Pediatrics Case Files

Question 0

What 2 vaccinations is a true egg allergy a contraindication for them?

Answer 0

1. Influenza
2. Yellow fever
   * *NOT MMR, it only contains minute amounts of egg products!

Question 1

Hypersensitivities and contraindications to vaccinations?

Answer 1

• only immediate hypersensitivity rxns to the given vaccine, one of its components, or the preservative agents are contraindications
• true egg hypersensitivities are contraindications for the influenza and yellow fever vaccinations

Question 2

Encephalopathy or encephalitis after a diphtheria, tetanus,and pertussis vaccine?

Answer 2

-DO NOT give the subsequent vaccines!

Question 3

Live vaccines and a child living in a home with a pregnant woman?

Answer 3

-OK to give the live vaccine

Question 4

MMR or varicella vaccines in asymptomatic HIV pts?

Answer 4

-OK to give

Question 5

What age is the Hib vaccine no longer reccommended?

Answer 5

-age 5+

Question 6

At what age are undiluted juices allowed? How should they be served?

Answer 6

• avoid until 6 months

- serve in cup, not bottle

Question 7

When should a child be able to roll over?

Answer 7

-4 months

Question 8

When should a child be able to sit up?

Answer 8

-6 mnths

Question 9

When should a child be able to fix and follow on the human face?

Answer 9

-from birth!

Question 10

Which 2 groups of patients should not receive live vaccines?

Answer 10

1. Pregnant

2. Severely immunocompromised

Question 11

Plumbism?

Answer 11

-lead poisoning

Question 12

2 methods of chelation for lead poisoning in asymptomatic kids?

Answer 12

1. IM calcium disodium Ethylenediamineteraacetic acid (CaEDTA)
2. Oral meso-2,3-dimercaptosuccinic acid (DMSA, succimer) –> more common

Question 13

Normal lead blood levels? Level that warrants hospitalization?

Answer 13

• normal < 10

- hospitalization > 70

Question 14

What lead level is chelation therapy started at?

Answer 14

• > 45

Question 15

What lead level is an environmental investigation warranted?

Answer 15

• > 20 or levels that remain elevated despite education of the parents/family

Question 16

What lead level are long bone radiographs recommended?

Answer 16

• NEVER recommended, no matter what the level is!

Question 17

After a chelation therapy, what should be done if the levels rise again?

Answer 17

• reassurance, the levels might rise after an initial fall due to redistribution in the body and the lead also deposits in other tissue (such as bone)
• rechelation tx is only recommended when the level rebounds to 45 or higher

Question 18

6 Ssx of in utero exposure to mercury?

Answer 18

1. Low birth weight
2. Microcephaly
3. Seizures
4. Developmental delays
5. Vision impairments
6. Hearing impairments

Question 19

7 SSx of mercury poisoning in children and adults?

Answer 19

1. Ataxia
2. Tremor
3. Dysarthria
4. Memory loss
5. Altered sensorium (vision, hearing, smell, or taste)
6. Dementia
7. Death

Question 20

Ssx of acute arsenic ingestion?

Answer 20

-severe GI sx

Question 21

Ssx of chronic arsenic exposure?

Answer 21

• skin lesions

- can also cause peripheral neuropathy and encephalopathy

Question 22

What is Orellanine?

Answer 22

-toxin found in cortinarius spe ies of mushrooms

Question 23

4 Ssx of Orellanine ingestion?

Answer 23

1. Nausea
2. Vomiting
3. Diarrhea
4. Renal toxicity (occurs several days later)

Question 24

5 Behavioral ssx of lead poisoning?

Answer 24

1. Hyper irritability 2. Altered sleep patterns 3. Decreased play activity 4. Loss of developmental milestones (esp speech) 5. Altered state of consciousness

Question 25

6 Physical ssx of lead poisoning?

Answer 25

1. Vomiting 2. Intermittent abdominal pains 3. Constipation 4. Ataxia 5. Coma 6. Seizures

Question 26

Tx for hospitalized pts with symptomatic lead poisoning?

Answer 26

1. 2,3-dimercaptopropanol (BAL) + CaEDTA

Question 27

3 Initial treatments given for an asthma exacerbation?

Answer 27

1. Administration of oxygen 2. Inhaled Beta-agonists 3. Systemic dose of prednisone

Question 28

Triad of asthma exacerbations?

Answer 28

1. Bronchoconstriction 2. Airway inflammation 3. Mucus plugging

Question 29

Pulsus paridoxus: definition? What 3 conditions is it associated with?

Answer 29

- bp that varies more widely with respirations than normal - variance > 10 mm Hg between inspiration and expiration - suggests: 1. obstructive airway dz 2. Precardial tamponade 2. constrictive pericarditis

Question 30

Median age of onset of asthma?

Answer 30

-4 yrs

Question 31

What are the 3 strongest risk factors for asthma development in a child?

Answer 31

1. Atopy 2. Family history 3. Respiratory infections early in life

Question 32

Pathophysiology of airway inflammation in asthma?

Answer 32

- result of mast cell activation - immediate IgE response to environmental triggers, usually occurs w/in 15-30 min (early phase reaction) - includes vasodilation, increased vascular permeability, smooth-muscle constriction, and mucus secretion

Question 33

Describe the Late Phase Reaction (LPR) in asthma?

Answer 33

- occurs 2-4 hrs after an acute asthma response - inflammatory cells infiltrate the parenchyma of the airways --> causes chronic inflammation - airway hyperresponsiveness can occur for weeks after an LPR

Question 34

Anticholinergics and asthma?

Answer 34

- can be helpful in the acute management of asthma exacerbations - dont help much with chronic management - MOA: inhibit the vagal reflex at smooth muscle

Question 35

Cromolyn: MOA? Use?

Answer 35

- MOA: anti-inflammatory drugs that reduce the immune response to allergen exposures - take 2-4 wks to become effective! - on,y successful in 75% of pts!

Question 36

Nedocromil: MOA? Use?

Answer 36

- MOA: anti-inflammatroy drugs that act by reducing the immune response to allergen exposures - take 2-4 weeks to become effective

Question 37

Name 2 anti-inflammatory drugs that reduce the immune response to allergen exposures?

Answer 37

1. Cromolyn | 2. Nedocromil

Question 38

Leukotriene modifiers: uses?

Answer 38

-anti-inflammatory medications that can be used for long term control

Question 39

Brachydactyly?

Answer 39

- shortening of hand and foot tubular bones --> results in boxlike appearance - can be seen in down syndrome

Question 40

Clinodactyly?

Answer 40

- incurving of one of the digits | - in down syndrome it is usually the pinky finger

Question 41

What are the three hormones tested in the triple screen and when during pregnancy are they done?

Answer 41

1. Alpha-fetoprotein 2. hCG 3. Estriol levels - usually done at 15-20 weeks

Question 42

In newborns with suspected down syndrome, what 2 potentially life-threatening conditions should they be evaluated for?

Answer 42

1. Cardiac abnormalities --> do echo! - 50% have cardiac defects - most common = endocardial cushion defect, VSD & tetralogy of Fallot 2. Gastrointestinal abnormalities - 12% have duodenal atresia --> do xray and look for "double-bubble" if there are feeding problems

Question 43

3 types of chromosomal abnormalities that can cause Down syndrome?

Answer 43

1. Trisomy 21 --> most common (95%) 2. Translocations (2%) 3. Mosaics (3%)

Question 44

What 3 screenings are important to do periodically in down syndrome children?

Answer 44

1. Thyroid 2. Hearing 3. Vision

Question 45

Common features of Down syndrome?

Answer 45

- trisomy 21 1. Hypotonia 2. Poor Moro reflex 3. Flat face 4. Slanted palpebral fissures 5. Laxity of joints 6. Excessive skin on the back of the neck

Question 46

Common features of Edwards syndrome?

Answer 46

- trisomy 18 1. Weak cry 2. Single umbilical a. 3. Micrognathia 4. Small mouth 5. High arched palate 6. Clenched hand with overlapping of index finger over the third finger 7. Simian crease 8. Rocker-bottom feet 9. Small pelvis 10. Short sternum

Question 47

Common features of Patau syndrome?

Answer 47

- trisomy 13 1. Microcephaly 2. Sloping forehead 3. Deafness 4. Scalp cutis aplasia 5. Microlthalmia 6. Coloboma 7. Cardiac defects 8. Omphalocele 9. Single umbilical artery 10. Hypersensitivity to agents containing atropine and pilocarpine

Question 48

Pauciarticular RA?

Answer 48

-RA that involves 1-4 joints

Question 49

Polyarticular arthritis?

Answer 49

-RA that involves 4+ joints

Question 50

Definition of arthritis?

Answer 50

- swelling or effusion that contains 2 or more of the following: 1. Limited ROM 2. Tenderness or pain on motion 3. Warmth

Question 51

Timing criteria for dx of juvenile RA?

Answer 51

1. Onset before age 16 | 2. Sx for > 6 mnths

Question 52

3 types of JRA?

Answer 52

1. Systemic-onset 2. Paciarticular 3. Polyarticular

Question 53

5 Common ssx of systemic-onset JRA?

Answer 53

1. Daily high spiking fevers 2. Rash --> wax and wane with fever 3. Arthralgias --> wax and wane with fever 4. Lymphadenopathy 5. Organomegaly

Question 54

3 Initial lab tests that should be done for systemic JRA? Results that support dx?

Answer 54

1. CBC 2. ESR 3. Blood cultures Supportive: 1. Anemia 2. Leukocytosis 3. Thrombocytosis

Question 55

What infectious disease can look like systemic JRA?

Answer 55

- Rubella | - MAKE SURE THEY HAD THEIR VACCINES!!

Question 56

In what group of kids is slipped capital femoral epiphysis common in?

Answer 56

-obese African American boys

Question 57

What should you think about in a child with a fever of unknown origin?

Answer 57

-systemic-onset JRA!

Question 58

Risk factors for neonatal physiologic jaundice?

Answer 58

1. Male 2. Cephalohematoma 3. Asian origin 4. Breast fed 5. Maternal DM 6. Prematurity 7. Polycythemia 8. Trisomy 21 9. Cutaneous bruising 10. Delayed bowel movements 11. Upper GI obstruction 12. HypoTH 13. Swallowed maternal blood 14. Sibling w/ physiologic jaundice

Question 59

Which bilirubin is neurotoxic?

Answer 59

Unconjugated

Question 60

Conjugated bilirubin?

Answer 60

- direct | - chemically attached to a glucuronide

Question 61

Erythroblastosis fetalis?

Answer 61

- increased RBC destruction due to transplacental maternal antibody passage - antibodies are active against infant's RBC antigens

Question 62

5 Ssx of hemolysis?

Answer 62

1. Rapid rise of serum bilirubin 2. Anemia 3. Pallor 4. Reticulocytosis 5. Hepatosplenomegaly

Question 63

Unconjugated bilirubin?

Answer 63

- indirect | - NOT attached to glucuronide

Question 64

When is the peak of bilirubin in full-term newborns?

Answer 64

- btwn 2nd and 4th day of life | - 5-6 mg/dL

Question 65

8 causes of NONphysiologic jaundice in newborns?

Answer 65

1. Septicemia 2. Biliary atresia 3. Hepatitis 4. Galactosemia 5. Cystic fibrosis 6. Congenital hemolytic anemia 7. Drug-induced hemolytic anemia 8. HypoTH

Question 66

4 Findings that suggest NONphysiologic jaundice in newborns?

Answer 66

1. Appears w/ in first 24-36 hrs if life 2. Bilirubin levels rise more than 5mg/dL/24 hrs 3. Bilirubin is > 12 mg/dL in a full-term infant w/out other physiologic jaundice risk factors 4. Jaundice that persists after 10-14 days of life

Question 67

6 Causes of jaundice that presents w/in the first 24hrs of life!

Answer 67

1. Erythroblastosis fetalis 2. Hemorrhage 3. Sepsis 4. Cytomegalic inclusion disease 5. Rubella 6. Congenital toxoplasmosis * *** any jaundice w/in 24 hrs requires IMMEDIATE attention!!

Question 68

Tx for breast-milk jaundice?

Answer 68

-stop breast feeding and use formula for 12-24 hrs --> then can resume breast-feeding

Question 69

5 Possible manifestations of neonatal HSV?

Answer 69

- herpes simplex virus 1. Premature delivery 2. Localized skin, eye, and mouth involvement (SEM) 3. CNS disease 4. Disseminated disease 5. Combo of any of above

Question 70

When is an infant's risk of contracting HSV highest?

Answer 70

-in a vaginal delivery when the outbreak of herpes is from a primary infection

Question 71

When is the risk of death the highest in infants with congenital HSV?

Answer 71

-with CNS disease, disseminated disease, esp if pneumonitis or DIC occurs

Question 72

4 Lab results common in congenital HSV?

Answer 72

1. Moderate peripheral leukocytosis 2. Elevated serum liver transaminase levels 3. Hyperbilirubinemia 4. Thrombocytopenia

Question 73

Tx for congenital HSV?

