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Step 2 CK (primary set) > pediatrie 2 > Flashcards

pediatrie 2 Flashcards

1
Q

kid with drooling fever odynophagia dysphagia muffled voice and trismus what can cause that(3)

A

infection of larynx
Pharynx
or

deep neck space

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2
Q

clue for retropharyngeal abcess in the setting of drooling fever odynophagia dysphagia muffled voice and trismus(2)

A

inability to extend the neck

widened prevertebral space in lateral xray

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3
Q

complication of retropharyngeal abcess(4)

A

airway compromise
bactriemia
carotid artery rupture
jugular venous thrombosis

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4
Q

cause of retropharyngeal abcess

A

direct spread infection from paharyngitis
tonsilitis
otitis media
or sinusitis

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5
Q

bugs involved in retropharyngeal abcess

A

polymicrobial

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6
Q

stable patient with retropharyngeal abcess

A

polymicrobial

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7
Q

clue for early congenital syphilis(5)

A 
hepatosplenomegaly
cutaneous lesion
jaundice
anemia
rhinorrhea
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8
Q

xray in congental syphilis(2)

A

metaphyseal dystrophy

periostitis

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9
Q

late manifestation of congenital syphilis (7)

A 
2 years
frontal bossing
high arched palate
hutchinson teeth
intersticial keratitis
saddle nose
perioral fissures
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10
Q

screening test for syphilis(3)

A

VDRL
RPR
Enzyme immunoassay

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11
Q

confirmatory test for syphilis(3)

A

FTA-ABS

TPPA=traponema particle agglutination assay

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12
Q

in the vignette the clue for syphilis congenital

A

ulcerative on his feet

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13
Q

3 phases of pertussis

A

catarrhal
paroxysmal
convalescent

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14
Q

immunisation in pertusis(2)

A

5 doses of Tdap from 2 months and 6 years

TDAP booster age 11-18 and during pregnancy

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15
Q

CBC in pertussis

A

lymphocyte predominant leukocytosis

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16
Q

does immunization protects for life

A

no immunity doen not provide lifelong immunity

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17
Q

confirmatory dx of pertussis(2)

A

bacterial culture

PCR

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18
Q

rx of pertussis

A

macrolides

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19
Q

complication of pertussis(5)

A 
pneumonia
weight loss
subonjonctival hemorage
pneumothorax
respiratory failure and deat
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20
Q

clue in catarrhal phase

A

mild cough

rhinitis

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21
Q

duration of catarrhal phase

A

1-2 weeks

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22
Q

clue for paroxysmal phase(4)

A

20-30 mn coughing paroxysms
inspiratory whoop
staccato cough
posttussive emesis

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23
Q

duration of paroxysmal phase

A

2 - 6 weeks

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24
Q

clue for convalescent phase(2)

A

cough and

post tussive emesis resolve

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25
Q

duration of convalecent phase

A

weeks to months

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26
Q

osteomyelitis in sickle cell disease(2)

A

salmonella # 1

staph aureus

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27
Q

important clue to dx pertussis

A

inadequate vaccination

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28
Q

predisposing factor for sinusitis

A

viral upper respiratory infection

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29
Q

clue for sinusitis(4)

A

erythema and swelling of the nasal turbinates
purulent drainage
congestion
cough

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30
Q

quid of preseptal cellulitis

A

mild infection of the eyelid anterior to the orbital septum

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31
Q

quid of orbital cellulitis

A

seriuos infection post to the orbital septum

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32
Q

clue to distinguish preseptal from orbital cellulitis

A

ophtalmoplegia in orbital cellulitis(diplopia)

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33
Q

eye problem in orbiatl cellulitis(4)

A

decreased visual acuity
diplopia
ophtalmoplegia
proptosis

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34
Q

dangerous complication of orbital cellulitis(4)

A

blindness
intracranial infection
orbital abscess
cavernous sinus thrombosis

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35
Q

characteristic of non inflammatory joint fuid(3)

A

clear
200-2000 wbc
25% PMN

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36
Q

example of non inflammatory joint disease

A

OA

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37
Q

characteristics of inflammatory joint fluid(3)

A

translucent and opaque
2000-100000 wbc
often> 50% PMN

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38
Q

example of inflammatory joint disease(2)

A

crystal

RA

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39
Q

characteristics of septic joint(3)

A

opaque
50 000-150 000 WBC
often 80%-90 %

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40
Q

first bug in septic joint

A

staph aureus

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41
Q

rx of septic joint(2)

A

IV antibiotics

emergency surgical drainage

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42
Q

complication of septic joint

A

permanent joint destruction

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43
Q

most frequent complication of mumps

A

orchitis

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44
Q

febrile illness with development of rash 1 day after taking amox which infection should be suspected and dx(2)

A

epstein barr virus

post antibio rash

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45
Q

triad in Mononucleosis infection(3)

A

exsudative tonsillitis or pharyngitis
posterior or diffuse cervical lymhadenopathy
fever

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46
Q

presentation of post antibiotoc rash(2)

A

polymorphous

maculopapular

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47
Q

break time in sport during mononucleosis

A

> ou egal a 3 semaines

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48
Q

common oropharyngeal lesions in kid(5)

A 
aphtous stomatitis
herpangina
herpes gingivostomatitis
group A streptococal pharyngitis
infectious mono
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49
Q

quid of aphtous lesions or canker sores(2)

A

reccurent ant oral mucosa ulcers

no fever

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50
Q

localisation of ulcers in canker sores(4)

A

lips
cheeks
mouth floor
ventrum of the tongue

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51
Q

clue for herpangina(2)

A

vesicles and ulcer on post oropharynx

fever

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52
Q

clue for gingivostomatitis

A

vesicles and ulcer on ant oropharynx

fever

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53
Q

clue for group A strep pharyngitis(3)

A

tonsillar exsudates
fever
anterior cervical lymphadenopathy

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54
Q

cause of unilateral cervical adenitis in children(5)

A 
staph aureus and staph pyogenes
anaerobic bacteria
non tuberculos bacteria
Mycobacterium TB
bartonella henselae
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55
Q

clue for adenitis induced by staph and strep(2)

A

associated cellulitis
or
suppuration

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56
Q

rx of adenitis induced by staph or strep

A

clindamycin

incision and drainage

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57
Q

risk factor for anaerobic bacteria induced adenitis(2)

A

dental caries

periodontal disease

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58
Q

rx of anaerobe adenitis(2)

A

clindamycin

augmentin

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59
Q

clue for non TB mycobacteria adenitis

A

rarely tender

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60
Q

rx of non tb mycobacteria adenitis(2)

A

excision

macrolide +/- rifampin

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61
Q

clue for adenitis caused by bartonella hensellae

A

exposure to kittens or cats

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62
Q

rx for adenitis caused by bartonella hensellae

A

no needed

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63
Q

contraindication to rotavirus vaccination(4)

A

history of antissuception
anaphylaxis to vaccine ingredients
history of uncorrected congenital malformation in the GI like Meckel
severe combined immunodeficiency

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64
Q

age for administration of rotavirus

A

2-6 months

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65
Q

management of cat bite

A

augmentin pendant 5 jours

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66
Q

most common cause of osteomyelitis in kid

A

staph aureus

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67
Q

most common cause of acute tender lymph node in kids

A

staph aureus

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68
Q

clue for rhinosinusitis(3)

A

persistent symptom> ou egal a 10 jours without improvement
or
severe symptoms including fever> ou egal 39,purulent discharge or face pain> ou egal a 3 days
or
worsening symptoms > ou egal a 5 jours after initially improving viral upper respiratory infection

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69
Q

bugs causing rhinosinusitis(2)

A

step pneumoniae

nontypeable haemophilus influenzae

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70
Q

rx of choice of bact rhinosinusitis

A

augmentin

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71
Q

step in management of septic joint with effusion(4)

A

Labs de routine
xray
arthrocentesis

(in some vignette arthrocentesis is more important than Xray)

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72
Q

osteomyelitis in kid less than 3 years(3)

