Peds

Question 1

additional risk factors for slipped capital femoral epiphysis

normal age for SCFE

Answer 1

endocrinopathies like hypothyroid, GH deficiency, renal failure and radiation history

-these pts usually have bilateral disease and present at earlier age

normally 10-16

Question 2

TB meningitis

WBC count
glucose
protein

Answer 2

wbc = 5-1000

glucose <10

protein >250

Question 3

what test should be performed at the time of dx of Kawasaki disease

Answer 3

echocardiogram

Question 4

the best diagnostic approach in sx children with rapidly increasing head circumference is what

Answer 4

CT scan

Question 5

what bleeding disorder presents with predominatly easy mucosal bleeding, ecchymoses or petechiae

Answer 5

VWd

Question 6

Foodborne botulism differes from infantile how

Answer 6

Prodrome of N/V, abdominal pain and diarrhea

Question 7

absence seizures

muscle tone?
comorbidities?
treatmetn

Answer 7

preserved muscle tone

ADHD
anxiety

ethosuximide

Question 8

McCune albright syndomre characterized by what

Answer 8

Precocious puberty, Pigmentation (cafe au lait spots) polyostotic fibrous dysplaiaand multiple bone defects

associated with endocrine disorders

Question 9

deficiency of niacin vitamin ____ causes what

Answer 9

B3

pellagra = diarrhea, dermatitis, and dementia, can lead to death if sever

can be seen in people with bowel disease that interferes vitamin absorption

Question 10

classic lab findings in sJIA

Answer 10

leukocytosis, thrombocytosis, and elevated inflammatory markers and anemia from chronic inlfmmation

Question 11

chest x ray: diffuse reticulogranular appearance, air bronchograms, low lung volume

sx

Answer 11

RSD

tachypnea
grunting
nasal falring
retractions

Question 12

complications of prematurity

Answer 12

RSD
PDA
bronchopulmonary dysplasia
IVH
NEC
retinopathy of prematurity

Question 13

second most common tumor in children and sx

Answer 13

medulloblastoma

infratentorial = comit, ha, ataxia

Question 14

Dx?

Bilateral bulbar palsies (eg ptosis, sluggish pupillary response to light, poor suck and gag reflexes) then descending flaccid paralysis

Tx

Answer 14

Botulinism

Tx: botulinism immune globulin

Question 15

biphasic stridor that improves with neck extension
can also have dsphagia, vomit, difficulty feeding

50% of pts also have what

Answer 15

vascular ring

aoritc arch developed wrong and wraps around trachea and esophagus

50% of pts have VSD or TOF

Question 16

if untreated splenic sequestration can progress to what

lab findings

Answer 16

hypovolemic shock bc lots of total blood volume trapped in the spleen

normocytic anemia, elevated reticulocyte count, thrombocytopenia

Question 17

newborns are born with a larger RV compared to LV bc the RV pumps systemic blood via the PDA which appears as what deviation and what waves

Answer 17

physiologic right axis deviation and R waves in V1-V3

Question 18

girl with turner syndrome and bones

Answer 18

decreased bone mineral density bc of no estrogen

increased risk of osteoperosis

Question 19

another name for osgood schlatters disease

path

pe

tx

Answer 19

traction apophysitis

periods of rapid growth in which quads tendon puts traction on apophysis of the tibial tubercle where patellar tendon inserts

PE: edema and tenderness over tibial tubercle
reproduce pain by extending knee against resistance

rest and nsaids

Question 20

____ should be suspected in any pt with continued ear drainage for several weeks despite appropriate antibiotic therapy

description

can lead to what ominous things

Answer 20

cholesteatomas

retraction pocket in the tympanic membrane, which can fill with granulation tissue and skin debris

hearing loss and life threat brain abscesses or meningitis

Question 21

when do you transfuse bili baby

Answer 21

at 20-25 total bili

Question 22

if body is pink in newborn but extremities or cyanotic is this normal?

Answer 22

yes

Question 23

when are parents not allowed to make medical decsiion for child

Answer 23

when there is a life saving treatment available for the child

Question 24

intrinsic pathway factors and what pt or ptt

Answer 24

aptt

XII, XI, IX, VIII, X

extrinsic pt
7 and 10

Question 25

abduction and internal rotation of hip limited in what disease

Answer 25

LCP ABIR limited in LCP

Question 26

x linked agammaglobulinemia cx manifestations dx tx

Answer 26

cx: recurrent sinopulmonary and GI infections after age 6 absence of lymphoid tissue on exam (tonsils LNs) dx: decreased Igs and B cells, normal T cells, no response to vaccines tx: IG replacement therapy, prophylactic antibiotics if severe

Question 27

____ is used to diagnose urinary refulx, what pt would need this

Answer 27

voiding cystourethrogram pts with recurrent urinary tract infections

Question 28

abnormal sexual behavior in preadolescents

Answer 28

repeated object insertion into vagina or anus sex play force threats or bribes in sex play age inappropriate sexual knowledge

Question 29

cyanosis, and dark chocolate colored blood standard pulse ox readings are low normal arterial partial pressure of oxygen** >5% difference btwn oxygen saturation on pulse ox and ABG

Answer 29

methemoglobenimea

Question 30

methemoglobinemia is most commonly acquired after what physiology of it or biochem of it not sure which subject it is but who cares

Answer 30

excessive exposure to an oxidizing agent like dapsone, nitrites, and local/topical anesthetics Fe2+ iron gets oxidized to ferric Fe3+ which has decreased affinity for oxygen but the remaining 3 ferrous sites have an increased oxygen affinity which leads to decreased oygen delivery to peripheral tissues due to poor oxygen affinity of methemoglobin O2 supplementation does not help bc arterial blood gas testing analyzes unbound arterial oxygen the PaO2 is normal and overestimates degree of true oxygen saturation

Question 31

abnormal social development and extreme behavioral rigidity, with onset in early development. higher functioning individuals with normal language and intellectual ability may present later when deficits become more paparent with increased social demands

Answer 31

autism

Question 32

what age group would you find breath holding spells

Answer 32

6 months to 6 years

Question 33

strawberry hemangioma is also what name tx

Answer 33

superficial hemangioma regress spontaneously

Question 34

what should be suspected in a cyanotic infant with left axis deviation and small or absent R waves in the precordial leads? what is needed for survical

Answer 34

tricuspid valve atresia lack of communication btwn right heart chambers = hypoplastic right ventricle and diminished RV forces on ECG the lack of blood flow to RV and pulmonary outflow tract = underdevelopment of pulmonary valve and or artery = decreased pulmonary markings on chest x ray associated ASD and VSD are needed for survival

Question 35

gaucher disease is due to ___ deficiency cx features loss of milestones?

