peds

Question 1

bacterial meningitis peds:
0-2 mo
3mo - 2 years
2yrs - 18 years

Answer 1

0-2 mo: GBS, Ecoli, Listeria
3mo - 2 years: Strep pneumo
2yrs - 18 years: Neisseria meningitidis

dx: lumbar puncture, blood culture, CSF analysis

tx: initial: empiric: vanco + cefotax/ceftriax — add IV dexamethasone for HiB

Question 2

coryza, cough, conjuctivitis, fever
morbilliform rash body and palms – macular rash start at back of neck and ears, then face, the downards
tiny grayish white dots on buccal mucosa

Answer 2

measles - rubeola
paramyxovirus
10-12 days
Koplik spots
tx: supportive, vitamin A

Question 3

delayed immunizations, low grade fever, pinpoint rash, rose spots on soft palate, post-occipital retro-auricular lymphadenopathy

Answer 3

Rubella - 3 day measles
14-21 days
Forschemier spots
polyarthritis
rash on face spread downard

Question 4

High fever for 3-4 days, fever goes away and gets a maculopapular rose colored rash starting on trunk spreads outward

Answer 4

Roseola – exanthem subitum – HHV-6
5-15 days
febrile seizure

Question 5

swelling in face masseter muscle, fever for last 4 days, not immunized,

Answer 5

MUMPS – paramyxovirus
unilateral/bilateral salivary gland swelling
orchitis oophoritis

Question 6

rhinorhea, nasal congestion, oodynophagia, b/l cervical lymphadenopathy, muffled voice, tonsils red with exudates

Answer 6

retropharyngeal abscess

Question 7

neonatal conjuctivitis

Answer 7

ppx: topical erythromycin for all babies

Question 8

sore throat and fever, month later gets chorea, prolonged P-R interval with diffuse ST evelation,

Answer 8

Strep Pyogenes – acute rheumatic fever

Question 9

acute pharyngitis in kids – sore throat fever exudates

next step?

Answer 9

1) Rapid strep antigen
2) Throat culture

Question 10

3yo with acute unilateral neck swelling

Answer 10

clindamycin

Question 11

5 year old, fever, oropharynx has 1 mm vesicles onf anterior palate, gray shallow ulcers on soft palate and uvula

Answer 11

herpangina coxsackie

Question 12

congential infections

Answer 12

Question 13

under 2 years old and has expiratory wheezing (asthma symtpoms) with rhinorhea

Answer 13

bronchiolitis RSV supportive tx

Question 14

puncture wound 1-2 months ago, now has encephalitis like symptoms; numbness over wound site

Answer 14

Question 15

high pitched noise during inspiration 2 yo cough

Answer 15

Question 16

congneital infection with periventricular calcifications microcephaly
mode of transmission

Answer 16

CMV
bodily fluids urine saliva

Question 17

bilious emesis with dilated loops and increased rectal tone
next step?

Answer 17

contrast enema

Question 18

abdominal pain, RUQ palpable mass, jaundice (increased bilirubin)
u/s: extrahepatic cystic mass and normal gallbladder

Answer 18

biliary cyst
increased risk of cholangiocarcinoma

Question 19

2-8 weeks old: jaundice, acholic stools, hepatomegaly
direct hyperbilirubinemia
next step?

Answer 19

liver biopsy
intraoperative cholangiography
tx:
hepatoportoenterostomy kasai

Question 20

failure to pass meconium, normal rectal tone, no stool in rectal vault, dilated loops of small bowel with no rectal air and no free air

Answer 20

intestinal obstruction by inspissated stool
meconium ileus

Question 21

patient with enteral feeds, premature and LBW at 3 weeks old, has tense abdomen and distended hypoactive bowel sounds. labs: leukocytosis and metabolic acidosis

Answer 21

abdominal xray with air in the bowel wall and portal veins

Question 22

watery stools that turn bloody within 3 days

Answer 22

Question 23

baby less than 1 week old, has elevated indirect bilirubin, after 6 days is audibly swallowing more breast milk

Answer 23

lactation failure jaundice

Question 24

necrotizing enterocolitis managmenet

Answer 24

stop enteral feeds
bowel rest
NG decompression
blood cultures and antibiotics

Question 25

infant feeding 0-6 mo: at 1 yr:

Answer 25

supplement with iron and vitamin D in exclusively breast fed

Question 26

bilious emesis --> x ray normal, next step?

Answer 26

Upper GI series

Question 27

cerebral edema, elevated LFT's and **hyperammoniemia** in child

Answer 27

Reyes syndrome

Question 28

loose stools with blood and/or mucus

Answer 28

food induced protein enterocolitis

Question 29

Hirschprungs management

Answer 29

Question 30

Answer 30

Question 31

painful vesicular rash in the setting of atopic dermatitis (eczema)

Answer 31

eczema herpeticum tx: systemic acyclovir

Question 32

bright red sharply defined rash that extends 2. cm circumferentially around the anus

Answer 32

Question 33

Answer 33

Question 34

dx bug tx

Answer 34

bullous

Question 35

high BP in upper extremities vs lower extremities with pulmonary edema and elevated lactic acidosis, cardiomegaly

Answer 35

coarctation of aorta tx: systemic blood flow via right to left ductal shunting (keep PDA open) will see increased left ventricular afterload d/t aortic art narrowing increased pressure

Question 36

cyanosis within first 24 hours of life, tachypnea, single S2 | narrow mediastinum

Answer 36

transposition of great vessels

Question 37

Di george

Answer 37

Question 38

routine newborn care

Answer 38

pulse oximetry

Question 39

single S2, crescendo decrescendo systolic murmur WITH tet spell hypercyanotic hypoxic, squats gets better

Answer 39

increases systemic vascular resistance tetralogy of fallot RVOT obstruction ( pulmonary steonsis or atresia) -- why you only hear single S2 pulmonic part is absent Right ventricualr hypertrophy overriding aorta VSD

Question 40

decresendo diastolic murmur at LSB that increases with inspiration

Answer 40

Pulmonary regurgitation

Question 41

turners

Answer 41

aoritic dissection

Question 42

biphasic stridor that improves with next extension

Answer 42

vascular ring

Question 43

neonate born premature, cxr diffuse ground glass appearance, decreased lung volumes, pulse ox is still low even after positive airway presure given | due to?

Answer 43

Question 44

little kid with seizures and hypo-pigmented macules on body, brain mri: subendymal nodules

Answer 44

Question 45

premature baby with LBW, head size increased

Answer 45

intraventricular hemorrhage

Question 46

11 boy with CF, recurrent sinusitis and lung infections, labs: eosinophilia and igE elevated

Answer 46

Question 47

18mo old with recurrent sinusitis pnemonia, heart maximal impulse on Right side of chest

Answer 47

Question 48

2 yo barking like a dog, inspiratory stridor at rest next step

Answer 48

Question 49

tachypnea shortly after birth resolves by day 2 of life

Answer 49

Question 50

prematurity severe resp disterss and cyanosis

Answer 50

Question 51

tachypnea and severe cyanosis

Answer 51