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Uworld Shelf Questions DF > Peds 2 > Flashcards

Peds 2 Flashcards

1
Q

most common reservoir for human rabies in the US

developing world?

paralysis?

what kind of phobia?

A

bats in US

dogs

ascending flaccid paralysis

hydrophobia and aerophobia

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2
Q

Herpangina

Etiology
Age
Season
Cx features
Tx
A

Coxsackie A

3-10 yrs

Summer and early fall

Fever, pharyngitis, gray vesicles/ulcers on posterior oropharynx

Supportive

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3
Q

what is hyper IgM due to

what kind of infections

A

defect in CD40 ligand which is on T cells and binds CD40 on B cells for class switching

sinopulmonary infections with encapsulated bacteria
viral infections
pcp too

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4
Q

pt with otitis and mastoiditis has serious risk factor for what and managment

A

direct spread of infection into a temporal brain abscess

next step is CT scan with contrast and MRI

CT better at depicting bone, and mastoid process damage
MRI better for soft tissue

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5
Q

Age for imaginary friends

A

Age 3-6

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6
Q

Pts with infection and resp distress that hyperextend the neck and maintain tripod position

A

Epiglottitis

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7
Q

Risk factors for IDA in children over 1 nutrition wise

A

Over 24 oz cows milk a day, don’t start till 1 yrs old

Under 3 servings a day of iron rich foods

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8
Q

CH50 assay is used to determine what

A

complement concentration

infections with encapsulated bcateria

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9
Q

in both infants and chidlren, ___ is the most common organism responsible for osteomyelitis

A

staph aureus

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10
Q

Language

12 months
18 months
2 yrs
3 yrs
4 yrs
5 yrs
A

12 months: first words besides mama and dada
18 months: 10-25 words and more than 1 body part IDd
2 yrs: 50+ vocab, 2 word phrase
3 yrs: 3 word sentence speech 75% recognized
4 yrs: id color and 100% speech intelligible
5 yrs: counts to 10, 5 word sentence

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11
Q

Laryngotracheitis is what

A

Croup

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12
Q

What term infants get NEC

A

Ones with reduced mesenteric perfusion from congenital heart disease and/or hypotension

Mainly terminal ileum, and colon

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13
Q

Vaccines for medically stable preterm infants should be administered based off what

A

Chronologic age

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14
Q

respiratory tract features in CF

A

sinopulm infx
nasal polyps
bronchiectasis
digital clubbing

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15
Q

Risk factors for vitamin K deficiency

A

Inadequate dieatary intake

Disorders of fat malabsorption: CF and biliary atresia

Disorders of intestinal inflammation: celiac and IBD

Decreaed production by bacterial flora from freq abx use

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16
Q

When do you use palivizumab in infants with RSV

A

Preterm birth under 29 weeks
Chronic lung disease of prematurity
Hemodynamically significant CHD

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17
Q

Koh prep showing hyphae and yeast cells in spaghetti and meatball pattern?

Cx feautres

Tx?

A

Tinea versicolor (pityriasis versicolor) malessezia globosa exposed to hot and humid weather

Hypopig, hyperpig, or mild erythemaout lesions

Topical ketoconazole, terbinafine, selenium sulfide

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18
Q

What age does malroation with midgut volvulus usually present

A

Under 1 month

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19
Q

INTRAOSSEOUS CANNULATION

A

When IV access cannot be ontained in emergency cases uses a IO access immediately.

Proximal tibia is most common spot

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20
Q

what is the single second heart sound from in TOF

A

normal aortic and inaudible pulmonary component of the S2

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21
Q

After 6 months of life what becomes the most important cause of IDA

A

Inadequate dietary intake

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22
Q

Gradual onset of hemiplegia
Neck pain
Aphasia (or other stroke sx)
Thunderclap headache

What is this and how diagnose and treat

A

GNAT: carotid artery injury or dissection which can lead to thrombus formation which can extend into the middle and anterior cerebral arteries

Dx: CT or MR angiography

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23
Q

primary ciliary dyskinesia extrapulmonary features

how about CF extrapulm

A

situs inversus
infertile
normal growth

CF: pancreatic insufficiency, infert, FTT

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24
Q

older children, unilateral LAD with history of periodontal disease

A

poptostreptococcus

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25
Q

Most common congenital cyanotic heart disease in the neonatal period

Exam and x ray finding

A

Transposition of great vessels

Single S2
+/- VSD murmur

Egg on a string heart (narrowed mediastinum)

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26
Q

____ causes hereditary fructose intolderance

Sx

A

Aldolasae B def

Fruits and veggies into diet accuulates fructose 1 phosphate

Vomit, poor feed, lethargy

Seizuress and encephalopathy

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27
Q

If you see nocturnal perianal pruritits think what

A

Helminth infection, enterobius vermicularis

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28
Q

___ anemia is often caused by excessive consumption of cow’s milk

A

IDA

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29
Q

the most common cause of a pediatric stroke is what

A

pts with SCD

mri if concern for stroke

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30
Q

RBCs in IDA, a thalassemia and b thalassemia

Increase, decrease or same?

A

Decreased, normal, normal

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31
Q

developmental dysplasia of hip, what is managment

treatment?

A

B/L US

after 4 months x rays are preferred

pavlik harness treats

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32
Q

clinical findings of congenital syphillis

A

rhinorrhea
abnormal long bone radiographs
desquamation or bullous rash (starts maculopapular)

syphillis is RAD

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33
Q

Non neurological manifestations in freidrichs ataxia

Death?

