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00Step 2 > Pediatrics UWorld > Flashcards

Pediatrics UWorld Flashcards

1
Q

what is dx in pt who refuses to speak in specific social situations but engages in normal communication when he/she feels comfortable >= 1 month

A

selective mutism

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2
Q

why is selective mutism not considered normal shyness

A

refusal to speak at school can impair both academic and social development and should not be considered normal shyness

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3
Q

what is dx in pt where social situations are avoided or endured with great distress due to fears of negative evaluation

A

social anxiety disorder

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4
Q

what is dx in pt who demonstrates impairments in social reciprocity and restricted or repetitive patterns of behavior during early development

A

children with autism spectrum disorder

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5
Q

when is stranger anxiety normal

A

usually begins in children 6-9 months old and generally subsides by 3yo

involves anxiety and distress when encountering unfamiliar people, even in the presence of a parent.

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6
Q

what is dx in pt who develops fever, urticaria, polyarthralgias, and lymphadenopathy ~1 week after penicillin therapy

A

serum sickness-like reaction

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7
Q

what type of hypersensitivity is serum sickness-like rxn

A

it’s a type 3 hypersensitivity rxn that occurs 1-2 weeks after admin of beta-lactams (penicillin, amoxicillin, cefaclor) or trimethoprim-sulfamethoxazole

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8
Q

what is management of serum-like sickness

A

removal of offending agent (penicillin d/c) resolves symptoms within 48 hrs

more severe cases may require glucocorticoid therapy

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9
Q

what is dx in systemic IgA-mediated vasculitis occurring after an URI
presents with fever, arthralgia, and palpable purpuric rash of buttocks and lower extremities

A

Henoch-Schonlein Purpura

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10
Q

what develops if mononucleosis is treated with amino penicillin

A

morbilliform rash on the trunk

rash typically spares the extremities (no arthralgias either)

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11
Q

what is dx in pt with fever and sandpaper rash following strep pharyngitis

A

scarlet fever

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12
Q

what is dx in pt who starts a medication then gets acute high fever, vesicular or bulls lesions, and painful hemorrhagic oral erosions

A

Stevens-Johnson syndrome

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13
Q

what is dx in infant who presents with easy bleeding/bruising born without prenatal care and/or at-home delivery

A

Vitamin K deficiency

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14
Q

what will labs look like in infant with Vitamin K deficiency

A

normal platelets

prolonged PT

prolonged PTT (possibly normal if mild deficiency)

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15
Q

what are 4 reasons infants are born Vitamin K deficient

A

poor placental transfer

absent gut flora

immature liver function

inadequate levels in breast milk

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16
Q

what is the most common inherited bleeding disorder

A

impaired synthesis of Von Willebrand factor

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17
Q

what is the most common congenital foot deformity, characterized by medial deviation of forefoot with normal/neutral position of the hind foot; usually bilateral

A

metatarsus adductus

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18
Q

what dx is characterized by flexible feet that overcorrect both passively and actively into lateral deviation (abduction)

A

metatarsus adductus

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19
Q

what is management for metatarsus adductus

A

reassurance

most forms of metatarsus adductus correct spontaneously

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20
Q

what is dx in infant with rigid medial and upward deviation of both forefoot and hind foot with hyper-plantar flexion of foot

A

congenital clubfoot

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21
Q

what is the management for congenital clubfoot

A

karyotyping should be considered due to risk of chromosomal abnormalities

requires ortho evaluation, and
serial manipulation and casting soon after birth

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22
Q

what should you be concerned with in a newborn with meconium ileus

A

cystic fibrosis

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23
Q

what is dx in infant with gradual growth failure and recurrent sinopulmonary infections with greasy stools

A

cystic fibrosis

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24
Q

how do CF pts develop pancreatic insufficiency?

A

pancreatic duct obstruction and distention due to viscous mucus and subsequent inflammation develop in utero, and
eventually lead to fibrosis

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25
Q

what will a CF baby’s growth chart reveal

A

normal birth measurements

deceleration in weight
followed by declaration in length

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26
Q

what is dx in pt who presents with decelerated velocity of height growth in infancy
normalization of height growth rate after age 2-3 but have short stature and delayed puberty; and catch-up growth after puberty

A

constitutional growth delay

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27
Q

for a thalassemia, what is:
MCV
RDW
total RBC

A

low MCV (microcytic)
RDW normal
total RBC count is normal or high

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28
Q

what is Mentzer Index, and when is it low vs high

A

Mentor index = MCV/RBC

<13 typically occurs in a thalassemia (small cells but nl/high RBC count)

> 13 in iron deficiency (due to decline in total RBC count)

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29
Q

what are contraindications to a rotavirus vaccine

A

anaphylaxis to vaccine ingredients

history of intussusception

history of uncorrected congenital malformation of GI tract (ex Meckel’s diverticulum)

SCID

30
Q

what is most common cause of gastroenteritis in infants and young children worldwide

A

rotavirus

31
Q

when is rotavirus vaccine administered

A

age 2-6 months

32
Q

what type of vaccine is rotavirus vaccine

A

live attenuated virus vaccine

33
Q

what is a risk when giving the rotavirus vaccine

A

intussusception

34
Q

which is the only type of vaccines that should be administered 4 weeks apart due to possible interference of immune response

A

live -virus vaccines

35
Q

what 2 types of injuries typically go along with shaken baby syndrome

A

shearing of dural veins and vitreoretinal traction (retinal hemorrhages)

