Peds

Question 1

A term infant experiences a difficult delivery with Apgars 7 at one min and 9 at 5 min. On PE a fractured clavicle is found. The infant is >95% for weight and 65th for length and head. What maternal condition likely contributed to this fracture?

Preeclampsia
Gestational diabetes
Maternal smoking
Insufficient prenatal nutrition
Placental insufficiency

Answer 1

Gestational diabetes. the rest would cause small babies

Question 2

A 2500 g infant is born at 35 weeks gestation. What is the most appropriate classification for this child’s birth?

A. Premature birth
B. LGA infant
C. SGA infant
D. Low birth weight infant
E. Very low weight birth infant

Answer 2

premature. LBW is <2500

Question 3

On PE, a dysmorphic infant is found to have two fused sutures. What is the best management?

No intervention
Emergent repair at birth
Surgical repair at 3-6 months
Varying the infant’s position at rest hourly
Surgical repair after 2 years of age

Answer 3

Surgical repair at 3-6 months

Question 4

At a 2 week newborn visit, an infant appears jaundiced. Labs reveal a total bilirubin of 13 and a direct bilirubin of 8 (high). Which of the following is the most likely diagnosis?
1. breast feeding jaundice
2. ABO incompatibility
3. Gilbert’s syndrome
4. Breast milk jaundice
5. biliary atresia – needs surgery

Answer 4

5. biliary atresia – needs surgery

Question 5

ibuprofen dose for kids 6 mo - 12 y/o and max

Answer 5

Ibuprofen 5-10 mg/kg/dose q6-8 hours prn . MAX 4 doses/day

Question 6

acetaminophen dose for kids and max

Answer 6

Acetaminophen 10-15 mg/kg/dose q 4-6 hours prn
MAX 5 doses in 24 hrs

Question 7

An 11 yr old girl has had no weight gain in the last 2 years. She has fallen from the 50% to the 30% in length. She reports episodic colicky abdominal pain, and intermittent painful bloody diarrhea over the last two years. PE reveals a thin, ill appearing 11 yr in NAD with decreased subcutaneous fat, HEENT unremarkable, Lungs CTA B, CV RRR s mrg, Abd, tenderness, fullness in RLQ. Which condition is most likely?
CGD
Cushing’s syndrome
UC

Answer 7

UC

Question 8

A 14 yr old boy is brought into your office b/c he is the shortest kid on his soccer team. He was born at the 90th percentile but since 2 years of age has tracked on the 5th percentile. His dad remarks that he was short as a child. You note that he is about 5’10” now. Sexual maturation of the boy is 2. What is the most likely cause of his short stature?

Answer 8

Constitutional growth delay

Question 9

A 36-month-old boy is being evaluated at your office. Parents are concerned because he is short and has evidence of developmental delay with hypotonia. He was born at term with a birth weight of 3250 grams. He has a history of poor suck that required therapy. Recent fluorescence in situ hybridization was positive for a deletion on chromosome 15. This patient is at a higher risk of suffering from which of the following conditions?

A Alzheimer disease
B Congenital heart disease
C Hypocalcemic seizures
D Obesity

Answer 9

obesity

Question 10

An 18-month-old girl presents to the emergency department with respiratory distress. She was well until yesterday, when she developed a mild cough and nasal congestion. Today, her cough became increasingly harsh, and her voice became raspy. On observation in her parent’s arms, she is tachypneic, has moderate subcostal retractions, and makes a monophonic inspiratory noise with each breath. What medication should be immediately administered?

ANebulized albuterol
BNebulized racemic epinephrine
COral dexamethasone
DOral oseltamivir
EOral vancomycin and ceftriaxone

Answer 10

epi

Question 11

A 3-year-old girl is brought in for her regular well-child exam and a cardiac murmur is auscultated on physical exam. The short, systolic murmur is grade II in intensity, softer in intensity when she is sitting, louder in intensity when supine, and has a “musical” quality. What is the most likely diagnosis?

A Atrial septal defect
B Innocent murmur
C Pericarditis
D Ventricular septal defect

Answer 11

innocent

Question 12

An 11-month-old girl presents to the pediatrician with her mother, who states that the child has not spoken any words since birth. The mother is concerned because the girl has even stopped making the noises she used to make. She does not seem to respond to voices or other noises in the room. On physical exam the external auditory canal appears patent. The tympanic membrane can be visualized and no abnormalities are noted. Which of the following would be appropriate to include in the physical exam at this time?

AOphthalmology exam
BRinne test
CSpeech audiometry
DWeber test

Answer 12

Ophthalmology exam

Question 13

4 year old has widely split and fixed S2. dx?

Answer 13

ASD

Question 14

most serious complication of kawasaki dz

Answer 14

coronary artery aneurysms

Question 15

In infants, the eyes should move in parallel without deviation by the age of
A) 2 weeks.
B) 3 months.
C) 6 months.
D) 1 year.

Answer 15

6 mo

Question 16

An 8 year-old boy is brought to a health care provider complaining of dyspnea and fatigue. On physical examination, a continuous machinery murmur is heard best in the second left intercostal space and is widely transmitted over the precordium. The most likely diagnosis is

Answer 16

PDA

Question 17

An infants birth weight should double by ____ of age and triple by ____of age.

Answer 17

4-5 mo
1 yr

Question 18

A newborn infant demonstrates hypoplasia of the distal phalanges, small nails, a flat nasal bridge and a cleft palate. Which of the following agents is likely responsible for these classic findings?

warfarin

phenytoin

alcohol

thalidomide

a retinoid

Answer 18

warfarin

Fetal warfarin syndrome (Dysmorphism due to warfarin, Warfarin embryopathy ) is a condition associated with the administration of Warfarin during pregnancy. Associated conditions include hypoplasia of nasal bridge, laryngomalacia, pectus carinatum, congenital heart defects, ventriculomegaly, agenesis of the corpus callosum, stippled epiphyses, telebrachydactyly, and growth retardation. It is also known as “DiSala syndrome”. The symptoms are as follows:

Nasal hypoplasia
Depressed nasal bridge
Deep groove between the nostril and nasal tip
Stippling of uncalcified epiphyses during the first year
Mild hypoplasia of nails
Shortened fingers
Low birth weight
Significant mental retardation
Seizures
Reduced muscle tone
Widely spaced nipples
Deafness
Feeding difficulty
Failure to thrive

Question 19

A woman brings her 3 month-old son to the clinic. Upon examination, it is noted he has a round face, a large protruding tongue, dry skin, an umbilical hernia, and his weight gain is below average. He appears apathetic and the mother says the infant is usually constipated. Which of the following is the most likely diagnosis?

hyperparathyroidism

nephrotic syndrome

phenylketonuria

hypothyroidism

Answer 19

Congential hypothyroidism presents gradually, and at 3-6 months findings include poor appetite and feeding, sluggishness, constipation, enlarged abdomen and umbilical hernia, enlarged tongue, and the child does not meet developmental milestones.