A

Hypertrophic cardiomyopathy, dm and skeletal deformities like scoliosis and hammer toes

cardiomyopathy in 90% of pts
Leading casues death is cardiomyop also resp failure can cause death

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34
Q

What are arterial lines used for

A

Continuous bp monitoring and to draw lab studies

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35
Q

What immunodef gives anaphylaxis during transfusion

A

Selective IgA def

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36
Q

Oral laxatives for kids

A

Polyethylene glycol and mineral oil

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37
Q

Do pituitary adenomas have calcifications within the mass

A

No

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38
Q

Intraventricular hemorrhage occurs predominatly in what infants

A

Premature and low birth weight

Also exposure to vascular perfusion injuries
Hypoxic episodes, hypotension, reperfusion of damaged vessels, increased venous pressure, abrupt change in cerebral flow

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39
Q

Electron microscopy findings in alport

A

Alternating areas of thinned and thick cap loops with split of GBM

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40
Q

Dx retropharyngeal abscesses

A

Lateral neck radiographs demonstrate prevertebral space thickening

CT scan of neck too

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41
Q

managment when vaginal foreign body suspected

A

external exam of genitalia with child in knee to chest

small bodies can usually be removed with calcium alginate swab or irrigation with warmed fluids after topical anesthetic applied

exam under anesthesia if that doesn’t work

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42
Q

Developmental dysplasia of the hip is assocaited with what

A

Breech presentation

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43
Q

Gastric outlet obstruction is also what

A

Pyloric stenosis

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44
Q

B thalassemia minor

MCV
RDW
RBCs
periph smear
serum iron studies
response to iron supplements
hemoglobin electrophoresis
A

MCV: decreased
RDW normal
RBCs normal
PS: target cells
serum fe study: normal or increased iron and ferritin
response to FE sup: no improvment
hemoglbin electrophoresis: increased hemoglobin A2

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45
Q

The diagnosis of autism is clinical but should what

A

Involve comprehensive eval with assessment of language, social, and intellectual development and hearing, vision and genetic stuff

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46
Q

retinal hemangioblastomas are associated with what

A

Von hippel lindau syndrome

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47
Q

breath holding spells common for what age and what are they

is this normal?

A

6 months to 2 years

episode of apnea precipitated by frustration, anger, or pain

benign

cyanotic: from crying and breath holding in forced expiration, then apnea, limpness, and LOC
pallid: from minor trauma

normal yes

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48
Q

When is a VCUG indicated

A

Hydronephrosis on renal US

Also in newborns under 1 month and kids under 2 with recurrent UTIs or first UTI from organism other than E coli

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49
Q

a thalassemia minor

MCV
RDW
RBCs
periph smear
serum iron studies
response to iron supplements
hemoglobin electrophoresis
A 
MCV: decreased
RDW normal
RBCs normal
PS: targer cells
serum iron studies: normal/ increased iron and ferritin

no response to iron supp

hemoglobin electrophoresis normal

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50
Q

Howell jolly bodies seen in what pts

A

Asplenic pts bc spleen usually removes normal nuclear remnants of RBCs which are the HJ bodies

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51
Q

Helmet cells or schistocytes seen in what

A

Microangiopathic hemolytic conditions like DIC, HUS, and TTP

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52
Q

crqadle cap in infants

greasy scales with mildy erythemaotous base on scalp

A

seborrheic dermaitits

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53
Q

RDW in iron deficiency anemia and how much

A

elevated over 20%

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54
Q

mono presents as what when treated with aminopenicillin

A

morbilliform rash on the trunk that spares extremities and arthralgia does not occur

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55
Q

Todd paralysis

A

Self limited focal weakness that occurs after a focal or generalized seizure

Postictal partial or complete hemiplegia involgin an ipsilateral upper and LE

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56
Q

most common type of tinea capitis is what

A

trichohyton tonsurans

microsporum can cause it too

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57
Q

EBV LAD

A

bilateral subacute-chronic LAD with systemic symptoms

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58
Q

If suspected lead poisoning then what is next step in management

A

Dra venous lead level

If 5-44 then no meds, repeat in 1 month

If 45-69 then DMSA, succimer

If over 70 then EDTA

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59
Q

Focal or gen seizures, mental retard, and port wine stain or nevus flameus along the teritory of the trigeminal nerve

Gongetical unilateral cavernous hemangioma

Other findings in this disease

A

Sturge weber syndrome

Hemiparesis, hemisensory distrub, ipsilateral gluacoma

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60
Q

Separation anxiety manifests at what age

A

9-18 months

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61
Q

Retropharyngeal abscess results from what and what infections

A

Pre existing URI and direct spread of bacterial inx from pharyngitis, tonsillitis, OM or sinusitis

Polymicrobial

S pyogens, a aureus, anaerobes

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62
Q

if contrast enema shows a transition zone btwn a narrow rectosigmoid and dilated megacolon workup for what and how

A

hirschrpungs

rectal biopsy performed

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63
Q

GERD in infants

physiologic

pathologic

and tx for both

A

physiologic

  • asx, happy spitter,
  • reassurance and position therapy and freq small feeds
  • usually resolves by 1

pathologic

  • FTT, really irritable, sandifer syndrome
  • thickened feeds, antacids, esohageal ph probe monitor and upper endoscopy if really severe
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64
Q

