Pediatrics incorrects

Question 1

I add incorrects/notes on google drive

Question 2

in a newborn with sensorineural hearing loss and systemic findings eg hepatospleenomegaly and growth restriction, what should you suspect?

Answer 2

a congenital torch infection.

other causes of sensorineural hearing loss wont have these findings.

learn findings in torch

Question 3

findings of HOCM in infants of diabetic mothers?
why does this occur?

management

Answer 3

asymptomatic or respiratory distress, hypotension + xray findings

increased glycogen and fat deposition in myocardial cells

beta blockers-> propanolol
*eventual spontaneous regression by age 1 due to normalization of insulin levels

Question 4

microcephaly and micrograthnia are both seen in what genetic condition

cutis aplasia and micropthalmia is seen in what condition?

Answer 4

edwards syndrome - T18

Pataus syndrome - T13

Question 5

Findings in rocky mountain spotted fever?

management?

Answer 5

athralgia, headache etc

maculopapular rash -> petechial rash. can include palms and soles

abdominal pain may occur

labs-> thrombocytopenia, elevates aminotransferases

history of living in grassy or wooded area

doxycycline

Question 6

in an infant with a new onset siezure, no fever, normal bloods, imaging

but microcephaly and eczema

what is next best step in diagnosis?

Answer 6

serum amino acid analysis -> to find hyperphenalanimea and diagnose phenylketonuria

Question 7

severe coughing in children particularly in setting of respiratory infection can cause subcutaneous emphesema and spontaneous pneumomediastinum. management/next investigation?

Answer 7

chest x ray

chest pain, sob =. signs

Question 8

how to detect corneal abrasion

how to detect lens dislocation

distinguishing optic nerve injury from vitreous hemorrhage?

Answer 8

+ve fluorescein test

iris tremulousness

both have RAPD. only optic nerve injury has an abnormal red reflex. optic nerve injuries can occur after head trauma

Question 9

a child with mucosal neuromas and tall with thin arms, is at greatest risk of what condition?

what condition does the child have?

Answer 9

medullary thyroid carcinoma!!!
tall long arms = marfanoid body habitus. ]

child has Men 2B

note! Men 2A has MTC but not these other features.

MEN1 = primary hypaparathyroidism, no MTC

Question 10

otitis externa treatment?

Answer 10

topical fluoroquinolone -> topical ciprofloxacin!! +/- a glucocorticoid.

(ear drops)

Question 11

a neonate with hypothermia, lethargy, leukopenia, and elevated neutrophil bands is concerning of what?

bulging fontanelle and apnoea also make you concerned of?

Answer 11

neonatal sepsis

meningitis

*note GBS is most common cause of neonatal sepsis and neonatal meningitis

Question 12

siezures in the setting of acute gastroeneteritis (fever, abdominal pain, bloody diarrhea) should raise suspicion of which particular pathogen?

Answer 12

shigella -> a complication

Question 13

name 2 posterior fossa tumours in children that can present with cerebellar dysfunction and increased ICP

Answer 13

medulloblastoma
pilocytic astrocytoma

Question 14

differentiate between irittant contact dermatitis in diapers, candida diaper dermatitis, and perianal streptococcus

Answer 14

irritant contant -> erythmatous papules/plaques sparing skinfolds. treat with petrolatum/zinc oxide topicals

candida -> beefy red involving skin folds topical nystatin

strep-> sharp red dermacated involving perianal area. oral! beta lactam

Question 15

define macrosomia.
what condition in a fetus predisposes them to macrosomia and thus shoulder dystocia?

Answer 15

> /= 4kg newborn

fetal hyperglycemia (as a result of maternal diabetes) -> increased fetal insulin -> macrosomia

Question 15

3 year old from refugee camp, scaling and fissures at corners of mouth (stomatitis), beefy red tongue(glossitis), swollen mucous mumbranes (stomatitis), normocytic anemia and erythematous scaly patches (seborrheic dermatitis) has what deficiency?

Answer 15

riboflavin, B2

Question 15

36

Question 15

metaphyseal corner fractures are a red flag for __ and should prompt what?

Answer 15

child abuse
skeletal survey

Question 16

the knee to chest position for an infant having a tet spell in TOF works by which mechanism?

Answer 16

increases systemic vascular resistance

much more than pulmonary vascular resistance

thus, right to left shunting and deoxygenated blood entering aorta is reduced.

Question 17

recurrent pneumonias(sinopulmonary infections) , GI infectons eg with giardia and small tonsils point to what condition?

*immunology coming back up

Answer 17

x-linked agammaglobulinemia

GI infections due to lack of IgA

low b cells = absent lymphoid tissue ie tonsils, adenoids

*note, SCID is associated with failure to thrive and therefore unlikely in an infant with normal growth

Question 18

congenital long QT syndrome symptoms?

management

Answer 18

syncope
sudden cardiac death
autosomal recessive form -> sensorineural hearing loss

beta blockers

Question 19

failure to thrive and recurrent respiratory symptoms, plus multiple bulky stools a day should raise suspicion of?

Answer 19

CF
bulky greasy stools = pancreatic insufficiency

Question 20

neonatal sepsis treatment?

Answer 20

ampicillin + gentamicin

Question 21

in a deteriorating child where peripheral venous cannulation has been impossible, next step is?

Answer 21

attempt intraosseous cannulation - rapid and requires less skill than central venous access

Question 22

in patients unable to protect airway (somnolent) or hypoxic despite supplemental oxygen, next step in management?

Answer 22

endotracheal intubation with mechanical ventilation

noninvasive positive pressure ventilation cant be used in patient that are somnolent as it does not protect against aspiration

Question 23

in a patient with cafe au lait macules, lisch nodules, what eye condition is often asociated?

Answer 23

optic pathway gliomas

condition = NF1

Question 24

treatment for infantile hemangiomas that are periorbital (increased risk of vision loss) or large/segmental (risk of scarring or ulceration) ?

Answer 24

oral propanolol

Question 25

a child with cyanosis, rhinorrhea, coughing spells and postussive emesis (eg coughing while feeding and apnea ) most likely has?

Answer 25

whooping cough

• risk of siezures also

Question 26

a child with chronic headaches, poor linear growth and pubertal delay raises suspicion of a tumour with what mri findings?

Answer 26

craniopharyngioma
suprasellar mass with calcifications
pituirary stalk compression -> panhypopituitarism, growth failure

Question 27

a pariteal lesion with air fluid levels and hyperdense rim on mri + fever, headache is most likely?