Answer 73

-parenteral acyclovir

Question 74

Congenital HSV prognosis?

Answer 74

- kids with isolated skin, eye, and mouth disease generally have the best outcomes - using acyclovir long-term can reduce the mortality in children who have localized CNS disease and disseminated dz - most kids who survive the CNS dz usually have neurological sequelae - most of the kids withs disseminated dz have normal development by 12mnths of age

Question 75

What should be done in a pregnant woman who gets recurrent HSV genital outbreaks?

Answer 75

- Risk of viral transmission of recurrent HSV is low --> BUT if lesions are present at time of delivery, a c-section should be done - surveillance cultures are not recommended --> not very predictive

Question 76

What to do in a child (older than neonate) has genital herpes?

Answer 76

- worry about sexual abuse! | - could also be from who bathes the child too though!

Question 77

Prognosis of HSV encephalitis in children?

Answer 77

-with appropriate tx and rehab, good outcomes are possible --> majority have permanent neurologic impairment though

Question 78

Dysentery?

Answer 78

-intestinal infection that results in severe bloody diarrhea with mucus

Question 79

Enteritis?

Answer 79

- inflammation of the small intestine - usually causes diarrhea - can be the result of an infection, immune response, or other cause

Question 80

Most common source of non-typhoidal salmonella? Season most common in?

Answer 80

- poultry and raw eggs most common source of human infection --> many animals harbor salmonella - iguanas and small turtles can also carry salmonella - infections are more common in the warmer months

Question 81

Spread of salmonella infection?

Answer 81

- need to ingest a lot of organisms | - spread is rarely from person-to-person

Question 82

Microbio of salmonella?

Answer 82

-aerobic gram-negative rods

Question 83

6 Common ssx of salmonella infection in kids?

Answer 83

1. Sudden onset of nausea 2. Emesis 3. Cramping abdominal pain 4. Watery or bloody diarrhea 5. Low-grade-fever 6. Sometimes can have neurologic sx (confusion, headache, drowsiness, and seizures)

Question 84

Microbio of shigella?

Answer 84

-small, gram-negative bacilli

Question 85

Transmission of shigella? Most common season?

Answer 85

- spread person-to-person most often (fewer organisms requried to cause dz) --> can be in food and water too though - most common in the warmer months

Question 86

6 Common Ssx of shigella infection?

Answer 86

1. Fever 2. Cramping abdominal pain 3. Watery diarrhea 4. Anorexia 5. Appear ill 6. Slmetimes neurologic sx (headache, confusion, seizure, hallucination)

Question 87

Lab findings of salmonella?

Answer 87

1. Stool culture is usually negative 2. Fecal leukocytes are usually positive = colonic inflammation 3. Occult blood test usually positive 4. Mild leukocytosis

Question 88

Common shigella lab results?

Answer 88

1. Stool culture is usually negative 2. Fecal leukocytes are usually positive = colonic inflammation 3. Occult blood = positive 4. Peripheral white count is usually normal with remarkable left shi!

Question 89

Tx of salmonella?

Answer 89

- fluid and electrolyte balance! - antibiotics are not helpful --> dont shorten course and can increase chances of HUS - dont use antimotility tx!

Question 90

Tx of shigella?

Answer 90

- fluid and electrolyte balance! - antibiotics --> decrease duration of diarrhea and decrease the amnt of organism shed (and spreading) - dont use antimotility tx!

Question 91

Most common cause of acute childhood renal failure?

Answer 91

-hemolytic-uremic syndrome --> can develop after e. coli (O157:H7)

Question 92

Typical presentation of HUS?

Answer 92

- Acute onset of: 1. Pallor 2. Irritability 3. Decreased or absent urine output 4. Stroke 5. Petechiae 6. Edema - occurs1-2wks after a diarrheal illness

Question 93

Tx and prognosis of HUS?

Answer 93

- tx: supportive, some children might require dialysis - most children recover and renal function goes back to normal - continue to follow and screen the child for HTN and chronic renal failure

Question 94

Tx for intussusception?

Answer 94

- barium enema | - can be diagnostic and therapeutic

Question 95

Otalgia

Answer 95

-ear pain

Question 96

6 Common ssx of otitis media?

Answer 96

1. Ear pain 2. Fever 3. Red TM 4. Opaque TM 5. Poorly moving TM 6. Bulging TM

Question 97

Serous OM?

Answer 97

- otitis media with effusion | - get a collection of fluid behind the TM, but without ssx of an acute OM

Question 98

3 Common bacterial causes of OM?

Answer 98

1. Strep pneumo 2. H. Influenza 3. Morexella catarrhalis

Question 99

What is the usual tx for acute OM?

Answer 99

- amoxicillin 80 mg/kg/d for 7-10 days | - if no improvement in 3 days, switch antibiotics!

Question 100

How long can middle ear fluid persist for after an acute OM episode? Tx?

Answer 100

- for several months! - just observe if no hearing loss - if hearing loss occurs, a myringotomy with tubes is needed!

Question 101

3 Important serious complications of OM?

Answer 101

1. Mastoiditis 2. Temporal bone osteomyelitis 3. Facial nerve paralysis

Question 102

2 common bacterial and 2 common fungal causes of otitis externa?

Answer 102

- bacteria: 1. Pseudomonas 2. Staph aureus - fungal: 1. Candida 2. Aspergillus

Question 103

Mastoiditis tx?

Answer 103

- myringotomy - fluid culture - parenteral antibiotics

Question 104

What to do if an OM fails several antibiotics txs?

Answer 104

-tympanocentesis and culture the middle ear fluid

Question 105

Myringotomy?

Answer 105

-putting a small hole into the ear drum to relieve pressure

Question 106

When do children start babbling things like "baba and dada"?

Answer 106

-usually by 9 mnths

Question 107

Conductive hearing loss?

Answer 107

-hearing loss caused by disorders of the outer ear (external auditory canal atresia and otitis externa) or middle ear (OM and cholesteatoma)

Question 108

Eetrocochlear hearing loss?

Answer 108

- central hearing loss | - caused by deficits in the auditory nerve or central auditory nervous system

Question 109

Sensorineural hearing loss

Answer 109

-hearing loss caused by cochlea disorders (damage from infection, noise, ototoxic agents, or genetic defects)

Question 110

Waardenburg syndrome: 6 ssx? Inheritance?

Answer 110

Autosomal dominant! 1. Partial albinism --> usually a white forelock 2. Deafness 3. Lateral displacement of the inner canthi 4. Heterochromic irises 5. Medial eyebrow flare 6. Broad nasal bridge and mandible

Question 111

Brachio-oto-renal syndrome: 5 ssx?

Answer 111

1. Hearing impairment 2. Preauricular pits 3. Brachial fistulas 4. Renal impairment 5. External ear abnormalities

Question 112

Most common infectious cause of congenital sensorineural hearing loss (SNHL)? 3 other infections?

Answer 112

- prenatal CMV - can also cause hearing loss later in infancy and childhood - other infections: 1. Toxoplasmosis 2. Rubella 3. Syphilis

Question 113

Two most common postnatal infectious causes of SNHL?

Answer 113

1. Group B strep | 2. Strep pneumo

Question 114

What is the current goal for dx and interventions in hearing loss?

Answer 114

- dx by 3 mnths - intervention by 6 mnths * *early intervention can enhance communication skills and academic performance

Question 115

What age can hearing aids be used? What age for cochlear implants?

Answer 115

- 2 mnths for hearing aids | - older than 2 yrs for cochlear implants

Question 116

What APGAR scores warrant an audiologic evaluation?

Answer 116

-< 4 @ 1 minute and < 6 @ 5 minutes

Question 117

Speech abilities of a 24 month old?

Answer 117

- vocab of 50 words | - able to make 2 word sentences

Question 118

Speaking abilities of a 36 mnth old?

Answer 118

- vocab of 250 words - produce at keast 3 word sentences - use pronouns

Question 119

Two most common drugs that can cause SNHL if taken during prenatal period?

Answer 119

1. Aminoglycosides | 2. Loop diuretics

Question 120

What should a female child be tested for when sexually abuse occurs (7)?

Answer 120

1. Trichomonads 2. Bacterial vaginosis 3. Yeast infections 4. Chlamydia 5. N. Gonorrhea 6. HIV test (for at least 6 mnths after the last sexual contact) 7. Syphillis

Question 121

How long is forensic information usually present for with sexual abuse?

Answer 121

-for 72 hrs

Question 122

Anal condylomata in a child < 3 yrs old?

Answer 122

- usually acquired at birth via direct conduct w/ genital condylomata of mother in the birth canal - but make sure to get a full history to make sure there is no sexual abuse!

Question 123

Emollient?

Answer 123

- cream or lotion that restores water and lipids to the epidermis - the more effective and lubricating ones contain urea or lactic acid - creams lubricate better than lotions

Question 124

Flexural areas?

Answer 124

- areas of repeated flexion and extension - often perspire on exertion - ex: antecubital fossae, neck, wrists, ankles

Question 125

In the infantile phase of atopic dermatitis, when do sx usually start?

Answer 125

-start to see first signs of inflammation during third month of life

Question 126

Another name for atopic dermatitis?

Answer 126

-eczema

Question 127

Prognosis of atopic dermatitis in infants?

Answer 127

-resolves in 50% by 18 months

Question 128

Tacrolimus & pimecrolimus: what are they? Use? Possible link?

Answer 128

- what: non-steroidal, immunomodulator topicals for tx of atopic dermatitis - use: children > 2 yrs old for short term, or long-term intermittent tx in pts who did not have an adequate response to conventional tx - link: possibly linked with lymphoma! --> consult dermatologist!

Question 129

Iral antihistamines and atopic dermatitis?

Answer 129

-can be of use at night to decrease itching, which is often worse at night, and to have some sedating effects

Question 130

Pityriasis rosea: describe rash? Tx?

Answer 130

- rash: herald patch followed by christmas-tree formation of salmon colored lesions - tx: antihistamines, topical antipruritic lotions, low-dose corticosteroids, & photo tx

Question 131

Eczema herpeticum: what is it? Tx?

Answer 131

- what: infants with atopic dermatitis can develop a rapid onset of diffuse cutaneous herpes, will have high fever and adenopathy 2-3 days after onset of vesicular rash - tx: admission to hospital and intravenous acyclovir --> medical emergency in young infant!

Question 132

Wiskott-Aldrich syndrome: genetics? 3 Ssx?

Answer 132

- X-linked - Ssx: 1. Recurrent infections 2. Eczema 3. Thrombocytopenia - T-cell dysfunction

Question 133

How do infants with poor caloric intake usually grow?

Answer 133

- fail to gain weight, but maintain length and head circumference - eventually length is affected next, and then head circumference last

Question 134

Failure to thrive definition?

Answer 134

- FTT - physical sign, not a dx! - growth below the 3rd or 5th percentile, or growth that crosses more than 2 major growth percentiles in a short time frame - usually seen in kids < 5 yrs old

Question 135

Nonorganic failure to thrive?

Answer 135

- psychosocial - poor growth without medical etiology - often due to poverty or poor caregiver-child interaction - it is usually the cause in nearly all the cases of failure to thrive in the primary care setting

Question 136

Organic failure to thrive?

Answer 136

- poor growth caused by an underlying medical condition | - ex: inflammatory bowel dz, renal dz, congenital heart conditions

Question 137

A good way to determine cause of FTT in a younger infant?

Answer 137

- observe a feeding | - it will give clues to maternal-child interaction, bonding issues, physical issues, etc.

Question 138

4 Tests to do in a child with no signs to the cause of FTT?

Answer 138

1. CBC 2. Lead level 3. Urinalysis and culture 4. Serum electrolyte levels

Question 139

How many kcal/kg/d do healthy children require in the first year of life? After first year? How much to give in FTT children to ensure catch-up growth?

Answer 139

- first year: 120 - after: 100 - catch-up growth: 50-100% more calories needed!

Question 140

What should be done when evaluating the growth of a premie?

Answer 140

-use a premie growth chart!

Question 141

When do children typically become "picky eaters"? What should be done?

Answer 141

-typically btwn ages 18-30 mnths -counsel parents to provide nutrition, avoid "force-feeding" , and avoid providing snacks + close follow-up

Question 142

4 Ssx of renal tubular acidosis? Tx?

Answer 142

1. FTT 2. Elevated chloride 3. Low bicarb 4. Low potassium - tx: oral bicarb supplementation

Question 143

What 3 characteristics are needed to dx ADHD?

Answer 143

1. Inattentiveness 2. Hyperactivity 3. Impulsivity

Question 144

2 First-line tx options for ADHD?

Answer 144

1. Methylphenidate 2. Dextroamphetamine - both are stimulants

Question 145

What are 3 other types of medications that can be used for ADHD besides stimulants?

Answer 145

1. Atomoxetine = nonstimulant that is a selective norepi reuptake inhibitor 2. Tricyclic antidepressants 3. Buproprion

Question 146

What are 4 common coexisting psychiatric conditions that can occur with ADHD?