Posterior urethral valves can present with what

A

Urosepsis, FTT and RENAL failure

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65
Q

what would CHF show on cxr

A

increased pulmonary vascular congestion and intersitial edema

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66
Q

features of LAD

A

recurrent skin and mucosal bacterial infections (omphalitis and periodontitis)
-no pus, poor wound healing

delayed umbilical cord sepration
marked peipheral leukocytosis with neutrophilia

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67
Q

What occurs in orbital cellulitis that isn’t in preseptal cellulitis

A

Ophthalmoplegia, pain with exye movement, proptosis, vision impairment

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68
Q

Neuroblastoma occurs when

Anatomy and sx

A

Within first year of life

Adrenal glands, abdominal mass that crosses midline with systemic sx

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69
Q

Complications of NEC

A

Short bowel syndrome
Septic shock
Intestinal strictures
Deat

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70
Q

acute bacterial rhinosinusitis most common orgnaisms and treatment

A

s pneumo
h flu
morax cat

amox-clav

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71
Q

Fever in measles or rubella has a fever of 104 or higher? And which has cervical adenopathy?

Which has posterior auricular or suboccipatal LAD?

A

Measles for fever and cervical

Rubella for post auric and subocc

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72
Q

Diagnosing wilms tumor

A

Abdominal US then contrast enhanced CT of the abdomen and of chest to ID pulmonary metastases

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73
Q

Pts who present with migraine sx that need neuorimaging

A

History of coordination difficulty, numbness, tingling, focal neuro signs, history of HA that awakens from sleep

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74
Q

Most common sites of thromboembolism in antithrombin III def

A

Femoral and messenteric veins

Cerebral thromboses is less common

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75
Q

Paroxysmal nocturnal hemoglobiunira is diagnosed by what

A

Erythrocyte CD55 and CD59 protein testing

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76
Q

small palpebral fissures

smooth philtrum
thin vermilion border

what in utero exposure

what other features

A

alcohol

decreased growth, microcephaly

adhd, dumb, social withdraw, motor and language delay

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77
Q

Clinical features of Digeorge

A

Conotruncal cardiac defects (truncus arteriosus)
Abnormal facies
Thymic aplasia (t cell lymphopenia and increased viral and fungal infx)
Cleft palate
Hypocalcemia: tetany, seizures and arrhythmias

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78
Q

Mentzer index in thalassemia is what

How bout IDA?

A

MCV/RBC and under 13

IDA: over 13 bc RBCs decreased

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79
Q

Criteria for cyclic vomiting syndrome

A 
3 or more episodes in 6 month period
1-10 days
Vomiting 4times or more and hour at peak
No sx in btwn vomiting
No underlying condition

Predictable pattern of vomiting

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80
Q

Opalescent teeth is found in what disease

A

Osteogenesis imperfecta

Calld dentinogenesis imperfecta discolered teeth

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81
Q

The incidence of cyclic vomiting syndrome is highest in which children

How treat

Age

A

Those whose parents have a hx of migraine headaches

Treat with antiemetics and sumatriptin

2/3 resolves on own by 5-10

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82
Q

Measles or rubella has maculopapular rash that erupts on face and spreads caudal WITHIN 24 hours

A

Rubella

Measles takes multiple days

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83
Q

Maternal withdrawal of estrogen key features

Treatment?

A

Presents in neonatal period and lasts under a week
Can cause vaginal bleeding and discharge
-neonatal endometrium may slough off after estrogen gone from birth = mucoid vaginal bleeding
-can lead to breast bud and external genitalia eongorgement

Reassurance

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84
Q

clindodactyly and large space btwn first 2 toes

A

DS

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85
Q

All children under the age of ___ with a first febrile UTI should undergo a renal and bladder US

A

2

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86
Q

What food should be introduced after 6 months of breastfeeding then what

A

Pureed fruits and vegetables then pureed proteins like meats.

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87
Q

Which is the only vaccines that pt needs to weigh 2 or more kgs (4 lbs 6 oz) before administering it

A

Hepatitis B

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88
Q

Scaly erythematous pruritic patch with centrifugal spread, subsequent central clearing with raised annular border is what and what is treatment

A

Topical clotrimazole and terbinafine

Second line is oral terbinafine and griseofulvin

Tinea corporis (ringworm)

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89
Q

Benign or pahtologic murmur?

Murmur that intensity decreases on standing and valsalva maneuver?

A

Benign

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90
Q

Clubfoot aka ____ presents with equinus of the ____ and varus of the ___ and varus of the ___ and adduction of the ___

A

Talipes equinevarus

Equinous calcaneum (EC if you know this dumb ass language)
Varus of talus (Va tech)

Varus of midfoot

Adduction of forefoot

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91
Q

In pts with type I DM infection can precipitate DKA due to systemic release of what

A

Insulin counterreg hormones like catecholamines and cortisol

Resultant excess of glucagon

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92
Q

TOF and what make TOF better and how

A

knee to chest and squatting

if the resistance of the systemic circulation exceeds the resistance of the pulmonary circulation, the blood will shunt from the ventricles to the pulmonary artery

otherwise PVR exceeds that of systemic and shunt from ventricles into aorta = cyanosis

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93
Q

progression to cardiac tamponade is characterized by becks triad which is what

cxr shows what

A

distant heart sounds, distended jugular veins, and hypotension

chest x ray shows cardiomegaly

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94
Q

Lower abdominal cramping with meses in absence of other pathology, cramping during first few days is what

And caused how

Tx

A

Primary dysmenorrhea
Prostaglandin release from sloughing endometrium

NSAIDs

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95
Q

hyper IgM syndrome quant Igs

tx

A

decreased IgG and IgA

increased IgM

antibiotic prophylaxis and interval admin IVIG

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96
Q

anstranger anxiety is normal finding that starts when and subsides when

A

6-9 months then ends by 3

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97
Q

Intestinal malrotation can present with what and dx

A

Recurrent bilious vomiting, lead to volvulus which causes severe bilious emesis and hypovolemic shock