A

staph
group B streptococcus
gram negative bacilli

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73
Q

osteomyelitis in kid more than 3 years(3)

A

staph aureus
group A streptococci
strep pneumo

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74
Q

rx of osteomyelitis in kid less than 3(2)

A

nafcillin or vancomycin
plus
gentamycin or cefotaxime

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75
Q

rx of osteomyelitis in kid more than 3(4)

A 
nafcilin
or
clindamycin
or
cefazolin
or 
vancomycin
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76
Q

quid of howel jolly bodies(2)

A

single round blue inclusions on wright stain

nuclear remnants

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77
Q

quid of aplastic anemia

A

everything is low

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78
Q

acquired cause of aplastic anemia(6)

A 
drugs
toxic chemicals
idopathic
viral infection
immune disorder
thymoma
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79
Q

drugs causing aplastic anemia

A

NSAIDS

sulfonamides

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80
Q

toxic chemicals causing aplastic anemia(2)

A

benzene

glue

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81
Q

congenital cause of aplastic anemia

A

fanconie anemia

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82
Q

inheritance of fanconi(2)

A

autosomal recessive

or xlinked

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83
Q

risk in fanconi

A

cancer by the age of 16

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84
Q

Dx of fanconi

A

chromosomal breaks

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85
Q

clue for fanconi(4)

A

congenital marrow failure
poor growth
morphologic abnormalities
macrocytic anemia

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86
Q

disease with cafe au laits spots(2)

A

fanconi

neurofibromatosis

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87
Q

eyes and ears problem in fanconi(3)

A

strabismus
lot set ears
middle ear abnormalities

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88
Q

middle ear abnormality in fanconi(4)

A

hemorrgae
incomplete development
chronic infections
deafness

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89
Q

definitive rx in fanconi for the anemia

A

hematopoietic stem cell transplantation

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90
Q

most common complication of sickle cell disease

A

painless hematuria

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91
Q

why patient will sickle cell disease pee a lot at night

A

isisthenuria=inability to concentrate urine

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92
Q

kid with foot refent foo woung you decide to vaccinate for tetanos mother who is the guardian accepts but the father not what to do

A

administer the vaccine

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93
Q

in case of separated couple how do you proceed for the consent

A

the consent of one parent or the guardian is sufficient to perform

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94
Q

clue for wiskott aldrich syndrome(3)

A

low platelet
plus eczema
plus reccurent bacterial infection

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95
Q

cause of thrombocytopenia in wiskott

A

decreased platelet production

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96
Q

platelet in wiskott aldrich

A

small

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97
Q

inheritance of aldrich wiskott

A

x linked

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98
Q

clue for acute lymphoblastic leukemia(5)

A 
bone pain
lymphadenopathy
hepatosplenomegaly
pallor from anemia
petechia from throbocytopenia
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99
Q

dx of acute lymphoblastic leukemia

A

bone marrow biopsy with >25 % lymphoblasts

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100
Q

most common cancer in childhood

A

ALL

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101
Q

peak of ALL

A

2 - 5 ans

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102
Q

rx of ALL

A

chemotherapy

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103
Q

clue in the USMLE for ALL(2)

A

infant

high WBC

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104
Q

nosebleed and congestion in a patient with CT shows visible mass at the back of the left nostril and erosion of the adjacent bone dx

A

angiofibroma

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105
Q

male adolescent with epistaxis and bone erosion on the back of the nose

A

angiofibroma until proven otherwise

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106
Q

when to rx angiofibroma(3)

A

if juvenile angiofibroma is enlarging
obstructing the airway
cause chronic nosebleeds

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107
Q

surgery in angiofibroma

A

risk of recurrence

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108
Q

xray in osteosarcoma of humerus(2)

A

sunburst periostal reaction

codman triangle

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109
Q

the most common bone tumor in kid and young adults

A

ostosarcoma

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110
Q

bone of predilection of osteosarcoma

A

long bone

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111
Q

quid of codman triangle

A

periostal elevation

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112
Q

rx of osteosarcoma(2)

A

tumor excision

chemotherapy

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113
Q

when to suspect herediatary spherocytosis(4)

A

coombs negative
hemolytic anemia
splenomegaly in the setting of reticulocytosis hyperbilirubinemia spherocytosis and family history of anemia

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114
Q

confirmatory dx of hereditary spherocytosis

A

eosin 5 maleimide and acidified glycerol lysis tests

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115
Q

stroke in kid next step

A

peripheral smear and reticulocyte count

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116
Q

stroke in kid cause

A

SCD

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117
Q

physiopatho of stroke in SCD(3)

A

unknown but we think
red blood cell adherence to endothelium
activation of von willbrand’s factor’s
hyperviscosity

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118
Q

patient with history of easy bruising develops knee swelling after trauma first step

A

platelet count and coagulation studies

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119
Q

3 clue for bleeding disorders

A

prolonged bleeding after dental or minor procedures
bruising at pressure points
hemarthrosis

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120
Q

cause of bleeding disorder(4)

A

hemophilia A
hemophilia B
von willebrand disease
platelet function disorder

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121
Q

disease with platelet dysfunction(2)

A

bernard souilier

glanzman thromboasthenia

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122
Q

patient knee pain and swollen without trauma xray show central lytic lesion onion skinning appearrance dx

A

ewings sarcoma

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123
Q

type of tumor in erwing sarcoma

A

malignant

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124
Q

xray in erwing sarcoma(3)

A

onion skin, lamelated appearance

with a moth eaten or mottled appearance and extension in soft tissue

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125
Q

dx differenciel in erwing sarcoma

A

osteomyelitis

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126
Q

lieu for metastasis in erwing cell sarcoma(2)

A

lung

lymph nodes

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127
Q

patient with reccurrent sinopulmonary infection and diarrrhea since childhood develops anaphylactic transfusion reaction after blood transfusion cause of that

A

IgA deficiency

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128
Q

confirmatory dx of IGA deficiency(2)

A

low IGA level

normal IGM and IGG

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129
Q

prevention of infection and death in SCD(2)

A

give PNC prophylaxis
plus
pneumococcal vaccination

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130
Q

admistration of PNC in SCD

A

twice a day

until they reach five yo

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131
Q

factors of coagulation missing in cystic fibrosis(3)

A

vit K dependent
2, 7,9 ,10
protein C et S

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132
Q

why you have problem of bleeding in cystic fibrosis(2)

A

pancreatic insufficiency

problem in liposoluble vit absorbtion

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133
Q

toddler with unilateral firm mass and hematuria

A

tumeur de wilms(nephroblastoma)

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134
Q

peak for wilms tumor

A

2-5 ans

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135
Q

associated syndrome with wilms tumor(3)

A

wagr
beckwith wiedman syndrome
denys drash syndrome

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136
Q

quid of WAGR syndrome(4)

A

wilms tumor
aniridia
genitourinary anomalies
retardation mental

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137
Q

most common primary renl neoplasm in kid

A

wilms

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138
Q

dx of wilms(2)

A

1- contrast enhanced CT

2- chest xray for metastasis

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139
Q

rx of wilms(3)

A

tumor excision or nephrectomy
chemo
+/- radiation therapy

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140
Q

prognosis for rx wilms

A

5 year survival rate with rx :90%

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141
Q

role of hydroxyurea

A

increase fetal Hb

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142
Q

side effect of hydroxyurea(3)

A

leukopenia
anemia
thrombocytopenia
bref marrow suppression

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143
Q

marrrow suppression with hydroxyurea

A

temporary

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144
Q

polycythemia in newborn quid

A

central nervous hematocrit level greater than 65%

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145
Q

cause of polycythemia in newborns

A

delayed clamping of the umbilical cord

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146
Q

risk foor neonate in polycythemia(3)

A

respiratory distress
poor feeding
neurologic manif

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147
Q

clue for ALL(4)

A

more then 25 % de lymphoblast
lymphoblast lacks of peroxydase positive granules
but contain periodic acid schiff positive material
immunostaining for terminal deoxynucleotidyltransferase