Answer 146

1. Oppositional defiant disorder 2. Conduct disorder 3. Anxiety disorder 4. Depressive disorder

Question 147

What should be done for a child with a new diagnosis of ADHD?

Answer 147

-send them for complete psychoeducational testing before developing a management plan

Question 148

4 First-line tx choices for combination acne?

Answer 148

1. Antibacterial soap 2. Keratolytic agent = benzoyl peroxide 3. Comedolytic agent = tretinoin 4. Topical antibiotics = erythromycin

Question 149

Open comedones?

Answer 149

- "blackheads" | - composed of compacted melanocytes

Question 150

Closed comedones?

Answer 150

- "whiteheads" | - contain purulent debris

Question 151

Cyst?

Answer 151

- dilated intradermal follicle | - usually tender

Question 152

Inflammatory papule?

Answer 152

-red "bump" under the skin that is due to sebum, fatty acuds, and bacteria reacting within a follicle

Question 153

Pustule?

Answer 153

-inflammation and exudate around comedones that occur in the superficial dermis

Question 154

Why is acne seen mostly during puberty?

Answer 154

-pubertal hormones cause an increase in sebum production by the sebaceous glands

Question 155

What is the bacteria involved in acne?

Answer 155

-propionibacterium acnes

Question 156

2 categories of acne lesions and what falls into each?

Answer 156

1. Inflammatory: - papules - pustules - nodules - cysts 2. Non-inflammatory: - open comedones - closed comedones

Question 157

Benzoyl peroxide: what is it? Use?

Answer 157

- what: bactericidal and keratolytic that causes follicular desquamation - use: for acne, available OTC, but better to use a higher potency prescription preparation - good to use when lesions are widely distributed

Question 158

Topical tretinoin: what is it? What does it do? Use?

Answer 158

- what: vitamin A derivative - function: inhibits formation of microcomedones and increases cell turnover - use: for acne, can cause drying of skin, avoid sun exposure & use sunscreen

Question 159

Isotretinoin: use? Sfx?

Answer 159

- AKA: accutane - use: tx for severe, resistant nodulocystic acne - sfx: 1. Highly teratogenic 2. Cheilitis 3. Conjunctivitis 4. Hyperlipidemia 5. Blood dyscrasias 6. Elevated liver enzymes 7. Photosensitivity

Question 160

Tinea barbae: what is it? Who is it more common in? Tx?

Answer 160

- what: fungal infection that is found in facial hair, can be aquired through animals - more common in farmers - tx: oral antifungals (topicals dont work!)

Question 161

What advice should be given to a female on oral contraceptives and oral antibiotics? Why?

Answer 161

-use another form of BC too, bc oral antibiotics can decrease the effectiveness of oral contraceptives

Question 162

Rash with mono?

Answer 162

- not common in adolescents with mono | - but pts with mono who take amoicillin, amoxicillin, or penicillin can get a morbilliform rash = looks like measles

Question 163

How long after an acute infection with EBV do people continue to shed the virus in their saliva?

Answer 163

- can continue to shed for more than 6 mnths | - can even shed intermittently for life!

Question 164

Replication of EBV in a pt after an infection?

Answer 164

-After an infection occurs EBV replicates in the oropharyngeal epithelium and later in B lymphocytes

Question 165

5 Possible ssx in a young/small child w/ primary EBV infection?

Answer 165

1. Adymptomatic 2. Fever only 3. Otitis media 4. Abdominal pain 5. Diarrhea

Question 166

Monospot test use?

Answer 166

- useful in children > 5 yrs | - early in illness can have false negatives

Question 167

4 Common results seen in blood tests of Mono pt?

Answer 167

1. Lymphocytic leukocytosis 2. Atypical lymphocytes 3. Mild thrombocytopenia 4. Mildly elevated liver function tests

Question 168

What is a life threatening complication of Mono?

Answer 168

-rupture of a spleen with splenomegaly --> causes blood loss that is life threatening!

Question 169

Tx of Mono?

Answer 169

- only rest - antivirals dont have any affect - steroids may be needed if tonsilar hypertrophy is threatening the airway!

Question 170

Dx of EBV in young children (< 5 yrs)?

Answer 170

-specific antibody assays

Question 171

What does eosinophils in a Hansel stain tell you?

Answer 171

-supports the diagnosis of allergic rhinitis --> rarely needed

Question 172

3 Most common bacterial causes of URIs?

Answer 172

1. Morexella catarrhalis 2. Strep pneumoniae 3. Nontypeable H. Flu

Question 173

Vasomotor rhinitis: what is it? Tx?

Answer 173

- sx are similar to allergic rhinitis, but brought on by weather changes, physical stimuli, or emotion - pts lack hx of atopy and lack eosinophils on nasal smear - tx: no tx necessary, but topical anti-histamines can be helpful in older children

Question 174

Nasal steroids and allergic rhinitis: use? Sfx?

Answer 174

- use: effective and well tolerated | - sfx: epistaxis, irritation, or burning

Question 175

What should be done for a child with nasal polyps who is less than 10 yrs old?

Answer 175

-sweat chloride test for CF!

Question 176

Tender, Soft fleshy mass in a nare?

Answer 176

- most likely a rhabdomyosarcoma - most common pediatric soft-tissue sarcoma - most are located in the head/neck region

Question 177

What causes nasal polyps?

Answer 177

- sequelae of chronic inflammation and allergic rhinitis | - but screen any kids < 10 yrs with nasal polyps for CF!

Question 178

What is the most common cause of ambiguous genitalia? Pathophysiology?

Answer 178

- congenital adrenal hyperplasia (CAH) - most commonly due to a deficiency in 21-hydroxylase --> low cortisol and high androgenic intermediate hormone production --> virilization

Question 179

Hermaphroditism?

Answer 179

-discrepancy btwn gonad morphology and external genitalia

Question 180

Intersex state?

Answer 180

-infant with ambiguous genitalia

Question 181

Microphallus?

Answer 181

- penis size below the 5th percentile for age | - neonate with stretched penis length of less than 2 cm

Question 182

Virilization?

Answer 182

- Masculinization where infant girls exhibit clitoromegaly, labial fusion, and labial pigmentation - infant boys appear normal

Question 183

Most common form of male pseudohermaphroditism?

Answer 183

- androgen insensitivity | - decreased androgen binding to target tissues

Question 184

True hermaphroditism?

Answer 184

- most are 46 XX, some 46 XY or mosaic - bilateral ovotestes or ovary and testis on opposite sides - gender assignment is based on genitalia appearance

Question 185

Mixed gonadal dysgenesis?

Answer 185

- most 46, XY/45 XO karyotype - sertoli and ledig cells, but no germinal elements on one side and streak gonads on the other side - hypospadias - partial labroscrotal fusion - undescended testes most common - usually assigned female gender and undergo gonadectomh (streak gonads are at risk for developing malignancy)

Question 186

What is the most important factor in detmining an infant's sex assignment?

Answer 186

-phallic size

Question 187

2 lab tests to do with ambiguous genitalia?

Answer 187

1. Karyotype | 2. Serum 17 alpha-hydroxyprogesterone level

Question 188

When is reconstructive surgery usually performed in cases with ambiguous genitalia?

Answer 188

- performed as early as possible, usually before 6mnths of age - want to do ASAP bc ambiguous external genitalia can reinforce doubt of sexual identity and can by psychologically harmful

Question 189

What is avoided in a pt with ambiguous genitalia who has hypospadias?

Answer 189

- circumcisions are avoided so the foreskin can be used for reconstruction - goal is to create a phallic urethra

Question 190

Cause of short/atretic vagina?

Answer 190

- testicular feminization - due to decreased androgen binding to target tissues or androgen insensitivity - 46 XY - phenotypically female - maintaine femal gender assignment

Question 191

What are the 3 ssx of prader-willi syndrome in early life?

Answer 191

1. Hypotonia 2. Failure to thrive 3. Hypogonadism

Question 192

Munchausen syndrome by proxy?

Answer 192

-abuse in which the caretaker falsifies symptoms or inflicts injury upon the child to necessitate medical intervention

Question 193

What tests should be done on a child with lots of bruises that is a suspected abuse vicitim?

Answer 193

1. Platelet count | 2. Coagulation studies

Question 194

4 common places for accidental bruises?

Answer 194

1. Knees 2. Elbows 3. Shins 4. Forehead * *bony areas!

Question 195

4 Areas where bruises are less likely to be accidental?

Answer 195

1. Abdomen 2. Buttocks 3. Thighs 4. Inner arms

Question 196

2 Classical patterns seen with hot water immersion?

Answer 196

1. Sharply demarcated border | 2. "Stocking glove" distribution

Question 197

What can cigarette burns look similar to?

Answer 197

-impetigo

Question 198

4 Common Ssx of osteogenesis imperfecta?

Answer 198

1. Long bone fractures and vertebral injury with minimal trauma (brittle bones) 2. Short stature 3. Deafness 4. Blue sclera

Question 199

Urine nitrite test?

Answer 199

- positive test = UTI - colony count > 10^5 needed for positive - nitrite = end product of enterobacter growth

Question 200

Urine leukocyte esterase test?

Answer 200

- usually positive in urethritis | - product of the inflammatory response that is associated with pyuria

Question 201

Condyloma?

Answer 201

- warts caused by HPV - small & papular or large & pedunculated - usually seen on genitalia, in perianal areas, or on surrounding skin - usually asymptomatic, or can be associated with local inflammatory rxn that is marked by tenderness or burning

Question 202

Balanitis?

Answer 202

- inflammation of glans penis | - can be caused by trauma or infections

Question 203

Why is annual GC and chlamydia urine screening in sexually active adolescents recommended?

Answer 203

-bc more than 60% of pts with urethritis will by asymptomatic

Question 204

3 Tests to do in a sexually active pt with a GU complaint?

Answer 204

1. Urine dipstick analysis for leukocytes, leukocyte esterase, and nitrites 2. Routine urine culturing 3. Urine PCR testing for GC and chlamydia --> but not always accepted in courts, so may have to do urethral swab if the pt is suspected to be an abuse vicitim

Question 205

Tx for gonorrhea?

Answer 205

- single IM dose of ceftriaxone | - PLUS tx for chlamydia incase there is a coinfection = one dose of azithromycin

Question 206

Tx for chlamydia?

Answer 206

-one dose of azithromycin

Question 207

Fitz-Hugh-Curtis syndrome?

Answer 207

- Complication of PID - Acute presentation = right upper quadrant pain that can refer to the back (from ascending pelvic infection and inflammation of the liver capsule and diaphragm) - can occur in both male and female patients, but more prevalent in females - can mimic other abdominal emergencies--> consider in any sexually active adolescent as a dx of exclusion - caused by either N gonorrhea or chlamydia - might see "violin string sign" on ultrasound

Question 208

Ddx for dysuria (4)?

Answer 208

1. Urethritis 2. UTI 3. Irritated GU lesions 4. Chemical urethritis

Question 209

Constitutional growth delay?

Answer 209

- The growth is slower than expected in a previously healthy child, but one or more of their parent's had a pubertal developmental delay and ultimately ended up with a normal adult height - bone age = height age

Question 210

Familial short stature?

Answer 210

- when a short child is born to short parents who had normal timing of their pubertal development - bone age = chronologic age

Question 211

Height age?

Answer 211

-age at which a child's measured height is at the 50th percentile

Question 212

Growth rate in 1st year of life? 2nd? 3rd?

Answer 212

-1st = 23 cm per year -2nd = 13 cm 3rd = 7.5 cm

Question 213

Growth rate for boys and girls during puberty?

Answer 213

- girls = 8-9 cm per yr | - boys = 10-11 cm per yr

Question 214

True or false: the growth rate in a child with constitutional growth delay is normal?

Answer 214

- true! | - they are considered "late bloomers"

Question 215

How to predict a boy's final height?

Answer 215

-(Father's height in cm - [mother's height in cm + 13])/2

Question 216

How to determine girl's final height?

Answer 216

-(Mother's height in cm - [father's height in cm + 13])/2

Question 217

5 Physical characteristics of a child with Growth hormone deficiency?

Answer 217

1. growth rate is slow 2. fall's off growth curve 3. child appears younger than stated age 4. frequently chubby 5. bone ages are delayed

Question 218

2 Tests for GH screening tests?

Answer 218

1. Serum IGF-1 or somatomedin C | 2. IGF-BP3

Question 219

Clues that growth failure is due to an underlying condition?

Answer 219

1. Poor appetite 2. Weight loss 3. Abdominal pain 4. Diarrhea 5. Unexplained fevers 6. Headaches 7. Vomiting 8. Weight gain that is out of proportion to height 9. Dysmorphic features

Question 220

What test should be done on all females with growth failure?

Answer 220

-karyotype to look for Turner's syndrome!

Question 221

Narcosis?

Answer 221

-deep stupor or unconsciousness caused by a chemical substance such as a drug or anesthesia

Question 222

Tx for narcotic-related respiratory depression in an infant?

