122
Q

<1y-o patient with harsh holosystolic murmur

Dx, next step and tx?

A

Ventricular septal defect (VSD)

Next step: Echo

Tx:
• Asx: wait until 1 yr and see if it’s gone
• If CHF or failure to thrive: surgery

123
Q

Newborn with continuous machine-like (multiphasic) murmu, which was not present in his first physical exam

A

Patent ductus arteriosus (PDA)

Next step: Echo

Tx:
• May self-close
• Closure when needed with Indomethacin

124
Q

Baby cardiac defect associated with history if DM in mom

A

Transposition of the Great Arteries

125
Q

Cyanotic newborn. Echo shows Transposition of the Great Arteries. Tx?

A
  • Prostaglandins to keep PDA

* Surgery

126
Q

Components of Tetralogy of Fallot

A

o VSD
o Overriding aorta (Dextroposition of aorta)–> Cyanosis
o Pulmonic stenosis
o Right ventricular hypertrophy

127
Q

Cyanotic child. Cyanosis relieved when squatting.
CxR showing boot-shaped heart

Dx and tx?

A

Tetralogy of Fallot

Tx: Surgery

128
Q

HTN/Warm in upper extremities
Hypotension/Cold in lower extremities
Claudication (the child refuses to cry or walk)

Dx, next step and tx?

A

Coarctation of aorta

Next step: Echo

Tx: Surgery

129
Q

Newborn with clicking of the hip (Barlow and Ortolani) that persist after 4 weeks.
Dx, next step and tx?

A

Development dysplasia of the hip (DDH)

Next step: U/S at 4 weeks
Tx: harness

130
Q

6-y-o patient with insidious onset, knee pain and antalgic gate.
Dx, next step and tx?

A

Legg-Calve-Perthes (avascular necrosis)

Next step: xR
Tx: Cast

131
Q

Teenage who is obese with no traumatic joint pain.

Dx, next step and tx?

A

Slipped capital femoral epiphysis (CFE)

Next step: frog-leg xR
Tx: Surgery

132
Q

Patient with joint pain, fever, leucocytosis, ↑ESR and CRP, inability to bear weight.
Dx, next step and tx?

A

Septic Joint

Next step: arthrocentesis with > 50,000 WBC
Tx: Drain and abx

133
Q

Toddler with hip pain after a viral illness, inability to bear weight, no fever, ESR and CRP are normal
Dx and tx?

A

Transient Synovitis

Tx: supportive care

134
Q

Teenage athletes with knee pain on tibial tubercle and tibial swealing.
Dx and tx?

A

Osteochondrosis (Osgood Schlatters)

Tx:

  • Stop exercise is curative
  • Continue exercise but a painful palpable nodule will form
135
Q

Teenage girl whose spine is tilted to the right.

Next step and tx?

A

Scoliosis

Next step:

  • Adam’s test (“touch your toes”)
  • xR

Tx:

  • Brace
  • Surgery
136
Q

Patient with focal atraumatic bone pain
xR shows sun burst pattern tumor in the distal femur

Dx, next step amd tx?

A

Osteosarcoma

Next step: MRI. Bx

Tx: resection

137
Q

Patient with focal atraumatic bone pain
xR shows onion-skin tumor located in the mid-shaft

Dx, next step amd tx?

A

Ewing’s Sarcoma

Next step: MRI. Bx

Tx: resection

138
Q

When to perform an open reduction internal fixation to a fracture in a child?

A
  • Open fracture
  • Comminute/angular
  • Involvement of the growth plate
139
Q

Child with light reflect in different spots of the eyes.

Dx and tx?

A

Strabismus

Tx:

  • Congenital: surgery before 6 moths
  • Acquired: patch the good eye or use glasses
140
Q

Congenital cataracts at birth associated with?

A

TORCH

141
Q

Congenital cataracts not present at birht but then developed are associated with?

A

galactosemia

142
Q

You’re doing the first physical exam in a newborn and there is no red reflex, instead, you see a white retina
Dx? Association in teenage years?

A

Retinoblastoma

Osteosarcoma association during the teenage years

143
Q

Premature newborn who received high levels of FIO2 used to treat bronchopulmonary dysplasia.
Whar diseases you need to keep an eye for?

A

Retinopathy of Prematurity, intraventricular hemorrhage, necrotizing enterocolitis

144
Q

24-hr newborn with Bilateral, non-purulent discharge on eyes. Dx?

A

Chemical conjunctivitis, highly likely due to silver nitrate that was given as Ppx.