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148
Q

immunostaining in ALL

A

TDT expression dans 95% des cas

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149
Q

cells expressing TDT(2)

A

pre T lymphoblastes

Pre B lymphoblastes

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150
Q

SCD patient with hip pain first dx

A

osteonecrosis(avascular nerosis)

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151
Q

mosr common affected bone in osteonecrosis in (2)

A

humerus

fever

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152
Q

patient with SCD presenting with dyspnea fatigue Hg: hb 4,5 wbc: 10000 platelets:300 000 reticulocytes=0,1% dx

A

aplastic crisis

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153
Q

low HB in SCD causes (3)

A

aplastic crisis
hemolysis
splenic sequestration

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154
Q

differentiate aplastic crisis from aplastic anemia

A

aplastic anemia =pancytopenia in a patient without SCD

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155
Q

characteristics of iron deficiency anemia(8)

A 
Hmt< 30%
RDW increased
total RBC decreased
low serum iron ferritin
increased TIBC
responds to iron supplementation
normal electrhoresis
no target cells
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156
Q

characteristics of alpha thalassemia anemia(8)

A 
Hmt.> 30%
RDW normal
total RBC normal
normal to increased serum iron ferritin
TIBC normal
 no responds to iron supplementation
normal electrophoresis
 target cells
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157
Q

characteristics of beta thalassemia anemia(8)

A 
Hmt.> 30%
RDW normal
total RBC normal to increased
normal to increased serum iron ferritin
TIBC normal
 no responds to iron supplementation
electrophoresis=elevated hb A2
 target cells
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158
Q

shistocytes in the settting of bloody diarhea administration of antibiotics,low Hb low platelet and high creat

A

microangiopathic hemolytic anemia

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159
Q

bugs involved in hus(5)

A 
E coli 0157h7
shigella
campylobacter
salmonella
yersinia
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160
Q

peripheral smear in HUS

A

schistocytes

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161
Q

continuous flow murmur in left sternla border in young child (son)

A

Patent ductus arteriosus

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162
Q

knee chest position of in fallot how it will improve cyanosis (2)

A

increased systemic vascular resistance

increases pulmonary blood flow

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163
Q

viral prodrome(rhinorrhea,fever) and heart failure

A

viral myocarditis

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164
Q

chest xray in viral myocarditis(2)

A

cardiomegaly

pulmonary edema

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165
Q

ECK in viral myocarditis

A

sinus tachycardia

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166
Q

echo in viral myocarditis(2)

A

decreased ejection fraction

diffuse hypokinesis

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167
Q

Biopsin in viral myocarditisdium with myocite necrosis(2)

A

gold standard

inflammatory infiltrate of the myocardium with myocite necrosis

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168
Q

prognosis of viral myocarditis in newborns

A

mortality 75%

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169
Q

prognosis of viral myocarditis in older infants and children

A

mortality in 25%

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170
Q

out come in viral myocarditis

A

full recovery within2-3 months 66%

dilated cardiomyopathy /chronic heart failure 33%

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171
Q

what dysfunction you have in viral myocarditis

A

systolic and diastolic

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172
Q

management of viral myocarditis(3)

A

ICU
to reduce the risk of acute decompensatio
fatal arythmia

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173
Q

antibiotics used in rheumatic fever prophylaxis

A

IM PNC G given q 4 semaines

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174
Q

duration of prophylaxis of rheumatic fever without carditis

A

5 years or until the patient reaches 21 yo

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175
Q

duration of prophylaxis of rheumatic fever with carditis but no residual heart or valvular disease clinical or by echo

A

10 years or until the patient reaches 21 yo

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176
Q

duration of prophylaxis of rheumatic fever with carditis and persistent heart or valvular disease

A

10 years or until 40 yo

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177
Q

why you give PNC in patient rheumatic fever(2)

A

to prevent recurrent group A streptococcus pharyngitis

limit progression of rheumatic heart disease

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178
Q

patient one day old comes for cyanosis ,pulse oxymetry 80% with no improvement with 100% inspired o2.continuous machine like murmur is heard on auscultation oral mucosa is blue dx

A

cyanotic heart disease

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179
Q

central cyanosis plus 70-90% oxygen saturation dx

A

cyanotic heart disease

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180
Q

what to do in front of cyanotic heart disease

A

prevent closure of ductus arteriosus by giving prostaglandine E 1

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181
Q

PDA dependent congenital heart disease(5)

A 
coarction of the aorta
D transposition of the great arteries
hypoplastic left heart syndrome
total pulmonary venous connection
tricuspid atresia
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182
Q

cause of supraventricular tachycardia in adolescent

A

WPW

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183
Q

mechanism involved in WPW

A

accessory atrioventricular pathway

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184
Q

EKG of WPW(3)

A

shortened PR interval
delta waves
widening qrs complex

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185
Q

clue for tricuspid atresia

A

left axis deviation

decrease pulmonary markings on chest xray

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186
Q

why tricuspid atresia you have decrease pulmonary markings on chest xray

A

due to hypoplasia of the right ventricle and pulmonary outflow tract

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187
Q

neonatal with EKG shwsleft axis deviation

A

it’s never normal

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188
Q

quid of tricuspid atresia

A

cyanotic heart disease

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189
Q

post pericardiotomy syndrome

A

pericardial effusion occurring within days or months after cardiac surgery

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190
Q

cardiomegalie with hypotension tachycardia muffled heart sound after surgery

A

pericardial effusion

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191
Q

most common heart malformation

A

VSD

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192
Q

clue for VSD

A

holosystolic murmur in left sternal border
plus
apical diastolic rumble

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193
Q

when will you have cyanosis in VSD

A

eisenmenger syndrome

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194
Q

quid of eisenmenger syndrome(2)

A

right to left shunt

unrepaired large VSD causes permanent pulmonary Hypertension and right to left shunt

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195
Q

cause of diastolic rumble in VSD at the apex

A

increased flow across the mitral valve

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196
Q

patietn 5y0 with asymptomaticgrade 2 left sternal border systolic ejection murmur best heard when the child is lying down and decreases with standing dx

A

benign chilhood murmurs

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197
Q

what to do in benign childhood murmur

A

observation

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198
Q

characteristics of inocent murmur(6)

A 
asymptomatic
no structural heart disease associated
grade 2/6
early or mid systolic
decreases with standing and valsalva
have a normal associated s2
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199
Q

characteristics of pathologic murmur(6)

A 
syptomatic
structural heart disease associated
grade 3/6 or higher
hars and holosystolic or diastolic
increases with standing and valsalva
loud s2 fixed s2 splitted
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200
Q

adolescent losing consciousness after crying or anytime she gets frustrated .EP normal dx and rx

A

breath holding spell

reassure the patients

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201
Q

type of breath holding spell(3)

A

pallid =patient pale
cyanotic=
mixed=cyanose plus seizure/pallid plus seizure

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202
Q

stridor improving with neck extension chez 1 patient de moins d’un an with cardiac abnormalities no improvement with epinephrine corticosteroids or bronchodilators

A

vascular ring

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203
Q

where can you have vascular rings(2)

A

trachea=stridor wheezing

esophagus=dysphagia

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204
Q

age pour vascular ring

A

mois d’un an

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205
Q

risk in long Qt syndrome(3)

A

syncope
ventricular arythmia
sudden cardiac death

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206
Q

medication used in prevention of death in long Qt syndrome(2)

A

betablocker

pacemaker

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207
Q

what a patient with long qt syndrome should avoid(2)

A

electrolyte derangement

medications that block K+ channels

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208
Q

ventricular arythmia in long Qt syndrome

A

torsade de pointes

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209
Q

congenital cause of long Qt syndrome(2)

A

Jervell and lange nielsen syndrome=autosomal recessive

romano ward syndrome=autosomal dominant

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210
Q

jervel and lange nielsen syndrome(3)

A

family history of sudden death
congenital neurosensorineural deafness
qt interval=600ms

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211
Q

what happen in jervell and lange nielsen syndrome

A

molecular defect in potassium channels

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212
Q

rx of JLN syndrome(3)