Upper GI series is dx

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98
Q

Contraindications to rotavirus vaccine

A

Anaphylaxis to vaccine
History of intussusception
History of uncorrected congenital malformation of GI tract like meckel
SCID

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99
Q

Maculopapular rash followed by successive crops of vesicles

A

Varicella

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100
Q

Turners syndrome

Estrogen
Fsh
Inhibin A 
Testosterone
GH
LH
A 
Estrogen decreased
FSH increased
Inhibin A decresaed
Testosterone decreased bc lack production ovaries
GH normal
LH increased
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101
Q

Thickening of the tunica media in the aortic arch is what

A

Coarctation of the aorta

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102
Q

Jaundice, hepatomegaly and FTT after breast milk or regular formula is what

A

Galactosemia from no galactose 1 phosphate uridyl transferase activity

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103
Q

congenital ___ is characterized by periventricular calcifications

A

CMV

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104
Q

gaucher disease

enzyme def

sx

A

glucocerebrosidase

bone pain and cytopenias

HSM

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105
Q

Tongue laceration in what

A

Seizure

106
Q

What age say dada and mama and what age first words

A

Mama and dada 9 montsh

12 months is first words

107
Q

how do you diagnose SCD

A

dx with hemoglobin electrophoresis

-if concern for stroke then do MRI

108
Q

Name for hair pulling disease and people with family or personal history of what have increased risk

Tx?

A

Trichotillomania

OCD

Tx: abit reversal training

109
Q

Hereditary spherocytosis

Lab findings

A

Increased MCHC
Neg coombs
Increased osmotic fragiltiy on acidified glycerol lysiss test
Abnormal eosin-5-malemide binding test

110
Q

What age is MMR recommended?

A

1 and 4

Mmmmrrr tyrel reid

111
Q

hereditary angioedema

edema without what
deficiency
elevated what

presents when

A

edema without eveidence of urticaria

C1 esterase inhibitor deficiency
-c1q levels normal in this and depressed in acquired form

elevated bradykinin and C2b

presets late childhood after infeciton, dentalprocedure or trauma

112
Q

Features of hemiplegic migraine

Tx

A

Onset in adolescence and often positive family history

History of HA and visual aura

Sx self resolve

113
Q

Systolic ejection murmur at the left interscapular area

A

Coarctation of the aorta

114
Q

Treatment of clubfoot aka ____

A

Talipes equinovarus

Stretch and manipulate foot, then seriel plaster casts, malleable splints or tabing

115
Q

If Digeorge suspected what must be ordered immediatelya

A

Serum calcium and echo

Hypo

116
Q

Moderate to Severe dehydration should be treated how

What % water loss cap refil

A

IV fluids, with isotonic crystalloid

10-15% cap refil over 3 seconds

117
Q

what is used to diagnose CGD

A

dihydrorhodamine test or the nitroblue tetrazolium test

118
Q

episodic inconsoluble crying with normalness in between episodes

lethargy ams, bloody stool, emesis

A

intussusception

119
Q

normal distribution of eczema in infants and another name for it

A

face, scalp, extensor surfaces and flexural creases in older children

atopic dermatitis

120
Q

Septic joint

Appearance, wbcs, pmns

Micro nd tx

A

Appearance: opaque
WBCs 50 k to 150k

Pmns >80-90%

Most common is staph aureus and streptococci

Empiric iv abx with vanco, also synovial fluid aspiration and surgical drainage

121
Q

Diagnosis of fanconi anemia is made by what

What is definitive treatment?

A

Chromosmal breaks on genetic analysis and clinical findings

SC transplant is tx

122
Q

If have tranposition of great vessels what must be done

A

Use prostaglandins to keep PDA open if there is one until surgery

123
Q

scaly erythematous patch with hair loss on scalp

can have black dots or tender LAD

most common in af american children

how to confirm

A

tinea capitis which is a dermatophyte infection

also common in ICPts

confirm with KOH exam

124
Q

causes of RTA type 1

urine pH?

A

genetic disorders and nephrolithiasis
meds
autoimmune disorders like sjogren and RA

> 5.5

125
Q

Peak age of wilms tumor and another name

sx

A

Neprhoblastoma and age 2-5

wagr, beckwith wiedemann and dnys drash

Asx

126
Q

Pains that occur at night and resolve by morning affect LE and normal physical exam and activity?

Tx?

A

Growing pains

Just massage, stretch, heat analgesics

127
Q

Degeneration of the spinal tracts

A

Freidrichs ataxia

128
Q

Lab findings in HUS

A

Heamolytic anemia, schistocytes, incerased billy
Thromboyctopenia
AKI

TRIAD

129
Q

Social/cognitive

12 months
18 months
2 yrs
3 yrs
4 yrs
5 yrs
A 
12 months: sep anxiety, follows 1 step commands 
18 months: understands mine
2 yrs: 2 step commands, toilet train
3 yrs: knows age/gender
4 yrs: cooperative play
5: has friends and potty trained
130
Q

By age 12 months of life a childs weight should ___ and height should increase by __

A

Tirple

50%

131
Q

Which bacteria is by far the most common cause of sepsis in pts with SCD

A

S pneumoniae from non vaccine serotypes

132
Q

patients refusal to speak in a specific social situation but engage in normal communication in situations in which she feels comfortable is consistent with what

