Pediatrics - General Flashcards
Bone age is advanced:
A) in case of hypothyreoidism
B) amongst children living in bad social conditions
C) in congenital adrenal hyperplasia
D) in familiar dwarfism
E) as a result of glucocorticoid application
C) in congenital adrenal hyperplasia
EXPLANATION
Bone age is advanced in congenital adrenal hyperplasia (CAH). The diagnosis of no-salt-losing CAH, especially in boys, is often made at the age of 3-6 years, by this time, bone maturation can even exceed the chronological age of 5 years. Appropriate treatment slows down growth; however, if the bone age is already equivalent of a 12-year-old, spontaneous gonadotropin-dependent puberty can occur, because hydrocortison therapy has already repressed the production of adrenal androgens, allowing the production of gonadotropins by the hypophysis.
How much is the daily maintenance fluid requirement of a child who weighs 14 kg?
A) 700 ml
B) 900 ml
C) 1200 ml
D) 2000 ml
E) 2800 ml
C) 1200 ml
EXPLANATION
Calculation of daily maintenance fluid requirement: For the first 10 kg of weight:100 ml/kg, then from 11 kg to 20 kg: 50 ml/ kg. Thus for a child, who weighs 14 kg it is 1200 ml.
The minimum daily fluid requirement of a 6-month-old baby with mild diarrhea is:
A) 50 ml/ttkg
B) 75 ml/ttkg
C) 150 ml/ttkg
D) 300 ml/ttkg
E) 400 ml/ttkg
C) 150 ml/ttkg
EXPLANATION
Infants require an amount of maintenance fluid of 100mlg/kg/day. In mild diarrhea, we have to add (supplement) the losses, which is 50 ml/kg/day. Thus, a total of 150 ml/kg/day should be administered.
Assuming dehydration of 5%, which is the easiest way to check for improvement?
A) measuring the child’s weight
B) determining serum osmolality
C) measuring central venous pressure
D) monitoring blood pressure
A) measuring the child’s weight
EXPLANATION
Measuring the weight is the most reliable method for assessing the degree of dehydration and controlling the rehydration. In an optimal case, the parents know the child’s weight before the fluid and electrolyte loss. We compare that with the current measured value. The change in serum osmolality can only be used to determine the type of dehydration. Arterial and venous pressure are only relevant in severe dehydration.
For moderate degree of dehydration, what is the initial optimal therapy in diarrhea?
A) 0.9% saline
B) half-isotonic sodium-chloride-dextrose solution
C) 10% dextrose solution
D) oral rehydration fluid
D) oral rehydration fluid
EXPLANATION
Oral rehydration fluid is optimal to treat moderate dehydration, if the child is not vomiting. It can compensate for the lack of liquid and electrolytes, furthermore it contains glucose which helps to absorb the electrolytes.
When should a child with severe hard-of-hearing get an audiphone?
A) When the hearing deficit is discovered, preferably in infancy
B) From the age of 3, in order to proper speech evolvement
C) Before going to school, because hard-of-hearing would be a disadvantage in school
D) Audiphone is contraindicated in childhood, because it is worsening the hearing
E) Never, it should be waited until the hearing loss can be corrigated with surgery
F) If the child would be bullied because of the audiphone, it would be a severe psychical handicap/disadvantage. In this case, it is better to seated the child in front of the teacher and speak with him/her well articulated.
A) When the hearing deficit is discovered, preferably in infancy
EXPLANATION
Because hearing – as one of the most important sensational mechanism – affects the child’s development, other sensory, motor and vegetative capabilities, corrigation of the loss should be done as soon as possible.
In what time should strabism be treated?
A) At the age of 1
B) In 3-4 years old age
C) Before going to school
D) At the time it is discovered
D) At the time it is discovered
EXPLANATION
Strabism should be treated at the time of the discovery, because delayed treatment can cause amblyopia
To prevent teeth impairment, the following rules should be observed, except one. Which one is that?
A) Eat less sweets
B) Giving Vitamin D
C) Giving fluorid
D) Giving food which provides proper chewing
E) Regular tooth brushing
B) Giving Vitamin D
EXPLANATION
Children’s starting teeth impairment does not belong to the symptoms of vitamin D deficiency. Unnecessary and excessive dosage of vitamin D can lead to renal injury.
All the following statements are true for the bilirubin transport, except for:
A) It is transported primarily by binding to albumin
B) The neurons are impaired by the albumin-linked bilirubin
C) The blue-light therapy has no effect of bilirubin’s bond to albumin
D) Bilirubin binding to albumin protects against central nerve system impairment
B) The neurons are impaired by the albumin-linked bilirubin
EXPLANATION
The lipid-soluble bilirubin is only toxic if its amount exceed the albumin’s binding capacity.
A 4-year-old child is suffering from salicylate intoxication. Which one is the most typical first symptom at this intoxication?
A) petechias and gingiva bleeding
B) diplopia and peripherial blindness
C) hyperventilation
D) diarrhoea and vomiting
E) convulsions
C) hyperventilation
EXPLANATION
One the first appearing and most typical symptoms of salicylate intoxication is hyperventilation due to acidosis.