Answer 35

glucocerebrosidase def HAT HSM, anemia, thrombocytopenia no loss of milestones or red macula

Question 36

neonatal treatment for RSD

Answer 36

maternal antenatal glucocorticoids continuous ppv intubation if severe

Question 37

what disease gives a maculopapular polymorphous rash after administration of ampicillin or amoxicillin

Answer 37

EBV

Question 38

chest xray for transient tachypnea of newborn path resolves when

Answer 38

bilateral perihilar linear streaking think liquid bc alveolar fluid clearance inadequate resolves by day 2 of life

Question 39

if pt with sinus infection gets periorbital edema, vision abnormalities or AMS then what management step

Answer 39

CT

Question 40

cholesteatoma causes sx what you see complications

Answer 40

genetic (younger pt) acquired usually occur secondary to chronic middle ear disesease cont ear drainage for sev weeks despite approp abx therapy granulation tissue and skin debris lead to hearing loss, CN palsies, vertigo, life threat brain infections *new onset hearing loss or chronic ear drain with abx therapy

Question 41

when a radiolucent foreign body is suspeected and not visualized on x-ray, ____ can be considered as the next diagnostic procedure

Answer 41

CT

Question 42

which kind of cerebral palsy is most common in preterm infants cx features resistance to what

Answer 42

spastic diplegia hypertonia, and hyperreflexia mainly LEs with both feet pointing down and inward (equijnovarus deformity) resistance to passive muscle movement

Question 43

optic pathway glioma in what dissease in children

Answer 43

NF type 1

Question 44

colon in meconium ileus

Answer 44

narrow, underdeveloped colon (microcolon)

Question 45

hurler syndrome is due to what deficiency? age presentation? cx features?

Answer 45

lysosomal hydrolase deficiency age 6 months to 2 years coarse facial features, inguinal or umbilical hernias, corneal clouding, and HSM

Question 46

diagnostic features of acute bacterial rhinosinusitis

Answer 46

persistent sx 10 days of more without improvement or severe sx with 102 fever, purulent nasal discharge or face pain 3 days or more or worsening sx 5 days after initially improving viral URI

Question 47

child with conjunctival injection, tarsal inflammation, and pale follicles are concerning for what types spreads in what conditions what kind of conjunctivitis concomitant what last thing real bad

Answer 47

trachoma chlamydia trachomatis serotypes A B and C which is leading cause of blindness worldwide spreads in crowded conditions follicaular conjunctiivits concomitant nasophayngeal infection scarring of eyelids

Question 48

celiac disease extraintestinal sx

Answer 48

fatigue IDA from poor absorption 2ndary to duodenal villous atrophy dermatitis herpetiformis located on knees, elbows, forearms, and buttocks

Question 49

legg clalve perthes disease is what and affects what pop

Answer 49

5-7 yrs in the LCP idiotpathic AVN of hip

Question 50

erythema tocicum neonatorum

Answer 50

healthy baby and asx papules and pustules common in full term neonates spares palms and soles in first 2 weeks of life goes away on own

Question 51

treatment for severe pneumonia in CF pts

Answer 51

empritic antistaph antibiotics like Cefepime (covers MSSA and psuedomonas) MRSA coverage with IV vancomycin

Question 52

treatment of sJIA

Answer 52

glucocorticoids, NSAIDs, biologic agents

Question 53

NF1 inheritance what gene, what protein what cx features

Answer 53

AD NF1 neurofibromin cafe au lait macules, freckling and lisch nodules low grade optic pathway glioma in 15% of pts under 6

Question 54

ependymoma what cells, location sx

Answer 54

glial cell tumor that arise in ventricles and spinal cord 4th ventricle in posterior fossa common in children tumor expansion leads to obstruction of CSF and increased ICP

Question 55

asthma pts with respiratory failure despite escalation of medical treatment require