Answer 222

-intraveneous, intramuscular, or subcutaneous naloxone

Question 223

What APGAR scores at 1 minute require immediate resucitation?

Answer 223

-less than 3!

Question 224

Neonate born with scaphoid abdomen, heart sounds heard on right and diminished breath sounds on left: what is probably the cause? Next step for resuscitation? What should be avoided?

Answer 224

- think: diaphragmatic hernia - next: endotracheal intubation - avoid: bag-and-mask ventilation bc it will, cause an accumulation of bowel gas (which is located in the chest) --> further respiratory compromise

Question 225

HR cutoffs for a neonate for chest compressions or drug therapy?

Answer 225

-less than 60 bpm despite 100% oxygen with PPV --> if still less than 60, use meds (usually epi)

Question 226

A neonate with respiratory distress when not crying, but fine when crying? Why?

Answer 226

- choanal atresia - infants are obligate nose breathers, when they cry they can breathe through their mouth, but when crying they need to have a patent nose

Question 227

Choanal atresia? Tx?

Answer 227

- congenital disorder - back of the nasal passage (choana) is blocked, usually by abnormal bony or soft tissue (membranous) due to failed recanalization of the nasal fossae during fetal development - tx: surgical recanalization

Question 228

Lactovegitarian?

Answer 228

-don't eat animal products, but do consume milk

Question 229

Omnivore?

Answer 229

-diet with both animal and plant products

Question 230

Ovovegitarian?

Answer 230

-dont eat animal products, but do eat eggs

Question 231

What supplements should infant's getting fed goat's milk as their primary nutrition source be given?

Answer 231

1. B12 2. Folate 3. Iron

Question 232

What should be done with Goat's milk before ingestion? Why?

Answer 232

- Goat's milk should be boiled first | - why: goats are more susceptible to brucellosis

Question 233

What 2 things does breast milk contain that help protect infants from infections?

Answer 233

1. High concentrations of IgA --> reduces viruses and bacteria intestinal wall adherence 2. Macrophages --> inhibit E. Coli growth

Question 234

3 disadvantages to breast feeding?

Answer 234

1. Possible virus transmission --> ex. HIV 2. Jaundice exacerbation --> increased unconjugated bilirubinemia levels 3. Low vitamin K levels

Question 235

Methylmalonic acidemia: what is it? How does it present in infants (5)? How can it be prevented?

Answer 235

- what: amino acid metabolism disorder, defect in conversion of methylmalonyl-coenzyme A to succinyl-CoA - possible presentation: 1. Failure to thrive 2. Seizure 3. Encephalopathy 4. Stroke 5. Other neuro ssx - prevention: give breast-feeding vegan mothers vit. B12

Question 236

What vitamin deficiency could cause fontanelle fullness in an infant?

Answer 236

-vitamin A

Question 237

What vitamin deficiency could cause hemolytic anemia in an infant?

Answer 237

-vitamin E

Question 238

Intrinsic factor?

Answer 238

-glycoprotein that is secreted into the stomach that binds to vitamin B12 --> together they attach to the receptors in the distal ileum and are absorbed

Question 239

4 Common causes of macrocytic anemia in children?

Answer 239

1. HypoTH 2. Trisomy 21 3. Vit B12 deficiency 4. Folate deficiency

Question 240

2 Ways that malabsorption of vit B12 in children can occur?

Answer 240

1. Terminal ileum is absent | 2. Infections/inflammation compromises the intestines ability to absorb B12

Question 241

What age are ssx of juvenile pernicious anemia usually seen?

Answer 241

-ages 1-5 yrs bc that is when the supply of B12 that was passed transplacentally from mother to child is exhausted

Question 242

What parasite is linked with a vitamin deficiency? What deficiency does it cause?

Answer 242

- parasite: fish tape worm = Diphyllobothrium latum --> uses B12 for growth and egg production - deficiency: vit B12 --> megaloblastic anemia

Question 243

Brudzinski sign?

Answer 243

- while the pt is supine, neck is passively flexed & results in involuntary knee and hip flexion - physical finding that is consistent with meningitis

Question 244

Kernig sign?

Answer 244

- while the pt is supine, legs are flexed at the hip and knee at 90* angle & pain results with leg extension - physical finding that is consistent with meningitis

Question 245

Encephalitis?

Answer 245

- brain parenchyma inflammation | - causes brain dysfunction

Question 246

Meningitis?

Answer 246

-leptomeningea, inflammations, typically infectious, can also be caused by foreign substances

Question 247

Top 3 causes of bacterial meningitis in infants?

Answer 247

1. E. Coli 2. Group B strep 3. Listeria

Question 248

3 Risk factors that make infants more susceptible to meningitis?

Answer 248

1. Low birth weight 2. Premie 3. Born to a mom with chorioamnionitis

Question 249

2 Most common causes of bacterial meningitis in older children?

Answer 249

1. Strep pneumo | 2. N. Meningitidis

Question 250

What does it mean when a pt infected with N. Meningitidis has a petechial or purpuric rash?

Answer 250

-they have septicemia

Question 251

3 Contraindications to lumbar puncture?

Answer 251

1. Skin infection over the planned puncture site 2. Increased intracranial pressure 3. A critically ill pt that may not tolerate the procedure

Question 252

8 Possible complications of acute meningitis infection? Most common?

Answer 252

1. Seizures 2. CN palsies 3. Cerebral infarction 4. Cerebral or cerebellar herniation 5. Venous sinus thrombosis 6. Subdural effusions 7. SIADH 8. Hearing-loss --> MOST COMMON

Question 253

What other infectious process besides bacterial meningitis, can cause neck stiffness?

Answer 253

-retropharyngeal abscess

Question 254

Osgood-schlatter disease: what is it? Pathogenesis?

Answer 254

- painful inflammation of the tibial tubercle - pathophysiology: repetitive running and jumping motions cause traction and microstress fractures to the developing area --> inflammation, edema, tenderness, and bony changes occur

Question 255

Slipped capital femoral epiphysis: when does it occur? How does it typically present? What is seen on xray? What at risk for?

Answer 255

- typically seen in adolescents during their growth spurt - Ssx: limp + groin or thigh pain, pain can be referred to the knee + limited hip flexion, internal rotation, & abduction - xray: widening of the femoral epiphysis and osteopenia - risk: avascular necrosis of the femoral epiphysis

Question 256

Osgood-schlatter dz: tx?

Answer 256

1. Decreased activity 2. Ice after exercise 3. NSAIDs 4. Knee immobilization --> in severe cases

Question 257

Early onset sepsis syndrome: when? Source?

Answer 257

- neonatal sepsis occurring in the first 6 days of life (majority of the time occurs within the first 24 hours of life) - the infection is typically caused by a microorganism from the mothers GU tract

Question 258

Group B strep: where can it be found in healthy adults? Most common site of colonization reservoir?

Answer 258

- infection with GBS is usually limited to the mucous membrane sites in a healthy adult - the GI tract is the most common reservoir

Question 259

Late-onset sepsis syndrome: when? Source?

Answer 259

- neonatal sepsis that usually occurs after approximately 7 days of lufe, but before 90 days - the source of infection is usually the caregiver's environment

Question 260

Intrapartum antibiotic prophylaxis?

Answer 260

-IV penicillin or ampicillin given during labor to prevent newborn GBS disease

Question 261

4 Most common Ssx of newborn sepsis and meningitis?

Answer 261

1. Temperature instability = high or low 2. Tachypena 3. Hypotension 4. Bradycardia

Question 262

How is overwhelming shock often manifested in newborns?

Answer 262

1. Pallor | 2. Poor capillary refill

Question 263

Meningitis v. Pneumonia? Early-onset or late-onset sepsis?

Answer 263

- pneumonia is more commonly seen with early-onset sepsis (w/in first 6 days of life) - meningitis is more commonly seen with late-onset sepsis (btwn days 7-90 of life)

Question 264

4 Signs of an infection on a CBC?

Answer 264

1. Markedly elevated or low WBC counts 2. Increased neutrophil count 3. Increased immature to total neutrophil ratios (left shift) 4. Thrombocytopenia w/ platelet count < 100,000

Question 265

What are the 4 tests that should be done to rule out neonatal sepsis?

Answer 265

1. CBC 2. Blood culture 3. Urine culture 4. LP with culture

Question 266

4 Most common causes of early-onset neonatal sepsis?

Answer 266

1. GBS 2. E. coli 3. H. Influenzae 4. Listeria monocytogenes

Question 267

What organism is the most common cause of neonatal sepsis from birth to 3 months?

Answer 267

Group B Strep!!!!!!!!

Question 268

5 Clinical hx and findings that are suggestive of early-onset GBS disease?

Answer 268

1. Prolonged rupture of membranes 2. Apnea 3. Hypotension in first 24 hrs of life 4. 1-minute Apgar score of less than 5 5. Rapid progression of pulmonary dz

Question 269

7 Risk factors for early-onset GBS disease?

Answer 269

1. Rupture of membranes more than 18 hrs before delivery 2. Chorioamnionitis 3. Intrapartum temp of > 100.4*F (38*C) 4. Previous infant with GBS 5. Mom < 20 yrs 6. Low birth weight 7. Prematurity (<37 wks gestation)

Question 270

What are the preventative guidelines for early-onset GBS infections?

Answer 270

-recommend screening women at 35-37 wks gestation for GBS and offering prophylactic antibiotics

Question 271

When does chemical conjunctivitis typically occur in a newborn? Prognosis? Cause?

Answer 271

- usually presents within 6-12 hrs after birth - self-limited - usually in response to ocular silver nitrate or erythromycin prophylaxis irritation

Question 272

What is the most serious newborn conjunctivitis? When does it typically present? 3 possible Complications?

Answer 272

- gonococcal conjunctivitis - usually occurs within 2-5 days after birth - if untreated, can cause: 1. Corneal ulceration 2. Perforation 3. Blindness

Question 273

What medication is associated with pyloric stenosis use in children?

Answer 273

-oral erythromycin

Question 274

When does chlamydial conjunctivitis typically present in mewborns? Tx? Risks?

Answer 274

- typically presents btwn days 5-14 of life - tx: oral erythromycin --> also reduces risk of chlamydial pneumonia - risk of oral erythromycin = increased risk of hypertrophic pyloric stenosis

Question 275

Chemical, gonoccoal, and chlamydial neonatal conjunctivitis: when do each usually occur?

Answer 275

1. Chemical = within 6-12 hrs 2. Gonococcal = days 2-5 3. Chlamydial = days 5-14

Question 276

Transient tachypena of the newborn is usually caused by what? Tx?

Answer 276

- caused by incomplete evacuation of fetal lung fluid in full germ infants --> more commonly seen with c-sections - tx: usually none, but supplemental oxygen if needed

Question 277

What should be done for a healthy newborn of an HIV positive mom who was on proper antiviral tx before delivery?

Answer 277

-begin the child on a course of zidovudine

Question 278

Tx of early-onset GBS infection?

Answer 278

-penicillin + aminoglycoside

Question 279

Tx of late-onset GBS infection?

Answer 279

-beta-lactamase-resistant antibiotic (such as vanco) + a 3rd generation cephalosporin

Question 280

Cerebral palsy: what is it? What is it caused by?

Answer 280

- what: disorder of movement and posture | - cause: insult or anomaly of the immature CNS, dysfunction has a central origin

Question 281

What is the most common childhood movement disorder?

Answer 281

-cerebral palsy

Question 282

How common are seizures and mental retardation in kids with cerebral palsy?

Answer 282

- seizures are seen in 1/3 of CP pts | - mental retardation is seen in 60% of all CP pts

Question 283

Which insults/difficulties are thought to be the cause of CP: antenatal or pregnancy/delivery/perinatal?

Answer 283

-antenatal insults are more likely to be the cause

Question 284

Can CP be dx at birth?

Answer 284

- no, the CNS is too immature | - it can be dx beyond infancy as a child fails to meet milestones, and/or fails to lose primitive reflexes

Question 285

Hempiplegia?

Answer 285

-refers to involvement of single lateral side of body + greater impairment of upper extremities than lower extremities

Question 286

Diplegia?

Answer 286

-four-limb involvement + greater impairment of the lower extremities

Question 287

Spastic quadriplegia?

Answer 287

- four-limb involvement with significant impairment of all extremities - upper limbs may be less impaired than lower limbs

Question 288

Paraplegia?

Answer 288

-term that is reserved for spinal and lower motor neuron disorders

Question 289

Motor quotient of CP?

Answer 289

- determined by dividing the child's "motor age" by their chronological age - the lower the number = the more significant impairment there is

Question 290

What are the 2 most common causes for sudeen development of respiratory sx in a child?

Answer 290

1. Foreign body aspiration | 2. Anaphylactic response to an allergen.

Question 291

Stridor v. Wheezing?

Answer 291

- easily confused by inexperienced 1. Stridor: - monophonic = one pitch - from partial airway obstruction - louder over UPPER chest 2. Wheezing: - polyphonic = multiple pitches - best heard at lung BASES

Question 292

Tachypnea: definition? Average resp rate for infant? 8 yr old child? Adult?