145
Q

2-days old baby with Bilateral Purulent discharge on eyes.

Dx, next step and tx?

A

Conjunctivitis (Gonorrhea)

Next step: Get chocolate agar culture and PCR

Tx:Ceftriaxone IM

146
Q

14-days old baby with discharge on eyes. Initially, it was unilateral and mucoid, but now it is bilateral and purulent.
Dx, next step and tx?

A

Conjunctivitis (Chlamydia)

Next step: Get culture and PCR. Look for possible pneumonia.

Tx: Oral erythromycin

147
Q

Kid with microscopic hematuria. Next step?

A

Might be self-limiting. CT scan if trauma

148
Q

Kid with macroscopic hematuria. Next step?

A

Umicro to see the morphology of the RBCs. If dysmorphic or RBC casts, think glomerular disease. If normal morphology and no casts, think no glomerular disease and do a U/S or cystoscopy.

149
Q

Baby with no urinary output and oligohydramnios.

U/S showing distended bladder and hydronephrosis.

Dx, next step and tx?

A

Posterior Urethral Valves

Next step: Voiding cystourethrogram (VCUG) to r/o reflux

Tx:

  • Catheter
  • Surgery
150
Q

What’s the most important think to keep on mind for hypo/epispadias?

A

DON’T CIRCUMCISE!! (foreskin is used to reconstruct the urethra)

151
Q

Teenager who when drinking alcohol has colicky abd pain than then resolves.

U/S showing hydronephrosis without hydroureter

Dx, next step and tx?

A

Uretropelvic Junction Obstruction

Next step: Voiding cystourethrogram (VCUG) to r/u reflux

Tx: Surgery

152
Q

Girl with normal bladder function but constant leak and never dry (like they if she had a fistula).

Normal U/S (no hydronephrosis)
Normal Voiding cystourethrogram (VCUG) r/u reflux

Dx and tx?

A

Ectopic Ureter (AKA low implantation ureter)

Tx surgery

153
Q

Child with recurrent UTIs and pyelonephritis.

U/S showing hydro

Dx, next step and tx?

A

Vesicoureteral Reflux

Next step: Voiding cystourethrogram (VCUG) confirming reflux

Tx:

  • Abx (if not severe it may resolve)
  • Surgery
154
Q

> 6 months patient with recurrent infections, severe infections with normal bugs, or infection with unusual pathogens.
Next steps?

A

Immunodeficiency

  • CBC + differential
  • Quantitative IgA, IgG, IgM
155
Q

Egg allergy. What vaccines are contraindicated?

A
  • Yellow fever
  • Influenza
    • Can be given if mild reaction (rash) with 30-min monitoring
    • It’s changing and some vaccines are no longer made out of eggs
156
Q

Immunocompromised or pregnancy. What vaccines are contraindicated?

A
  • MMRV
  • Influenza (intranasal)
157
Q

Mother Hep B (+). How to immunize the baby?

A

Give Heb B Ig and Heb B vaccine ASAP

158
Q

Mother with unknown status of Hep B status. How to immunize the baby?

A

Hep B vaccine ASAP and check mom’s HBsAg. If +, give baby Hep B Ig

159
Q

Mother Hep B (-). How to immunize the baby?

A

Heb B vaccine within 2 weeks of age.

160
Q

Tetanus immunization

A

DTad 5 doses (3 in 1st year and 2 between 1-4 yrs. Td (booster) or Tdap (adults) q10yrs.

161
Q

Hib immunization

A

Vaccine before the age of 2

162
Q

MMRV immunization

A

Vaccine and booster before school

163
Q

Differences of pneumococcal immunization between immunocompromised and asplenic patients, and infants.

A

23 valent if immunocompromised and asplenic and 13 valent as infant

164
Q

Meningococcal immunization is required for?

A

Rerquired for collegue and military

165
Q

HPV immunization.

A

All boys and girls aged 9-26 years

166
Q

Vaccine that is contraindicated if intussusception

A

Rotavirus (oral)

167
Q

Patient with clean wound and < 3 tetanus vaccine doses or unknown. Next step?

A

Clean the wound and give TdaP (“never miss an opportunity to give the TdaP”)

168
Q

Patient with dirty wound (metal, puncture, rust) and < 3 tetanus vaccine doses or unknown. Next step?

A

Clean the wound and Give TdaP + TIG (IV-Ig–passive immunity)

169
Q

Patient with clean wound and > 3 tetanus vaccine doses, the last of which was 10 years ago. Next step?