Answer 55

endotracheal intubation and mechanical ventilation

Question 56

risk factors for cerebral palsy

Answer 56

``` prematurity IUGR Intrauterine infection antepartum hemorrhage placental path multiple gestation maternal alcohol consumption and tobacco ```

Question 57

disesae with low IgM IgA IgG in the normal B lymphocyte count

Answer 57

common variable immunodeficiency

Question 58

what increases HCOM murmur what inheritance and pop

Answer 58

valsalva bc decreases preload and abrupt standing and nitroglycerin AD in blacks

Question 59

how can OM with effusion be distinguished from AOM

Answer 59

om with effusion has lack of acute inflammaotry signs

Question 60

ewings sarcoma common sites metastasis age appearance

Answer 60

metaphysis and diaphysis of the femur, followed by the tibia and humerus lungs and LNs white males, 0-20 lamellated appearance, o onion skin periosteal rxn, lytic cental lesion moth eaten appearance

Question 61

midgut volvulus classically presents in what pop and how

Answer 61

neonate under 1 month with bilious vomiting can cause bloody stools, bowel perforation, abdominal distension and peritonitis signs of ischemia or systemic decompensation are indication for emergency laparotomy

Question 62

universal screening for dyslipidemia in children at what age

Answer 62

9-11 and 17-21 pre and post puberty

Question 63

the thymus is normally visible on chest x rays in children under what age

Answer 63

3 sail sign bc looks triangular, scalloped and dense

Question 64

dx pertussis tx

Answer 64

pertussis culture or PCR lymphocyte predominant leukocytosis macrolides

Question 65

bartonella henselae cx manifestations tx type of bacteria

Answer 65

papule at scratch/bite site regional adenopathy +/- fever of unknown origin for 14 days or more azithromycin gram neg bacillus affected lns are enlarged, tender and have overlying erythema

Question 66

cyanosis and respiratory distress during feeding that improves when infant cries

Answer 66

bilateral choanal atresia

Question 67

dermal melanocytosis aka what occurs in what pop where are they located, what do they look like nad tx

Answer 67

mongolian spot lower back and buttocks native americans, africans, asians, hispanices fades spontaneously look like brusies but bruises are more varied in color and fade quickly

Question 68

infected infants of toxo should receive what

Answer 68

pyrimethamine, sulfadiazine, and folate for a year

Question 69

hepatitis B pt can have what renal disease

Answer 69

membranous nephropathy

Question 70

pts with galactoinase deficiency present with what

Answer 70

cataracts only

Question 71

evaluation of primary amenorrhea

Answer 71

pelvic US: uterus present---> serum FSH - increased = karyotype - decrease = cranial MRI US: uterus absent--->karyotype serum testosterone too - if 46 xx and normal test = abnormal mullerian devel - if 46, xy and normal test level = AIS

Question 72

Chronic granulomatous disease results from what susceptible to what organisms test

Answer 72

inability of phagocytes to produce hydrogen peroxide in their lysosomes abscesses due to fungi or catalase positive bacteria like s aureus, serratia, burkholderia, aspergillus dihydrohodamine 123 test nitroblue terazolium test

Question 73

idiopathic precocious puberty gender LH and GnRH

Answer 73

girls | basal levels of LH elevated and wil increase with GnRH stimulation

Question 74

dx of Kawasaki:

Answer 74

pt should have fever for 5 consecutive days as well as 4 of 5 of the following 1) conjunctivitis, spares limbus 2) oral mucosal changes with erythema, fissured lips, strawberry tongue 3) rash 4) extremity changes, erythema, edema, desquamation of the hands and feet 5) cervical LAD: >1.5 cm, usually unilateral

Question 75

major criteria acute RF

Answer 75

JONES ``` joins (migratory arthritis) O (carditis) nodules (subcut) erythema marginatum sydenham chorea ```

Question 76

iron poisoning dx

Answer 76

iron is radiopaque and can be visualized on abdominal xray aspirin similar but doesn't show up on xray

Question 77

truncus arteriosus is strongly associated with what

Answer 77

Digeorge syndrome

Question 78

____ is characterized by severe pain, pallor, poikilothermia, paresthesias and late findings of pulselessness and paralysis

Answer 78

comparment syndrome

Question 79

chronic oligoarthritis, daily fever and rash in child what kind of disease almost all pts with it present with what

Answer 79

systemic onset juvenile idiopathic arthritis sJIA auto-inflammatory 2 weeks of fever occuring once a day, arthritis of 1 or more joints and a pink macular rash that worsens with fever joint pain worse in morngin and better as day goes on

Question 80

clinical manifestations of late onset CAH aka non classic

Answer 80

premature adrenarche/pubarche, severe chystic acne resistant to treatment, accelerated linear growth, advanced bone age normal electrlyts

Question 81

nephrotic syndrome in a pt with hepatitis B infection what kind

Answer 81

membranous nephropathy

Question 82

posterior fossa tumor typically presents with what

Answer 82

cerebrellar dysfunction (ataxia, dysmetria)

Question 83

how does neonatal polycythemia effect hematocrit which effects other stuff

Answer 83

hematorcrit rises with plycythemia which increases viscosity of the blood and impairs blood flow to various organs

Question 84

celiac disease is associated with what other diseases and should be screened for in these ptws how to screen

Answer 84

DM1 and thyroiditis screen with anti-tissueTG antibody IgA followed by endoscopic duodenal biopsy for conifrmation

Question 85

gold standard for testing for duchennes muscular dystrophy and what is finding

Answer 85

genetic testing -will find muscle biopsy with absent dystrophin deletion of dystrop[hin gene on Xp21 x linked recessive

Question 86

infant or newborn with failure to thrive, bilateral cataracts, jaundice and hypoglycemia has what pts at increased risk for what infection tx

Answer 86

galactosemia from galactose-1-phosphate uridyl transferase deficiency (GPUT) increased blood galactose levels increased risk for E coli elimante galactose from diet

Question 87

angiokeratomas, perpiheral neuropathy, and asx corneal dystrophy renal and heart failure possible to and risk thromboembolic events

Answer 87

fabrys diseae FABRY ball CAP (corneal dys, angioker, periph neuorp) KC (kidney and cardiac failure)

Question 88

otitis externa -micro infection clinical manfest tx

Answer 88

pseudomonas staph aurues -swimmers ear pain with auricle manipulation, pruritus, discharge tx: topical antibiotic (fluoroquinolone topical glucocorticoid

Question 89

testicles that have not descended by age what are unlikely to descend spontaneously and require surgery at the optimal age of what (orchiopexy)

Answer 89

6 months | 1 year

Question 90

beckwith wiedemann syndrome pathogenesis (what chrom) PE complications survellance

Answer 90

deregulation of imprinted gene expression in chrom 11 PE: fetal macrosomia, rapid growth unitl late childhood - omphalocele or umbiical hernia - macroglossia - hemihyperplasia complications: wilms tumor or hepatoblastoma surveillance: AFP and abdominal/renal US monitor hypoglycemia, which is transient

Question 91

treatment for HSP

Answer 91

supportive with hydration and NSAIDs for most pts hospitalization and systemic glucocorticoids in pts with severe symptoms

Question 92

orbital cellulitis location, bugs, clinical manifestations

Answer 92

posterior to orbital septum staph oaureus, strep pneumo and other streptococci possible abscess within the orbit or brain, blindness, or sinus venous thrombosis ophthalmoplegia, pain with extraocular movements, proptosis, virison impairment

Question 93

inherited forms of QT prolongation and inheritance sx tx standard mild sx sx with history of syncope

Answer 93

jervell lange nielsen AR romano ward syndome AD syncope, life threatening ventricular arrhytmias like torsades and sudden death avoid exercise, certain meds, normal calcium, K+, and Mg+ beta blockers like propranolol shorten QT if sx with history of syncope then need b blocker and pacemaker placement

Question 94

treat diamond blackfan syndrome

Answer 94

corticosteroids, and transfucsion if needed

Question 95

biliary atresia presents when and with what

Answer 95

early infancy with obstructive jaundice and acholic stools and is fatal without intervention

Question 96

guillain barre syndrome pathology sx final stage accompanying sx tx

Answer 96

demyelination of the peripheral motor nerves ascending weakness accompanied by feet tingling and neuropathic pain final stage is flaccid paralysis with absent DTRs and nerve conduction velocities accompanying autonomic sx can occur pooled IG or plasmapheresis

Question 97

carotid pulse with a dual upstroke is what what other murmur

Answer 97

HCM and also systolic ejection murmur along LSB with strong apical impulse bc LVOT

Question 98

erythema multiforme is seen most commonly in what infection

Answer 98

herpes simples

Question 99

all infants, regardless of maternal screen results should receive what for eyes and infections

Answer 99

topical prophylaxis within an hour of birth prevents gonococcal disease erythromycin ointment

Question 100

maternal estrogen effects in mnewborns

Answer 100

breast hypertrophy in boys and girls swollen labia physiologic leukorrhea uterine withdrawal bleed

Question 101

medulloblastoma occurs where and causes what

Answer 101

posterior fossa in children | infratentorial in cerebrellar vermis and presents with vomiting, HA, ataxia

Question 102

0758 and 590

Answer 102

reveiew

Question 103

juvenile idiopathic arthritis cx features poly vs oligo which joints involved

Answer 103

symmetric arthritis for at least 6 weeks polyarticular is 5 or more joints oligoarticular is less than 5 knees, wrists, ankles, cervical spine and joints in hands and feet

Question 104

what is a side effect of hydroxyurea (major)

Answer 104

myelosuppression, predisposes pt to infection

Question 105

c trachomatis neonatal conjunctivits occurs when and what type of discharge

Answer 105

5-14 days after birth, watery discharge

Question 106

granulosa cell tumor of the ovary cx featuers in child

Answer 106

precocious puberty increased estrogen pelvic US shows ovarian mass, thickened endometrium

Question 107

edwards syndrome clinical features head limbs organs

Answer 107

micrognathia prominent occiput low set ears clenched hands with overlapping fingers renal defects heart defects (VSD) limited hip abduction rocker bottom feet

Question 108

inspiratory stridor that worsens while supine what helps

Answer 108

laryngomalacia prone helps

Question 109

marfanoid habitus has which direction displacement of lens? how about homocystinuria? what protein? inheritance?

Answer 109

upward (homocystinuria is AR that has displacement down) fibrillin 1 AD

Question 110

is prophylaxis recommended for all close contacts for pertussis

Answer 110

yes, use macrolides even if vaccinated