A

refrain from vogorous exercice
maintaining normal ca++,K+and Mg++
avoid medication that can lengthen the qt interval

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213
Q

metabolic derangements causing long Qt syndrome(3)

A

hypocalcemia
hypoK+
hypoMg++

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214
Q

antibiotics induced long qt syndrome(2)

A

macrolide

fluoquinolone

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215
Q

psychotics meds induced long qt syndrome(3)

A

antipsychotics
TCA
SSRI

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216
Q

opioids meds induced long qt syndrome(2)

A

methadone

oxycodone

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217
Q

antiemetics meds induced long qt syndrome(2)

A

ondansetron

granisetron

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218
Q

antiarythmics meds induced long qt syndrome(5)

A 
quinidine
procainamide
flecainide
amiodarone
sotalol
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219
Q

Qt interval

A

debut qrs a fin onde T

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220
Q

scaly rash in eyebrows nasolabial fold and scalp dx

A

seborrheic dermatidis

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221
Q

rx of seborheic dermatidis(3)

A

moisturisers
antifungals
topical steroids

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222
Q

quid cradle cap

A

seborrheic dermatidis

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223
Q

platelet in henock shonlein purpura

A

normal

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224
Q

problem in henock shonlein purpura

A

IGA mediated vasculitis

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225
Q

clue for Henock shonlein purpura(4)

A

palpable purpura on lower extremities
abdominal pain
arthralgia
renal involvement

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226
Q

atopic dermatitis in infant(2)

A

pruritis

skin lesions

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227
Q

skin lesions in atopic dermatitis localisation(4)

A

face
scalp
extensor surfaces
diaper region is spared

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228
Q

rx of atopic dermatitis in kid

A

improve the skin barrier function through the use of mild cleanserss and thick bland emollients in addition to mild topical antiinflammatory ointments

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229
Q

Tinea corporis=date

A

erythematous scaly pruritic rash with central clearing

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230
Q

rx of tinea corporis

A

topical antifungals

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231
Q

dx of tinea corporis(2)

A

skin scraping

koh examination

232
Q

rash in neonates(4)

A

erythema toxicum neonatorium
neonatal herpes simplex virus
neonatal varicella
staphyloccocal scalded skin syndrome

233
Q

quid of erythema toxicum neonatorium(2)

A

asymptomatic erythematous blanching macules ,papules and pustules throughout the bodies
resolves spontaneously within 2 weeks after birth

234
Q

Rx of erythema toxicum neonatorium

A

none

235
Q

quid of neonatal herpes simplex virus(3)

A

vesicular clusters on skin eyes and mucous membranes
central nervous system involvement
fulminanat multiorgan failure

236
Q

rx of neonatal herpes simplex virus

A

acyclovir

237
Q

neonatal varicella(3)

A

fever
vesicular clusters on skin
fulminant disseminated disease

238
Q

rx of neonatal varicella

A

acyclovir

239
Q

quid of staphyloccocal scalded syndrome(4)

A

fever
irritability and diffuse erythema
followed by blistering and exfoliation
positive nickolsky sign

240
Q

rx of staphyloccocal scalded syndrome(3)

A

oxacillin
or nafcillin
or vancomycin

241
Q

recommendtion during sunburn even if if the patient is suing factor 50 sunscreen and develops sunburn(prevention)

A

apply sun protection factor(15-30) or higher 50 sunscreen 15- 30 mn before sun exposure
avoid tannig beds

242
Q

rx of mild to moderate sunburn(4)

A

cool compresses
aloe vera
calamine lotion
NSAIDS

243
Q

severe sunburn rx(4)

A

hospitalization
IV fluids
analgesia
wound care

244
Q

complications of sunburn(2)

A

cancer

photoaging

245
Q

cancer in sunburn(4)

A

melanoma
basal cell carcinoma
squamous cell carcinoma

246
Q

after camping patietn presents with itching,burning and oozing skin lesions in both legs dx

A

allergic contact dermatitis

247
Q

type of hypersenstivity in allergic contact dermatitis

A

cell mediated hypersensitivity

248
Q

bugs in impetigo(2)

A

staph aureus

strep

249
Q

2 types of impetigo

A

vesicular pustulous

bullous

250
Q

cause of bullous impetigo

A

staphylococcus

251
Q

characteristics of impetigo(3)

A

erythmatous papules
rapidly evolves in vesicles and pustules
and at last honey colored crusted exsudates

252
Q

primary herpes simplex virus associated with dermatitis atopic

A

eczema herpeticum

253
Q

clue for eczema herpeticum(2)

A

numerous vesicles over area of atopic dermatitis

fever

254
Q

rx of eczema herpeticum(2)

A

can be life threatning

acyclovir

255
Q

physiopatho of staphylococal scalded skin syndrome

A

toxins produced targeting desmoglein 1

256
Q

role of desmoglein 1

A

keratinocyte adhesion in the superficial dermis

257
Q

rash in staphylococal scalde skin syndromeSSSS(5)

A 
1- erythema starting on the face
2-generalizes in 24-48 h
3-superficial flaccid blisters develops 
4 nickolsky sign posive
5-fever
258
Q

age de SSSS(3)

A

children below 10
adults with kidney disease
immune compromise patient

259
Q

capillary hemangioma(strawberry)(2)

A

tumors composed of capillaries separated by connective tissues
appear first week and regress by 5-8 yo

260
Q

clue for measles(rubeola)(4)

A

cough
coryza
conjunctivitis
koplik spots

261
Q

rash in measles

A

maculor papular rash spreading in a cranial caudal pattern sparing palms and soles

262
Q

prevention of measles

A

vaccination

263
Q

rx of measles(2)

A

isolation in private room with negative air pressure and a minimum of 6-12 air changes per hour with door closed
wear of facemask N95 by staff and parents

264
Q

transmission of measles

A

respiratory droplets

265
Q

dx of measles(2)

A

PCR

serology

266
Q

what should be given to any kid with measles

A

vit A

267
Q

complications of measles(4)

A

otitis media
pneumonia
neurologic
gastroenteritis

268
Q

neurologic complications in measles(3)

A

encephalitis within days
acute disseminated encephalomyelitis(within weeks)
subacute sclerosing panencephalitis(within years)

269
Q

after trauma 5 yo kid develops headcahe vomiting and left pupil dilation dx possible

A

epidural hematoma

270
Q

ct of epidural hematoma

A

biconvex mass on ct

271
Q

indication of emergent craniotomy in epidural hematoma(5)

A 
GCS< 8
sign of increased ICP
pupillary abnormalities
hemiparesis 
cerebellar signs
272
Q

6 yo boy with poor feeding and bulging anterior fontanelle best next step in the management ot this baby

A

CT of the brain

273
Q

clue for hydrocephalus

A

rapidly increasing in size of head circumference greater than the 97 th percentile(growth chart)

274
Q

symptoms in hydrocephalus(4)

A

poor feeding
irritability
decreased activity
vomiting

275
Q

physical exam in hydrocephalus(4)

A

tense and bulging fontanelle
prominent scalp veins
widely spaced cranial sutures
rapidly increasing head circumference

276
Q

when using ultrasound in the setting of hydrocephalus

A

kid less than 6 months

277
Q

drug of choice for absence seizure in kid(2)

A

ethosuximide(++++++)
or
acid valproic

278
Q

patient with ear pain on antibio develops vomiting and awakened headaches inthe morning.Physical exam shows left tender mastoid next step in the patient

A

CT of brain

279
Q

red flag for intracranial pathology

A

morning vomiting

nocturnal headaches

280
Q

risk in otitis media or mastoiditis

A

brain abcess formation

281
Q

dx of brain abcess formation

A

ring enhancing and hypointense center lesion on CT or MRI

282
Q

ceiteria dx for febrile seizure(5)

A 
age 6 months -6 years
T.> ou egal a 38
no history of previous afebrile seizures
no CNS infection
no acute metabolic cause of seizure
283
Q

quid of simple febrile seizure(3)