Answer 292

- respiratory rate that is faster than normal - infant average RR = 30 breaths/min - 8-yr old child = 20 - adult = 16

Question 293

4 Most common causes of croup?

Answer 293

- AKA: laryngotracheobronchitis - usually a viral cause - top 4: 1. Parainfluenza 2. Influenza 3. Measles 4. RSV

Question 294

Epiglottitis: cause? 5 most common Ssx?

Answer 294

- cause: H. Influenzae b - Ssx: 1. Drooling 2. Preference to sit in a tripod or upright position ("sniffing" position) 3. Muffled vocalizations 4. Inspiratory stridor 5. Absence of cough

Question 295

Bacterial tracheitis: most common cause? When is it seen? What is the biggest concern?

Answer 295

- cause = staph aureus - can occur as a sequela to viral croup - worry = life-threatening airway obstruction --> may require emergency intubation or tracheostomy

Question 296

3 Common noninfectious causes of respiratory distress that mimic a foreign body aspiration?

Answer 296

1. Tracheomalacia = congenital wkness/floppiness of the muscles of the trachea 2. Airway compression --> ex vascular ring or tumor 3. Intraluminal obstruction --> ex papilloma or hemangioma

Question 297

Spasmotic croup: what is it? Possible etiologies?

Answer 297

- syndrome of sudden nighttime onset of hoarseness, "barky" cough, and inspiratory stridor in a previously healthy, afebrile child - possible etiologies: viral infections, respiratory allergies, gastroesophageal reflux, and psychosocial factors

Question 298

Croup Tx?

Answer 298

- aerosolized epi and oral or aerosolized steroids --> reduce airway edema and relieve croup sx - cool mist to relieve spasm --> not supported - avoid irritating procedures --> (ex tongue blades or needles, etc) agitation and crying will aggravate resp sx

Question 299

Dx for foreign body aspiration?

Answer 299

- rigid broncoscopy | - can also be therapeutic!

Question 300

Recurrent sinusitis in young children?

Answer 300

- uncommon bc their nasal passages are not fully pneumatized | - probably an underlying dz going on, ex. CF!

Question 301

Triad of CF?

Answer 301

1. Chronic obstructive pulmonary disease 2. Pancreatic exocrine deficiency 3. Abnormally high sweat electrolyte concentrations

Question 302

Respiratory infections in CF: what is the typical vicious cycle? Common bacterial causes of pneumonia in these kids?

Answer 302

- cycle: persistent bronchial obstruction from impaired mucus secretion --> predisposes to secondary bacterial infections --> inflammation --> tissue damage --> further obstruction --> chronic infection - bugs: at first, bacterial pneumonia is caused by staph aureus, then caused by pseudo aeruginosa

Question 303

Airway hyper-reactivity in CF?

Answer 303

- present in half of the pts | - response to bronchodilators is varried

Question 304

What are the growth defects of CF due to? 4 consequences?

Answer 304

- maldigestion from exocrine pancreatic insufficiency - consequences: 1. Abdominal distention 2. Rectal prolapse 3. Subcutaneous fat and muscle tissue deficiency 4. Steatorrhea

Question 305

Genetics of CF?

Answer 305

- mutation is on the long arm of chromosome 7 = deletion of AA 508 - genetic testing can be used if CF is suspected, but the sweat test is negative - test will pick up pts who carry mutations on both of their 7's, but may not if they only have it on one

Question 306

CF and newborn screening?

Answer 306

- research shows that earlier diagnosis improves outcomes - most states in US do a blood spot screening test on all newborns - test detects the pancreatic enzyme immunoreactive trypsinogen (IRT), which is elevated in infants with CF

Question 307

Mean survival for pts with CF?

Answer 307

-over 35 yrs

Question 308

Meconium ileus: what is it? What is it caused by? What is it almost pathognomonic for?

Answer 308

- obstruction of the distal ileum by congealed meconium - thought to be caused by a deficiency in proteolytic enzymes - almost pathognomonic for CF!

Question 309

2 Possible complications of meconium ileus?

Answer 309

1. Volvulus | 2. Perforation peritonitis

Question 310

What can cause an infant with CF to present with a bulging fontanelle?

Answer 310

- vitamin A excess, due to their inability to metabolize fat soluble vitamins (ie vitamin A) - the excess can cause pseudotumor cerebri = increased intracranial P

Question 311

Dacryostenosis: what is it? Cause?

Answer 311

- congenital nasolacrimal duct obstruction - caused by failure of canalization of the nasolacrimal duct - have either unilateral or bilateral increased tearing

Question 312

Initial tx of dacryostenosis?

Answer 312

1. Nasolacrimal massage 2. Eyelid cleansing 3. Topical antibiotics for purulent discharge

Question 313

Chemosis?

Answer 313

-swelling and fluid collection in the membranes lining the eye.ids and conjunctiva

Question 314

Prognosis of dacryostenosis?

Answer 314

- 90-96% of cases resolve spontaneously, usually by 1 yr of age - if not resolved, surgery is the tx

Question 315

Triad of infantile glaucoma?

Answer 315

1. Tearing 2. Photophobia 3. Blepharospasm

Question 316

Dacryocystitis: tx?

Answer 316

- immediate systemic antibiotics | - may need surgical tx too

Question 317

What to do for conjunctivitis within the first few hours of life?

Answer 317

- send the eye discharge for culture and start antibiotic based on culture status - usually due to chemical irritation

Question 318

What can chlamydia cause in newborns? In 1-3mnth old infants?

Answer 318

- newborns = conjunctivitis | - 1-3 mnths = pneumonia

Question 319

How does pneumonia caused by chlamydia trachomatis usually present?

Answer 319

- infants1-3mnths old - Ssx: 1. Cough 2. Tachypena 3. Rales 4. NO FEVER 5. Eosinophilia on CBc

Question 320

What are topical tertacycline, erythomycine, and silver nitrates used for in newborns?

Answer 320

- prophylaxis for gonococcal eye infections | - does NOT offer prophylaxis against chlamydial eye infections!

Question 321

Enterobius vermicularis?

Answer 321

- pinworms - part of the roundworm/nematode family - most common nematode infection in North America

Question 322

Tx of pinworm?

Answer 322

-a single dose of either mebendazole, albendazole, or pyrantel pamoate

Question 323

Perianal cellulitis: presentation & tx?

Answer 323

- presentation: 1. Perianal pain 2. Blood-streaked stool 3. Perianal puritus 4. Perianal erythema that is well demarcated - tx: oral or topical bactroban (mupirocin)

Question 324

What parasite is known to cause rectal prolapse?

Answer 324

-whipworms = trichuris trichuria

Question 325

Ddx for enterobuis vermicularis?

Answer 325

- pinworm - cellophane tape test - stool ova and parasite studies may not identify pinworm bc the count within the stool is often low

Question 326

What is the most serious complication of Kawaskai syndrome? Dx?

Answer 326

- coronary artery aneurysms & coronary artery disease | - dx via echo

Question 327

Kawasaki dz Tx?

Answer 327

1. High-dose IVIg --> reduces inflammation | 2. ASPIRIN --> reduces risk of coronary complications

Question 328

Strawberry tounge?

Answer 328

- erythema of the tongue with prominent papillae | - sx of kawasaki dz

Question 329

Common age & gender for kawasaki dz?

Answer 329

- usually seen in boys < 5 yrs old

Question 330

What part of the well child check changes after a child was on IVIg? For how long?

Answer 330

-live-virus vaccines (MMR & varicella) are delayed 11 mnths following high dose IVIg (ex after kawasaki disease)

Question 331

What vaccine should kids on prolonged aspirin tx get? Why?

Answer 331

- should get influenza! | - bc they are at risk for Reye syndrome if they get influenza while on aspirin!

Question 332

6 Risk factors of getting CAD with Kawasaki dz?

Answer 332

1. Male 2. Fever for > 10 days 3. < 12 months old 4. Low serum albumin or Hb 5. Early cardiac findings 6. Thrombocytopenia

Question 333

Kussumaul breathing?

Answer 333

-deep, rapid respirations associated with acidosis

Question 334

BUN and creatinine levels associated with dehydration?

Answer 334

-both are elevated

Question 335

WBC counts with DKA?

Answer 335

-usually elevated, esp if an infection exacerbated the DKA

Question 336

What should be added to the IV fluids after a pt being treated for DKA urinates? Why?

Answer 336

- potassium - to counteract the total body potassium depletion - serum K will be normal or slightly elevated, but the intracelluar K will be low - when the hyperglycemia is treated potassium will be driven into the cells and hypokalemia will begin to occur

Question 337

When should glucose be added to the IV fluid when treating a pt with DKA?

Answer 337

-when the serum glucose levels drop to approx 250-300

Question 338

4 Reasons why bicarb infusion should be avoided when treating DKA?

Answer 338

1. Can precipitate hypoK 2. Can shift O2 dissociation curve to the left and make O2 delivery worse 3. Can overcorrect acidosis 4. Can cause a worsening cerebral acidosis while the plasma pH is being corrected

Question 339

Headache, personality changes, vomiting, and decreased reflexes in a pt being treated for DKA?

Answer 339

- think: cerebral edema | - this is potentially life threatening!!

Question 340

Apnea?

Answer 340

- cessation of breathing for at least 20 sec - can be accompanied by cyanosis or bradycardia - recurrent episodes can be seen with immaturity, can be seen in premies --> usually resolved by 37 weeks postgestational age

Question 341

Most common cause of death of infants 1 week - 1 yr old?

Answer 341

-SIDS

Question 342

When is SIDS more common? In what ethnicities?

Answer 342

- usually btwn 1& 5 mnths, peak btwn 2 & 4 mnths - more common in winter - More common in African Americans and Native Americans

Question 343

8 Risk factors of SIDS?

Answer 343

1. Prone sleep position 2. Sleeping on soft surface 3. Pre & post-natal exposure to tobacco smoke 4. Over heating 5. Late or no prenatal care 6. Young maternal age 7. Prematurity &/or low birth weight 8. Males

Question 344

What is one negative consequence of macrosomia due to uncontrolled maternal gestational diabetes?

Answer 344

- respiratory distress --> bc of increased fetal oxygen demand - AKA: surfactant deficiency & hyaline membrane dz - can be seen in infants born to GDM moms later than typically seen in babies born to normal moms

Question 345

What blood glucose level of an infant born to a mom with DM be fed at? Given IV glucose?

Answer 345

- fed at a glucose level btwn 25-40 | - IV glucose of blood levels < 25

Question 346

4 Complications of gestational DM?

Answer 346

1. Hypoglycemia 2. Polycythemia 3. Hypocalcemia 4. Hyperbilirubinemia

Question 347

Fasting glucose level for gestational DM? Non-fasting?

Answer 347

- fasting > 100 | - nonfasting > 130

Question 348

Blood glucose level that is defined as hypoglycemia?

Answer 348

-< 40

Question 349

What percentile does a baby need to exceed to be considered macrosomic?

Answer 349

-90th

Question 350

Caudal regression syndrome?

Answer 350

- rare congenital malformation - found almost only in gestational DM babies - hypoplasia of sacrum & lower extremities

Question 351

When are women usually screened for gestational DM?

Answer 351

-btwn 24 & 28 wks

Question 352

What can polycytemia lead to in a baby of a gestational DM preg?

Answer 352

1. Elevated bilirubin | 2. Renal vein thrombosis

Question 353

What can hypocalcemia lead to in an infant born of a GDM mom?

Answer 353

1. Irritability | 2. Decreased myocardial contractility

Question 354

How can renal vein thrombosis present in a newborn?

Answer 354

-as an abdominal mass --> hydronephrosis

Question 355

What is a still's murmur?

Answer 355

- low pitch systolic ejection murmur | - most common innocent murmur in kids

Question 356

What is a carey coombs murmur?

Answer 356

- seen in acute rheumatic fever | - caused by thickening of mitral valve

Question 357

Subdural and epidural hematomas, which are more common in older children and kids < 1 yr? Chronic subdural hematomas?

Answer 357

- subdural = < 1 yr - epidural = older children - chronic subdural hematomas are more common in older children

Question 358

Epidural hemorrhage?

Answer 358

- bleeding btwn dura and skull | - common w/ skull fractures with middle meningeal artery (or dural sinuses, or middle meningeal v) lacerations

Question 359

Subarachnoid hemorrhage?

Answer 359

- bleeding btwn dura and arachnoid space | - occurs with disruption of bridging veins that connect cerebral cortex and dural sinuses

Question 360

How many subdural hemorrhages are bilateral?

Answer 360

-3/4ths!

Question 361

Ssx of chronic subdural hematomas?

Answer 361

1. Chronic emesis 2. Seizures 3. Hypertonicity 4. Irritability 5. Personality changes 6. Inattention 7. Poor weight gain 8. Fever 9. Anemia

Question 362

What is the best way to evaluate subacute and chronic hematomas?

