Peds

Question 1

Down syndrome

Answer 1

Most common chromosomal disorder, associated with maternal age

Hypotonia, macroglosia, upslanted eyes with epicanthal folds, simian crease,
http://www.womens-health-advice.com/assets/images/photos/down-syndrome.jpg

Question 2

Patients with Down syndrome are in increased risk for:

Answer 2

ALL

ATLANTOAXIAL INSTABILITY&raquo_space; COMPRESSION OF THE SPINAL CORD&raquo_space; UPPER MOTOR NEURON SYMPTOMS

GI: Duodenal atresia, aganglionar colon

Cardio: AV cana 60% ASDs VSDs PDAs

Neuro: Early alzheimer’s

Question 3

Kallman syndrome

Answer 3

no gnrh secretion

anosmia, no puberty, short folks

Question 4

Reye syndrome

Answer 4

Aspirin in children

encephalopathy + acute liver injury [microvesicular fatty liver]

Question 5

Cat 🐱 bite

What do you do?

Answer 5

tetanus booster if > 5 y after last , amoxicillin clavulanate due to risk of p Multocida and anaerobes infection

Question 6

Jones criteria

Answer 6

Major:
––Migratory arthritis –– Carditis ––Nodules ––Erythema marginatum –– Corea
Minor:
––Fever ––Arthralgias ––Elevated ESR, PCR ––prolonged PCR
2 major or 1 major + 2 minor

Prevention: penicillin

Question 7

Mumps complication

Answer 7

aseptic meningitis
Orchitis
Parotiditis

Question 8

Subperiosteal hemorrhage involving one cranial bone:

Answer 8

Cephalomahematoma

If diffuse: caput succedaneum

Question 9

Neonate with unconjugated (indirect) hyperbilirubinemia

Answer 9

Breast milk jaundice
Gilbert’s syndrome Crigler-Najar
Erythroblastosis fetalis
Physiologic > first 24 hours

If conjugated: + Hepatomegaly : Biliary atresia

Question 10

Tricuspid valve atresia

Answer 10

Cyanotic
Left axis deviation + absent R waves
Pulmonary under-circulation

Question 11

Obssesive compulsive disorder treatment

Answer 11

Non pharm: Cognitive behavioral therapy
pHARM: High dose SSRIs

ALSO clomipramina or antipsychotic

Question 12

Treating hypernatremia

Answer 12

ONLY isotonic fluids initially

Question 13

Non-cyanotic heart defects

Answer 13

VSD
ASD
PDA

Question 14

cyanotic newborn, tachypnea, hypoxemia, single loud S2,

Answer 14

Most commonly> transposition of great vessels

Question 15

Encapsulated microorganism

Answer 15

Hib
S pneumoniae
Pseudomonas

Question 16

Ataxia telangiectasia

Answer 16

Auto recessive > ATM gene> DNA repair impairment
Cerebellar ataxia / oculocutaneous telangiectasias
↑ Cancer

Question 17

Severe combined immunodeficiency due to…

Answer 17

ADA deficiency

Question 18

Wiskott Aldrich syndrome

Answer 18

X linked recessive
↑ IgE / IgA ↓ IgM
Thrombocytopenia
(bleeding, eczema and recurrent otitis media)

Question 19

Chronic granulomatous disease diagnosis

Answer 19

Deficient superoxide production
Neutrophil count with
nitroblue tetrazolium

Question 20

Partial albinism
Peripheral neuropathy
Neutropenia

Answer 20

Chediak Higashi syndrome

X recessive > defect in neutrophil chemotaxis and microtubule polymerization

Question 21

Pilonidal disease

Answer 21

Folliculitis> mass 4-5 cm cephalad to the anus

Question 22

Avoiding confounding

Answer 22

Matching
restriction
randomization

Question 23

Tumor lysis syndrome

Answer 23

Hyperkalemia
hyperphosphatemia
hyperuricemia

Question 24

Osteosarcoma

Answer 24

common in male adolescents
No systemic symptoms
Local pain and swelling
Metaphyseal lesion!