A

non focal (tonic clonic or atonic)
one episode last< 15 mn
or multiple episode< 30 mn

284
Q

quid of complex febrile seizure(3)

A

focal
one episode > ou egal a 15 mn
or multiple episode > ou egal a 30 mn

285
Q

risk factor of febrile seizure

A

infection virale
immunization
family history

286
Q

immunization involved in febrile seizure(2)

A

DTAP

MMR

287
Q

management of febrile seizure(2)

A

reassurance

abortive rx if seizure lasts more ou egal a 5 mn

288
Q

prognosis of febrile seizure(3)

A

normal intelligence and development
environ 30% risk of recuurrence
less than 5% risk of epilepsy

289
Q

quid of petit mal

A

absence seizure

290
Q

confirmatory test for petit mal

A

EEG studies

291
Q

clue for generalised seizures(3)

A

can have loss of consciousness
bilateral motor findings
can be convulsive or non convulsive(bsence)

292
Q

physiopatho of generalised seizures

A

both hemisphere is involved

293
Q

seizure activity in partial seizures

A

appears limited to part of oen hemisphere in brain

294
Q

quid of simple partial seizures(4)

A

no loss of consciousness
feeling of deja vu(familiarity)
can have aura
patient remeber event well

295
Q

partial seizure with generalisation(2)

A

1- loss of consciousness

2-tonic clonic activity

296
Q

complex partial seizures(6)

A 
loss of consciousness
can have aura
motor automatism
bilateral motor findings
staring spells
postictal confusion
297
Q

motor automatism in complex partial seizures(4)

A

chewing
swallowing
sucking
picking movements

298
Q

clue for partial seizure with secondary generalisation(2)

A

blood tinged sputum suggesting bite tongue

urinary incontinence

299
Q

fever with tonic clonic seizure in a patient with digeorge during exam babay cries and develops cyanosis

A

brain abcess

300
Q

risk factor for brain abcess

A 
otitis media /mastoiditis
frontal and ethmoidal sinusitis
dental infection
cyanotic heart diasease
bacteriemia from ather sites of infection
301
Q

pathogenesis of brain abcess in otitis media and mastoiditis(2)

A

direct spread

temporal lobe and cerebellum abcess

302
Q

pathogenesis of brain abcess in frontal and ethmoidal sinusitis(2)

A

direct spread

frontal lobe

303
Q

pathogenesis of brain abcess dental infection(2)

A

direct spread

frontal lobe

304
Q

pathogenesis of brain abcess in bacteriemia from other sites of infection and cyanotic heart disease(2)

A

hematogenous spread

mulptiple abcess along the distribution of middle cerebral artery(gray white matter junction)

305
Q

most common cause of headaches acute and reccurent in the pediatric population

A

migraine headache

306
Q

firs-line regimen in rx migraine(2)

A

acetaminophen

NSAID

307
Q

EEg in complex partial seizures(2)

A

normal
or
show brief discharges

308
Q

day dreaming episodes in 4 to 8 yo child , brief staring spells and decline in school performance and post ictal phase rx and dx(3)

A

ethosusuximide
valproate
dx absence seizures

309
Q

skin changes in aptient taking anabolic steroid(2)

A

acne

accelarated male pattern baldness

310
Q

why gynecomastia in patient taking anabolic steroid

A

testosterone is converted to estrogen and will drive breast enlargement

311
Q

psychiatric problem in anabolic steroid(2)

A

aggresssion

major mood disorder

312
Q

metabolic problem in anabolic steroid

A

low HDL

313
Q

cardiac problem in anabolic steroid

A

cardiac dysfunction in high dose of anabolic steroid use

314
Q

why erythrocytosis in anabolic steroid use

A

androgen stimulating erythropoiesis

315
Q

endocrine problem in patient taking anabolic steroid(3)

A

decreased testicular size
low sperm count
virilization

316
Q

quid of anabolic steroids(3)

A

testosterone
stanalozolol
nadrolone

317
Q

clue for neurofibromatosis type 1(7))

A 
cafe au lait spots
 axillary freckles 
lish nodules ot the iris 
bony lesion
neurofibroma
macrocephaly
short stature
318
Q

complication or assoiciated problem in neurofibromatosis(4)

A

tumor in CNS
tumor in peripheral nervous system
skin
viscera

319
Q

learning problem in neurofibromatosis

A

learning disability

320
Q

dx differetiel in delayed passage of meconium(2)

A

hirshprung

meconium ileus

321
Q

level of obstruction in hirsprung

A

rectosigmoid

322
Q

level of obstruction in meconium ileus

A

ileum

323
Q

consistency of meconium in hirsprung

A

normal

324
Q

consistency of meconium in meconium ileus

A

inspissated

325
Q

earliest manif of cystic fibrosis

A

ileus meconial

326
Q

associated condition in cystic fibrosis

A

rhinosinusitis

327
Q

clue for duodenal atresia(2)

A

bilious vomiting

double bubble sign

328
Q

congenital problem associated with down

A

duodenal atresia

329
Q

blood in stool of 2 yo boy

A

meckel

330
Q

rule of 2’s in Meckel(4)

A

2% prevalence
2/1 male to female ratio
2% asymptomatic at age 2
located 2 feet of ileoceacal valve

331
Q

dx of Meckel

A

technetium 99 m pertechnetate scan

332
Q

clinic of Meckel(4)

A

painless hematochezia
intussuception
intestinal obstruction
volvulus

333
Q

most common congenital small intestine anomaly

A

meckel’s diverticulum

334
Q

cause of Meckel(2)

A

incomplete obliteration of vitelline duct(omphalomesenteric duct)

335
Q

why bleeding in meckel

A

ectopic gastric tissue secretes HCL

336
Q

risk factor for NEC(4)

A

prematurite
very low birth weight
reduced mesenteric perfusion by hypotension and congenital heart disease
enteral feeding

337
Q

pathogenesis of NEC(2)

A

gut immaturity

expose to bacteria from enteral feeds

338
Q

measure to decrease NEC

A

breast feeding premature infant

339
Q

clue for NEC in abdominal xray(4)

A

visible air in bowel wall=pneumatosis intestinalis
portal venous air
normally you have inside the bowell
train track appearance or double line

340
Q

complication of NEC(5)

A 
necrosis and pneumoperitoneum
septic shock
intestinal strictures
short bowel syndrome
death
341
Q

patient with ulcerative colitis develops diarrhea irritability and poor concentration rash resembles to sunburn on distal arms and legs dx

A

niacin deficiency

342
Q

4 D in Niacin deficiency

A

Diarrhea
Dermatitis
Dementia
Death

343
Q

clue for intussuception (3)

A

periodic abdominal pain associated with drawing the legs up the abdomen
vomiting
intestinal obstruction
currant jelly stools

344
Q

most common cause of intestinal obstruction in kid

A

intussuception

345
Q

why currant jelly stools in intussuception(2)

A

ichemia of bowel wall

occult bleeding

346
Q

risk factor for intussuception

A

viral infection plays role in inflaming intestinal lymphatic tissue(payers patches) which can serve as a lead point for intussucetion

347
Q

ultrasound in intussuception

A

target sign

348
Q

rx of intussuception

A

reduction with air or water soluble enema

349
Q

role of lead point in intussuception

A

75% des cas no lead point identified

350
Q

25 % des cas cause of intussuception(2)

A

meckel

polyps and hematoma in case henock shonlein purpura

351
Q

esophageal coin in asymptomatic patient

A

observe for 24 hours after ingestion

352
Q

symptomatic esophageal coin or time of ingestion is unknown

A

prompt removal with flexible endoscopy

353
Q

most common foreign body ngested by children

A

coin

354
Q

when to suspect foreign body aspiration(3)

A

difficulty swallowing
feeding refusal
vomiting

355
Q

rx of NEC(3)

A

supportive care
IV antibiotics
surgery

356
Q

supportive care in NEC(2)

A

bowel rest

parenteral hydration /nutrition

357
Q

importanceof abdominal xray in the setting of intestinal occlusion

A

to rule out pneumoperitoneum

358
Q

next step after ruling out pneumoperitoneum in teh setting of intestinal occlusion