Answer 362

-MRI bc the signal intensity can help you estimate age of lesion

Question 363

Most epidural hemorrhages are bilateral or unilateral?

Answer 363

-unilateral!

Question 364

Mortality is greater in which subdural or epidural hemorrhages?

Answer 364

- epidural! | - but long-term morbidity is low in survivors!

Question 365

Which require urgent surgical evacuation: subdural or epidural hemorrhages?

Answer 365

-epidural!

Question 366

What is the typical adult course of ssx of an epidural hemorrhage?

Answer 366

-first see altered mental status (initial concussion) --> period of lucidity --> redevelopment of altered mental status + ssx of increased ICP (hematoma effect)

Question 367

What are the common sequelae of a subdural hemorrhage?

Answer 367

1. Headaches 2. Fatigue 3. Nausea 4. Sleep disturbances

Question 368

3 Common associated findings with subdural hemorrhages?

Answer 368

1. Retinal hemorrhages 2. Seizures 3. Increased ICP

Question 369

Seizures and retinal hemorrhages with epidural hemorrhages?

Answer 369

-NOT as common as with subdural hemorrhages

Question 370

Which cranial hemorrhage type has more long-term morbidity? Why?

Answer 370

-subdural, bc brain parenchyma is more often involved

Question 371

Widened pulse pressure: what is it? Physical sign? 5 common causes?

Answer 371

- increase in the difference btwn systolic & diastolic pressures - ssx: bounding arterial pulse - conditions: 1. Fever 2. HyperTH 3. Anemia 4. AV fistula 5. PDA

Question 372

What is the most common heart lesion in kids?

Answer 372

-VSD

Question 373

Harshness of murmur and size of VSD?

Answer 373

-the harsher the murmur is the smaller the size probably is!

Question 374

5 Ssx of large VSD?

Answer 374

1. Dyspnea 2. Feeding difficulties 3. Growth failure 4. Profuse perspiration 5. Cardiac failure

Question 375

Prognosis of small VSDs?

Answer 375

-most will close spontaneously by 6-12 mnths

Question 376

4 acyanotic congenital heart lesions?

Answer 376

1. VSD 2. ASD 3. PDA 4. AV septal defects

Question 377

What is the most common heart lesions seen in premies?

Answer 377

-PDA

Question 378

In normal infants, when does the ductus arteriosus usually close?

Answer 378

- usually w/in 10-15 hrs | - always by day 2!

Question 379

Describe the murmur of a large ASD?

Answer 379

-splitting of second heart sound that does not vary with respiration + systolic murmur at left upper and midsternal borders

Question 380

ASD and endocarditis prophylaxis?

Answer 380

- not necessary | - endocarditis is rare

Question 381

3 Common complications of uncorrected AV septal defects?

Answer 381

1. Cardiac failure 2. Growth failure 3. Recurrent pulmonary infections in infancy

Question 382

Medical tx for PDA?

Answer 382

-indomethacin

Question 383

Who is recommended to get prophylaxis for endocarditis (4)?

Answer 383

Patient's who have/had: 1. Hx of endocarditis 2. Prosthetic valve 3. Heart transplant 4. Severe or partially repaired cyanotic congenital hearg defect

Question 384

What med should be given to keep ductus arteriosus open?

Answer 384

-prostaglandins

Question 385

What is the most common congenital cyanotic heart disease?

Answer 385

-transposition of great arteries

Question 386

When are symptoms of TGA first noticed? Why? What is the initial tx?

Answer 386

- usually noticed in the first or second day of life - bc during the first few hours the ductus arteriosus and the foramen ovale provide provide a connection btwn the 2 circuits --> symptoms develop when these two structures begin to close - tx: prostaglandins to keep the ductus arteriosus patent

Question 387

What is classically seen in a CXR of a pt with TGA?

Answer 387

-"egg-on-a-string" appearance to the heart = heart is slightly enlarged and looks like an egg lying on its side w/ a narrow vascular pedicle (bc aorta and pa are lying one in front of the other)

Question 388

What 2 conditions can pulmonary stenosis be seen?

Answer 388

1. Noonan syndrome | 2. Glycogen storage disease

Question 389

What is seen on CXR in tetrology of fallot?

Answer 389

1. "Boot-shaped" heart | 2. Decreased pulmonary vascularity

Question 390

Hypercyanotic spells: AKA? Cause? Maneuver that can relieve a spell?

Answer 390

- AKA: tetrology spells - caused by a sudden increase in R-->L shunting of blood, can be brought on by activity or agitation - maneuver = squatting or bringing the knees to the chest

Question 391

Pulmonic murmurs: describe the features of both the benign and pathologic murmurs?

Answer 391

- Benign: left upper sternal border murmur that does not radiate w/ no click or radiation - pathologic features: left upper sternal border murmur that radiates, click heard, & ssx of cardiac dz

Question 392

Venous hum murmur?

Answer 392

- low-pitched murmur that is heard at the sternal notch ONLY when a child is upright - benign childhood murmur

Question 393

Still vibratory murmur?

Answer 393

- high-pitched "musical" systolic murmur that is heard at the left sternal border in the SUPINE position - benign childhood murmur

Question 394

Defects in tetrology of fallot?

Answer 394

1. VSD 2. Pulmonic stenosis 3. Overriding aorta 4. RVH

Question 395

Kippel-feil syndrome: 6 features?

Answer 395

1. congenital fusion of portions of the cervical vertebrae 2. restricted neck mvmnts 3. short neck 4. Low hairline 5. Sprengel deformity 6. Structural urinary tract abnormalities

Question 396

Sandifer syndrome: 3 features?

Answer 396

1. GERD 2. Hiatal hernia 3. Posturing of the head

Question 397

Sprengel deformity?

Answer 397

-congenital elevation of the scapula

Question 398

Torticollis: what is it?

Answer 398

- an obviously twisted neck with the head tilted to one side and the chin tilted toward the opposite side - usually caused by injury or contracture of sternocleidomastoid m.

Question 399

Torticollis: presentation?

Answer 399

- presents at or soon after birth - usually seen in infants that experienced birth trauma - usually have palpable, firm mass within the affected muscle

Question 400

Torticollis: tx? Consequence if persistent?

Answer 400

- tx: gentle sternocleidomastoid m stretching via mvmnt of head toward natural position (as long as the spine is normal, which is checked via radiography) - if it persists longer than 5 mnths, an ortho consultation is needed - persistent torticollis can lead to facial asymmetry

Question 401

2 Causes of torticollis that presents after infancy?

Answer 401

1. Trauma --> cervical vertebrae injury or musculature 2. Inflammation --> after URI, cervical lymphadenitis, retropharygneal abscess, cervical vertebral osteomyelitis RA, upper lobe pneumonia

Question 402

3. Drugs known to cause drug-induced dystonia?

Answer 402

1. Phenothiazine 2. Metoclopramide 3. Haloperidol

Question 403

Transient tachypnea of the newborn?

Answer 403

- slow absorption of fetal lung fluid can cause this transient tachypnea - more common in babies born via c-section

Question 404

Meconium aspiration syndrome: what can be seen on CXR? What lung condition can it cause?

Answer 404

- CXR: hyperinflattion w/ patchy infiltrates | - meconium can plug small airways --> air trapping --> pneumothorax

Question 405

ECMO: what does it stand for? What is it?

Answer 405

- extracorporeal membrane oxygenation | - system of a modified heart-lung machiene that is used in severe pulmonary failure

Question 406

Transient tachypnea of the newborn: what can be seen on CXR? Prognosis?

Answer 406

- CxR: perihilar streaking and fluid in fissures + aerated lungs - prognosis: usually resolves in 24-48hrs --> does not lead to chronic lung dz!

Question 407

RDS: tx?

Answer 407

1. supplemental oxygen, want to maintain oxygen saturation to 90-95% 2. IV fluids to maintain hydration 3. Exogenous surfactant

Question 408

2 Possible causes of asymmetrical breath sounds in a neonate?

Answer 408

1. Pneumothorax | 2. Congenital diaphramatic hernia

Question 409

Transient tachypnea of newborn: tx?

Answer 409

-observe and tx with supplemental oxygen as needed

Question 410

Meconium aspiration tx?

Answer 410

-endotracheal intubation with direct suctioning

Question 411

In children of what ages do febrile seizures usually occur?

Answer 411

-6mnths - 6 yrs

Question 412

At what age can you begin to assess meningeal signs such as the kernig and brudzinski signs?

Answer 412

-in children > 1 yr

Question 413

True or false: febrile seizures can be genetic?

Answer 413

- true! | - febrile seizure risk increases when first-degree relatives have had febrile seizures

Question 414

Simple v complex febrile seizures?

Answer 414

- simple: last less than 15 min, no focal or lateralizing signs or sequelae - complex: lasts more than 15 min, may have lateralizing signs

Question 415

What can be used to interrupt a febrile seizure?

Answer 415

1. Lorazepam 2. Diazepam - if seizure lasts for more than 5 min

Question 416

Dx of febrile seizures?

Answer 416

-workup not usually needed, just observation

Question 417

What 2 situations call for a workup of febrile seizures? Workup?

Answer 417

1. Not 6mnth-6yrs old 2. Complex seizure - workups? 1. LP (esp if < 1 yr old) 2. CT scan 3. EEG

Question 418

Febrile seizure prognosis?

Answer 418

- Generally good - kids < 1 yr at the time of their first seizure have a 50-65% chance of having another febrile seizure - older kids only have a 20-30% occurrence chance

Question 419

Biliary atresia?

Answer 419

-congenital condition where the liver's bile ducts become blocked and fibrotic --> results in reduced bile flow into the bowel

Question 420

Kasi procedure?

Answer 420

-surgery procedure that uses a bowel loop to form a duct to allow bile to drain from the liver in a pt with biliary atresia

Question 421

What lab results will you see in a pt with rickets?

Answer 421

1. Reduced serum calcium levels (not always) | 2. Elevated alkaline phosphatase

Question 422

What is the most common form of nonnutritional rickets?

Answer 422

- primary hypophosphatemia - familial, x-linked dominant - defective phosphate reabsorption + conversion of 25(OH)2D in the proximal tubule of the kidneys is abnormal

Question 423

Spiral fracture of humerus in a child?

Answer 423

-suspicious, but not diagnostic for child abuse

Question 424

Odonophagia?

Answer 424

-painful swallowing

Question 425

Stridor?

Answer 425

- abnormal, musical breathing | - result of large airway obstruction

Question 426

Dysphagia?

Answer 426

-Difficulty swallowing

Question 427

Trismus?

Answer 427

- inability to open mouth | - secondary to pain, inflammation, or mass effect involving the facial nereve

Question 428

What is the most common age group to see retropharyngeal abscesses in?

Answer 428

-toddlers less than 4 yrs old

Question 429

What age group is peritonsillar abscess usually seen in?

Answer 429

- can be seen at any age | - more common in adolescents or young adults

Question 430

Patient who refuses to passively refuses to move neck secondary to pain?

Answer 430

-think: retropharyngeal infection!

Question 431

Best imaging for neck abscess?

Answer 431

- lateral cervical xray | - retropharyngeal abscess = widening of retropharyngeal space

Question 432

XRay findings for epiglottitis?

Answer 432

-"thumb sign" on a lateral film

Question 433

What is the danger with retropharyngeal abscesses?

Answer 433

-potential spread to mediastinum --> can affect cardioresp function or cause mediastinitis

Question 434

Top 3 bacterial causes of neck abscesses?

Answer 434

1. Strep pyogenes 2. Staph 3. H. Influenzae

Question 435

Definition of delayed puberty?

Answer 435

- no signs of puberty in girls by age 13 or boys by age 14 | - can be caused by: gonadal failure, chromosomal abnormalities, hypopituitarism, chronic disease, or malnutrition

Question 436

Definition of precocious puberty?

Answer 436

- secondary sexual characteristic onset before the age of 8 yrs in girls and 9 yrs in boys - different ethnic groups can undergo puberty at different times --> ex black girls < white girls

Question 437

True precocious puberty?

Answer 437

- AKA: True precocious puberty - gonadotropin-DEPENDENT - hypothalmamic-pituitary-gonadal activation leading to secondary sex characteristics

Question 438

Precocious pseudopuberty?

Answer 438

- gonadotropin-independent - NO hypotjalamic-pituitary-gonadal activation - hormones usually are either exogenous (birth control pills, estrogen creams) or from adrenal/ovary tumors

Question 439

Premature adrenarche?

Answer 439

- early activation of adrenal androgens - usually occurs in girls aged 6-8 - gradually increasing pubic/axillary hair development and body odor

Question 440

Premature thelarche?

Answer 440

- early breast development - typically in girls aged 1-4 yrs - WITHOUT pubic/axillary hair development or linear growth acceleration

Question 441

Precocious puberty in boys v girls (stats)?

Answer 441

- more common in girls, but more likely to be idiopathic in girls (>90%) - in boys, 25-75% of the time a structural CNS abnormality is present

Question 442

What are the levels of the sex hormones like in a child with precocious puberty?