Question 25

Hyper IgM syndrome

Answer 25

X linked / defect in the CD40 ligand ↓ IgG IgA ↑IgM

Question 26

Igs in Humoral immunodeficiencies

Answer 26

Bruton: ↓ Igs / low or absent B Lymphs Common variable: Normal B lymphs, ↓ Igs ALL hyper IgM: Normal lymphs ↑ IgM ↓ IgG IgA

Question 27

Newborn with bilious emesis/ No gas in abd Xray

Answer 27

Rule out malrotation and secondary volvulus > upper GI series > corkscrew pattern

Question 28

Lead poisoning diagnostic clue

Answer 28

GI: Abdominal pain, constipation, anorexia Neuro: peripheral neuropathy Hemato: anemia DX: Lead leves / basophilic stippling

Question 29

Lead poisoning pathophysiology

Answer 29

Disrupt heme synthesis | impaired purine metabolism > hyperuricemia

Question 30

Popliteal cyst rupture

Answer 30

Calf pain Resembling DVT Arc of ecchymosis in the medial malleolus

Question 31

Boerhaave syndrome

Answer 31

Transmural tear Esophagography with gastrofin or CT: leakage Pleural effusion: exudate, very high amylase, low pH

Question 32

Duodenal atresia highly associated with

Answer 32

Down syndrome

Question 33

Acute interstitial nephritis

Answer 33

New drug > penicillins, TMP SMX, cephalosporin Rash / fever / new drug exposure / arthralgias AKI, EOSINOPHILIA, urinary eosinophils, WBC casts

Question 34

Huntington's chorea

Answer 34

Auto dominant Chorea/behavioral changes/dementia Atrophy of the caudate nucleus (neuroimaging> enlarged lateral ventricles)

Question 35

Superficial unilateral hip pain | exacerbated by external pressure to the upper lateral thigh

Answer 35

Trochanteric bursitis

Question 36

Neurofibromatosis type I

Answer 36

``` Autosomal dominant Café au lait spots lisch nodules NEUROFIBROMAS optic glioma ```

Question 37

Pseudocyesis

Answer 37

Somatization Early pregnancy symptoms > negative paraclinics PSYCH

Question 38

Ureteral stones <10 mm treatment

Answer 38

Supportive | consider alpha blocker > Tamsulosin alpha 1 blocker

Question 39

Hoarding disorder

Answer 39

OCD accumulation Tx: Cognitive behavioral therapy

Question 40

Beckwith Wiedemann syndrome (clues and complications)

Answer 40

overgrowth syndrome Macroglossia/ hemihyperplasia / umbilical hernia ↑Risk > Wilms tumor hepatoblastoma > abd US and AFP

Question 41

Strabismus after 4 months treatment

Answer 41

Occlusion of normal eye

Question 42

Renal carcinoma

Answer 42

flank pain scrotal varicocele paraneoplastic > anemia, thrombocytosis, fever, hypercalcemia, cachexia DX: Abdomen CT

Question 43

Chronic prostatitis

Answer 43

Pain in pelvis perineum or genitalia irritative voiding symptoms pain with ejaculation sterile urine symptoms

Question 44

Mini mental state examination: dementia when

Answer 44

<24 / 30

Question 45

Alzheimer's brain imaging findings

Answer 45

Early findings: normal | late stages: cortical and subcortical atrophy (worse in parietal, temporal and hippocampi)

Question 46

After diagnosing brain death doctors needslegal authorization to stop vital support?

Answer 46

No | Brain death is a legally acceptable definition of death

Question 47

Pinworm (entrobius vermicularis) treatment

Answer 47

Albendazon OR pyrantel pamoate

Question 48

Parkinsonism with risperidone treatment

Answer 48

Low dose If not effective> Benztropine (Anticholinergic) or amantadine

Question 49

Acute dystonia treatment

Answer 49

Benztropine OR diphenhydramine

Question 50

Positive first trimester aneuploidy screening, next step:

Answer 50

15 weeks: Amniocentesis | 10-13 weeks: chorionic villus sampling

Question 51

Systolic ejection murmur in pregnancy, workup?

Answer 51

No | Normal

Question 52

Mitral regurgitation murmur in pregnancy

Answer 52

Echo

Question 53

Histoplasma capsulatum prophylaxis in HIV

Answer 53

<150 CD4 and Ohio Mississippi river valleys areas

Question 54

Respiratory alkalosis causes:

Answer 54

Hyperventilation high altitude salicylate intoxication

Question 55

Osteogenesis imperfecta clues

Answer 55

Blue sclerae hearing loss recurrent fractures opalescent teeth

Question 56

History of preterm labor, intervention?

Answer 56

Progesterone injections and TVUS-Cervical Length till week 24

Question 57

Fibromyalgia with no improvement after exercise program

Answer 57

Tricyclic antidepressants > if not improvement | SNRI (duloxetine, milinacipran) OR pregabalin

Question 58

Aspirin exacerbated respiratory disease

Answer 58

Asthma Chronic rhinosinusitis Nasal polyposis exacerbation if NSAIDS or aspirin

Question 59

Other findings in hypothyroidism

Answer 59

Hypercholesterolemia hyponatremia ↑ CK and Transaminases

Question 60

Acute angle closure glaucoma

Answer 60

sudden onset eye pain headache nausea