36
Q

what is the most common heart defect with Down Syndrome

A

complete atrioventricular septal defect

37
Q

how does a complete AtrioVentricular septal defect present

A

heart failure in early infancy

systolic ejection murmur due to increased pulmonary flow form the ASD

holosystolic murmur due to the VSD

38
Q

what causes a complete atrioventricular septal defect

A

failure of endocardial cushions to merge

39
Q

what is coarctation of aorta associated with

A

Turner syndrome

40
Q

what causes Ebstein anomaly

A

severe tricuspid regurgitation

41
Q

what does auscultation reveal in Ebstein anomaly

A

“triple or quadruple gallop”
(widely split S1 and S2 sounds plus a loud S3 and/or S4

and

holosystolic or early systolic murmur at the LLSB

42
Q

which murmur presents as continuous machine-like murmur

A

Patent ductus arteriosus

43
Q

what is PDA strongly associated with

A

congenital rubella syndrome

44
Q

what 2 heart defects are strongly associated with DiGeorge syndrome

A

Truncus arteriosus

transposition of the great arteries (TGA)

45
Q

which vaccine is associated with a decreased risk in developing hepatocellular carcinoma, esp in regions of Asia and Africa

A

Hepatitis B vaccine

46
Q

what is the initial tx for hypernatremia

A

initial goal is to stabilize with fluid resuscitation

–only isotonic solutions such as 0.9% NS or LR should be used to slowly lower the Na levels

47
Q

what type of solutions are 0.45% NS and 5% dextrose

A

hypotonic solutions

48
Q

what is the classic triad for brain abscess

A 
fever
severe headaches (nocturnal or morning)
focal neurologic changes
49
Q

what should you give for treatment and post-exposure prophylaxis for pertussis

A

Macrolides (azithromycin, clarithromycin, erythromycin)

all close contacts should be given the Abx regardless of age, immunization status, or symptoms
–Pertussis is highly contagious

50
Q

what are the doses of each macrolide for pertussis treatment and Post-exposure prophylaxis

A

< 1 mo: Azithromycin x 5 days

all others:
Azithromycin x 5 days
OR
Clarithromycin x 7 days
OR
Erythromycin x 14 days
51
Q

what should you suspect in pt with dermatitis herpetiformis and/or T1DM

A

Celiac disease

52
Q

what does the work-up of Celiac disease involve

A

a high tissue transglutaminase (TTG) IgA antibody

intestinal biopsy (villous atrophy)

53
Q

what age is bedwetting normal up to

A

bedwetting is normal before age 5

54
Q

what two options might help a pt with nocturnal enuresis >5yo?

A

enuresis alarm
or
desmopressin therapy

55
Q

what is dx in pt who presents with persistent symptoms of nasal drainage, congestion, and cough, lasting 10-30 days without improvement; pt appears ill, high fevers, and purulent nasal drainage for at least 3 days

A

bacterial sinusitis

56
Q

what is the most common predisposing factor for acute bacterial sinusitis

A

viral upper respiratory infection

57
Q

why does a viral URI predispose a pt to bacterial sinusitis

A

contaminating bacteria cannot be cleared by mucociliary clearance due to mucosal inflammation from viral infection,
leading to secondary bacterial infection

58
Q

what is first-line treatment for acute bacterial sinusitis

A

amoxicillin plus clavulanic acid

59
Q

what is dx in pt with rapid onset of:
noninflammatory edema of the face, limbs, and genitalia
laryngeal edema (could be life-threatening)
edema of the intestines, resulting in colicky abdominal pain
no evidence of urticaria

usually follows an infection, dental procedure, or trauma

A

angioedema (hereditary)

60
Q

what is pathogenesis of hereditary angioedema

A

C1 inhibitor deficiency, dysfunction, or destruction

low C1 inhibitor leads to elevated levels of edema-producing factors C2b and bradykinin

61
Q

what’s the most common cause of acquired isolated angioedema

A

ACE inhibitor use, which results in elevated levels of bradykinin

62
Q

what are C1q and C4 levels in hereditary vs acquired forms of angioedema

A

C1q is normal in hereditary

C1q is low in acquired

C4 levels are depressed in all forms of angioedema

63
Q

what is the best way to dx phenylketonuria

A

quantitative amino acid analysis

–elevated phenylalanine

64
Q

what is the deficiency in PKU

A

phenylalanine hydroxylase

  • -inability to metabolize phenylalanine into tyrosine
  • -accumulation in phenylalanine and its neurotoxic byproducts
65
Q

what is the mutation in Marfan syndrome

A

auto dominant disorder that results from mutations in the fibrillin-1 gene

66
Q

what is dx in pt with tall stature, long/thin extremities; arachnodactyly; joint hyper mobility; upward lens dislocation; aortic root dilation

A

Marfan syndrome

fibrillin-1 gene mutation

67
Q

what is management of newborn with hydrocele

A

most will disappear spontaneously by 12 months
–observation

hydroceles that do not resolve spontaneously should be removed surgically due to risk of inguinal hernia

68
Q

what is the most common type of brain tumor in children

A

astrocytoma

69
Q

what is dx in young pt with recurrent, severe viral, fungal, or opportunistic (Pneumocystitis) infections, failure to thrive, and chronic diarrhea

A

SCID

70
Q

what is etiology of SCID

A

gene defect leading to failure of T cell development

B cell dysfunction due to absent T cells

71
Q

what is treatment of SCID

A

stem cell transplant ASAP

00Step 2 (7 decks)

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