Answer 442

- usually appropriate for the observed stage of puverty, but inappropriate for the child's age - estradiol in girls - testosterone in boys

Question 443

What is the goal in the tx of precocious puberty? Tx?

Answer 443

- goal: prevent early closure of growth plates so full adukt height can be reached - tx: GnRH agonist

Question 444

How do boys with adrenal hyperplasia usually present? Dx?

Answer 444

- present: virilization despite prepubertal testicles | - dx: look for overproduction of 17-alpha hydroxyprogesterone and a deficiency in cortisol

Question 445

Vesicourethral reflux?

Answer 445

- VUR - retrograde urine flow from the bladder into the ureters and even into the kidneys - females > males - can lead to recurrent UTIs and diminished renal function

Question 446

Voiding cytourethrogram?

Answer 446

- VCUG - radiographic study in which a catheter is placed in the bladder and contrast is pumped into the bladder --> have pt void and take XRays to see if ureters are outlined

Question 447

What is the most common cause of severe urinary tract obstruction in boys?

Answer 447

-posterior urethral valves --> ONLY occurs in boys!

Question 448

How do posterior urethral valves present?

Answer 448

- in neonates: distended bladders, poor or dribbling urinary streams, palpable kidneys - in older infants: failure to thrive, renal dysfunction, UTI

Question 449

What tests should be done on ANY boys with a UTI?

Answer 449

- VCUG - renal ultrasound * *look for posterior urethral valves bc there is a strong connection!!

Question 450

Tx of posterior urethral valves?

Answer 450

- immediate tx: bladder catheterization via urethra with a small feeding tube - long term tx: endoscopic transurethral valve ablation

Question 451

Tx of VUR in infants and kids?

Answer 451

1. Prophylactic antibiotics | 2. Close monitoring for infections w/ UA and cultures avery 3-4 months

Question 452

Grading of VUR? Which is more likely to resolve spontaneously? Which is more likely to cause renal damage?

Answer 452

- graded I-V based on degree of reflux | - higher grade = less likely to resolve spontaneously & more likely to cause renal damage!

Question 453

Beckwith-Wiedemann syndrome?

Answer 453

* *overgrowth syndrome 1. Macrosomia 2. Macroglossia 3. Pancreatic beta cell hyperplasia = excess islet cells = hypoglycemia 4. Fetal adrenocortical cytomegaly 5. Omphalocele = intestines that stick out of abdomen 6. Hemihypertrophy 7. Linear fissures in lobule of external ear 8. Increased risk of abdominal tumors --> ex. Wilms and hepatoblastoma

Question 454

What are boys with posterior urethral valve at risk for?

Answer 454

-end-stage renal dz, even after proper tx!!

Question 455

Rales?

Answer 455

- wet or "crackly" inspiratory breath sounds due to alveolar fluid or debris - usually heard with pneumonia or CHF

Question 456

Pleural Rub?

Answer 456

-inspiratory and expiatory "rubbing" or scratching breath sounds heard when inflamed visceral and parietal pleurae come together

Question 457

Staccato cough?

Answer 457

- coughing spells with quiet intervals - often heard with: 1. Croup 2. Chlamydial pneumonia

Question 458

Progression of bacterial v viral pneumonia?

Answer 458

- viral is more gradual than bacterial | - bacterial progresses rapidly over a few days

Question 459

What 2 causes of pneumonia can cause consolidation on CXR?

Answer 459

1. Pneumococcal | 2. Staphhlococcal pneumonia

Question 460

What cause of pneumonia causes air trapping and a flattened diaphragm on CXR?

Answer 460

1. Viral pneumonia w/ bronchospasm

Question 461

What cause of pneumonia causes perihilar lymphadenopathy on CXR?

Answer 461

1. Mycobacterial pneumonia

Question 462

What type of pneumonia is more commonly seen with pleural effusion and abscess formation, bacterial or viral?

Answer 462

-bacterial

Question 463

5 Most common causes of pneumonia in the first few days of life?

Answer 463

1. Enterobactefiaceae 2. Group B strep 3. Staph aureus 4. Strep pneumo 5. Listeria

Question 464

Pneumonia with staccato cough and tachypnea during first few mnths of life? Tx?

Answer 464

- Think: chlamydia | - tx: erythromycin

Question 465

4 Common viral causes of pneumonia?

Answer 465

1. Herpes simplex virus 2. Enterovirus 3. Influenza 4. RSV

Question 466

What is the most prevalent and concerning cause of viral pneumonia in the first few days of life? Tx?

Answer 466

- HSV | - tx: acyclovir

Question 467

5 Viral causes of pneumonia in kids 1-5 yrs old?

Answer 467

1. Adenovirus 2. Rhinovirus 3. RSV 4. Parainfluenzae 5. Influenza

Question 468

2 Bacterial causes of pneumonia in kids 1-5 yrs?

Answer 468

1. Penumococcus | 2. Nontyleable H influenzae

Question 469

What can be 2 causes of pneumonia in a pt intubated in the ICU?

Answer 469

1. Pseudomonas aeruginosa | 2. Fungal species --> ex candida

Question 470

Pneumonia in someone who travel to southwestern US?

Answer 470

-coccidiodies immitis

Question 471

Pneumonia with retinitis?

Answer 471

-CMV

Question 472

Pneumonia in a pt with refractory asthma?

Answer 472

-aspergillus

Question 473

Pneumonia in a pt exposed to infected sheep or cattle?

Answer 473

-coxiella brunetti

Question 474

Pneumonia in a spelunker?

Answer 474

-Histoplasma capsulatum

Question 475

Top cause of pneumonia in: neonates? Toddlers? Adolescents?

Answer 475

- neonates = group B strep - toddlers = RSV - adolescents = mycoplasma

Question 476

How to dx organophosphate poisoning?

Answer 476

- use high index of suspicion & begin tx! - dont delay tx! - confirm dx via measuring serum pseudocholinesterase and erythrocyte cholinesterase levels --> both will be decreased!!

Question 477

What is the leading cause of nonpharmaceutical ingestion fatality in kids?

Answer 477

-organophosphate poisoning!

Question 478

Nicotinic ssx?

Answer 478

1. Cardiac: - HTN - tachy - arrhythmia 2. Muscle: - fasciculations - wknss - tremor 3. Respiratory failure --> due to diaphragm paralysis

Question 479

Muscarinic ssx?

Answer 479

1. GI: - emesis - urinary & fecal incontinence 2. Respiratory: - bronchorrhea - bronchospasm 3. Cardiac: - hypotension - brady 4. Tearing 5. Drooling 6. Miosis

Question 480

3 Routes that organophosphate poisoning can occur?

Answer 480

1. Across skin or mucous membranes --> so take off contaminated clothing! 2. Inhalation 3. Ingestion

Question 481

Organophoshates: MOA?

Answer 481

- bind irreversibly to the cholinesterase of neurons and erythrocytes & to liver pseudocholinesterase - causes failure to terminate the effects of acetylcholine at the receptor sites

Question 482

Ssx of cholinergic excess (8)?

Answer 482

1. Diarreha/Defication 2. Urination 3. Miosis 4. Bradycardia 5. Bronchorrhea 6. Emesis/Excitation of muscles 7. Lacrimation 8. Salivation * *"DUMBBELS"

Question 483

Atropine: Use? MOA?

Answer 483

- Use: organophosphate poisoning | - MOA: antagonizes the muscarinic receptor, so the Ach cant bind!

Question 484

2 Tx for Organophosphate poisoning?

Answer 484

1. Atropine 2. Pralidoxime PLUS: supportive care!

Question 485

Pralidoxime: use? MOA?

Answer 485

- Use: can be used for organophosphate poisoning, esp in a pt with significant muscle wkness, esp if mechanical ventilation is required bc of diaphragmatic muscle failure! - MOA: reactivates cholinesterase

Question 486

What ssx will a pt have if they ingest mercury from a thermometer?

Answer 486

-probably none bc the amnt is so small!

Question 487

Ssx of ingestion of a large amnt of mercury?

Answer 487

-GI complaints

Question 488

3 Ssx of ingestion of fish contaminated with mercury?

Answer 488

1. Ataxia 2. Dysarthria 3. Paresthesias

Question 489

3 Ssx of chronic inorganic mercury exposure?

Answer 489

1. Gingivostomatitis 2. Tremor 3. Neuropsychiatric disturbances * * "Mad as a hatter!"

Question 490

5 Ssx of acute arsenic ingestions?

Answer 490

1. Nausea 2. Vomiting 3. Abdominal pain 4. Diarrhea 5. Hypovolemic shock due to third spacing and hemorrhage in the gut

Question 491

Paraneoplastic syndrome?

Answer 491

-HTN & secretory diarrhea caused by tumor production of catecholamines and vasoactive intestinal peptide

Question 492

Opsoclonus-myoclonus syndrome?

Answer 492

- chaotic eye mvmnts & myoclonic jerks --> "dancing eyes and dancing feet" - caused by autoantibodies against neuronal elements

Question 493

What is the most common solid, extracranial tumor in children?

Answer 493

-neuroblastoma

Question 494

Where do most neuroblastoma tumors arise from? What do they contain?

Answer 494

-most arise in the abdomen from the adrenal gland, intrathoracic, or paraspinal from neuronal ganglia

Question 495

Describe the abdominal mass that is typical of neuroblastoma?

Answer 495

1. Nontender 2. Irregular 3. Crosses the midline

Question 496

4 Typical location of mets from neuroblastomas? Ssx they cause?

Answer 496

1. Skin --> bluish skin discoloration 2. Lungs --> increased work of breathing, dyspnea, pneumonia 3. Liver 4. Bone --> bone pain, pancytopenia, petechiae, brusing, pallor, fatigue, if orbital bones are involved get proptosis & bluish periorbital discoloration = "raccoon eyes"

Question 497

3 Common Ssx of Wilms tumor?

Answer 497

1. Hematuria 2. HTN 3. Localized abdominal mass that does NOT cross the midline

Question 498

Typical lab results of neuroblastomas?

Answer 498

1. Elevated urinary vanillylmandelic acid 2. Elevated homovanillic acid levels * *both are catecholamine metabolites 3. Elevated enolase 4. Elevated ferritin 5. Elevated lactate dehydrogenase levels

Question 499

Tx of neuroblastoma?

Answer 499

-decrease tumor size via chemo and/or radiation, then surgical removal of tumor

Question 500

Prognosis of neuroblastoma?

Answer 500

- Overall cure rates exceed 90% - infants typically have a better response than older children - poor prognosis: skeletal mets or N-myc oncogene amplification

Question 501

Mysenteric lymphadenitis?

Answer 501

- often viral-mediated swelling of mesenteric lymph node | - can cause nonspecific abdominal pain

Question 502

Wilms tumor v. Neuroblastoma?

Answer 502

- neuroblastoma pts are usually younger and appear sicker than wilms - the abdominal tumors of neuroblastoma usually cross the midline, wilms do not

Question 503

Ssx of abdominal migranes?

Answer 503

-Recurrent abdominal with emesis

Question 504

3 Ssx of appendicits?

Answer 504

1. RLQ pain 2. Abdominal gaurding 3. Rebound tenderness

Question 505

3 Ssx of bacterial enterocolitis?

Answer 505

1. Diarrhea (may be bloody) 2. Fever 3. Vomiting

Question 506

Abdominal pain in cholecystitis?

Answer 506

-RUQ

Question 507

4 Ssx of Henoch-Schonlein purpura?

Answer 507

1. Purpuric lesions 2. Joint pain 3. Blood in urine 4. Guaiac positive stool

Question 508

2 Ssx of hepatitis?

Answer 508

1. RUQ pain | 2. Jaundice

Question 509

3 Ssx of incarcerated hernia?

Answer 509

1. Inguinal mass 2. Low abdominal or groin pain 3. Emesis

Question 510

2 Ssx of intussusception?

Answer 510

1. Colicky abdominal pain (paroxysmal) 2. Red currant jelly stool 3. Fever 4. Sausagelike abdominal mass

Question 511

3 Ssx of Intestinal malrotation with volvulus? When does it usually occur?

Answer 511

1. Abdominal distention 2. Bilious vomiting 3. Blood per rectum * *usually presents in infancy

Question 512

3 Ssx of pancreatitis?

Answer 512

1. Severe epigastric pain 2. Fever 3. Persistent vomiting

Question 513

3 Ssx of Pneumonia?

Answer 513

1. Fever 2. Rales 3. Cough

Question 514

4 Ssx of streptococcal pharyngitis?

Answer 514

1. Fever 2. Sore throat 3. Headache 4. Abdominal pain

Question 515

Volvulus?

Answer 515

- twisting of mesentery of small intestines | - leads to decreased vascular perfusion, ischemia, and bowel necrosis

Question 516

Most common location for intussusception?

Answer 516

-ileocolic portion of the bowel

Question 517

Cause of intestinal malrotation?

Answer 517

- occurs when intestinal rotation is incomplete during fetal development - usually volvulus occurs --> necrosis

Question 518

Abdominal XRay will show what with volvulus?