A

selective mutism

has to happen for 1 month or more

133
Q

Posterior urethral valves and amnio

A

Oligohydramnios

134
Q

Etiology of pediatric viral myocarditis

Clinical presentation

A

Coxsackie B virus
Adenovirus

HF, dyspnea, tachy, nausea, vomit

135
Q

Clinical manifestations of fanconi anemia

Bone marrow
Appearance
Skin
Eyes and ears

A

Bone marrow: aplastic anemia
Appearance: short, microcephaly, abnormal thumbs, hypogonads
Skin: hypopigmented/hyperpigmented, cafe au lait, large freckles
Eyes and ears: strabismus, low ears, mid ear abnormalities

136
Q

causes of RTA 2

urine pH

A

fanconi syndorme

(glucosuria, phosaturia, aminoaciduria)

<5.5

137
Q

Complications of bronchioloitis

A

Apnea and resp failure

138
Q

What is the most common predisposing factor for orbital cellulitis
And dangerous complications

A

Bacterial sinusitis

Blindness, subperiosteal abscesses, cavernous sinus thrombosis, intrcranial infection and death

139
Q

What can increase pulmonary vascualar resistance in TOF

A

Exertion, feeding and agitiation resulting in complete RVOT obstruction

140
Q

what is technetium-99m scan used to diagnose

A

meckels diverticulum, which presents with painless rectal bleedinng in chidlren

141
Q

RDW in IDA

How about in:
A thal?
B thal?

A

Increased

Normal in thals

142
Q

Treatment for lyme disease in kids under 8 or pregnant women or just anyoone

A

Everyone: doxy, amoxicillin, cefuroxime

Kids and preggos: amox and cefuroxime

143
Q

Oral succimer can be used for whqat

A

Lead posioning

144
Q

3 things in HUS

A

HAT

Hemolytic anemia (schistocytes and increased bilirubin)
Acute kidney injury
Thrombocytopenia

145
Q

hypoketotic hypoglycemia during fasting states is in what metabolic disease

A

medium chain acyl coa dehydrogenase deficiency MCAD

146
Q

Severe aortic narrowing in coarctation makes systemic blood flow dependent on what and then what happens when it closes

A

ductus arteriosus

When closes around day 3 of life, infants may develop heart failure and shock

147
Q

Microcolon in what disease

A

CF and meconium ileus

148
Q

chronic hemolysis of SCD can lead to what deficiency

A

folate as BM tries to make more red blood cells to compensate for anemia

macrocytic anemia, hyperseg m=neutrophils and low reitc count

149
Q

morning vomiting and nocturnal HAs are red flags for what

A

intracranial pathology

150
Q

crescendo decresecedo systolic ejection murmur reps what in TOF

A

RVOT obstruction

151
Q

Most common CHD in turners syndrome

A

VSD

152
Q

Low pitched, muscial pure or squeaky tone at LLSB (still’s murmu) or high pitched at LUSB (pulmonary flow murmur)

Benign or pathologic?

A

Benign

153
Q

Second and third trimester maternal hyperglycemia can lead to what

A

Fetal hyperglycemia and hyperinsulinemia
-increased metabolic demand—>hypoxemia—>Increased EPO—>polycythemia

  • organomegaly neonatal hypoglycemia
  • macrosomia
154
Q

cutaneous ___ causes an erythematous vesiculopapular rash in warm, moist areas

A

candidiasis

155
Q

DD of hematochezia in early toddlerhood is what

A

Hemorrhoids, infectious colitis, intusssception, meckels diverticulum and IBD

156
Q

hypointense center and ring enhancement with surrounding edema

A

brain abscess

157
Q

Complications of bacterial meningitis

A

Hearing loss (most common)
Intellectual disability (ADHD, absence seizures, etc)
Cerebral palsy
Epilepsy

158
Q

Moonface with large ears and neurobehavioral problems and big ass balls

A

Fragile x syndrome

CGG repeat

159
Q

Treatment of cephalohematoma

A

Most cases don’t need any and resorb spontaneously within 2 weeks to 3 months

160
Q

Breast feeding reduces the risk of what cancer

A

Ovarian and breast

161
Q

slanted palpebral fissures

A

DS

162
Q

Diagnosing meckels diverticulum and tx

A

Technetium 99m pertechnetate scan

Surgical resection is necessary to prevent further bleeding

163
Q

iron deficiency anemia

MCV
RDW
RBCs
periph smear
serum iron studies
response to iron supplements
hemoglobin electrophoresis
A

MCV decreased
RDW increased
RBCs decreased
periph smear: microcytosis, hypochromia
iron study: increased TIBC decreased iron and ferritin
response to Fe supp: increased hemoglobin
hemoglobin electrophoresis: normal

164
Q

Inspiratory strigoder that worsens when supine and better when prone

  • peak age is when
  • management
A

Laryngomalacia

Peak age is 4-8 months

Confirm with flexible laryngoscopy

Reassurance for most cases
Supraglottoplasty if severe

165
Q

how long do absence seizures last

A

10-20 seconds

166
Q

_____ rehydration should be initial tx in children with mild to moderate dehydration which is what % volume loss? Cap refill?