Question 111

11B hydroxylase def

Answer 111

same as 21 but no salt wasting, have HTN and salt retention from increased 11 deoxycorticosterone

Question 112

normal features of LNs feels mobile or not mobile size

Answer 112

soft mobile under 2 cm

Question 113

cx presentation of measles

Answer 113

prodrome of cough coryza, conjunctivitis fever, koplik spots maculopapular rash that starts head and goes down

Question 114

wet diapers in neonates

Answer 114

how ever many days old is how many wet diapers should be up to first week. after first week should have 6 or more

Question 115

due to its location, supracondylar humerus fractures may be complicated by ___ injury or ____

Answer 115

neurovascular injury or compartment syndrome

Question 116

prolonged pt and aptt in newborn from what

Answer 116

vitamin k deficiency

Question 117

21 hydroxylase deficiency hormonal abnormalities sx

Answer 117

decreased aldosterone and cortisol increased testosterone increased 17 0h progest sx: ambig genitals in girls, salt wasting with hypotension and decreased na and increased K

Question 118

caustic injury first and scond steps

Answer 118

remove contaminated clothing and then do upper GI endoscopy within 24 hours

Question 119

type of strabismus that usually arises in children age <2 and is associated with eye deviation when trying to focus on objects

Answer 119

accommodative esotropia

Question 120

causes of edema in turner syndrome pt

Answer 120

congenital lymphedema from abnormal development of the lymphatic netowrk accumulation of pretein rich interstitial fluid in hands, feet and neck (webbed neck) severe obstruction of lymphatic vessels can lead to cystic hygroma of neck and fetal hydrops

Question 121

The most common congenital heart malformation is what Murmur?

Answer 121

VSD Holosystolic murmur at left lower sternal border

Question 122

adolescent with a solitary breast mass most likely has what what kind of tenderness is common management

Answer 122

FAD premenstrual observation in adolescents -check one cycle later then if decreased reassure US for a persistent mass or older pt

Question 123

using ___ in pregnancy causes long smooth philtrum, small palpebral fissures and thin upper lip and also ____

Answer 123

alcohol CNS abnormalties like mental retardation

Question 124

infants of diabetic mothers second trimester problems

Answer 124

fetal pancreas sufficient so now increased storage causes organomegaly, incrased GF (macrosomia) and increased oxygen consumption (polycythemia)

Question 125

what is a GnRH stimulation test used for

Answer 125

evaluation of precocious puberty

Question 126

pts with known or suspected measles should be what when to give vaccine

Answer 126

isolated and placed in airbrne precautions 2 doses (age 1 and 4) give btwn age 6 and 11 momths if suspected travel

Question 127

truncus arteriosus strongly associated with what syndrome and sx

Answer 127

digeorge neonatal cyanosis, heart failure and systolic ejection murmur with a loud ejection click at LSB

Question 128

anatomical injury mech with shaken baby syndrome sx dx

Answer 128

repetitive acceleration-deceleration forces cause shearing of the dural veins and coup-contrecoup injury with brain impact on the skull subdural bleed can manifest as seizures, increased head circumference, bulging anterior fontanelles and AMS also causes vitreoretinal traction and RETINAL HEMORRHAGES (pathognomonic) dx: CT without contrast and skeletal survey

Question 129

inattentive staring spell

Answer 129

occurs during boring activity variable length over 1 minute respond to stimulus no automatisms

Question 130

intussusception presents how dx tx

Answer 130

intermittent periodic pain associated with drawing the legs up toward the abdomen, emesis may follow sausage shaped mass in RUQ US to detect, use air enema to treat

Question 131

what can cause neonatal polycythemia

Answer 131

increased EPO from intrauterine hypoxia: maternal diabetes, hypertension, or smoking: IUGR pre-eclampsia delayed cord clamp, t-t transfusion hypothyroidism or hyper, trisomies

Question 132

juvenile idiopathic arthritis laboratory findings

Answer 132

elevated inflammatory markers hyperferritenemia, and hypergammaglobulinemia thrombocytosis ANEMIA (chronic inflammation and IDA), inflammatory markers increase hepcidin which prevents absoprtion of iron

Question 133

milk or soy protein induced proctocolitis pt pop sx (triad) from what tx

Answer 133

infants non IgE immune respone to proteins in formula or breast milk that cause rectal and colonic inflammation eczema, regurgitation or vomit and painless bloody stools mom elimate all dairy and soy from diet when breast feeding

Question 134

evaluation of bilious emesis in the neonate first thing you do then next thing

Answer 134

stop feeds NG tube decompression IV fluids abdominal x-ray

Question 135

positive nikolsky sign erythema on face and generalizes within 24-48 hrs superficial bullous

Answer 135

SSSS

Question 136

xrays for osteosarcoma show what

Answer 136

mix of radiodense and radiolucent areas

Question 137

weird GI thing that can happen in HSP location dx tx

Answer 137

intussusception small bowel or ileo ileal dx by presence of a target sign on ulstrasound -ileal ileal cannot usual be fixed with air enema and need surgery

Question 138

bedwetting is normal before age what

Answer 138

5

Question 139

treatment for umbilical hernia gastroschisis omphalocele

Answer 139

umbilical hernia: monitor for spontanseous resolution by age 5 other 2 need immediate surgery after birth

Question 140

polyhydramnios and vomiting with inital feeds with no RD abdomen not distended and intestinal gas absent on xray

Answer 140

duodenal atresia

Question 141

if have cryptorchid gonads what should you do in AIS

Answer 141

perform gonadectomy after puberty can become dysgerminoma, gonadoblastoma after puberty still want testosterone for normal height so do not removed till after puberty

Question 142

breastfeeding failure jaundice timing pathophys cx features

Answer 142

first week of life lactation failure results in decreased billy elimination, increased enterohepatic circulation of billy suboptimal breastfeeding and signs of dehydration (brick red urate cystals, decreased urine output and losing weight) jaundice

Question 143

in congenital diaphragmatic hernia what is next step hfter airway has been secured

Answer 143

nasal or orogastric tube to provide continuous suction and prevent bowel distension against the lungs also umbilical arterial line and venous cath should be placed

Question 144

evaluation of primary amenorrhea steps 1) ___ or ____ if uterus absent then what

Answer 144

pelvic exam or US uterus absent karyotype and serum testosterone - 46 xy = AIS - 46 xx = Abnormal mullerian development

Question 145

howell jolly bodies are what and seen in what

Answer 145

nuclear remnants within red blood cells that are typically removed by the spleen single round blue inclusions on wright stain presence of them indicates physical absense of spleen or functional hyposplenism due to splenic autoinfarction or splenic congestion

Question 146

birth weight and loss in neonates

Answer 146

may lose up 7% of birth weight in first 5 days and it should be regained by age 10-14 days

Question 147

differential for lytic bone lesion in a child if have hypercalcemia narrows to what

Answer 147

infectious osteomyelitis endocrine: hyperparathroid oseitis fibrosa cystica neopalstic: ewing, langerhans cell histocytosis, metastasis idiopathic narrow to lytic bone neoplasm or hyperpatathyroid state (pituitary adenoma most common but occurs in pts over 50)

Question 148

what kind of seizures have automatisms length of these seizures?

Answer 148

absence seizures last under 20 seconds

Question 149

cx features of biliary atresia

Answer 149

well appearing at first followed by development of the following over 1-8 weeks jaundice, acholic stool or dark urine, hepatomegaly, increased hyperbili, mild elevation transaminases

Question 150

tx for AOM

Answer 150

initial is amoxicialin 2nd line is amox clav

Question 151

evaluation of bilious emesis in the neonate get abdominal x ray and see no evidence of free air and the bowel gas pattern is not suggestive of duodenal atresia or distal obstruction then

Answer 151

upper GI series (barium swallow) fastest way of diagnosin midgut volvulus with malroation ligmanet of treitz on right = malrotation corkscrew pattern = volvulus

Question 152

uric acid crystals in diapers with pink stains or brick dust in neonatal diapers abnormal?

Answer 152

no this is normal

Question 153

most appropriate step in a 1 month old with VSD

Answer 153

echo to assess the size if small spont close by age 2 usually with no long term sequelae large defects have softer murmur bc of leess turbulence -eisenmenger syndrome

Question 154

pt with turner syndrome are at risk for decreased what due to what

Answer 154

bone mineral density bc lack estrogen increased risk of osteoporosis

Question 155

atresia of the jejunum or ileium is thought to occur due to what sign

Answer 155

vascular accident in utero vasoconstritive meds like coaine and tobacco sign is triple bubble sign and gasless colon on xray

Question 156

most common bufs for AOM

Answer 156

strep pneumo H influeznae moraxella catarrhalis

Question 157

hemoglobin SC

Answer 157

type of sickle cell where you inherit C and S similar complications like pain crises as SS but less often and less severity splenic sequestration/infarction happens in adolescence rather than childhood

Question 158

is lymphedema in turners pitting or non pitting

Answer 158

non pitting

Question 159

treatment for radial head subluxation (nursemaid's elbow)

Answer 159

hyperpronation of forearm or supination of forearm and flexion of elbow

Question 160

classic presentation of slipped capital femoral epiphysis

Answer 160

metaphysis and proximal femur slip relative to epiphysis at epiphyseal plate obese adolescent male with complaints of pain

Question 161

kallman syndrome is what inheritance and cx features

Answer 161

x linked recessive normal genotype absence of GnRH = short, and delayed or absent puberty amenorrhea, absent breast development anosmia hyposmia

Question 162

most children are ready to begin toilet training at age what

Answer 162

2 or older

Question 163

laboratory findings in hemophilia A and B PTT platelet bleeding time PT

Answer 163

PTT prolonged | normal platelet, bleeding time and PT

Question 164

vesicoureteral reflux ``` grade I II III IV V ```

Answer 164

I: into nondilated ureter II: into pelvis and calyces without dilation III mild to mod dilation of ureter, renal pelvis and calyces with min blunting of fornices IV moderate ureteral tortuosity and dilation of pelvis and calyces V: gross dilation of ureter, pelvis and calyces, loss of papillary impressions, ureteral tortuosity

Question 165

management of primary nocturnal enuresis which is most effective long term intervention of these

Answer 165

