Peds

Question 1

2 month milestone

Answer 1

social smile, lifts head 45d, coos

Question 2

laughs, lifts head to 90d, eyes follow past midline. Age?

Answer 2

4 months

Question 3

rolls over, sits without support, grasps-attempts to feed self. Age?

Answer 3

6 month. Also has stranger anxiety

Question 4

9 month milestone

Answer 4

separation anxiety, crawls, pulls to stand, first words

Question 5

walks with help, pincer grasp, 5-10 word vocabulary. Age?

Answer 5

12 months- 2 block tower

Question 6

18 month milestone

Answer 6

parallel play, walks well, uses a cup/spoon, tower of four blocks, 2 word combination, 10-50 word vocab

Question 7

dresses self, runs, 50-75word vocab, 3 word sentences

Answer 7

2 year- also 6 tower block

Question 8

3 year milestones

Answer 8

magical thinking, makes tower of nine blocks, draws circle

Question 9

plays with others, hops on 1 foot, 250 word vocab, 4 word sentence

Answer 9

4 year milestone- draws a line image- draws triangle

Question 10

able to distinguish fantasy from reality, skips, fluent speech

Answer 10

6 year old- draws a person

Question 11

Beckwith-Wiedemann syndrome

Answer 11

Macroglossia, anterior abdominal defects, hepatomegaly, pitting of external ear. Concern for MR and Wilms tumor

Question 12

8yr male. Unsteady gait, B/L LE weakness, dec vibratory and position sense, absent Achilles, hearing/vision problems, diabetes. What are the cardiac concerns?

Answer 12

Arrhythmia or hypertrophic cardiomyopathy. Freidrich Ataxia: Auto recessive with trinucleotide repeats. Neuro involves spinocerebellar, corticospinal and posterior column

Question 13

5yr male. Single lytic lesion on Xray. Painful

Answer 13

Langerhan Histiocytosis X: eosinophilic type

Question 14

Differentials for lytic bone lesions

Answer 14

Infectious: Brodie abscess-osteomyelitis
Endocrine: hyperparathyroidism-osteitis fibrosa cystica
Neoplastic: Ewing, Langerhan, met

Question 15

3 year old presents with oral white plaques that can easily be scraped off for the third time. No other infections. A decrease in what cellular component causes that reaction.

Answer 15

Decrease in IgG. Frequently associated with adrenal pathology.
txt: antifungal- fluconazole

Question 16

10 year old with frequent strep pneumo, Hib and staph aureus. Increased IgM in serum. Deficiency mechanism

Answer 16

HyperIgM: deficiency in CD40 ligand. Low IgG and IgA. Low Hgb, Hct, platelets
txt: IvIG, prophylactic antibiotic, bone marrow transplant
encapsulated organisms need protein for immunity

Question 17

9 year old with recurrent strep pneumo infections, eczema.

Definitive treatment?

Answer 17

txt: splenectomy, Abx prophylaxis, IVIG, bone marrow transplant
Wiskott-Aldrich: recurrent infections with encapulated organisms, eczema and thrombocytopenia. decreased IgM

Question 18

4 year old with abnormal gait, recurrent pneumonia with darkened skin lesions.
Method of inheritance?

Answer 18

Autosomal recessive.
Ataxia-telangiectasia- cerebellar dysfunction, telangiectasia, increased risk of cancer, impaired WBC and IgA development
txt; IVIG prophylaxis and abx

Question 19

4 year old with recurrent MRSA infection with the recent one located in the perirectal abscess. Deficiency?

Answer 19

Neutrophils cannot digest engulfed bacteria.
Chronic Granulomatous Disease- recurrent S.Aureus and fungal infections.
txt: prophylactic antibiotics, gamma interferon, corticosteriods, bone marrow transplant

Question 20

5 year with multiple episodes MRSA infections and pneumonia. He also has more than 32 teeth. CBC results?

Answer 20

increased eosinophils and IgE.
HyperIgE - defect in neutrophil chemotaxis, T-cell signalling and overproduction of IgE
txt: prophylactic abx. skin hydration and emollient use

Question 21

6 year old with albinism and recurrent MRSA infections who presents with numbness and tingling in her feet.
Deficiency?

Answer 21

Lysosomal trafficking disorder.
Chediak-Higashi: Autorecessive: large granules seen on peripheral smear.
txt: prophylactic abx and bone marrow transplant

Question 22

Newborn born but had a delay in the separation of the umbilical cord.
Type 2 treatment?

Answer 22

Fucose supplementation
LAD- inability of neutrophils to leave circulation. Type 2 has abnormal facial features, short stature. increased serum neutrophils. Defective response of neutrophils to stimulation

Question 23

13 year old has recurrent infections with niesseria. What is she at risk for in the future?

Answer 23

SLE or other autoimmune disorders.

Complement deficiency.