A

Oral

Mild: 3-5%,
Moderate: 6-9% 2-3 cap refil delay

167
Q

Prodrome of nausea, warmth, lighthead and or diaphoresis then pass out

A

Vasovagal syncope

168
Q

Reye syndrome cx features and after what infection

A

Encephalopathy and acute liver failure

Varicella and influenza giving aspirin

169
Q

Renal complications of sickle cell trait

painless hematuria from

A

Hematuria, renal medullary carincoma and UTIs

Painless hematuria from papillary ischemia or necrosis

170
Q

What is the antibiotic prophylaxis for RF

A

Continuous intramuscular benzathine penicillin G every 4 weeks

171
Q

focal seizure may be what kind

originate in how many hemispheres then what

what kind of weird things

A

motor, sensroy, or autonomic (sweating)

one hemi, may generalize and cause impairment of consciousness

repetitive semi puproseful movements like cheiwing sucking and swallowing called automatisms

172
Q 
Social and cognitive for 
2 months
4 months
6 months
9 monhts
12 months
A

2: smiles
4: looks around a lot
6: stranger anxiety
9: waves by and patty cake
12: separatoin anxiety, comes when called

173
Q

Etiology of exudative effusions

A 
Empyema
Chylothorax (lymphatic flow through thoracic duct disrupted = direct leakage of chyle

Malignancy
TB

174
Q

renal angiomyolipoma in what disesae

A

TS

175
Q

Most common cause of aplastic anemia in children is what

A

Congenital: fanconi anemia

-AR or x linked

176
Q

What kind of feeding in neonate increases risk of NEC

A

Formula feeding

177
Q

Inflammatory joint WBCs and PMNs

Non inflammatory

A

Inflammatory is 2-10k and over 50%

Non inflamm is 200-2000 wbcs and 25%

178
Q

Constitutional growth delay is characterized by what

-normal birth weight and height but btwn 6 months and 3 yrs age, hieght growth velocity slows and child drops % on the growth curve. At 3 child regains normal growth velocity and follows the growth curve at 5-10%, growth spurt happens later

A

Delayed growth spurt puberty and bone age

179
Q

The presence of microvesicular steatosis on liver bx in context of acute hepatic encephalopathy is consistent with what

A

Reye syndrome

180
Q

Fever sore throat and HA preceding a rash which spreads across the trunk, groin, and axillae, and has a finely papular sandpaper texture most pronounced in the skin folds.

What disease?
As the illness resolves, ____ of the rash results in what

A

scarlet fever after strep pyogenes

Desquamation results in peeling of hands and feet

181
Q

Fine motor

12 months
18 months
2 yrs
3 yrs
4 yrs
5 yrs
A

12 months: two finger princer grasp
18 month: 2-4 cubes, remove clothes (kobe 24 cubes & 18 nude)
2 years: 6 cubes and line
3 years: cipy circle
4 years copies cross
5 years: copies square, tie shoes, dress/bath on own, print letters

182
Q

Infants who are SGA are at risk for what complications

Calcium and sugar is 2

A

Hypoxia, perinatal asphyxia, meconium aspiration, hypothermia, hypoglycemia, hypocalcemia, and polycythemia

183
Q

Fetal factors for SGA

A

Genetics, chroms, congential ifx, inborn errors of metabolism

184
Q

Treatment for pyloric stenosis

A

Laboratory derangements should be normalized first with IV rehydration then pyloromyotomy

185
Q

What vaccines should infants get at 2 months

A 
dTAP
Rotavirus
H influenza
Pneumococcal
Inactivated polio
186
Q

milk protein allergy cx features

A

regurge/vomit
eczema
bloody stools

187
Q

Pneumococcal sepsis is present up to ____ years after splenectomy

A

30

188
Q

Iron poisoning can lead to what

A

Free raidcal production and lipid peroxidation

Abdominal pain and hematemesis, hypovolemic shock and metabolic acidosis

189
Q

neurofibromatosis type 1 inheritance and manifestaions

A

AD

cafe au lait,
freckles lisch nodules
neurofibromas which is a nerve sheath tumor
optic gliomas

190
Q

nucleated RBCs are seen in what

A

severe hemolysis or myelofibrosis

191
Q

When is a vaccine contraindicated to give agin

A

Anaphylaxis to vaccine

Neuro disorder in person

Encephallopathy within week of previous vaccine

Personal history nor family history of febrile seizures is contraindication

192
Q

Exudative effusions

Pleural fluid analysis:
Pleural protein/serum protein ration
Pleural ldh/serum ldh
Pleural ldh

A

> 0.5

> 0.6

> 2/3 UL of normal for serum LDH

193
Q

Pt with gross hematuria nad UA with normal appearing red blood cells suggests what etiology

A

Extra glomerular

194
Q

Atlantoaxial instability is a malformation seen in 10-15% of what pts and from what

sx

A

DS pts

Laxity of posterior transverse ligament which causes increased mobility btwn C1 and C2

Sx: behavioral change, torticollis urinary incontinence, vertebrobasilar sx like dizzy, vertigo and diplopia

UMN signs too

195
Q

clinical presentation of possible child abuse

A

unexplained injury
injury in diff stages of healing
malnutrition
sudden behavioral or scholastic changes

196
Q

Most common cause of osteomyelitis in healthy children and SCD
And treatment

A

Healthy: s aureus

SCD: salmonella

-healthy: naf/oxacilllin or cefazolin with low MRSA chance
If high MRSA then clinda or vanco