``` lifestyle change enuresis alarm (most effective long term intervention) UA to r/o secondary causes ``` Desmopressin therapy if above does not work TCAs only if desmopressin does not work bc of AEs

Question 166

painful vesicular rash with punched out erosions and hemorrhagic crusting

Answer 166

eczema herpeticum superimposed primary herpes simplex virus infection open area that is exposed to HSV type 1 can develop painful vesicles with erythemaouts base that evolve to punched out erosions with hemorrhagic crusting

Question 167

pt has abnormal uterine bleeding defined as what during adolescence. what causes it

Answer 167

menstrual bleeding under 21 days or over 45 days apart immaturity of HPO axis fails to produce correct ratios of gonadotropin releasing hormone and therefore LH and FSH to induce ovulation first few years post menarche, majority of menstrual cycles are anovulatory and present as painless, irreg, heavy bleeding no progesterone in anovlulatory cycles

Question 168

normal sex beahvior in preadolescents: toddlers

Answer 168

EMU explore own or other genitals masturbate undressing self or others

Question 169

purple or red eardrum +/- bulging

Answer 169

hemotympanum

Question 170

chest radiograph sowing diffuse reticulogranular pattern and air bronchograms is what

Answer 170

RDS

Question 171

optic pathway glioma found in what pts

Answer 171

NF1 can cause decreased visual acuity, alterations in color vision, optic nerve atophy and proptosis

Question 172

transient synovitis typically presents in what pop and cx features tx follows what on exam hip is what

Answer 172

kids 2-8 with restricted ROM of hip joint, resolves with conservative therapy follows viral infection or mild trauma hip flexed, slightly abducted and externally rotated FABER Tran Sexuals

Question 173

complications of prader-willi syndrome feeding pattern: infancy and later

Answer 173

sleep apnea DM gastric distension/rupture death by choking poor suck and feeding problems in infancy followed by a life of compulsive binge eating

Question 174

acute lymphoblastic leukemia other features with it peripheral smear degree of what diagnostic peroxidase positive granules positive for what

Answer 174

30-50% pts present with infections 1/2 have splenomegaly of LAD lymphoblasts on perioph smear vary degree of anemia, neutropenia, thrombocytopenia presence of more than 25% lymphoblasts in BM diagnostic no peroxidase posigve granules PAS positive TdT positive

Question 175

fungal infection of scalp that causes pruritc patchy, fine, white scales that may resemble SD does not involve what and not age

Answer 175

tinea capitits no eyebrows or nasolabial folds not common first year of life

Question 176

fanconi anemia blood stuff age clinical sx

Answer 176

progressive pancytopenia and macrocytosis age 8 is average age cafe au lait spots, microcephaly, microphthalmia, short stature, horseshoe kidneys and absent thumbs

Question 177

what is the most common causes of chronic renal insufficiency/failure in children and occurs in what population anatomy

Answer 177

posterior urethral valves causes obsturction distended bladder, ureters and hydronephrosis only in boys

Question 178

supratentorial tumor presents with what

Answer 178

seizures, weakness, and sensory changes

Question 179

minor criteria in acute RF

Answer 179

P FACE Prolonged PR Fever Arthralgias CRP up ESR up

Question 180

what kind of blood penia should raise concern for malignancy

Answer 180

thrombocytopenia

Question 181

comorbidities with cerebral palsy

Answer 181

intellectual disability epilepsy strabismus scoliosis

Question 182

congenital toxoplasmosis what risk factors

Answer 182

undercooked meat unwashed fruits/veggies cat feces cx: macrocephaly, intracranial calcifications, jaundice, HSM, blueberry muffin spots

Question 183

congenital diaphragmatic hernia is what __ from esophag compresion PE tx

Answer 183

herniation of abdominal viscera into chest making pulmonary hypoplaia and PHTN 85% of cases on left polyhydramnios can occur from esophageal compression causes concave abdomen and barrel shaped chest on PE emergecny intubation and cautious ventilation