Answer 27

brain abscess

Question 28

tuberous sclerosis mri findings?

Answer 28

subependymal nodules in lateral ventricles

Question 29

what is the biggest risk factor for orbital cellulitis?

Answer 29

bacterial sinusitis

• infections of teeth specifically close to maxillary sinus is also a risk factor but not greatest

Question 30

in a patient with low leukocytes, low platelets, low hemoglobin
bleeding gums, fatigue

short stature, hyper/hypopigmentation patches and absent or hypoplastic thumbs

has what condition?
what is the cause of this condition?

Answer 30

Fanconi anemia - most common congenital cause of aplastic anemia

DNA repair defect

Question 31

acute iron poisoning signs

treatment?

how to narrow down choices with lab results?

Answer 31

abdominal pain, diarrhea, hematemesis -> hypovolemic shock may deveolp

xray may show opacities = iron pills specifically show this

defiroxasime chelation therapy

• calculate anion gap -> this + ph = anion gap metabolic acidosis
• lead posinoing causes altered mental status/siezures and hematemesis is not seen
• aspirin you expect tinnitus

Question 32

in nephrotic syndrome due to amylodosis, name an important investigaton

Answer 32

echocardiography - risk of restrictive cardiomyopathy

Question 33

a boy presenting after vomiting and diarrhea (gastroenteritis) with hip pain and decreased range of motion, ultrasound shows small intracapsular fluid collection (small hip effusion)

what is diagnosis and treatment?

what are some other risk factors for this condition?

lab test findings?

Answer 33

transient synovitis

ibuprofen

post infective, posttraumatic eg gymnastic class, idiopathic

WBC, ESR and CRP may be normal or mildly elevated

*joint effusions may be bilateral vs septic arthritis which is always Unilateral. In addition, is septic arthritis, outright refusal to weightbear vs limited in transient synovitis

Question 34

in a patient with localised bony tendernessm erythema and warmth to proximal tibia

in an otherwise well child

what is most likely condition and organism?

Answer 34

osteomyelitis

staph aureus

*osteomyeltis typically occurs in metaphyses of long bones eg tibia, femur

Question 35

biliary cyst symptoms

management?

Answer 35

asymptomatic OR RUQ pain, mass, jaundice

in neonates - jaundice, acholic stools, dark urine

RESECTION! Due to increased risk of malignancy -> cholangiocarcinoma, pancreatic cancer, gallbladder cancer

Question 36

examination findings in a baby with rickets?

x ray findings?

biggest risk factor in infants?

Answer 36

craniotabes - i.eskull bones that are soft and flexible/depress to pressure

radius/ulnar bowing

x ray: metaphyeal widening, metaphsyeal cupping and fraying

exclusive breastfeeding with no vitamin D supplementation!

Question 37

*in conmmon variable immune deficiency, differentiation from b cells into plasma cells is impaired. so b cell count is normal, but all igs are low

*SCID is caused by Tcell impairent and then subsequent b cell dsysfunction, both T and b cells low

*CD40 ligand deficiency = x linked hyper IGM. defective class switching so all Igs low except IgM which is high. normal b cell count x

job syndrome/hyper IgE -> everything normal except elevated igE

X linked agammaglobunemia -> defect in tyrosine kinase -> bone marrow cant make B cells for circulation. low b cells and low all Igs

Question 38

hereditary hemorrhagic telangiectasia causes what neurological condition in children?

symptoms?
CT findings?

Answer 38

stroke -> due to AVM

headache, vomiting, focal neurological deficit, altered mental status

hyperdense intraparenchymal fluid collection

hemorrhagic stroke is always hyperattenuated on CT vs ischemic

Question 39

a neonate that presents with respiratory distress, hypoglycemia, jiteriness, normal chest xray, mother with preclampsia, raised hematocrit, ruddy/plethoric appearance.

what is most likely condition?

name other risk factors

management

Answer 39

neonatal polycythemia. polycythemia = hematocrit >65 % in term neonates

intrauterine hypoxia (maternal diabetes, maternal HTN, smoking). erythrocyte transfusion (delayed cord-clamping, twin to twin transusion), hypo/hyperthyroidism, genetic trisomy conditions

iv fluids, glucose, partial exchange transfusion

*note in TTN - CXR findings include increased pulmonary vascular markings and fluid in the fissures.

Question 40

state etiologies of cerebral palsy and imaging findings

Answer 40

prematurity/LBW = periventricular leukomalacia, IVH

hypoxic ischemic injury = watershed injury, basal ganglia/thalamic lesions

perinatal stroke = vascular distribution

intrauterine infecitons = calcifications

Question 41

how does acute bacterial sinusitis present?

Answer 41

nasal discharge and cough diagnosed as:
- lasting greater than10 days
- OR with severe fever >/= 39 for >/= 3 days
- OR worsening symptoms following initial improvement

viral sinusitis usually resolves by 7-10 days

non typeable hib = most common
strep pneumonia
moxarella catarrhalis

amoxicillin =/ clavulanate

Question 42

10 year old boy, continuous left knee pain. worse at night. no trauma, swelling of leg

x ray = central lytic lesion of distal femur with cortical layering (onion skinning) and ‘Moth eaten” appearance and extension into soft tissue

increased leukocyte and increased ESR!

most likely diagnosis?

Answer 42

ewing sarcoma = second most common MALIGNANT pediatric bony tumour after osteosarcoma

other systemic signs like fever and weight loss may be present

*local pain and swelling
* xray features
*white adolescent boys
*common in pelvis and long bones

Question 43

distinguish between the mechanism and clinical features of lactation failure jaundice and breast milk jaundice

Answer 43

lactation failure jaundice:
- insufficient mil intake = delayed stooling -> decreased bilirubin elimination= high unconjugated/indirect bilirubin
- suboptimal breastfeeding (less than every 3 hours)
- signs of dehydration - wet diapers should equal or exceed neonates age in days eg >/=4 on day 4, weight loss

encourage frequent breastfeeding
if this is not sufficient formula feeds and phototherapy may be considered

exchange transfusion is reserved for patients with bilirubin >/= 25 or bilirubin induced neurological dysfunction = change in tone, lethargy or rise in bilirubin despite phototherapy

breast milk jaundice
- beta glucoronidase in brast milk deconjugates intestinal bilirubin and increases its circulation.
- adequate breastfeeding and well hydrated

Question 44

In ABO blood group incompatibility, what blood group would mother have?

Answer 44

group O.

anti -a or anti- B
antibodies to child blood group A or B

Question 45

1st step in management of primary amenorrhea in a girl?