SCD: healthy coverage + 3 gen cepahlosporin

197
Q

s aurues is common in what type of sinusitis

A

chronic

198
Q

what infections with CGD

A

catalase positive

199
Q

ostsclerotic cortical lesion on image with central nidus lucency

pain at night

quickly releived by NSAIDs

A

osteoid osteoma

200
Q

Maternal factors for small for gestation age

A

Preeclampsia, malnutrition, placental insufficiency, multiparity, drugs

201
Q

friedreichs ataxia

sx
MRI
inheratince

A

neurologic findings like loss of reflexes and vibratory position sense, weakness
-CV manifestations, loss cardiac muscle fibers and arrhythmias

feet deformed with high plantar arches

MRI or brain and SC show marked atrophy of cervical spinal cord and minimal cerebellar atorphy

AR GAA repeat

202
Q

Incopmleete obliteration of the fetal vitelline duct (omphalomesenteric)

What tissue

Sx

A

Meckel’s diverticulum

Heterotopic gastric tissue

Painless hematochezia most comomon

Ectopic gastric tissue secretes acid causing mucosal ulceration of surrounding small bowel

203
Q

46 xy male internal genitalia, and female or undermasculinized external genitialia at birth

at puberty experience maculinization due to testosterone but lack breast development

A

5-a reductase deficiency

204
Q

Osteod osteoma presents in what decade of life and side of pain

A

Unilateral and second decade

10-20

205
Q

Biliary atrewsia presents with what type of hyper billy

A

Direct

206
Q

A peripheral smear of thalassemias shows what cells

A

Target cells and teardro cells

207
Q

Gold standard for diagnosis of viral myocarditis is what

Tx?

A

Myocardial biopsy

Diuretics and inotropes bc of the HF

208
Q

Murmur that increases with standing and valsalva maneuver is benign or pathologic

A

Benign

209
Q

Lab findings in reye syndrome

Tx?

A

Increased:
AST, ALT, PT, INR, PTT, NH3

Supportiveq

210
Q

DKA and free fatty acids

A

Increased circulating bc of increased glucagon and lipolysis

211
Q

Hypopigmentation involving skin hair eyes and brain nuclei metabolic thing that is not albinism

Dx in newborn
Dx later in life

A

Pku

Dx: positive newborn tandem mass spectrometry

If suspected later in life then quantitative aa analysis

212
Q

Most common congenital foot deformity characterized by medial deviation of forefoot with neut position of hindfoot is what

Tx?

A

Metatarsus adductus

Corrects spontaneously

213
Q

AUB is often from what in kids and requires what

A

anovulatory dysfunction from immature HPO axis = heavy irreg bleeds

first do CBC, preg test, and coag study

if hemodynamically stable then IV estrogen or high dose oral estrogen/progestin contraceptive pills

hemodynamically unstable pt: dilation and curettage

214
Q

billious emesis in neonate workup when stable and pt also has not passes meconium so suspect what and workup

A

suspect distal intestinal obstruction

abdominal x ray first to ID pneumoperitoneum from perforated bowel

then after that is excluded do water soluble contrast enema (gastrografin) can dissolve and break up poop

surgery if this does not work

-microcolon = meconium ileus

215
Q

Applying sunscreen correctly

A

50 SPF 30 mintues before sun exposure

216
Q

Antibiotic prophylaxis for RF

RF without carditis

RF with cardidtis but no residual heart or valve disease

RF with carditis and persistent heart or valve disesae

A

1) 5 yrs or until 21
2) 10 yrs or until 21
3) 10 yrs or until 40 yrs old

217
Q

tx of tinea capitis

A

oral griseofulvin or terbinafine

218
Q

acute unilateral LAD in children usually from what

A

bacteria

s aureus most common then strep

219
Q

Treatment of strabismus to prevent amblyopia (vision loss from disuse)

A

Eyeglasses

Patch normal eye (occlusion therapy)
Blurring the vision of the normal eye with cycloplegic drops (penalization therapy)

Surgery if persistent or severe cases

220
Q

Lateral neck radiograph shows widened prevertebral space but no other abnormalities

Other findings

Dx

A

Retropharyngeal abscess

Inability to extend neck and widened preverterbal space

Lateral x ray
CT contrast for pts with no respiratory compromise for size of abscess

221
Q

Treatment for enterobius vermicularis pinworm

A

Albendazole or pyrantel pamoate

222
Q

Treatment for clubfoot and managment

A

Serial manipulation and casting sx, for refractory cases

Karyotyping shouold be considered

223
Q

Fever and maculopapular rash a week after receiving the MMR vaccine

Tx?

A

Most likely due to infx with vaccine strain
Can cause mild version of infx

No treatment needed

224
Q

infant with a normal anion gap and FTT most likely has what

what do all types of the thing present with and why

A

renal or GI etiology of acidosis

all types of RTA can present as growth failure bc of acidic conditions

225
Q

Maternal hyperglycemia in the first trimester can lead to

A

Congenital heart disesae
Neural tube defects
Small left colon syndrome
Spontaneous abortion

226
Q

von gierke disease

what def
sx

A

glucose 6 phosphatase def so no glycogen to glucose and leads to glycogen accumulation in liver, kidney, intestinal mucosa

3-4 months pt gets hypoglycemia–>seizure, and lactic acidosis

hyperuricemia and hyperlipidemia

Doll like face and hepatomegaly

227
Q

Dactylitis (hand foot syndrome) can be the earliest manifestation of what

A

Vaso occlusion in a SCD

Age 6 months to 4 years
Symmetric swelling of hands and feet

228
Q

When does pyloric stenosis usually start being symptomatic

A

Week 3-5 KD

229
Q

Keoptic chiasm compression
Pituitary stalk compression and endocrinopathies like GH def and DI