Question 184

help preventing SIDS

Answer 184

``` smoke avoidance during and after pregnancy supine sleep firm sleep surface room sharing but not in same bed pacifier use when sleeping ```

Question 185

PE with slipped capital femoral epiphysis

Answer 185

loss of abducrtion and internal rotation of the hip as well as external rotation of the thigh while the hip is being flexed

Question 186

PE: webbed neck, cleft lip, shielded chest, triphalangela thumbs, pale mucous membranes and conjunctivae what else on labs systolic ejction murmur

Answer 186

diamond blackfan anemia macrocytic anemia, and low retic count -no hypersegmented neutrophils

Question 187

osteonecrosis is a common complication of what disease

Answer 187

SCD groin, buttock, or thigh pain that initially occurs with weight bearing but progresses to occuring at rest pain and limited ORM with INTERNAL roation and abduction of hip no erthemia or warmth of jionts, leukocytosis or elevated inflammatory markers xrays of hip may appear normal early and MRI should be performed to confirm diagnosis

Question 188

what is the most common congenital heart defect in pts with down syndrome? from what embryo stuff what happens with blood flow sx with feeding

Answer 188

complete atrioventricular septal defect endocardial cushions don't merge so both VSD and ASD HF occurs from blood mixing and valve regurge = volume overload and excessive pulmonary blood flow diaphoresis/dyspnea with feeds and crackles around age 6 weeks

Question 189

prophylaxis for measles

Answer 189

vitamin A

Question 190

what other workup with TE fistula

Answer 190

VACTERL vertebral, anal atresia, cardiac, TE fistula, renal, limb

Question 191

heinz bodies are what and seen in what disease

Answer 191

hemoglobin precipitation is seen in G6PD deficiency hemoglobin becomes oxidized and forms insoluble precipitants called heinz bodies

Question 192

light microscopy findings with minimal change disesae tx IF staining? electron microscopy?

Answer 192

normal tx: corticosteroids no abnormality diffuse effacement of foot processes on EM

Question 193

tuberous sclerosis associated with what

Answer 193

cortical tubers, hamartomas, subependymal giant cell astrocytomas, subep nodules cardiac rhabdomyomas, renal angioleiomyomas, seizures, metbal retartdation facial angiofibroas

Question 194

what is a complication of IVH in 1/3 of cases those who survive may have what

Answer 194

communicating hydrocephalus cerebral palsy if survive

Question 195

when does type 1 DM present

Answer 195

4-6 or at early puberty

Question 196

evaluation of bilious emesis in the neonate get abdominal x ray and see double bubble sign then what is next

Answer 196

it is duodenal atresia

Question 197

intellectual disability, fair complexion, eczema and ___ body odor is what

Answer 197

musty | PKU

Question 198

who is at risk for meconium aspiration syndrome

Answer 198

neonates born after due date

Question 199

precocious puberty is defined as development of 2ndary sex characteristics before age what

Answer 199

8 in girls 9 in boys accelerated bone growth is also comon central early HPO activation peripheral: low fsh and lh - from adrenal or gonadal relaease of excess sex hormones

Question 200

point tenderness at the inferior pole of the patella

Answer 200

patellar tendonitis

Question 201

medically emancipated minor

Answer 201

emergency care, sti, substance abuse, prenancy, contrapception

Question 202

drooling,tripod position (sitting up and leaning forwrd), sniffing position, stridor, high fever, dysphagia what infection managment

Answer 202

h influenza type B endotracheal intubation antibiotics

Question 203

treatment for chlamydial neonatal conjunctivitis

Answer 203

PO macrolide

Question 204

congenital diaphragmatic hernia presents how and imaging

Answer 204

cyanosis and RD immediately after birth polyhydramnios can occur crom esophageal compression abdominal viscera into thorax shows schaphoid appearing abdomen xray: displaced cardiac silhoutte, bowel in thorax and gasless abdomen

Question 205

why is human milk better than formula

Answer 205

it absorbs better and improves gastric emptying - 70% whey and 30% casein - whey digested easier actually has less vitamin D so need to supplement with it if breast feeding

Question 206

emancipated minor

Answer 206

homeless, parent, married, military, financially independent, high school grad

Question 207

treatment of slipped capital femoral epiphysis

Answer 207

surgical pinning of the femoral head

Question 208

physiologic jaundice should be gone when

Answer 208

after 1-2 weeks

Question 209

question 9 on central vs peripheral precocious puberty

Answer 209

question 9

Question 210

evaluation of bilious emesis in the neonate get abdominal x ray and see NG tube in misplaced duodenum then what next what procedure

Answer 210

upper GI series if see ligament of treitz on right side of abdomen then maltoration need surgery with Ladd procedure

Question 211

in pediatric pts the most common etiology of osteomyelitis is what

Answer 211

hematogenous seeding by s aureus

Question 212

enzyme def in niemann pick

Answer 212

sphingomyelinase

Question 213

definition of neonatal polycythemia

Answer 213

hematocrit over 65% in term infants

Question 214

what can cause subcutaneous emphysema with leaking from chest wall into subcut tissues what else can occur this way managment

Answer 214

severe coughing paroxysms pneumothorax can occur this way too get chest xray

Question 215

what should be obtained in all neonates with suspected sepsis and tx how

Answer 215

CSF culture antibiotic therapy

Question 216

what is the best treatment for breastfeeding failure jaundice in otherwise healthy full term newborns

Answer 216

increase freq and duration of feeds to stimulate milk production, maintain hydration breast feed every 2-3 hours for 10-20 mintues or more per feed in first month of life

Question 217

cx features adhd sx occur where tx

Answer 217

sx must occur in at least 2 settings tx: stimulants: methylphenidate, amphetamines nonstimulants: atomoxetine, a-2 agonist behavioral therapy

Question 218

treatment for neonatal polycythemia

Answer 218

IV fluids glucose partial exchange transfusion

Question 219

refeeding syndrome happens in what pts

Answer 219

anorexic

Question 220

what does a white reflex in the eye mean metast where

Answer 220

aka leukocoria considered retinoblastoma until proven otherwise, child needs prompt referral to an ophthalmologist liver and brain metastases

Question 221

dry flaky peeling skin of the hands and feet of newborn problem?

Answer 221

not a problem, this is normal

Question 222

pertussis tx for close contact under 1 month 1 month or older

Answer 222

under 1 = azithromycin 5 days (erythromycin can cause pyloric stenosis and clarithromycin not proven safe) 1 month or older azithromycin 5 days or clarithromycin 7 days or erythromycin 14 days

Question 223

most common cause of hypothyroidism in infants

Answer 223

thyroid dysgenesis (hypoplasia, aplasia)

Question 224

monocular visual acuity assessment by snellen letters or numbers can begin when

Answer 224

at age 3

Question 225

iron poisoning sx

Answer 225

abdominal pain, NVD and hematemesis within 30 min to 6 hrs of ingestion vasodilator too, so hypotensive shock and anion gap metabolic acidosis from poor perfusion gastric scarring and pyloric stensosis can occur

Question 226

pts with complement def are at increased risk for what infections

Answer 226

disseminated bacterial with encapsulated bacteria, giardia wouldn't effect these pts worse

Question 227

when does pyloric stenosis most commonly present

Answer 227

at age 3-6 weeks with nonbilious projectile vomiting

Question 228

esophageal coins in asx pts what if sx or time of ingestion unknown

Answer 228

observe for up to 24 hrs flexible endoscopy

Question 229

tx for hemophilia A and B

Answer 229

factor VIII for hemophilia A factor IX for hemophilia B desmopressin for mild hemophilia A

Question 230

how does neonatal herpes simplex virus infection of eye present

Answer 230

2nd or 3rd week of life with vesicular or ulcerative eye disease

Question 231

cessation of breastfeeding should be reserved for infants with what

Answer 231

suspected galactosemia jaundice, lethargy, vomiting and hepatomegaly

Question 232

xray features with vit d def rickets

Answer 232

osteopenia metaphyseal cupping and fraying epiphyseal widening

Question 233

treatment for SCID same tx in what other disease

Answer 233

stem cell transplantation wiskott Aldrich syndrome too

Question 234

orchiopexy reduces risk of what but not what

Answer 234

testicular torsion and decreases risk of testicular cancer not help subfertility

Question 235

blood smear with occasional RBCs with single, round, blue inclusions on wright stain are what and from what

Answer 235

howell-jolly bodies from splenectomy or hyposplenism usually removed by spleen

Question 236

acute unilateral LAD in children is most commonly caused by what

Answer 236

s aureus and s pyogenes

Question 237

respiratory isolation during first ___ days of antibiotic therapy for pertussis

Answer 237

5

Question 238

dx of homocystinuria based on elevated what and what is treatement

Answer 238

elevated homocysteine and methionine tx: B6, folate, B12, antiplatelets or anticoags

Question 239

newborn with fTT, bilater cataracts, jaundice, and hypoglycemia has what and what enzype

Answer 239

galsctosemia and G 1PUT def

Question 240

impetigo bacteria involved, cx features and tx

Answer 240

non bullous - s. aureus and group A strep - painful non pruritic pustules, honey crusted lesion bullous - s aureus - rapidly enalrged flaccid bullae with yelow fluid, ruptured lesions in periphery tx: limited skin involvement = mupirocin topical extensive skin involvement = orals like cephalexin, dicloxacillin, clindamycin

Question 241

risk factor of intussusception

Answer 241

recent viral illness or rotavirus vaccine pathological lead point -meckel divert, HSP, celiac, intestinal tumor, polyp

Question 242

features of turner syndrome that aren't as common

Answer 242

bicuspid aortic valve coarctation of aorta broad chest with widely spaced nipples narrow high arched palate

Question 243

pt with sickle cell that has decreased reticulocytes and no splenomegaly what is it from presents with what tx

Answer 243

aplastic crisis 2ndary to parvovirus B19 pallor, weakness, fatigue (nonspecific for anemia) but funcitonal systolic murmur due to hyperdynamic blood flow tx: blod transfusion

Question 244

when should the quadrivalent meningococcal vaccine be given and booster when give it really early and what age

Answer 244

11-12 booster at 16 age 2 if asplenic, HIV postiive or complement deficiency

Question 245

accumulation of fluid in the inner ear that leads to hearing loss vertigo, and tinnitus

Answer 245

meniere's diseae

Question 246

ADHD dx requires that several sx be present before age what

Answer 246

12

Question 247

hemoglobin precipitation is seen in what

Answer 247

G6PD deficiency, hemoglobin oxidized and forms insoluble precipitants called heinz bodies

Question 248

autosomal recesive polycystic kidney disease manifestations

Answer 248

large flank masses in infancy, leads to oligohydramnios pulmonmary hypoplasia and potter faces

Question 249

inspiratory stridor infection treatment?

Answer 249

parinfluenza virus corticosteroids and racemic epinephrine for pts with stridor at rest

Question 250

____ children of all ethnicities are also at high risk for precocious develpoment

Answer 250

obese

Question 251

risk of desmopressin in notcturnal enureisis

Answer 251

relapse in up to 70% and hypnatremia

Question 252

central vs peripheral precocious puberty look at what first

Answer 252

bone age if advanced then basal LH if low then GnRH test if low then gonadotrophin indep prec

Question 253

x linked agammaglobulinemia is also called what casued by defect in what susceptible to what organisms

Answer 253

bruton agammaglob Tyrosine Kinase that prevents development of mature B cells encapsulated organisms liek H flu, strep pneumo, GIARDIA bc no IgA

Question 254

how do ulipristal, levonorgestrel and OCPs, stop pregnancy in emergency situation

Answer 254

delay ovulation

Question 255

child with deep cat bite what should management be and why

Answer 255

antibiotic prophylaxis and irrigation give amox/clav for pasteurella multocida and aneorobic bacteria

Question 256

evaluation of bilious emesis in the neonate get abdominal x ray and see dilated loops of bowel what is next steps

Answer 256

contrast enema if see microcolon--> meconium ileus if see rectosigmoid transition zone-->hirschsprungs

Question 257

nec x ray shows what what population

Answer 257

abdominal x ray with air in the bowel wall and portal veins premies with bloody stool

Question 258

myotonic muscular dystrophy type 1 inheritance

Answer 258

AD trinucleotide repeat delayed muscle relaxation

Question 259

phases of pertussis

Answer 259

catarrhal (1-2 weeks) mild cough rhinitis paroxysmal (2-6 weeks) gough with inspiratory whoop, posttussive emesis convalescent (weeks to months) symptoms reslove gradually

Question 260

Acute OM age groups most common

Answer 260

6-18 months and 5 yrs old

Question 261

causes of meningitis in children under 3

Answer 261

GBS (*****most common) e coli listeria HSV

Question 262

serous liquid filled blisters on the typanic membrane

Answer 262

bullous myringitis

Question 263

the most common cause of syncope in children

Answer 263

vasovagal syncope

Question 264

organisms in septic arthritis in kids birth to 3 months and older than 3 months tx

Answer 264

staph, GBS, gram neg bacilli nafcillin or vancoymicn plus gentamicin or cefotaxime older than 3 months -staph, group A strep, strep pneumoniae nafcillin, clinda, cefazolin, vanco need arthrocentesis as dx and tx

Question 265

medulloblastoma occurs where cause what sx

Answer 265

posteior fossa in cerebella vermis which is important for balance and coordinaton truncal and gain instability can cause obstructive hydrocephalus

Question 266

auscultation in DS pt with complete AV septal defect

Answer 266

loud S2 due to pulmonary HTN systolic ejection murmur from increased flow across the pulmonary valve from L to R shunt across the ASD holosystolic murmur of VSD may be ther too

Question 267

stages of lyme disease earl localized early disseminated late

Answer 267

EL: erythema migrans fatigue, ha mayalgias, arthralgias ``` ED: multiple erythema migrans bells palsy meningitis carditis migratory arthralgias ``` lateL arthritis, encephalitis, peripheral neuropathy

Question 268

pyridoxine (vitamin ____) deficiency causes what

Answer 268

B6 irritability, depression, dermatitis, stomatitis causes eleveated homocysteine concentration which is increase risk factor for VTE and atherosceleoris DIDS you see that pyrate

Question 269

extraintestinal sx in celiac disease

Answer 269

IDA dermatitis herpetiformis -pruritic popular or vesicular rash located on knees, elbos, forearms and buttocks

Question 270

rickets (vit D def) clinical manifestations

Answer 270