A

contrast enema to determine the level of obstruction

359
Q

contrast enema in meconium ileus

A

microcolon

360
Q

role hyperosmolar enema

A

can break up the inssipated meconium and remove the obstruction

361
Q

physiopatho in cystic fibrosis(2)

A

delta F508 mutation responsible chlorde transport and tenacious secretions in multiple organs

362
Q

when to perform sweat chloride testing(2)

A

age > 2 weeks
or
weight > 2 Kg

363
Q

timing in breatfeeding failure jaundice

A

first week of life

364
Q

timing in breast milk jaundice(2)

A

starts at 3-5 days

peaks at 2 weeks

365
Q

physiopatho of breastfeeding failure jaundice(3)

A

lactation failure results in
decreased bilirubib elimination
increased enterohepatic circulation

366
Q

physiopatho of breast milk jaundice

A

high levels of B-glucuronidase in breast milk deconjugate intestinal bilirubin and increase enterohepatic circulation

367
Q

clinical features in breastfeeding failure(2)

A

suboptimal breastfeeding

signs of dehydration

368
Q

clinical features in breastfeeding failure(2)

A

adequate breastfeeding

normal examination

369
Q

normal number of wet diaper in the first week of life

A

should equal the infants age in days

370
Q

sign of dehydration in infant during first week of life(3)

A

slightly decreased urine output
brick red urate crystals in diaper
lost of weight

371
Q

rx of breastfeeding failure(2)

A

breakfast 15 mn per side every 2-3 hours

supplementation with cow’s milk if the mother’s milk supply is inadequate

372
Q

squirt sign in hirshprung

A

positive

373
Q

squirt sign in meconium ileus

A

negative

374
Q

baby with failure to pass meconium within 48 hours in the setting of down syndrome

A

hirsprung

375
Q

presentation of hirshprung(3)

A

poor feeding
abdominal distension
absent air in the rectum

376
Q

associated disease with hirsprung

A

down

377
Q

associated disease with meconium ileus

A

cystic fibrosis

378
Q

differential dx in vomiting and regurgitation in infants(4)

A

physiologic GER
Milk protein allergy
GERD
pyloric stenosis

379
Q

clue physiologic gastroesophageal reflux(2)

A

happy spitter

asymptomatic

380
Q

clue milk protein allergy(3)

A

regurgitation
eczema
bloody stools

381
Q

GERD in baby(3)

A

failure to thrive
significant irritability
sandifer syndrome

382
Q

pyloric stenosis in baby(3)

A

projectile non bilious vomiting
olive shaped abdominal mass
dehydration and weight loss

383
Q

management of physiologic GER(2)

A

reassurance

positionning therapy

384
Q

management of milk protein allergy

A

elimination of dairy and soy protein from diet

385
Q

management of GERD(4)

A

thickened feeds
antacid therapy
esophageal PH probe monitoring
upper endoscopy

386
Q

management of pyloric stenosis(2)

A

abdominal US

pylomyotomy

387
Q

why post prandial regurgitation is frequent in infant(4)

A

shorter esophagus
decreased angle between the stomach and the esophagus
incomplete closure of the lower esophageal sphincter
greater time spent in the suoine position

388
Q

management of physiologic GER(2)

A

frequent small volume feeds

hold the infant upright 20-30 mn after feeds

389
Q

Mild dehydration in kid(2)

A

3 a 5 % volume loss

minimal or no clinical symptoms

390
Q

moderate dehydration (7)

A 
6 -9 % volume loss
decreased skin turgor
dry mucus membranes
tachycardia
irritability
a delayed capilary refill(2-3 seconds)
decreased urine output
391
Q

severe dehydration (10)

A 
10-15 % volume loss
cool clammy skin
delated capillary refill> 3 seconds
cracked lips
dry mucous membrane
sunken eyes
sunken fontanelle
tachycardia
lethargy
minimal or no urine output
392
Q

rx of moderate to severe dehydration

A

IV bolus of isotonic fluid

393
Q

indication for renal and bladder US(4)

A

infants and children age < 24 months with a first febrile UTI
recurrent febrile uti in children of any age
children who do not respond to appropriate antibio rx
UTI in a child of any age with a family history of renal or urologic disease HTA and poor growth

394
Q

children < 24 months with first febrile UTI(2)

A

rx for 7-14 jours antibio

renal and bladder US for structurakl abnormality that could predispose to UTI

395
Q

first cause of vulvovaginitis in prepubertal children

A

vaginal foreign bodies

396
Q

most common vaginal foreign body in kid

A

toilet paper

397
Q

removing of toilet paper in vaginal(2)

A

calcium alginate swab
or
irrigation with warmed fluid

398
Q

quid of monosymptomatic enuresis

A

urinary incontinence occuring at least twice a week after age of 5 without any medical condition

399
Q

first line rx of enuresis

A

enuresis alarm

400
Q

second line regimen in enuresis

A

medication

401
Q

first line medication used in enuresis

A

desmopressin

402
Q

second line medication used in enuresis

A

TCA

403
Q

most efficient long term rx of enuresis

A

enuresis alrm

404
Q

inconvenient with desmopressin

A

high risk of relapse

405
Q

normal age for bedwetting

A

before 5

406
Q

mastery of the nightime continence in kid

A

can take months to years

407
Q

gender in nightime continence

A

boys generally achieves this milestone later than girls

408
Q

most common urologic problem in children

A

vesicoureteral reflux

409
Q

quid of vesicoureteral reflux

A

retrograde flow of urine from the bladder up into the ureter and renal pelvis

410
Q

long term complication of vesicoureteral reflux

A

renal scarring

411
Q

best test to Dx vesiculo ureteral reflux

A

voiding cystourethrogram

412
Q

first UTI next step

A

renal ultrasound

413
Q

reccurent UTI next step

A

voiding cystouretrogram

414
Q

acute pyelonephritis next step(2)

A

bood and urine culture

hospitalizatin and empiric therapy with IV antibiotics

415
Q

patient with fever and rhinorrhea ,an incidental urine shows 2 + protein

A

transient proteiunuria

416
Q

what to do in transient proteinuria

A

repeat urine dipstick testing on 2 separate occasions to rule out persistant proteinuria

417
Q

most common cause of isolated proteinuria

A

transient proteinuria

418
Q

transient proteinuria cause(5)

A 
fever
exercice
seizure
stress
volume depletion
419
Q

causes of secondary enuresis(5)

A 
psychological stress
urinary tract
diabetes mellitus
diabetes insipidus
obstructive sleep apnea
420
Q

associated symptom of secondary enuresis with psychological stress(2)

A

behavior regression

mood lability

421
Q

secondary enuresis in urinary tract infection(4)

A

dysuria
hesitancy
urgency
abdominal pain

422
Q

diabetes mellitus (6)

A 
polyuria
polydipsia
polyphagia
weight loss
lethargy
candidiasis
423
Q

diabete insipidus in secondary enuresis(2)

A

polyuria

polydipsia

424
Q

assoicated symptom in obstructive sleep apnea(4)

A

snoring
dry mouth
fatigue hyperactivity
irritability

425
Q

syndrome nephrotic in kid eleven YO with postive HBsag HBe ag dx

A

membranous glomerulonephritis

426
Q

what marker will be positive in membranous glomerulonephritis induced by infectious viral hepatitis B

A

HBe ag

427
Q

Potter sequence

A

urinary tract anomaly—>anuria and oligoanuria in utero——> oligohydramnios

428
Q

three consequences of oligohydramnios in potter (3)

A

pulmonary hypoplasia
flat facies
limb deformities

429
Q

prenal US showing bladder distension ,bilateral hydronephrosis and bilateral hydroureters Dx?