Suprasellar, calcified mass on imaging

A

Craniopharyngioma

230
Q

Is prematurity a risk factor for IDA in young children

A

Yes

231
Q

bacteria in otitis media

A

h infl, morax, strep pneumo

232
Q

subacute chronic LAD from what

uni or bilateral?

age group and description

A

mycobacterium avium intracellulare (non tb mycobacteria)

unilateral

under 5 years old, firm, nontender LAD less that 4 cm in size

skin over LN often violaceous color

233
Q

vaginal foreign bodies is a common cause of what

what is most common foreign body

presents with what

A

can cause vulvovaginitis (foul smelling discharge, bleeeding an spotting or urinary complaints in prepubertal children

toild paper most common,

234
Q

Intermittent strabismus can be expected in infants under what

A

Under 4 months bc immature extraocular muscles

235
Q

Solitary hyperpigmented lesion in first few months of life that has increased density of overlying dark, coarse hairs and tx

A

Congenital melanocytic nevus

Large lesions removed

236
Q

mullerian agesnisis aka what

reproductive organs?

A

mayer rokitansky

kuster hauser

absent or rudimentary uterus and upper vagina, normal ovaries

breast and body hair growth normal too

237
Q

abuse in children must be ruled out in any child with what

A

abrupt onset mood change, bedwetting and or academic difficulty

238
Q

Other classical findings of scarlet fever besides rash

Tx?

A

Strawberry tongue, palatal petechiae, tonsillar exudates
Mouth pale with red cheeks = circumoral pallor

treat with PCN

239
Q

PaCO2 and HCO3 in pyloric stenosis

A

PaCO2 increased, HCO3 increased

Loss of volume increases angiotensin II which increases HCO3 reabsorption and aldosterone

240
Q

Biphasic stridor due to tracheal compression

What is
Diagnose and confirm

A

Vascular rings

Barium swallow and confirm with MRI with angiography

241
Q

Clinical features of pineal gland masses

A

Limited upward gaze
Upper eyelid retraction
Pupils non reactive to light but are to accomodation

Obstructive hydrocephalus: papilledema, HA, Vomit, ataxia

242
Q

DKA and potassium

A

Diuresis accompanied by net renal loss of K+ with depletion of total body K+ stores

Serum concentration of K+ may be elevated due to acidemia and decreased insulin activity causeing redistribtion of K+ to EC comparment

243
Q

laboratory findings in anemia of prematurity

A

Low hemoglobin and hematocrit

Low reticulocyte count

Normocytic, normochromic RBCs

244
Q

Pt with guillen barre syndrome, what is the most life threatening complication and how do you manage this pt

Other dysfunction

A

Neuromuscular respiratory failure

Assess pts pulmonary fnct with seriel spirometry and measure FVC
-decline in 20mL/kg req intubation

Autonomic dysfunction like hr and bp instability, flaccid quads and bulbar palsy

245
Q

fever urticaria and joint pain 1 week after penicillin therapy is concerning for what?
-no mucosal involvement too

what type rx
etiology

A

serum sickness like reaction
type III HS

etiology: antibiotics (beta lactam and sulfa) and acute hep B

246
Q

Treatment of NEC

A

Broad spectrum abx bc of risk of septic shock

247
Q

Gross motor

12 months
18 months
2 yrs
3 yrs
4 yrs
5 yrs
A

12 months: walk first steps independently, throw ball,
18: kick ball and run
2 yrs: walk up/down stairs with both feet on each step, jump
3 years: walk up/down staris with alt feet, ride trike
4 yrs: hops on 1 foot
5 yrs: skips and catch ball with 2 hands

248
Q

Varicella post exposure prophylaxis

History of immunity (prior infection or 2 doses of vaccine)

Yes and no

A

Yes: observe

No: varicella vaccine in normal person
-VZIG in ICP

249
Q

dermatophyte infection of scalp (tinea capitis) always requires what

A

oral antifungal

250
Q

Lab values in reye

A

Ast and alt up

Pt and ptt and inr up

Increased NH3

Bilirubin is normal

251
Q

causes of RTA 4

urine pH

A

obstructive uropathy
CAH (aldosterone def)

<5.5

252
Q

infant pt that developed tachycardia, tachypnea, and ddistant muffled heart sounds 1 week after cardiac surgery is suggestive of what

can progress to what

large ones can lead to what

A

life threatening pericardial effusion

eventual progression to cardiac tamponade

larger effusions can lead to abdominal pain, vomiting, and decreased appetite

253
Q

Classical features of NEC

A

Feed intol
Increase abdom girth
Blood stools
Vomiting

254
Q

DKA and renin

A

Increases it bc of diuresis

255
Q

Endometriosis pain is when

A

A few days before menses

256
Q

osteosarcoma age group highest risk

location

constitutional sx

A

13-16

metaphyses of long bones
distal femur, prox tibia, prox humerus

no fever, weight loss or malaise

257
Q

if have presence of exudates, edema, petechiae on palate and no viral sx then what test do you get?

if negative then what

A

rapid strep test

if negative then throat culture (bc rapid strep only 70-90% sensitive), if that is negative then it is viral pharyngitis

258
Q

Ages to give varicella vaccine

A

1 and 4 yrs old

259
Q

Basophilic stippling seen in what

A

Thalassemias and lead or heavy metal poisioning

260
Q

Rotavirus vaccine is usually administered when

A

2-6 months

261
Q

treatment for ringworm and what infection

A

tinea corporis from trichophytopn rubrum

first line is topical like clotrimazole and terbinafine

oral griseofulvin and terbinafine if that fails

Uworld Shelf Questions DF (8 decks)

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