Answer 518

1. "Corkscrew" pattern of the duodenum | 2. "Bird's beak" pattern of the second, or third portions of the duodenum

Question 519

Describe the pain associated with intussusception?

Answer 519

-paroxysmal abdominal pain

Question 520

What is the "gold standard" for tx & dx of intussusception?

Answer 520

-contrast enema for both dx and tx

Question 521

In which infants is pyloric stenosis more common?

Answer 521

- 4x more common in males | - more common in first-born children

Question 522

4 common ssx of pyloric stenosis?

Answer 522

1. Projectile vomiting 2. Olive shaped abdominal mass 3. Hypochloremic metabolic acidosis 4. Visible peristaltic waves

Question 523

3 Common presentations of immunosuppression?

Answer 523

1. Failure to thrive 2. Atypical infections 3. Difficult-to-eradicate infections

Question 524

Chance of vertical transmission of HIV without tx? What is the prophylactic tx to prevent transmission?

Answer 524

- 25% chance of vertical transmission | - zidovudine is given to the mother during the second trimester and to the baby through age 6 wks

Question 525

Dx of HIV in peds?

Answer 525

- >18 mnths = ELISA first, then westernblot to confirm | - < 18 mnths = HIV DNA PCR testing

Question 526

When does prophylaxis for PCP start in an HIV infected infant? What drug is used?

Answer 526

- start prophylaxis at 6wks old | - tx: trimethoprim-sulfamethoxazole

Question 527

Which two vaccines should not be given to HIV positive kids?

Answer 527

1. MMR | 2. Varicella

Question 528

Pathophysiology of immunosuppression caused by DM?

Answer 528

- hyperglycemia produces neutrophil dysfunction | - circulatory insufficiency contributes to ineffective neutrophil chemotaxis during an infection

Question 529

Hemolytic-uremic syndrome: triad of ssx? What causes it? Common prodrome?

Answer 529

-Ssx: 1. Nephropathy 2. Thrombocytopenia 3. Microangiopathic hemolytic anemia -associated with : E. Coli 0157:H7, shigella, or salmonella Prodrome: bloody diarrhea is common

Question 530

Idiopathic thrombocytopenic purpura: AKA? What is it?

Answer 530

- AKA: immune thrombocytopenic purpura | - condition of increased platelet destruction by circulating antiplatelet antibodies, usually antiglycoprotein IIb/IIIa

Question 531

What is the most common cause if thrombocytopenia in kids aged 2-5yrs?

Answer 531

-acute ITP

Question 532

Triggers of ITP?

Answer 532

- can be viral illness | - but often unknown

Question 533

What would be seen on a bone marrow in a pt with ITP?

Answer 533

- increased number of megakaryocytes | - bone marrow is not necessary, but can be helpful to confirm dx

Question 534

Prognosis of ITP in kids?

Answer 534

- within 1 mnth more than half of untreated pts have recovered - another 30% are recovered in 6 mnths - thrombocytopenia for more than 6 mnths = chronic ITP

Question 535

What is the most serious ITP complication?

Answer 535

-intracranial hemorrhage!

Question 536

Tx of ITP?

Answer 536

- tx is controversial - to decrease platelet destruction: 1. IV Ig for 1-2 days 2. IV anti-D therapy 3. Systemic steroids for 2-3 wks 4. Splenectomy in serious cases with no response to tx w

Question 537

Ddx of ITP?

Answer 537

1. Physical exam | 2. Peripheral blood smear

Question 538

Management of HSP?

Answer 538

1. Urinalysis | 2. Supportive care of hydration and pain management

Question 539

What is seen in the perioheral blood smear of HUS (3)?

Answer 539

1. helmet cells 2. burr cells 3. fragmented RBCs

Question 540

Granulocytopenia?

Answer 540

-reduction of total circulating leukocytes

Question 541

Lymphoblast?

Answer 541

- large, primitive, undifferentiated precursor cell | - not normally seen in peripheral circulation

Question 542

Pancytopenia?

Answer 542

-reduction in circulating erythrocytes, leukocytes, and platelets

Question 543

What is the most common childhood cancer?

Answer 543

-leukemia

Question 544

What is the most common leukemia in kids?

Answer 544

-acute lymphoblastic leukemia (ALL)

Question 545

What is the peak incidence of ALL? What gender is it more common in?

Answer 545

- 4 years old | - boys

Question 546

Common presenting ssx of ALL?

Answer 546

1. Anorexia 2. Irritability 3. Lethargy 4. Pallor 5. Bleeding 6. Petechiae 7. Leg & joint pain 8. Fever 9. Petechia/brusing 10. Hepatosplenomegaly * *ALL is known as the "great imitator" bc ssx are nonspecific!

Question 547

What are kids presenting with ALL typically misdiagnosed with?

Answer 547

-JRA

Question 548

What is the leukocyte count usually in kids newly dx with leukemia?

Answer 548

-less than 10,000

Question 549

What percentage of blasts in a bone marrow is normal? What percentage is necessary for an ALL dx?

Answer 549

- less than 5% is normal | - minimum of 25% for ALL

Question 550

Prognosis based on: gender? Ethnicity? Age? Leukocyte counts? Mature B-cell or T-cell immunophenotypes? # of blasts in CSF?

Answer 550

- girls have better prognosis - African-Americans and Hispanic populations have lower remission and higher relapse rates - kids < 1 yr & older than 10 yrs have worse prognosis - higher leukocyte counts have worse prognosis - pts with mature B-cell or T-cell immunophenotypes have worse outcome than B-precursor ALL - more blasts in CSF is worse

Question 551

Tx of ALL?

Answer 551

-combined chemotx is principal tx

Question 552

5 yr survival rate for ALL?

Answer 552

-> 80 %

Question 553

What 6 diseases/syndromes are associated with a higher risk of leukemias?

Answer 553

1. Kleinfelder syndrome 2. Bloom syndrome 3. Fanconi syndrome 4. Ataxia telangiectasia 5. Neurofibromatosis 6. Chromosomal disorder (ex Down syndrome)

Question 554

Vaccines while undergoing chemo for ALL?

Answer 554

- Live virus vaccines are contraindicated in the pt and all the household members during chemo and at least 6 mnths after - non live vaccines are not contraindicated, but the immunosuppression with the chemo can inhibit the antibody response to the vaccine

Question 555

What are 4 common ssx of newborn with tracheoesophageal fistula?

Answer 555

1. Excessive oral secretions 2. Coughing 3. Choking 4. Cyanosis --> due to aspiration with first feeds

Question 556

Describe the "H-type" TEF? How does it typically present?

Answer 556

- Esophagus and trachea are fully formed, but the esophagus is connected proximally to the trachea - often present later in life with recurrent aspiration pneumonia or feeding difficulty

Question 557

VATER association?

Answer 557

- most common association with TEF 1. Vertebral abnormality --> ex fused or bifid vertebral bodies 2. Anal imperforation 3. TracheoEsophageal fistula 4. Radial and Renal anomaly

Question 558

Menorrhagia?

Answer 558

-excessive and/or prolonged uterine bleeding w/ regular menstrual cycle

Question 559

Metrorrhagia?

Answer 559

-irregular uterine bleeding btwn menstrual cycles

Question 560

Menometrorrhagia?

Answer 560

-irregular uterine bleeding with excessive and/or prolonged flow

Question 561

What 2 lab tests should be done first when evaluating dysfunctional uterine bleeding?

Answer 561

1. Pregnancy tes | 2. Hb --> to determine severity of anemia to help determine severity of bleeding

Question 562

Tx for dysfunctional uterine bleeding?

Answer 562

* * according to Hb - Hb > 12 = mild bleeding --> tx = iron supplements - Hb 9 - 12 = moderately severe bleeding --> tx = iron + monophasic OCPs - Hb < 9 = severe blleing --> may need hospitalization and transfusion

Question 563

Glomerulonephritis: what is it? Triad of ssx?

Answer 563

- glomerular inflmmation - triad: 1. Hematuria --> can be microscopic or gross 2. Proteinuria 3. HTN

Question 564

What are RBC casts a marker for?

Answer 564

-glomerular injury

Question 565

What gender and age group is post strep glomerulonephritis usually seen in?

Answer 565

- boys | - ages 5-15 yrs

Question 566

What infections can lead to post strep glomerulonephritis? Time frame? Prophylaxis?

Answer 566

- group B strep infections: pharyngitis or impetigo - usually seen 1-2 wks after pharyngitis or 3-6 wks after impetigo - antibiotic tx of both will reduce the risk for rhuematic fever, but wont reduce the risk for PSGN

Question 567

Most important lab tests for Post strep glomerulonephritis?

Answer 567

1. Serum C3 --> usually low | 2. Serum C4 --> usually normal

Question 568

What 2 antibody tests can be helpful with GBS infections?

Answer 568

1. ASO antibodies: - will be present in 80% of kids with GBS pharygitis - only positive in less than 50% of kids with impetigo 2. Anti-DNase B antibody assays: - present in almost all pts after GBS pharyngitis & most after impetigo

Question 569

Post strep glomerulonephritis tx?

Answer 569

1. Fluid balance is important w/ sodium & potassium intake restriction 2. CCBs for HTN * *tx is mainly supportive

Question 570

Prognosis of post strep glomerulonephritis?

Answer 570

- resolves rapidly and completely - urinalysis may be abnormal for years though! - edema resolves in 5-10 days - HTN goes away in 3 wks - C3 levels normalize in 2-3mnths

Question 571

Recurrent painless gross hematuria that is frequently associated with a URI?

Answer 571

-think: IgA nephropathy

Question 572

What would be seen on a renal bx of a pt with a hx of familial persistent or intermittent hematuria that does not progress to renal failure?

Answer 572

- thin basement membrane | - think: benign familial hematuria

Question 573

C3 and C4 in lupus?

Answer 573

-both low!

Question 574

Nephritis and pulmonary hemorrhage?

Answer 574

-think: goodpasture syndrome!

Question 575

Abdominal pain that is followed by anorexia and vomiting?

Answer 575

-think: appendicitis!

Question 576

Periumbilical pain that migrates to the right lower quadrant?

Answer 576

-think: appendicitis!

Question 577

McBurney's point?

Answer 577

- middle third of the line that connects the anterior superior iliac spine and the umbilicus - point of greatest discomfort in acute appendicitis

Question 578

Psoas sign?

Answer 578

-irritation if the psoas muscle caused by passive hip extension in pts with appendicitis

Question 579

Obturator sign?

Answer 579

-irritation of the obturator muscle caused by passive internal rotation of the thigh in pts with appendicitis

Question 580

What is the peak time of appedicitis?

Answer 580

-adolescence

Question 581

What will a CBC show in appedicitis?

Answer 581

- leukocytosis with a predominance of polymorphonuclear cells ("left shift") = inflammatory process - not specific

Question 582

Test of choice for appendicitis?

Answer 582

- CT scan is the test of choice in most places | - ultrasound can be very sensitive, esp in females, where the ddx includes ovarian cysts and pregnancy

Question 583

Right lower quadrant pain, abdominal guarding, and rebound tenderness?

Answer 583

-think: appendicitis

Question 584

Diarrhea (often bloody), fever, acute abdominal pain, and vomiting?

Answer 584

-think: bacterial enterocolitis

Question 585

Right upper quadrant pain that radiates to the subscapular region on the back?

Answer 585

-think: cholecystitis

Question 586

Infrequent hard stools and recurrent abdominal pain?

Answer 586

-think: constipation

Question 587

Lower abdominal pain, vaginal bleeding, and an abnormal menstrual history?

Answer 587

-think: ectopic pregnancy

Question 588

Fever, vomiting, acute abdominal pain, and hyperactive bowel sounds?

Answer 588

-think: gastroenteritis

Question 589

Iritability, petechiae, edema, and acute abdominal pain?

Answer 589

-think: hemolytic-uremic syndrome

Question 590

Acute abdominal pain, Purpuric lesions, and joint pains (esp in lower extremities)?

Answer 590

-think: henoch-schonlein purpura

Question 591

Weight loss, diarrhea, acute abdominal pain, and malaise?

Answer 591

-think: inflammatory bowel dz

Question 592

Sudden onset of right or left lower quadrant pain with ovulation + copious mucoid vaginal discharge?

Answer 592

-mittelschmerz

Question 593

Hematuria & colicky abdominal pain?

Answer 593

-Think: nephrolitiasis

Question 594

Acute lower abdominal pain in a female with a WBC of < 11,000?

Answer 594

- think: ovarian cyst | - vomiting is rare

Question 595

Acute abdominal pain, Cervical motion tenderness, and WBCs in vaginal secretions?

Answer 595

-Think: Pelvic inflammatory dz

Question 596

Acute abdominal pain, anemia, and extremity pain?

Answer 596

-think: sickle cell crisis

Question 597

Acute abdominal pain, cough, fever, tachypnea, and diminished breath sounds?

Answer 597

- think: pneumonia | - lower lobe pneumonias can cause abdominal pain!