A

posterior uretral valves

430
Q

why respiratory distress in oligoamnios

A

pulmonary hypoplasia

431
Q

most common cause of secondary HTA in children

A

fibromuscular dysplasia

432
Q

clue fibormuscular dysplasia(2)

A

hum or bruit in the costovertebral angle due to well developped collaterals
HTA

433
Q

angiography in fibromuscular dysplasia

A

strings and beds pattern of renal artery

434
Q

most common artery involved in fibromuscular dysplasia

A

right one

435
Q

patient with severe pneumonia with absolute level of CD3 normal and low CD19 dx(2)

A

x linked agammaglobulinemia
or
bruton’s agammaglobulinemia

436
Q

rx in bruton’s

A

regular infusion of IV immunoglobulin

437
Q

quid of CD 3

A

lymphocytes T

438
Q

quid of CD 19

A

Lymphocytes B

439
Q

lymho low in bruton’s

A

lympho B

440
Q

indication of endotracheal intubation and mechanical ventilation in asthma(6)

A 
asthma unresponsive to medications who have
Fatigue
altered mental status
Co2 retention
worsening hypoxemia
poor air movement on examination
441
Q

first line rx of anaphylaxis

A

IV epinephrine

442
Q

age for brutons

A

6-18 mois

443
Q

physical exam in brutons

A

absent tonsils and other palpable lymphoid tissue

444
Q

chest xray in infant les than 3

A

tonsils will be seen

445
Q

tonsil on xray(2)

A

sail sign

triangular shape

446
Q

role of thymus

A

production of lymphocyte and maturation

447
Q

what to do in a patient with history of anaphylaxis

A

patient should carry self injectable epinephrine

448
Q

next step in hymenoptera sting triggers

A

refferal to an allergist for venom immunotherapy

449
Q

patient with neck swelling and irritability ,he keeps his head rotated slightly to the right side dx

A

acquired torticollis

450
Q

next step in acquired torticollis

A

xray of the neck

451
Q

most common cause of acquired torticollis(5)

A 
upper respiratory infections
minor trauma
cervical lymphadenitis
retropharyngeal abcess
atlantoaxial subluxation
452
Q

why neck xray in acquired torticollis(3)

A

to rule out cervical spine fracture
dislocation
which requires extreme caution

453
Q

prematured infant with respiratory distress dx

A

hyaline membrane disease

454
Q

risk factor for hyaline membrane disease(5)

A 
prematurity
maternal diabetes
c section without labor
perinatal asphyxia
sexe male
455
Q

how maternal diabetes increases the risk of respiratory distress syndrome or hyaline membrane disease(2)

A

delays maturation of surfactant

hyperinsulinism antagonizes the action of cortisol and the lung maturation process

456
Q

how do you differentiate artralgia in jones criteria

A

if you choose arthritis in major criteria you can’t choose arthralgia anymore

457
Q

clue for lyme disease

A

trip in northeastern and upper midwestern united states

458
Q

time to have early localised Lyme

A

days to 1 month after the bite

459
Q

clue for early localised Lyme disease(2)

A

erythema migrans

myalgias and arthralgias

460
Q

time to have early disseminated lyme

A

weeks to months

461
Q

carditis in early disseminated lyme(2)

A

AV block

cardiomyopathy

462
Q

neurologic problem in early disseminated lyme(3)

A

unilateral or bilateral cranial nerve defects
meningitis
encephalitis

463
Q

cranial nerve most commonly involved in Lyme disease

A

7

464
Q

muscular problem in early disseminated lyme

A

migratory arthralgias

465
Q

skin problem in early disseminated lyme

A

multiple erythema migrans

466
Q

eye problem in early disseminated lyme

A

conjunctivitis

467
Q

most common finding in early disseminated Lyme

A

migratory arthralgia dans 60% des cas non traites

468
Q

time for late or chronic manif of Lyme disease

A

months to years after the bite

469
Q

problem in late or chronic manif of Lyme disease(3)

A

muscular =arthritis dans 60% des cas non traites
encephalomyelitis
peripheral neuropathy

470
Q

adolescent male athlete with knee pain

A

osgood schlatter disease

471
Q

quid of osgood schlatter disease

A

traction apophysitis of the tibial tubercle

472
Q

xray finding in osgood schlatter(3)

A

soft tissue swelling
lifting of tubercle from the shaft
irregularity and fragmentation of the tubercle

473
Q

rx osgood schlatter(3)

A

activity restriction
strectching exercice
NSAIDS

474
Q

synovial fluid in lyme disease

A

average leucocyte count 25000

475
Q

patient rx for sore throat fever difficulty swallowing ,symptom subsides rapidly with PNC.ten days later the patient presents with fever ,skin rash fleeting joint pain in lower extremities dx

A

serum sickness like reaction

476
Q

quid of serum sickness like reaction

A

hypersensitivity reaction occurring one to 2 weeks after administration of certain drugs

477
Q

drugs involved in serum sickness like reaction (4)

A

PNC
amox
TS
cefaclor

478
Q

physiopatho of serum sickness like reaction

A

immune complex mediated hypersensitivity reaction to non human proteins

479
Q

age for kawasaki

A

less than 5 years

480
Q

conjunctivitis in kawasaki

A

spares limbus

481
Q

oral mucosae changes in kawasaki(3)

A

erythema
fissure lips
strawberry tongue

482
Q

extremity changes in kawasaki(3)

A

erythema
edema
desquamation of the hands and feet

483
Q

quid of kawasaki

A

vasculitis

484
Q

lab in kawasaky(4)

A

elevated CRP and ESR
leucocytosis with neutrophilia (viral= lymphocytosis)
reactve thrombocytosis
sterile pyuria in uninalysis

485
Q

rx of kawasaki(2)

A

aspirin

plus IV immunoglobulin

486
Q

complications of kawasaki(2)

A

coronary artery aneurisms

myocardial infarction and ischemia

487
Q

consequense of coronary artery aneurism

A

thrombotic occlusion —> myocardial ischemia and death

488
Q

echocardiography in kawasaki(2)

A

at the time of Dx

repeat 6-8 weeks later

489
Q

baby born at 33 semaines de gestation how will you deal with immunization

A

immunization should be given according to chronologic age

490
Q

what is the rule to administer hep B vaccine

A

weight should be > ou egal a 2 kg

491
Q

region with high level of hepatitis b infection(2)

A

asia
and
africa

492
Q

cancer preventable by vaccination

A

hep B

493
Q

congenital manif of german measles(4)

A

sensorineural hearing loss
cardiac anomalies
cataracts
glaucoma

494
Q

cardiac problem in rubella(german measles)

A

PDA

495
Q

children with german measles(4)

A

low grade fever
conjunctivitis coryza and cervical lymphadenopathy
cephalocaudal spread of blanching erythematous maculopapular rash

496
Q

german measles in adults (5)

A

low grade fever
conjunctivitis coryza and cervical lymphadenopathy
cephalocaudal spread of blanching erythematous maculopapular rash
arthritis

497
Q

prevention of german measles in baby

A

vaccination (live atenuated vaccine )

498
Q

rubella in first trimester

A

teratogenic

499
Q

screening test in infant 0-5 ans recommneded by the USPSTF(united preventive services task force)(3)

A

strabismus
amblyopia
refractive errors( bref vision screening)

500
Q

the most common reservoir for rabies in the US(2)

A

racoon

bats

501
Q

clue for encephalitis rabies(2)

A

hydrophobie

aerophobie

502
Q

post exposure prophylaxis of rabies(2)

A

rabies immune globulin
plus
rabies vaccine

503
Q

quid of encephalitic rabies(5)

A

hydrophobie
aerophobie
pharyngeal spasm
agitation spastic paralysis

504
Q

quid of paralytic rabies

A

ascending flaccid paralysis

505
Q

complication of rabies(3)

A

coma
respiratory failure
death within weeks

506
Q

transmission of rabies

A

exposure to saliva

507
Q

clue for acute otitis media(2)

A

middle ear effusion
plus
acute eardrum inflammation

508
Q

quid of acute eardrum inflammation(2)

A

bulging eardrum

fever

509
Q

clue for otitis media with effusion(2)