``` craniotabes (soft skull( delayed fontanel closure enlalargred -skull, costochondral joints, wrist widening genu varum ```

Question 271

hemophilic arthropathy in hemophilia a and b tx

Answer 271

late complication of both types and is caused by iron/hemosiderin deposition leading to synovitis and fibrosis withing the joint early prophylactic tx with factor concentrates

Question 272

complications of pediatric constipation

Answer 272

anal fissures hemorrhoids enuresis/UTIs -fecal retention can cause rectal distension and can compress the bladder and prevent complete voiding (urinary stasis)

Question 273

definition of tourettes disorder tx

Answer 273

both multiple motor and 1 or more vocal tics that persist for one year after initial onset onset under age 18 tx: antipsychotics (1st gen approved second get being prescribed more often now), alpha-2 adrenergic receptor (clonidine and guanfacine) agonists, behavioral therapy

Question 274

iron studies in microcytic anemia

Answer 274

check uworld

Question 275

brutons agammaglobulinemia presents when and how

Answer 275

3-6 months after birth bc maternal ABs gone sinopulmonary infection GI (salmonella, campylobacter)

Question 276

withdrawal to ____ presents with irritability, a high pitched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeds, vomiting, diarrhea

Answer 276

opiates

Question 277

patients with sickle cell disease are at risk for ____ disease due to increased ____ secondary to chronic anemia and what

Answer 277

cardiac disease, CO, infarction of myocardial microvasculature

Question 278

renal involvement in HSP

Answer 278

can occur 4-6 weeks after illness most pts have hematuria and some proteinuria severe can lead to HTN and acute renal fialure

Question 279

evaluation of primary amenorrhea steps 1) ____ or ____ uterus present then

Answer 279

pelvic exam or US if uterus there then check FSH if increased then get karyotype if decreased then cranial MRI