Answer 45

pelvic ultrasonography - look for abnormalities of ovaries, uterus etc

-> MRI brain is only indicated in patients with uterus and LOW or inapppropriately elevated FSH

Question 46

when would a urodynamic study be appropriate for a child with eneuresis?

what about imipramine

Answer 46

urodynamic study if bladder dysfunction suspected = daytime incontinence, weak stream, urgency, straining

imipramine = no underlying conditions eg OSA (if osa = polysomnography). and 1st line treatments eg desmopressin and alarm have failed

Question 47

all patients with tracheesophageal fistula and oesophageal atresia should undergo what screening?

Answer 47

echocardiography and renal ultrasonography!

association with VACTERL
- Vertebral
- anal
- cardiac
- tracheoEsophageal fistula
- renal
- limb abnormalities

Question 48

How does an osteoid osteoma present?
x ray findings?

Answer 48

• pain, worse at night
• femur most common
• improves with NSAID use!! - unlike ewings sarcoma in which pain is also worse w activity!
• round, small lucency on x ray!

Question 49

how does an osteosarcoma present?

Answer 49

moth eaten lytic lesions
sunburst pattern!!

chronic localised pain and soft tissue mass

Question 50

a patient with hyperglycemia and anion gap metabolic acidosis with a recent infection most likely has what?

what is most likely decreased in body?

Answer 50

DKA
*if given electrolytes, always calculate anion gap!

total body potassium -> high glucose levels causes osmotic diuresis -> net renal loss of K+ -> however serum K+ may be normal as insulin causes extracellular shift

*in DKA after osmotic diuresis, blood urea nitrogen and creatinine may be acutely elevated due to hypovolemia
*DKA is characterised by increase in circulating fatty acids due to lipolysis

Question 51

gyaecomastia/breast lump in a boy with abnormal features eg rapidly progressing, outside of puberty with an increased beta-hcg. no palpable mass on testes examination

next best step in evaluation?

Answer 51

testicular ultrasound!

high hcg points to a twsticular germ cell tumour (may not be picked up on palpation) (eg seminoma etc)

hcg suppresses testosterone and increases aromatase activity = more estrogen

Question 52

PSGN treatment?

Answer 52

loop diuretics eg furosemide for volume overload

Question 53

most common cause of heavy menstrual bleeding in adolescence is ?

Answer 53

VWD -> impaired platelet adhesion

Question 54

heart failure in Kawasaki disease is due to what aetiology?

Answer 54

lymphocytic myocarditis -> LV dysfunction

daiphoresis during breastfeeding, s3 gallop, pulmonary edema, hepatomegaly

Question 55

minimal change disease pathogenesis?

Answer 55

cytokine induced glomerular injury!

Question 56

differentiate between Ehlers Dahnlos and Marfans syndrome

Answer 56

Ehlers Danhlos
- defective collagen production
- scoliosis, joint laxity, aortic dilation

Marfans syndrome
- defective fibrillin 1 gene
- scoliosis/kyphosis, joint laxity, aortic root dilation (aortic regurg, aneurysm & dissection risk!!)
- unlike Ehlers, also has tall long then extremities, long fingers, upward lens dislocation!!

MarFans. F= fibrillin

Question 57

recurrent episodes of edema in a child, eg face, limbs, genitals. with no other symptoms eg urticaria, pruritus, is what condition?

pathology?

Answer 57

Hereditary angioedema

C1 inhibitor deficiency

Question 58

risk factors for lead poisioning?

if capillary blood test for lead is positive, next step in management?

Answer 58

living in home built before 1978
pica/mouthing behaviours
chipping paint or dust released during renovation

1. measure venous lead level for confirmation and remove from lead containing environment = best next step!!
2. Chelation therapy if lead level >/= 45 -> dimercaptosuccinic acid (succimer) or if at least 70, dimercaprol (British-lewisite) + calcium disodium edetate (EDTA)

AXR only indicated if GI symptoms eg vomiting, constipation, abdominal pain, or suspicion of ingestion

at a later point you will screen for IDA if hemoglobin is low

Question 59

what are the similaritis between marfans syndrome and homocystinuria? how would you differentiate

homocystinuria management?

Answer 59

both have marfanoid body habitus eg skin elasticity, tall etc

homocystinuria only = intelectual disability, thrombosis (stroke in child/MI), downwards lens dislocation, fair complexion, magaloblastic anemia.
management = B6 supplementation + antiplatelets/anticoagulation

marfans only = aortic root dilation, upwards lens dislocation

Question 60

Tuberclous meningitis CSF findings?

onset

Answer 60

high lymphocytes, high protein and low glucose

very gradual onset w weeks/ months of non specific symptoms first in contrast to strep pneumonia <7 days onset + neutrophil predominance

Question 61

in neonatal respiratory distress syndrome, what mechanism drives the hypoxia?

Answer 61

surfactant deficiency -> alveolar/lung collapse -> increased right to left intrapulmonary shunting

Question 62

in paeds, immunology, biochem and repro eg CAH come up

Question 63

most common cause of congenital adrenal hyperplasia?

presentation?

diagnosis?

Answer 63

21 hydroxylase deficiency. it inhibits conversion of progesterone to 11 deoxycorticosterone

aldosterone deficiency
= dehydration -> sunken fontanelle, dry mucous membranes
= salt loss = hyponatremia, low bp, high k+

virilization in females only

increased 17-hydroxyprogesterone = diagnostic

Question 64

in a patient whose urethral meatus extends to the corona of the ventral aspect of the penis (hypospadia), what is the next step in management of patent if circumcision is requested by father?

Answer 64

urology evaluation prior to circumsicion as foreskin may be edded forrepair and traditional circumcision methods may not be safe

renal ultraosund only if other congenital abnormalities eg aniridia indicative of WAGR

Karyotype if sever hypospadia and undescended testes also present -> may be a sexual development disorder

Question 65

boy with tilting his head to right followed by arm twitching, then chewing of lips and picking at shirt while staring ahead. episode lasted 2-3 minutes and patient was confused after

most likely diagnosis?