The parents bring a 4-month-old infant to the ER. His/her body cooled down and is hypotonic. The parents said that at night, when they had taken him/her to the bed, everything was fine with him/her. When they picked up him/her in the morning, they found no sign of life. During physical examination except for the lack of vital signs, there wasn’t another deviation. The rutinely ordered whole body X-ray showed 3 bone fractures, which were in a different period of healing. Which is the most likely diagnosis?
A) Scurvy
B) Syphilis
C) SIDS – sudden infant death syndrome
D) Osteogenesis imperfecta
E) Battered child syndrome
E) Battered child syndrome
EXPLANATION
SIDS can be occurred but it does not fit together with the fractures. The fractures are characteristic of osteogenesis imperfecta, but this disease usually does not lead to sudden death in 4 month old age. Child abuse is not rare, its negation by parents does not exclude it.
The followings are true for the data of the body length percentiles, except for:
A) There are distinct curves for the data of the boys and girls body length
B) The 50th percentile is the average body length for the exact age
C) Values/data between 25th and 75th percentiles indicate detailed further examination
D) Body length below 3 percentile indicates severe growth retardation
C) Values/data between 25th and 75th percentiles indicate detailed further examination
EXPLANATION
Among of the data of the body lenght-percentil, the ones between 3 and 97 percentil are acceptable as normal. A body length value below 3 percentile means growth retardation, which needs further investigation.
How high is the prevalence of neonatal HIV infection with HIV-positive mothers without antiviral treatment?
A) 20–30%
B) 100%
C) 80–90%
D) less than 10%
A) 20–30%
EXPLANATION
In the case of the mother’s HIV infection, the probability of the first child infection is between 25-30%. If the first child was infected, the risk of the second child’s infection is even higher. But if a prophylactic treatment was performed, vertical infection is much less common, only 1-2%.
Which of the following increases the chance of the infection of a HIV positive mother’s child?
A) if the father is also infected
B) twin pregnancy
C) breastfeeding
D) Rh incompatibility
C) breastfeeding
EXPLANATION
The HIV virus has been isolated from both colostrum and breast milk, therefore breastfeeding increases the chance of infection.
Mother’s milk contains relatively high concentrations of antibodies of the following types:
A) IgG
B) IgA
C) IgE
D) IgM
B) IgA
EXPLANATION
Breastmilk contains antibacterial and antiviral antibodies, including a relatively high concentrations of IgA antibodies that prevent the pathogens’ adherence to the intestinal wall.
If yellow amniotic fluid is detected during delivery, first to do is:
A) early umbilical cord ligature
B) termination of the delivery
C) UH examination of the mother’s liver after delivery
D) UH examination of the newborn liver after delivery
A) early umbilical cord ligature
EXPLANATION
In Rh-incompatibility, bilirubin and other pigments, so-called bilirubinoids could build up in the amniotic fluid, turning it to yellow. Blood transfusion during delivery of the placenta to the newborn increases the degree of hyperbilirubinemia even further during the first days. That is why the early umbilical cord ligature is recommended.
Which statement is true for the childhood schizophrenia?
A) prevalence decreases with age
B) prevalence increases after the age of 7 years
C) the pathogenic role of stress is not likely
D) the syndrome is different from the adult form
E) there are no hereditary factors
B) prevalence increases after the age of 7 years
EXPLANATION
Childhood schizophrenia, as a syndrome, is not fundamentally different from the adult form. Both external factors and internal - genetic factors play a role in its development. Its prevalence increases with age.
Neonatal skin candidiasis can be confused clinically with the following disease:
A) acne neonatorum
B) scabies
C) seborrheic dermatitis
D) miliaria rubra
E) erythema toxicum neonatorum
C) seborrheic dermatitis
EXPLANATION
Seborrheic dermatitis is similar in appearance, moreover because it can be superinfected with Candida albicans in later stages.
Which of the following is true of infants’ scabies?
A) the diagnosis cannot be confirmed when the scabies examination of sample is negative
B) secondary superinfection of the lesion is common
C) the rash does not occur on the head or on the face
D) connatal form is also known
E) steroid-containing ointment results in permanent healing
B) secondary superinfection of the lesion is common
EXPLANATION
untreated scabies often gets superinfected
Causes an annular skin erythema:
A) Borrelia burgdorferi
B) Mycobacterium leprae
C) Nickel allergy
D) Mycoplasma pneumoniae
E) Sarcoptes scabiei
A) Borrelia burgdorferi
EXPLANATION
An early manifestation of Lyme borreliosis is circular erythema. The leprosy may have two symptoms: nods developing on the skin, and the skin becomes insensitive. Nickel-dermatitis are a contact disease and is the most common on the ears. Mycoplasma pneumoniae does not cause skin symptoms. Scabies are visible on the palm and on the sole.
