Peds

Question 1

12 Month Milestones

Answer 1

MOTOR: walks, throws objects

LANGUAGE: 1-3 words, follows 1-step command

SOCIAL: stranger and separation anxiety

Question 2

4 Year Milestones

Answer 2

MOTOR: draw a cross, identify body parts, hops on one foot, throws overhand, copies a square (4.5)

LANGUAGE: language understood by strangers, uses past tense

SOCIAL: plays with other kids, social interaction

Question 3

Imaging in hypertrophic pyloric stenosis

Answer 3

Thickened pyloric muscles via US

Upper GI w/Contrast may show elongated pyloric canal and a “double track” sign (two thin tracts of barium created by compressed pyloric mucosa)

Question 4

Peritonsillar abscess

Answer 4

Infection of the superior pole of tonsils, most common in young teenagers. Presents with fever, sore throat, muffled voice, drooling, trismus, and neck pain.

May have deviation of uvula

Question 5

1 Month Milestones

Answer 5

MOTOR: Reacts to pain

LANGUAGE: Responds to noise

SOCIAL: Regards human face, eye contact

Question 6

Hypertrophic Pyloric Stenosis

Answer 6

Usually presents @ 3-6wk as “hungry baby” with projectile vomiting that is non bilious and occurs immediately after meals.

Physical exam will reveal olive shaped mass at RUQ and peristaltic waves across upper abdomen moments before emesis.

Question 7

3-Year Milestones

Answer 7

MOTOR: copies a circle, pedals a tricycle, builds 3-block tower, repeats 3 numbers

LANGUAGE: speaks in sentences, 3/4 speech understood

SOCIAL: group play, plays games, knows gender, knows first and last name

Question 8

2 Year Milestones

Answer 8

MOTOR: runs, walks up and down stairs, kicks a ball, copies a line

LANGUAGE: 2-3 word phrases, half of speech understood by strangers

SOCIAL: parallel play

Question 9

Child lead screening?

Answer 9

All kids not previously enrolled in Medicaid should be screened @ 36-72mo

All children @ risk for exposure should be screened @ 1 yr

Question 10

Intussusception

Answer 10

Telescoping of intestine → intermittent severe abdominal pain, associated vomiting that becomes bilous as obstruction occurs.

May get currant jelly stools and elongated mass palpable in right abdomen

Most common in ileocecal junction

Question 11

4 Month Milestones

Answer 11

MOTOR: Eyes move past midline, rolls over

LANGUAGE: laughs and squeals

SOCIAL: regards hand

Question 12

5 Year Milestones

Answer 12

MOTOR: copies a triangle, catches a ball, partially dresses self

LANGUAGE: writes name, counts 10 objects

Question 13

2 Month Milestones

Answer 13

MOTOR: eyes follow object to midline, head up prone

LANGUAGE: Vocalizes

SOCIAL: social smile, recognizes parent

Question 14

6 Year Milestones

Answer 14

MOTOR: skips with alternating legs, ties shoes, draws a person with 6 parts

LANGUAGE: identifies right from left leg

Question 15

6 Month Milestones

Answer 15

MOTOR: sits unsupported, transfers object from hand to hand, and rolls prone to supine

LANGUAGE: babbles

SOCIAL: recognizes strangers

Question 16

Retropharyngeal Abscess

Answer 16

Most common in kids 2-4 y/o via extension of pharyngeal infection, prenetrating trauma, iatrogenic instrumentation, or foreign body.

Will get fever, drooling, dysphagia, stridor, etc… May have tender enlarged cervical lymp nodes.

Question 17

Young patient with 3-days of low grade fever and runny nose followed by erythematous rash on cheeks…cause?

Answer 17

Parvovirus → erythema infectiosum or “fifths disease”

Question 18

Retropharyngeal abscess treatment

Answer 18

Cephalosporin

Antistaph penicillin

Question 19

Conjunctivitis Treatment

Answer 19

Self limited in 10-14 days, can decrease to 2-3 days with sulfonamide given locally TID

Question 20

What adolescents needs to see a cardiologist before getting cleared for their sports physical?