Answer 65

focal siezure

motor movements = head tilting,, arm twitching

impairment of awareness may occur (eg staring). this is associated with automatisms eg chewing, picking

Question 66

differentiate between
absence siezure

juvenile myoclonic epilepsy

lennonx-gastaut syndrome

Answer 66

absence siezure = staring spell with or without automatisms. last 10-20 seconds. not asosciated with post-ictal period

juvenile myoclonic epilepsy = in adolescents. jerks immediately on awakening. absence and generalised tonic clonic siezures may also be seen

lennox-gastaut = intellectual disability and several siezures of varying type. slow spike and wave pattern on EEG

Question 67

conjuctivitis, mucosal changes, rash, cervical lymphadenopathy are seen in a certain condition. what other finding is there in distal extremeties in this condition?

Answer 67

edema

Question 68

in a 7 day old infant that presents with ecoli sepsis, vomiting after breastfeeding, jaundice and elevated transaminases, normocytic anemia. what is the most likely diagnosis?

Answer 68

galactosemia -> inability to metabolize galactose to glucose

*excessive galactose can impair leukocyte function and superoxide relase -> increased succeptibility to ecoli
*galactose-1 phosphate acucmulates in RBC, promoting their death -> unconjucated hyperbilirubinemia

Question 69

boy has truamatic eye injury. was prescribed cyclopentolate. patient then develops hallucinations, tachycardia, dilated pupils. management?

Answer 69

physostigmine
patient has anticholinergic toxicity

Question 70

microcephaly (HC<3RD percentile) in a normal child with no developmental delay and normal exam. management?

Answer 70

measure parents heads
benign familial microcephaly

Question 71

where is the location of murmur in VSD?

what signs seen in infants>

Answer 71

left lower sternal base!! - think ventricles at bottom

increased work of breathing, tahcycardia, diaphoresis, pallor, particularly during times of exertion eg feeding

vsds lead to left to right shunting, and as a result, increased pulmonary blood flow and volume overload on left side of heart. signs of high output LV failure described above. signs of right sided HF also seen sometimes eg hepatomegaly.

Question 72

distinguish between non typhoidal salmonella and salmonella typhoid including risk factors for each. which one does vaccine protect against?

Answer 72

non typhoidal = diarrhea(may be bloody in children), abdominal pain, fever, vomitng. bacterial gastroenteritis. inadequate cooking or refrigeration of chickens/egg. diagnosis =stool culture. self limiting

typhoidal = FEVER+ bacteremia, rose spots. hepatosplenomegaly may be seen. diagnosis = blood culture. antibiotics

vaccine is for typhoid. no vaccine for non-typhoidal salmonella

Question 73

in a patient with HSP how is this diagnosed?

Answer 73

clinical -= no additional testing

if incomplete presentation =skin biopsy

Question 74

12 year old with recent diarrheal infection, cant walk anymore, pins and needles sensation in feet and weakness in past few days. absent ankle and patellar reflexes . upper extremeties weak and hyporeflexic. sensation intact.

what structure is primarily impaired in patients condition

Answer 74

peripheral nerve fibres -> GBS

Question 75

newborn baby when initially breastfed began to appear blue around the lips and face but turned pink when removed from the breast and began crying . no murmurs on auscultation. what is the most likely diagnosis?

how is this confirmed

Answer 75

Choanal atresia - failure of posterior nasal passage to cannalize completely

diagnosis:
inability to pass catheter past nasopharynx
CT scan/nasal endoscopy

if unilateral rather than bilateral - presents with chronic nasal discharge

Question 76

how should biphasic anaphylaxis be treated?

Answer 76

with an additional dose of IM adrenaline

if 3 doses fail to resolve symptoms -> IV adrenaline

if hypotenson -> iv crystaloid and trendelenburg positioning

bronchospasm -> give albuterol

Question 77

severe cases of croup (stridor at rest) is treated with what?

Answer 77

Nebulised epinephrine!!! (in addition to dexamethasone used for mild cases)

Question 78

at what age should infants be able to babble and turn to their name?

Answer 78

9 months

if not = audiology evaluation

Question 79

high myopia increases the risk of?

Answer 79

retinal detachment and macular degneration

Question 80

boy presenting with fever, pruritic rash and joint pain and palpable lymph nodes after given penicillin for step throat 9 days ago, what is the most likely cause

Answer 80

Serum sickness like reaction (SSLR) due to penicillin. can also be caused by sulfa drugs.

note* same symptoms as serum sickness (SS) which has a different cause

Question 81

3 year old. 3 episodes of vomiting today and 5 watery stools today (acute onset). Fever of 38. no blood in stool.

what is the most likely diagnosis? management?

Answer 81

viral gastroenteritis

discharge with ORS

additional evaluation only needed if bacterial or parasitic pathogen suspected (bloody diarrhea, diarrhea for more than week, high fevers, particularly >40). *note in a campylobacter infection with mucoid diarrhea abut no blood and no features described above, symptomatic care ie rehydration is sufficient

IV rehydration only neded if signs such as weak or rapid pulse, increased cap refill, reduced skin tugor, decreased urine output

Question 82

what long term complications are expected from a greenstick fracture eg of forearm?

Answer 82

none

limb length discrepancy -> seen with fractures involving growth plate

limited range of supination and pronation -> seen in malunion in severely displaced fractures

Question 83

bronchiolitis is seen in what age group?
symptoms?
CXR findings?

Answer 83

<2 years
cough, crackles, wheezing

CXR: hyperinflation, peribronchial cuffing(bronchial wall haziness due to inflammation), increased interstitial markings

usually clinical diagnosis but x ray may be done to exclude other causes

Question 84

distinguish selective mutism from stranger anxiety

Answer 84

selective mutism = refusal to speak in certain social situations eg home, vs an environment where they feel more comfortable eg friends/family

stranger anxiety -> anxiety and distress encountering unfamiliar people even in presence of parent

Question 85

an 18 month old girl develops IDA due to excessive consumption of cows milk. following a blood transfusion the girl develops:

respiratory distress, HTN, tachycardia and pulmonary edema (bilateral crackles), S3 gallop

managment?

Answer 85

in a toddler (2 years). systolic blood pressure should be expected to be around 105

thus 130/60 will be hypertension

furosemide

S3 gallop indicates HF (JVP distension may also be present). respiratory distress probably due to pulmonary edema.

• anaphylaxis would cause hypotension
• resp support only is used to treat TRALI = resp distress caused by noncardiogenic pulmonary edema. HYPOTENSION is seen in TRALI. signs of circulatory overload not seen (S3 gallop, diffuse crackles)

Question 86

in a patient with acute pharyngitis with no viral symptoms (cough, rihnorrhea, conjuctivitis, oral ulcers), and a negative rapid streptococcal antigen test. what is the next step in management?