The child drank gasoline. After the arrival at the hospital, the following procedures are required, except one:
A) drinking paraffin
B) careful physical examination
C) chest x-ray
D) gastric lavage
E) fever measurement
D) gastric lavage
EXPLANATION
Drinking paraffin prevents the gasoline from getting absorbed. Physical examination, fever measurement and chest x-ray can provide information on the appearance of possible complications of pneumonia. Gastric lavage, however, is dangerous due to the possibility of aspiration in case of hydrocarbon poisoning.
A confused and somnolent six-year-old child was found in a gas-smelling room. The first thing to do is:
A) starting infusion in the room
B) gastric lavage in the room
C) antibiotic administration
D) immediate release to air
E) artificial ventilation in the room
D) immediate release to air
EXPLANATION
Any maneuver in a gas-filled room may be a life-threatening delay and may be seriously harmful for the helper also. The first thing to do is to get immediately to the clean air.
What to do if a newborn’s breast enlargement is detected?
A) antibiotic administration immediately
B) if it is detected without hyperaemia, it is a consequence of maternal hormone effect, there is nothing to do with it
C) gently press the breast to make sure that there is no secretion
D) cold pack
B) if it is detected without hyperaemia, it is a consequence of maternal hormone effect, there is nothing to do with it
EXPLANATION
If symptoms of inflammation, erythema, edema, cellulitis are not detected and the enlargement of the mammary gland is detected under the reaction-free skin covering then no intervention is required. Newborn breast enlargement is caused by maternal estrogen hormone, mostly increasing to 10 days of life, then slowly decreasing.
In a six-week-old infant, we are thinking of muscle tone disturbance when:
A) does not raise his head
B) does not turn
C) crosses the lower extremities during the elemental walk
D) do not sit
C) crosses the lower extremities during the elemental walk
EXPLANATION
A muscle tone disorder is suggested in infants, when it crosses the lower limbs at six weeks of age when triggering an elemental walk. The infant’s movements are organized by the elemental motion patterns of the brain that developed during the fetal life in the nervous system. Such elemental movement pattern is the elemental walking. If this leads to a tense muscle tone, it crosses its leg and then it suggests an infantile cerebral paresis.
What is the age when the large fontanelle closure is normal?
A) 4-6 months
B) 2-3 months
C) 12-18 months
D) 20-24 months
C) 12-18 months
EXPLANATION
The large fontanelle closure normally takes place between 12 and 18 months. At birth the small or early closing fontanelle can be a sign of microcephaly. Some diseases cause enlargement of the fontanelles (hydrocephaly, osteogenesis imperfecta, Alport syndrome, etc.).
Physiological weight loss is considered when:
A) the newborn loss 5% of his weight in the first 10 days
B) 20% weight loss during the first week of life
C) loss about 10% of birth weight on the first days of life and it will regain ca. at the 10th day
D) loss up to 200 g after the birth
C) loss about 10% of birth weight on the first days of life and it will regain ca. at the 10th day
EXPLANATION
Physiological weight loss is considered when the newborn loss about 10% of birth weight on the first days of life and he will regain it for day 10. The initial weight loss is part of the postnatal adaptation in which several hormones play a role (natriuretic peptide, renin-angiotensin system, prolactin, vasopressin). As a result of these processes the extracellular fluid space is narrowed while the intracellular space extends. This weight loss is usually around 10%, and in healthy, well-feeding babies, usually at the 2nd week of life, with weight gaining, the initial loss is regenerated.
The 5-month-old infants generally:
A) weigh 5 kg
B) weigh 9 kg
C) double their birth weights
D) increase by 30% of their birth weights
C) double their birth weights
EXPLANATION
Infants usually double their birth weight for 5 months of age. This is, of course, a general approach of weight gaining. But it can be used in practice, since premature babies usually do not reach the 6-7 kg of term baby’s weight for their 5 month old age. Of course, for the purpose of accurate information and registration, the percentile curves developed for the Hungarian population are used.
Which of the following statements about infant nutrition is incorrect?
A) breastfeeding is the optimal nutrition of healthy infants
B) breastfeeding is recommended during the first half year
C) protein content of breast milk is lower, its fat content is generally higher than that of cow’s milk
D) babies fed exclusively with breast milk should receive vitamin D and vitamin K prophylaxis
E) breast milk protects the infants by providing active immunity
E) breast milk protects the infants by providing active immunity
EXPLANATION
Breast milk provides significant passive immunization (secretory IgA, lysozyme, leukocytes), but no active immunization of infant.
Unilateral atrophy and fasciculation of the tongue can be observed in the damage of the following cranial nerve:
A) V.
B) VII.
C) IX.
D) X.
E) XII.
E) XII.
EXPLANATION
Cranial nerve XII. (n. hypoglossus) is responsible for the motor innervation of the tongue.
The most informative diagnostic test for detecting an intracranial vascular malformation:
A) X-ray
B) ultrasound
C) MRI
D) scintigraphy
E) MR angiography
E) MR angiography
EXPLANATION
The most effective tool for detecting an intracranial vascular malformation is MR angiography.