A

middle ear effusion
without
acute inflammation

510
Q

clue for bullous myringitis

A

serous liquid filled blisters on the tympannic membrane

511
Q

clue for cerumen impaction(2)

A

liquid or wax in auditory cana

no visualisation of eardrum

512
Q

clue for hemotympanum

A

purple or red eardrum plus ou moins bulging

513
Q

clue for otitis externa(3)

A

pain with tragal traction
erythematous and swollen external auditory canal
+/- otorhea

514
Q

dx in otalgia(6)

A 
acute otitis media
otitis media with effusion
bullous myringitis
cerumen impaction
hemotympanum
otitis externa
515
Q

cardinal clue for otitis media(2)

A

bulging of the tympannic membrane

which reflects middle ear effusion

516
Q

peak for otits media(2)

A

6-18 mois in daycare

around 5 when school initiation

517
Q

next step in any children with trouble in school to understand or behavioral disorder in childhood dx

A

undetected hearing impairement

518
Q

first cause of hearing impairment

A

conductive hearing loss due to repeated ear infection

519
Q

when to suspect hearing inpairment(3)

A

poor language development
social skills
inattentiveness

520
Q

patient with sore throat dysphagia odynophagia pharyngeal and tonsillar erythema dx(2)

A

viral pharyngitis

strep pharyngitis

521
Q

when to think about strep pharyngitis(5)

A 
presence of exsudates
edema
palatal petechiea
tender anterior cervical lymphadenopathy
absence of viral symptoms
522
Q

when to think of viral pharyngitis

A

presence of viral symptoms

523
Q

quid of viral symptoms(4)

A

cough
rhinorrhea
conjonctivitis
oral ulcers

524
Q

what to do if you suspect strep paharyngitis

A

rapid antigen test

525
Q

what to do if you suspect strep paharyngitis with neagtive rapid antigen test

A

obtain throat culture

526
Q

left sided ear discherge resistant to antibiotics EP reveals granulation and some skin debris

A

cholesteatoma

527
Q

new onset of hearing loss or chronic ear drainage despite antibiotic therapy dx

A

cholesteatoma

528
Q

otoscopy in cholesteatoma(3)

A

granulation tissue
skin debris
retraction pockets of the tympannic membrane

529
Q

cause of cholesteatoma(2)

A

congenital

ssecondary to chronic middle ear disease

530
Q

criteria to dx attention deficit hyperactivity disorder

A

symptoms present before age of 12

in at least 2 settings(schoole home and other)

531
Q

what is so improtant to make the dx of attention deficit hyperactivity disorder

A

teachers evaluation

532
Q

clue for night terrors(5)

A 
fear
crying
screaming
decreased level of consciuosness
amnesia of the event
533
Q

when does night terror occurs

A

during non REM sleep

534
Q

triggers for night terrors(4)

A

acute stress
sleep deprivation
illness
medication affecting central nervous system

535
Q

peak of incidence of night terrors

A

2 a 12 ans

536
Q

patient 11 yo with continuous thought of stabbing his mother dx

A

Obssessive compulsive disorder

537
Q

rx of obssessive compulsive disorder (2)

A

CBT
plus
high dose of selective serotonin inhibitor

538
Q

rx of obssesive compulsive disorder with no response to CBT and serotonin reuptake inhibitor(2)

A

clomipramine
or
increase dose of antipsychotic rx

539
Q

severe refractory obsessive compulsive disorder

A

deep brain stimulation

540
Q

which of the following behaviors should be concerning in a young children 2-5 years(extensive sexual knowledge)(5)

A 
simulating forplay
simulating intercourse
preoccupation of masturbation
touching other genitals
excessive talk about swxuality
541
Q

what sexual extensive knowledge can teach us in kid

A

possibility of sexual abuse

542
Q

quid of constitutionnal growth delay(3)

A

delayed growth spurt
delayed puberty
delayed bone age

543
Q

14 yo boy with feeling of a mass under his right nipple.Physical exam is normal dx

A

gynecomastia

544
Q

physiologic cause of gynecomastia(3)

A

preburte
can be unilateral or bilateral
you have firnm subareolar nodules sometimes tender with the touch

545
Q

rx of pubertal gynecomastia (2)

A

nothing

resolve within few months to years

546
Q

percentage of adolescent with gynecosmatia in prepuberte

A

2/3

547
Q

pathological causes of gynecomastia(2)

A

increased estrogen production or peripheral conversion

androgen deficiency

548
Q

pathology with increased estrogen production or peripheral conversion causing gynecomastia(9)

A 
testicular adrenal or HCG secreting tumors
cirrhosis
malnutrition
thyrotoxicosis
congenital excessive aromatase activity
androgen use
medications
herbal products
illicit drugs
549
Q

medication induced gynecomastia by increasing estrogen production or peripheral conversion(2)

A

spironolactone

cimetidine

550
Q

illicit drugs induced gynecomastia by increasing estrogen production or peripheral conversion(4)

A

alcohol
amphetamines
heroin
marijuana

551
Q

herbal products induced gynecomastia by increasing estrogen production or peripheral conversion(2)

A

tea tree oil

lavender oil

552
Q

androgen deficiency causing gynecomastia(3)

A

primary or secondary male hypogonadism
hyperprolactinemia
renal failure

553
Q

cause of primary or secondary male hypogonadism(2)

A

klinefelter syndrome

testicular damage

554
Q

4 yo boy comes with nausea vomiting and abdominal pain.parents found pills scattered on the kitchen floor next to an open unlabeled bottle.boys develops hematemesis abdominal xtay reveals several small opacities in teh stomach and duodenum dx

A

iron poisonning

555
Q

acid base problem in iron poisonning

A

metabolic acidosis with anion gap

556
Q

complication of iron poisonning within 2 days

A

hepatic necrosis

557
Q

complication of iron poisonning within 2-8 weeks

A

pyloric stenosis

558
Q

rx of iron poisonning(3)

A

whole bowel irrigation
deferoxamine
supportive care for circulation airway and breathing

559
Q

risk for factor for lead poisonning(5)

A 
home built before 1978 under renovation with peeling paint
Pica
sibling with lead poisonning
low socio economic status
immigrant  or international adoptee
560
Q

screening for lead poisonning

A

capillary blood specimens

561
Q

confirmatory test for lead poisonning when lead level > ou egal a 5 microgram/dl

A

vcenous lead

562
Q

venous lead 2-44 Micro/dl (mild)next step(2)

A

nothing

repeat in < 1 month

563
Q

venous lead 45-69Micro/dl(moderate) next step

A

use meso 2,3 dimercaptosuccinic acid(DMSA)

564
Q

venous lead > ou egal a 70 Micro/dl(moderate) next step(2)

A

use meso 2,3 dimercaptosuccinic acid(DMSA)
plus
calcium dodium edetate(EDTA)

565
Q

action of iron pills

A

disruption of basic cell process

566
Q

action of deferoxamine(2)

A

binds ferric iron

allowing urinary excretion

567
Q

cause of hypervolemic hypernatremia

A

renal losses

extrarenal looses

568
Q

renal losses in hypervolemic hypernatremia(2)

A

diuretic use

glycosuria

569
Q

extrarenal losses cause of hypovolemic hypernatremia(2)

A

GI upset

excessive sweating

570
Q

rx of hypovolemic hypernatremia

A

nacl 0,9 %

571
Q

cause of hypervolemic hypernatremia(2)

A 
exogenous sodium intake
mineralocorticoid excess(hyperaldosteronism)
572
Q

patient with vomiting caused by pyloric stenosis metabolic disturbance(5)

A 
Hco3increased
cl decreased
K+ decreased
Paco2 increased 
PH increased
573
Q

metabolic problem in pyloric stenosis induced vomiting

A

hypochloremic hypokaliemic metabolic alkalosis

574
Q

complication of supracondylar fracture in kid

A

compartment syndrome

575
Q

clue for compartment syndrome

A

severe pain
pallor
paresthesia

576
Q

late finding in compartment syndrome(2)

A

pulselessnes

paralysis

Step 2 CK (primary set) (22 decks)

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