Answer 86

Throat culture -> properly rule out step throat due to risk of acute rheumatic fever.

note if viral symptoms were present, you wont even need rapid antigen test, it would be a clinicial diagnosis

Question 87

cephalohematoma presentation?

Answer 87

firm well demarcated scalp swelling that doesnt cross suture lines -> forceps delivery is risk factor. risk of hyperbilirubinemia

caput succadenum -> boggy, poorly demarcated edema that crosses suture lines

Question 88

subgleal hemorrhage presentation?

Answer 88

fluctuant scalp swelling that expands with time!! and crosses suture lines. can cause life threatening blood loss! overlying skin may be bruised

Question 89

acute mastoiditis is a complication of what?

how does it present?

treatment?

distingusish this from parotitis

Answer 89

otitis media

tenderness and swelling behind ear (mastoid area), displacement of the auricle

tympanic membrane may show evidence of erythema/bulging/perforation or may not be visible

IV antibiotics and drainage

parotitis has both post and pre auricular swelling and typically occurs in the elderly

Question 90

recap blood transfusion reactions

Question 91

in a patient with dark urine, with a urine dipstick that says 3+ blood but red blood cells of only 1-2 what could be the cause?

next investigation?

Answer 91

red blood cells <3 therefore not hematuria. could be myoglobinuria or hemaglobinuria.

in a patient with mechanical heart valve & absence of muscle aches, hemaglobinuria more likely => full blood count, check for evidence of hemolytic anemia due to heart valve

Question 92

SCID treatment?
CVID Treatement?
in which conditions are antiviral and antifungals indicated?

Answer 92

stem cell transplant

intravenous immunoglobulins (also give this in x-linked agammaglobulinemia). note in CVID only the B cell count is normal, i e, variable to Igs which are low.

conditions in which cellular immunity is impaired eg SCID, chronic granulomatous disease

Question 93

baby with meningitis signs. CSF shows elevated wcc and protein. Glucose is NORMAL. baby missed a vaccine at 1 year old. most likely cause

Answer 93

Viral meningitis

probably mumps virus due to missing MMR vaccine

Question 94

3 month old baby with episodes of reflux. normal weight gain, no pain or back arching, what is the management?

what is pathologic reflux? managment?

Answer 94

• reassurance that it is physiolgical and should resolve by 12-18 months.
• upright positioning after feeds, burbing, frequent small volume feeds.
• cholecalciferol/vitamin d supplementation! to all breastfed infants!!
• irritability, poor feeding, weight loss!
• if bottle fed -> thickening feeds, extensive hydrolysed formula
• breastfed -> mother to eliminate cows milk and soy protein from diet

Question 95

newborn presents with hypoxia that is responsive to oxygen supplementation (indicates a pulmonary pathology. if not responsive = cardiac in which you would administer prostaglandin). cardiac examination shows a 1/6 ejection systolic murmur. mother had gestational diabetes.

CXR shows ground glass opacities. next step in management after putting on CPAP?

Answer 95

surfactant administration!!
patient has RDS

*Maternal diabetes is a risk factor
*murmur here = innocent

Question 96

persistent pulmonary hyppertension of newborn symptoms?

management?

Answer 96

differential cyanosis = saturation in right hand> foot

nitric oxide (pulmonary vasodilator)

Question 97

management of patient with a history of acute rhuematic fever?
symptoms of the condition?

Answer 97

penicillin at time of disgnosis

and then penicillin prophylaxis to prevent recurrent infections and progression of heart disease

migratory arthritis, carditis, chorea and erythema marginatum may be present, elevated acute phase proteins

rash here is non purpuric -> contrast HSP

systemic juvenile arthritis in contrast to rhuematic fever, the rash is not migratory! and cant be diagnosed until arthritis is present for >6 weeks

Question 98

toxic metabolic encephalopathy & cerebral edema has different aetiologies. in the case of reyes syndrome, what is it due to?

Answer 98

liver failure -> hyperammonia

not uremia! uremia is acondition that can cause encephalopathy but not cerebral edema

Question 99

elevated PT or PTT or both and being able to identify a cause eg a specific factor deficiency

Answer 99

factor 7 deficiency presents with a prolonged PT!! and all other lab findings are normal!! patient has prolonged bleeding episodes

Question 100

vomiting predominant acute gastroenteritis is caused by what organisms?

management?

Answer 100

b cereus -> rice
s aureus -> raw or prepared foods eg dairy, eggs, meat, potato salad

clinical diagnosis, fluid repletion and reassurance

Question 101

what are some triggers for breath holding spell?

Answer 101

Pallid bhs -> pain or fear from a minor trauma

cyanotic bhs -> crying

pallor with brief LOC

Question 102

in a patient who had a drowning episode rushed to hospital and is seen to have high blood pressure and bradycardia, what is the most likely cause?

Answer 102

increased ICP -> cushings triad = htn, bradycardia, irregular respirations

Question 103

FEVER (myalgias, weight loss) + MURMUR (new or changing) + SPLEENOMEGALY in a child with a history of congenital heart disease

lab evidence of glomerulonephritis + inflammation (raised wcc, anemia of chronic diease)

what do you suspect? next step in management?

Answer 103

infective endocarditis -> echo

Question 103

pancytopenia in the setting of NORMAL cell morphology for all cells points towards?

Answer 103

aplastic anemia

Question 104

pinworms first line treatment?

Answer 104

pyrantel pamoate!!!! or albendazole

Question 105

how does reactive attachment disorder present?

how is disinhibited social engagement disorder different?

Answer 105

childhood abuse/neglect -> emotional and social withdrawal and a lack of response to comfort

lack of boundaries eg sitting in strangers laps

Question 106

manaegement of patient with voiding cystourethogrpahy showing retrogade urine flow and renal ultrasound showing hydronephrois?

Answer 106

prophylactic antibiotic therapy -> child has vesicoureteral reflux

Question 107

in a patient with infections, failure to thrive
lymphopenia
low CD19 and CD3
low immunoglobulins

management?

Answer 107

stem cell transplant.

patient has SCID as T cells and B cells are both low

Question 108

how does respiratory distress syndrome present?
why might a murmur be present in newborn?

what are the cxr findings in RDS,TTN and PPH

Answer 108

cyanosis immediately after birth, as well as grunting flaring and retractions which is not seen in cardiac causes

murmur could represent a physiologically open DA, which only closes from 12 hours after birth

RDS = ground glass opacities, air bronchograms
TNN = bilateral, perihilar streaking, fluid within interlobular fissures
PPH = clear lungs with decreased pulmonary vascularity

Question 109

newborn cyanosis that occurs with feeding but improves with crying evaluation?