Answer 20

Any adolescent with the stigmata of Marfan syndrome, a murmur suggestive of HCM (heard along left sternal border that gets worse with standing or valsalva and improves with squatting), a grade 3/6 systolic murmur, or any diastolic murmur

Question 21

9 Month Milestones

Answer 21

MOTOR: pincer grasp (10 mo), crawling, cruises (walks holding furniture)

LANGUAGE: “mama”, “dada”, “bye-bye”

SOCIAL: starts to explore

Question 22

Peritonsillar abscess treatment

Answer 22

Ampcillin-sulbactam

or

clindamycin

Question 23

Signs & Symptoms of Neonatal Sepsis

Answer 23

Temperature instability

Tachypnea, grunting, nasal flaring, retractions

Hypotension

Bradycardia

Overwhelming Shock → pallor & poor cap refill

Question 24

Factors that increase risk of Early Onset GBS

Answer 24

1. Ruptured membranes > 18hr prior to delivery
2. Chorioamnionitis
3. Intrapartum fever
4. Previous infant with GBS
5. Mom < 20 y/o
6. Low birth weight or prematurity

Question 25

Treatment for suspected neonatal GBS infection?

Answer 25

IV aminoglycosides (gentamicin, tobramycin) + Penicillin (ampicillin)

Question 26

Osgood Schlatter Disease

Answer 26

Microfractures in the area of the insertion of the patellar tendon into the tibial tubercle, most common in athletic adolescents.

Get swelling, tenderness, and increase in size in the tibial tuberosity.

Question 27

Orbital Cellulitis Treatment

Answer 27

Hospital admin w/CT or MRI to determine extent of infection

IV abx

Question 28

Complications of orbital cellulitis in children

Answer 28

Cavernous sinus thrombosis

Meningitis

Brain abscess

Vision loss from increased intraorbital pressure w/retinal artery occlusion

Question 29

Febrile, ill-appearing child with proptosis and restriction of eye movement

Answer 29

Orbital cellulitis

Question 30

5 year old boy with itchy rash that was on his face as an infant but as he got older moved to his flexural areas. Rash is worse during winter.

Rash is maculopapular, red, and weepy.

Answer 30

Eczema

Initial Presentation = papulovesicular, weeping eruption that progresses to a scaly, lichenified dermatitis

From 3 mo-2 yr typical on cheeks, wrists, scalp, arms, and legs.

From 2-12 yr moves to mostly extensor surfaces

Question 31

Presentation of head lice

Answer 31

Intensely itchy scalp that can be weepy, boggy, and red.

May also get swollen posterior auricular and suboccipital LN

Question 32

Head Lice Treatment

Answer 32

Children > 6 mo: Topical ivermectin

Rid & Nix (OTC) often have resistance

Question 33

Tuberculous Meningitis

Answer 33

Most common between 6 mo-4 yrs

Stage 1 = 1-2 wk of non-specific symptoms such as vomiting, irritability, listlessness, fever, regression of milestones, etc…

Stage 2 = begins abruptly with seizures, lethargy, hypertonicity, hydrocephalus, and focal neurologic signs

Stage 3 = coma, HTN, posturing, decompensation, & death

Question 34

Leukocyte Adhesion Deficiency Type 1 (LAD-1)

Answer 34

Intact umbilical cord after 1 month

Overwhelming bacterial infections

CBC will show leukocytosis; can make diagnosis by measuring CD11b using flow cytometry

Question 35

Screening for lead poisoning

Answer 35

Blood Lead Level, preferably venous

Toxicity can occur at levels as low as 10ug/dL and EPO may not be elevated in such low-level poisonings

Question 36

Fragile X Syndrome Characteristics

Answer 36

Macrocephaly w/long face, large ears, & prominent jaw

High arched palate

Evidence of mitral valve prolapse

Macroorchidism

Pectus excavatum

Repetitive speech, gaze avoidance, and hand flapping

Question 37

1-wk old infant with transient rash = splotchy areas of erythema with a central pustule whose fluids reveal eosinophils

Answer 37

Erythema toxicum

2-3cm erythematous macules, occasionally with central yellow-white pustule

Question 38

Adolescent boy with 3-5cm red rash at nape of neck that gets more significant with exertion or emotion

Answer 38

“Salmon patch”

Aka: nevus simplex or nevus flammeus

Vascular lesions that occur on face, nuchal, and occipital regions

Question 39

3-day old African-American boy with 3mm pustules filled with milky fluid that are easily wiped away to reveal an underlying small hyper-pigmented macule

Answer 39

Pustular Melanosis

More common if African-Americans

Usually found at birth and consistent of 1-2mm pustules → hyperpigmented lesion encircled by scale after they rupture.

Question 40

1-day old with a 0.5cm oval lesion on the righ occiput that is yellowish and slighly raised, hairless, and “orange-peel” in texture.

Answer 40

Sebaceous nevi = small sharply edged lesions on head and neck of infants.

Can get malignant degernation after adolescence