A

Clean the wound and TdaP

170
Q

Patient with clean wound and > 3 tetanus vaccine doses, the last of wish was less than 10 years ago. Next step?

A

Clean the wound and send them home

171
Q

Patient with dirty wound (metal, puncture, rust) and > 3 tetanus vaccine doses, the last of wish was 5 years ago. Next step?

A

Clean the wound and TDaP

172
Q

Patient with dirty wound (metal, puncture, rust) and > 3 tetanus vaccine doses, the last of which was < 5 years ago. Next step?

A

Clean the wound and send them home

173
Q

Child immigrant without immunizations who after flu-like symptoms has cough spells followed by inspiratory woops that sound like wheezing.
Dx and Tx?

A

Pertussis

Tx: supportive + erythromycin

174
Q

Child immigrant without immunizations who has fever and pseudomembrane in the back of the throat causing dysphagia and dyspnea.

Dx and tx?

A

Diphtheria

Tx:

  • Secure airway (intubate)
  • Anti-toxin + IV Ab
175
Q

Nontender abdominal mass associated with elevated Vanillylmandelic acid (VMA) and Homovanillic acid (HVA).

A

Neuroblastoma.

176
Q

The most common type of tracheoesophageal fi stula (TEF). Diagnosis?

A

Esophageal atresia with distal TEF (85%). Unable to pass NG tube.

177
Q

Not contraindications to vaccination.

A

Mild illness and/or low-grade fever, current antibiotic

therapy, and prematurity.

178
Q

Tests to rule out shaken baby syndrome.

A

Ophthalmologic exam, CT, and MRI.

179
Q

A neonate has meconium ileus.

A

CF or Hirschsprung’s disease.

180
Q

Bilious emesis within hours after the first feeding.

A

Duodenal atresia.

181
Q

A two-month-old baby presents with nonbilious projectile emesis. What are the appropriate steps in management?

A

Correct metabolic abnormalities. Then correct pyloric

stenosis with pyloromyotomy.

182
Q

The most common 1° immunodeficiency.

A

Selective IgA deficiency.

183
Q

An infant has a high fever and onset of rash as fever breaks.
What is he at risk for?

A

Febrile seizures (roseola infantum).

184
Q

A boy has chronic respiratory infections. Nitroblue tetrazolium test is (+).
What is the immunodeficiency?

A

Chronic granulomatous disease

185
Q

A child has eczema, thrombocytopenia, and high levels of IgA.
What is the immunodeficiency?

A

Wiskott-Aldrich syndrome

186
Q

A four-month-old boy has life-threatening Pseudomonas infection.
What is the immunodeficiency?

A

Bruton’s X-linked agammaglobulinemia

187
Q

Acute-phase treatment for Kawasaki disease.

A

High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms.

188
Q

Treatment for mild and severe unconjugated hyperbilirubinemia.

A

Phototherapy (mild) or exchange transfusion (severe).

189
Q

Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.

A

Reye’s syndrome.

190
Q

A child has loss of red light refl ex. Diagnosis?

A

Suspect retinoblastoma.

191
Q

Vaccinations at a six-month well-child visit.

A

HBV, DTaP, Hib, IPV, PCV.

192
Q

Tanner stage 3 in a six-year-old girl.

A

Precocious puberty.

193
Q

Infection of small airways with epidemics in winter and

spring.

A

RSV bronchiolitis.

194
Q

Cause of neonatal RDS.

A

Surfactant deficiency.

195
Q

A condition associated with red “currant-jelly” stools.

A

Intussusception.

196
Q

A congenital heart disease that causes 2° hypertension.

A

Coarctation of the aorta.

197
Q

First-line treatment for otitis media.

A

Amoxicillin × 10 days.

198
Q

The most common pathogen causing croup.

A

Parainfluenza virus type 1.

199
Q

A homeless child is small for his age and has peeling skin and a swollen belly.

A

Kwashiorkor (protein malnutrition).

200
Q

Defect in an X-linked syndrome with mental retardation, gout, self-mutilation, and choreoathetosis.

A

Lesch-Nyhan syndrome (purine salvage problem with

HGPRTase defi ciency).

201
Q

A newborn girl has a continuous “machinery murmur.”

A

Patent ductus arteriosus (PDA).

202
Q

Eisenmenger’s syndrome

A

Reverse of a L–>R Shunt to R–>L shunt. Occurs later in life reverse of shunt, and has cyanosis (unlike L–>R shunts)

MCCQE1 (19 decks)

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