Answer 109

pass a catheter through the nares

choanal atresia

Question 110

in a child, cough, sudden onset respiratory distress, unilateral hyperinflation on xray and mediastinal shift with decreased breath sounds and expiratory wheezing is concerning for?

management?

Answer 110

foreign body aspiration

rigid bronchoscopy

*differentiate form pneumothorax = lung collapse not hyperinflation and reduced lung markings

Question 111

18 month old with meningism signs and a petechial rash, what is the most likely cause

Answer 111

Neisseria meningitiidis

<1month usually listeria
<3 months usually GBS
>1 year, strep pneumonia is most common cause but Neisseria meningitidis is also cause (was answer in question stem)

Question 112

the presence of gamma tetramers on hemoglobin analysis is consistent with what condition? what specific rbc morphology is seen and why?

why is erythrocyte count raised?

Answer 112

alpha thalessemia

target cells due to loss of rbc volume as lack of hemoglobin

abnormal rbcs -> hemolysis -> increaed reticulocytes

Question 113

lab values in a patient with turners syndrome and thus primary amenorrhea?

Answer 113

low estrogen
low testosterone -> ovaries cant make it

high FSH and LH due to lack of negative feedback from eostrogen

turners causes premature ovarian insufficiency NOT pcos

Question 114

*rhD positive mothers do not produce antibodies

Question 115

child that used to struggle to eat, now stealing other childrens food , sees a speech therapist as speaks with 1-2 words, short height, poor muscle tone, surgery done years ago for cryptorchidism

Answer 115

prader willi syndrome - classic triad of hypotonia, hyperphagia, obesity

genetic test -> loss of expression on paternal copy of chromosome 15

Question 116

late onset GBS can present with meningitis, bacteremia and a focal infection like cellulitis!

Question 117

causes and risk factors for acute unilateral cervical lymphadenitis

Answer 117

staph and strep = most common -> pus formation occurs

anerobic bacteria eg prevotella -> poor dental hygeine/ periodontal disease

francisella tularenesis = history of contact with infected animal eg rabbi t

mycobacterium avium = chronic, non tender, violaceous

bartonella henslae = chronic, at site of cat scratch

Question 118

5 year old girl with down syndrome presenting with gait changes (ataxic gait), vertebrobasilar symptoms eg imbalance/dizziness (eg tripping whilst walking), urinary/fecal incontinence and UMN signs such as hypereflexia and positive babinski most likely has what?

Answer 118

atlanto-axial instability -> symptoms due to compression of the spinal cord

Question 119

night blindness, peripheral vision loss

retinal vessel attenuation (narrowing) and pale optic disc are all features of?

Answer 119

Retinitis pigmentosa

*pigment deposition = late finding and might not be seen

Question 120

• in hydrocephalus, developmental delay can occur due to axonal damage in brain due to raised ICP

Question 121

8 year old with chorea, emotional lability, obsessive compulsive disorders, milk maid grip what is this condition? what is the pathology?

Answer 121

syndehma chorea
molecular mimicry!!!! = (step antibodies cross reacting with basal ganglia )

this is NOT basal ganglia atrophy because this occurs in huntingtons disease, a disease with adult onset, characterised by chorea + dementia +pyschiatric features

Question 122

given a picture of a beefy red diaper rash that involves the skins folds. treatment?

Answer 122

topical antifungal - patient has candida dermatitis

(petrolatum and zinc oxide would be used irritant contact dermatitis)

(amoxicillin is used in perianal group A strep disease)

Question 123

patient with history of tetralogy of fallot which was repaired now presents with a decrescendo Diastolic! murmur at the left sternal border in the 3rd intercostal space at 30 years old. most likely cause?

Answer 123

pulmonic regurgitation = common complication of TOF repair, repair of pulmonary stenosis

*tricuspid regurg is a systolic NOT diastolic murmur

Question 124

which of the following is most likely associated with tubero sclerosis?

1. cardiac rhabdomyoma
2. optic nerve glioma
3. phaeochromocytoma
4. vestibular shwannoma
5. wilms tumor (nephroblastoma)

Answer 124

cardiac rhabdomyoma! -> all patients suspected must have an echo!

renal association = angiomyolipoma

Question 125

when there is a personal or family history of drug abuse, or parent prefers a drug without abuse potential, what do yo prescibe for ADHD?

Answer 125

Atomoxetine!

avoid stimulants (methylphenidate, amphetamines) which are normally 1st line

Question 126

first step in evaluating a patient with speech problems even without a history of ear infections or abnormality on otoscopy is?

Answer 126

hearing test

Question 127

baby teething, nasal congestion, fevers

despite mother giving acetaminophen and topical anesthetic she had to babys teeth, baby still fussy and presents with cyanoiss, 85% sats which are refractory to O2 supplementation

what is the most likely cause? most likely laboratory finding on ABG sampling?

treatment?

Answer 127

methemoglobinemia. exposed to topical/local anaesthetic!!! (also seen with other oxidising agents eg dapsone, nitrites)

normal PaO2!!, saturaiton gap between ABG and pulse oximetry

this is because ABG analyses only unbound arterial oxygen

methylene blue. “give meth to meth”

another example = baby with methemoglobinemia after circumcision and lidocaine application

cyanosis respiratory depression (seizures and death may also occur)

Question 128

treatment for a newborn when mother has chickenpox? (varicella exposure)

Answer 128

Varicella immunoglobulins!. give passive vaccination as active vaccination with Varicella vaccine is contraindicated in children <1
same goes for pregnant and immunocompromised peoples!

in contrast, immunocompetent = vaccine within 5 days of exposure!!!. After 5 days, in a healthy person with no symptoms, vaccine no longer recommended as PEP but still recommended to prevent future infection

acyclovir is only used to treat neonates that develop signs of disease!

Question 129

newborn girl, not moving legs, and not responding to heel prick test (ie no sensation) DTR +1 in legs, hemangioma over midline lumbosacral region

what is the most likely diagnosis?

Answer 129

spinal dysraphism!! AKA spina bifida

specifically a closed one = spina bifida occulta!!
common dermatological findings = dimple, hair tuft, hemangioma, lipoma, nevus
*some also present with tethered cord syndrome = LMN signs seen! as in patient = weakness, loss of sensation, hyporeflexia. abnormal gait, urinary dribbling and back pain may also occur

answer would not be spinal cord infarction as that would occur in adults and have UMN signs

Question 130

maneuvers that decrease LV volume, worsen LVOT obstruction in HCOM and increases the intensity of the murmur. name two such maneuvres

Answer 130

Valsalva and standing from supine

Question 131

Cholesteatoma presentation?
Otoscopy findings?

Answer 131

New onset hearing loss despite antibiotics or chronic ear drainage besides antibiotics

Otoscopy - granulation and skin debris, retraction pockets of the tympanic membrane may also be seen

Question 132

Patient with a history of sickle cell
Groin pain/ thigh pain weight bearing which has now progressed to at rest
Pain on hip abduction and internal rotation
Normal wcc and crp
History of viral illness
Most likely diagnosis?

Answer 132

Osteonecrosis/ avascular necrosis of femoral head
Patients complain of groin thigh or buttock pain

Can also occur at humeral head

Question 133

How to differentiate central precocious puberty from peripheral PP?
Next step in evaluation of central PP?
Management?

Answer 133

Central = high LH, advanced bone age
MRI of brain to rule out tumour
GnRH agonist if no tumor identified to prevent premature fusion of growth plates

Question 134

A patient with pneumonia which has not improved and now has a localised pleural effusion has what?
Medication needs to be changed from amoxicillin to?

Answer 134

Empyema
Ceftriaxone and vancomycin!! to target the most common organisms = strep pneuma and staph including MRSA

Question 135

In a 3 day old boy, with Petechia, prolonged PT and slightly prolonged PTT. Normal platelet count. Diagnosis?

Answer 135

• vitamin K deficiency - presents in newborns in first 2-7 days of life - in newborns that did not receive intramuscular Vit k - easy bruising, mucosal bleeding, GI bleeding, intracranial hemorrhage. PTT prolonged if severe
• in conditions with impaired platelet function, PT and PTT normal, platelet count normal

-in VWD, factor 8 and VW factor deficient. Prolonged PTT only

Question 136

Describe the two ways in which a disseminated gonorrheal infection may present?

Answer 136

Purulent monoarthritis

Migrating Athralgia, pustular rash, tenosynovitis

Question 137

JIA presentation?

Answer 137

Arthritis for at least 6 weeks
Fever for at least 2 weeks
Hepatospleenomegaly and lymphadenopathy common
Pink rash common
Quotidian fevers = spiking once daily

Question 138

Management for atopic dermatitis complicated by impetigo?

Answer 138

Topical mupirocin!!

Or oral antibiotics

Question 139

Short stature, normal growth velocity (eg following the 2nd percentile line on growth chart), delayed puberty and delayed bone age are all features of?

Answer 139

Constitutional growth delay - adult height typical normal

Contrast this to growth hormone deficiency where linear growth velocity is slowed so declining growth percentiles crossing two major percentiles eg 50 and 25

Question 140

Premature neonate with acute neurological symptoms (apnea, hypotonia, lethargy ie decreased movements, seizures) and rapidly enlarging head circumference, temp 37.1, Apgar scores 8 and 9, most likely has?

Next step in diagnosis?

Answer 140

IVH

Hemorrhage can also cause bulging fontanelle, bradycardia

Cranial ultrasound

Apgar scores normal so would point away from HIE
A normal temp = 36.1 to 37.2!!! - points way from meningitis
Inborn errors of metabolism cause seizures but not expanding head circumference

Question 141

Neonate with refractory jaundice and spleenomegaly. Anemia and elevated MCHC. Mothers blood group O+ and baby A+. Direct Coombs test is negative. What is the most likely diagnosis?

Answer 141

Defect of red blood cell membrane - hereditary spherocytosis

Direct Coombs test would be positive in ABO incompatibility/ antibody mediated hemolysis!!

Question 142

Playfully appearing 10 month old girl, fever 38. No Coryzal symptoms. maculopapular rash starting on face and then spreading to extremities
Small tender lymph nodes - suboccipital, posterior auricular, posterior cervical. Patchy erythema of small palate. Most likely diagnosis?

Answer 142

Rubella!!! = low grade fever, rash spreading from head, lymphadenopathy, forchheimer spots (erythematous papules on soft palate)

Measles in contrast which spreads the same way but coalesces and darkens after a few days and patients are ill appearing with high fevers up to 40!!! And coryzal symptoms and cough

In scarlet fever - rash begins Along skin folds (axillae, groin) and spreads to extreme toes

Erythema infectiously = no lymoahadenopathy or palatial lesions. Rash is lacy

Question 143

respiratory distress syndrome pathology?

Answer 143

surfactant deficiency -> increased alveolar surface tension

Question 144

newborn at 3 weeks of age presenting with erythematous papules and pustules limited to the face and scalp has?

management?

Answer 144

neonatal cephalic pustolosis

daily cleansing with soap and water

Question 145

Signs of pathological causes of constipation

Answer 145

Poor weight gain or linear growth
Sacral abnormalities eg hair tuft
Delayed passage of meconium
Blood mixed IN stool
Narrow ribbon stools

Question 146

Differentiate between droplet precautions and airborne precautions

Answer 146

Airborne = small particles that stay in air for long time. Negative pressure rooms, respiratory masks - = TB, varicella, sars, measles

Droplet = larger particles, not suspended for long time in air. Surgical masks = Neisse Ria meningitidis, Hib, mycoplasma pneumonia, influenza, adenovirus

Contact = C. difficile, ecoli, RSv , scabies

Question 147

A premature infant requiring continuous oxygen supplementation for 28 or more days after delivery has what condition? Classic x ray finding?

Answer 147

Bronchopulmonary dysplasia

Diffuse hazy infiltrates on CXR, low or normal lung volumes

In severe cases =

Question 148

Suspected fibroadenoma management?

Answer 148

Observation and repeat examination at 6 weeks ie after completion of full menstrual cycle. If mass has enlarged then ultrasound evaluation required

Question 149

Bow leg is physiological up until what age?

Answer 149

Age 2

If legs are bowed and no other signs and symptoms, rickets unlikely

Question 150

A girl with short stature, ie greater than or equal to 2 standard deviations below the mean or less than or equal to the 2nd percentile. She also has short metacarpals a high arched palate and malocclusion of teeth and strabismus. What is the most likely diagnosis? Management of height?

Answer 150

Turners syndrome

Recombinant growth hormone

Question 151

Thymus silhouette In patients under age 3 is normal. How does it appear in cxr? When would you be worried

Answer 151

Appears as sail sign
Worried if opacities in this location in adults - could be lymphoma or germ cell Tumour

Question 152

Vision is tested at every well child visit. In addition, at what age is formal vision testing recommended?

Answer 152

4 years

Question 153

In children under 4, avoid grapes, raw vegetables eg carrots, peanuts, hot dogs, hard candy, basically foods that have the potential to choke

Question 154

Transition to forward facing car seat should not be done before age 2 ie 24 months

Question 155

Distinguish ADHD from conduct disorder and ODD

Answer 155

In adhd a patient may grab the doctors stethoscope so hyperactive
However CD involves extreme misconduct ie harming others or animals!!, property destruction so fire setting and vandalization, lying, stealing, skipping school
ODD = willful disobedience and spite vs disobedience due to distraction in ADHd

Question 156

Child with uti, and persistent fevers despite treatment management?

Answer 156

Ultrasound of bladder and kidneys!
Broaden antibiotics. Avoid ct due to uneccessary radiation exposure

Question 157

Name 5 infectious complications of eczema

Answer 157

1. Impetigo = staph or strep. Honey crusted lesions. Papules
2. Eczema herpeticum = HSV = vesicles, crusting, lymphadenopathy
3. Molluscum contagiosum
4. Tinea Corporis =

Question 158

OCD 1st line?

Answer 158

SSRI = fluoxetine
Or CBT

Question 159

When you can’t tell if it is hereditary spherocytosis or G6PD deficiency, a family history of spleenectomies makes which more likely?

Answer 159

Hereditary spherocytosis- which is treated w folic acid, transfusions and splenectomy for severe anemia

G6PD is treated by avoidance of triggers

Question 159

Most common condition causing IVH?

Answer 159

Prematurity

Question 160

Septic arthritis in child management

Answer 160

Vancomycin - strep aureus main cause

If unresolving = ceftriaxone for gram negative cover

Question 161

Distinguish between primary dysmenorrhea and endometriosis

Answer 161

Primary dysmenorrhea = pain a few days before start of menstruation and resolves a few days after start. Normal physical examination

Endometriosis = pain few days prior AND throughout period. Uterosacral ligament tenderness, cul de sac nodularity and endometrioma on examination

Question 162

What tumour of the head and neck is seen in tuberous sclerosis?

Answer 162

Subepyndymal giant cell Tumour!! Cardiac rhabdomyoma and renal angiomyolipoma also seen

NF1= optic nerve glioma
Neurofibromatosis 2 = vestibular shwannoma

Question 163

18 month old with loss of speech , wanting to be soon fed rather than feed herself (loss of purposeful, hand movements) , stereotypical, movements (eg pulling at hair) and lurching gait (gait abnormality), siezures is concerning for? Diagnosis via?

Answer 163

Rett Syndrome
DNA analysis

Question 164

swinging child by arm -> crying and refusal to use arm -> arm held extended downward with forearm pronated and avoiding using it

several bruises at various stages of healing on anterior lower legs bilaterally

what does patient have?

managament?

what d

Answer 164

Nursemaids elbow/radial head subluxation

hyperpronate forearm or supinate+flexion!!!

bruise locations = common for kids

Question 165

17 year old boy, ankle pain ,

then petechial rash on legs and top of feet

then dull ache in scrotum

anemia

sexually active with 1 partner
what is the most likely diagnosis?

Answer 165

IgA vasculitis (HSP)

triad =
1. petechie on LOWER extremeties
2. athralgia
3. abdominal pain (or occult GI bleed which can result in anemia or intussecption)

scrotal pain and swelling common in boys!!! (localised vasculitis)

scrotal edema not seen in syphilis, and chlamydia doesnt have petechial rash

Question 166

small VSD vs large VSD presentation? managment?

Answer 166

small = asymptomatic except holosytolic murmur at left lower sternal edge.
spontaneous closure

large = resp distress, poor feeding and growth. CXR. = cardiomegaly, increased pulmonary markings

diuretics + surgery

Question 167

risk factors for curve progression in adolsecent idiopathic scoliosis?

Answer 167

female sex
age <12
premenarchal status!!
skeletal immaturity
initial severe curvature (cobbs angle > 25)

Question 168

normal serum complement levels in IGaA nephropathy helps distinguish from PSGN with reduced serum complement

Question 169

4 month old boy with occasional episodes of bilious vomiting, refusal to feed

history of omphalocele repaired

normal bowel sounds and rectal exam shows normal stools

most likely diagnosis?
investigation?
management

Answer 169

intermittent volvulus (partial obstruction)

upper GI series

Ladds procedure

Question 170

toddler with a unilateral, foul smelling, purulent nasal discharge (may be bloody)

most likely diagnosis?

Answer 170

nasal foreign body

Acute bacterial sinusitis = bilateral, fever, cough!!

Question 171

distinguish between the findings in transient synovitis and septic arthritis which both cause hip pain and limp

if a child presents with features concerning for septic arthritis, next step in management?

Answer 171

transient synovitis = well appearing, afebrile or low grade fever, able to weight bear/ ambulate, normal or mildly elevated wbc, ESR, CRP

septic athritis = Ill appearing, febrile, not able to weight bear, moderately elevated labs

bilateral hip ultrasound!!! to distinguish cause
unilateral effusion -> arthrocentesis to eveluate for septic arthritis
bilateral effusions -> can occur in transient synovitis

Question 172

patients with ITP are only treated if what?
management?

Answer 172

bleeding!!! (or if platelets less than 30,000 in adults)
glucocorticoids, anti-D, IVIG

Question 173

microcephaly, wide anterior fontanelle, cleft palate, hypoplasia of distal phalanges in newborn mostlikely due to use of what in mother?

Answer 173

phentoyin!! (fetal hyndantoin syndrome) = exposure to epileptic eg carbamezapine, valproate also

• also cause neural tube defects, and cardiac defects
• lowest epileptic dose for mothers + folic acid
• syphilis by contrast presents with rhinitis and maculopapular rash

Question 174

the most common causes o microcytic anemia in children are iron deficiency anemia and thalessemias. which one has a normal RDW and which one an increased RDW?

Answer 174

normal RDW = thalessemias!!!

increased RDW = iron deficiency

*note alpha and beta thalessemia mino/trait are both often asymptomatic but routine blood tests will pick up anemia

Question 175

How to distinguish pyromania from conduct disorder

Answer 175

conduct disorder - fire setting done to cause damage not relieve tension or out of fascination. also must be a history of aggression to others and animals, theft.

pyromania = eg playing with a lighter when hes stressed (done to relive tension). always wanted to be a firefighter (fascination with fire)