Question 280

SS disease aplastic crisis reticulocytes and key features

Answer 280

decreased retics transient arrest of erythropoiesis secondary to infection of parvovirus B19

Question 281

pruritic circular patch with central clearing and raised scaly border is what what pathogen

Answer 281

tinea corporis trichophyton rubrum

Question 282

seborrheic dermatitis clinical features: age, location, description tx: what species

Answer 282

peaks first year of life and adulthood erythemaotous plaques and or yellow greasy scales on scalp, face, posterior ears, nasolabial folds, umbilicus and diaper area treatment: first line--> emollients, nonmedicated shampoos 2nd: topical antifungals or low potenency glucocort malassezia species

Question 283

wiskott aldrich syndrome inheritance increased risk of what infections gene regualtes what sx tx

Answer 283

TIE thrombocytopenia, Infections (recurrent) and eczema x linked infections of bacteria, viral and fungal hematopoietic cells and regulates cytoskeleton remodeling, dysfunction of cell migration cytoskeleton of platelets regulated by this too so can lead to petechiae or purpura, severe bleed, IC hem, hematemeis or hematochezia tx: stem cell transplant

Question 284

neuroblastoma what cells arise

Answer 284

Nc cells which become sympathetic chains and adrenal medulla calcifications and hemorrhages are seen on plain xray and CT HVA and VMA usually elevated but no pheo sx

Question 285

dep space neck infeciton most common in children under 4. high fever, muffled voice, and limited rotation of neck

Answer 285

retropharyngeal abscesses

Question 286

deficiency of riboflavin (vitamin ___)

Answer 286

B2 cheilosis, glossitis, seborrheic dermatitis, pharyhngitis, and edema or erythema of the mouth

Question 287

central lytic bone defect with surroudning sclerosis termed brodies abscess

Answer 287

osteomyelitis

Question 288

classic triad of brain abscess

Answer 288

fever, severe headaches and focal neurologic changes

Question 289

pasteurella mulocida caused by what

Answer 289

normal oral flora in dogs and cats that cuases cellullitis within 1-2 days of dog or cat bite

Question 290

intraventricular hemorrhage is a common complication in neonates born at ___ weeks gestation or ____ grams

Answer 290

30 weeks or 1500 grams (3.3 lbs)

Question 291

APGAR score under what may require further evaluation and resuscitation

Answer 291

7

Question 292

treatment of obsessive compulsive disorder

Answer 292

cognitive behavioral therapy and/or SSRI (fluoxetine) clomipramine or antipsychotic augmentation for treatment nonresponse deep brain stim for tx of severe or refractory cases

Question 293

most common spot for spondylolisthesis

Answer 293

L5 over S1

Question 294

xray in persistent pulmonary HTN

Answer 294

clear lungs with decreased pulmonary vascularity

Question 295

is it the toxin or the spore that is ingested in infantile botulinism? how is it ingested

Answer 295

Spore Environment, highest incidence in cali, penn, and utah. Leads to production and releaser of the toxin Raw honey too

Question 296

immune thromboycytopenia most common in what pts age

Answer 296

2 to 5 (b rush Is The Prohphet)

Question 297

langerhans cell histiocytosis causes what tx

Answer 297

solitary lytic long bone lesions eosinophilic granuloma is least severe form and is in children and young adults as solitary bone lesion usually resolve on own

Question 298

evaluation of bilious emesis in the neonate get abdominal x ray and see free air, hematemesis, unstable vital signs then whats next

Answer 298

surgery bc this means it is pneumoperitoneum, which is intestinal perforation and need immediate emergency surgery

Question 299

what should always be high on the differential for neonates (28 days or less) with decreased activity or poor feeding temperature in these pts? other signs

Answer 299

sepsis may have either fever or hypothermia mild jaundice, irritable, lethargic, hypotonic, abnormal WBC count high or low, left shift

Question 300

diagnosing biliary atresia tx

Answer 300

US, absent or abnormal GB failure of liver to excrete tracer into the small bowel on scintigraphy is suggestive cholangiogram is diagnostic gold standard tx: liver transplant

Question 301

why is bilirubin higher in newborns

Answer 301

hematocrit is 50-60% in newborns and has shorter life span so higher turnover lower level of uridine diphosphogluconurate glucoronosyltransferase (UGT) enterohepatic recycling is increased as the sterile newborn gut cannot break down bilirubin to urobilinogen for fecal excretion

Question 302

tx of ITP

Answer 302

self limited in children and spont recovery in 6 momths so observe only treat in kids if have cutaneous symptoms, IVIG or glucocorticoids

Question 303

pt with AIS, what is treament of mass

Answer 303

cryptorchid gonads have 1-5% risk of devolping dysgerminoma or gonadoblastoma AFTER puberty benefits from undergoing gonad stimulated puberty (attainment of adult height) outweigh low risk of malignancy so wit to remove until after puberty

Question 304

complications of cryptorchidism alsmost all of these pts have associated what

Answer 304

inguinal hernia testicular torsiojn]subfertility testicular cancer processus vaginalis, repair to prevent inguinal hernia

Question 305

gonococcal conjunctivits age presentation neonate tx prevention

Answer 305

age 2-5 days one dose IM ceftriaxone or cefotaxime erythromycin ointment

Question 306

homocystinuria inheritance, what deficiency, sx besides marfinoid

Answer 306

AR, systathione synthase intellectual disability, thrombosis, downward lens dislocaiton, megaloblastic anemia, fair complexion

Question 307

adenitits due to m tuberculosis is strikingly what

Answer 307

nontender

Question 308

Erythema marginatum

Answer 308

Erythematous ring like rash that comes and goes associated with acute RF

Question 309

neonatal polycythemia definition causes cx presentation treatment

Answer 309

hematocrit over 65% in term infants cause: - increased EPO from intrauterine hypoxia: maternal DM, hypertension, smoking, IUGR - erythrocyte transfusion: delayed cord clamping, t-t transfusion - trisomy, hypo or hyperthyroid sx: - mostly asx - respiratory distress, cyanosis, apnea, hypoglycemia, hyperbili tx: IV fluids, glucose, partial exchange transfusion

Question 310

epiglottitis cx features management

Answer 310

tripod position (sit up and lean forward), sniffing position, stridor drooling manage with intubation and abx tracheotomy if attempts at intubation fail

Question 311

when give rotavirus vaccine

Answer 311

2-8 months

Question 312

treatment for enterobius vermicularis (what worm)

Answer 312

pinworm albendazole or pyrantel pamoate

Question 313

Rash clasically begins with hearld patch, erythematous annular lesion on trunk which may increase in size and develop scaling around the edge. Within a week clusters of smaller oval red lesions appear on trunk. Scaly macules and papules distributed obliquely along the lines of tension in pattern on back Can cause pruritis What may precede this Tx

Answer 313

Pityriasis rosea Preceding viral prodrome Self limited and resolves on its own, can use antihistamines and topical corticosteroids to help itching

Question 314

avascular necrosis of the femoral head is seen in what children age

Answer 314

legg calve perthes disease which is idiotpathic avascular necrosis of femoral head, presents with limp or hip pain and is common in kids age 4-12 sickle cell diseae can cause too

Question 315

nearly all pts with Cystic fibrosis dvlop what

Answer 315

sinopulmonary disease

Question 316

neurofibromatosis type 1 tumor types and what can they causae so management

Answer 316

optic pathway glioma holocranial HA, vision change, vomiting, and HTN get MRI of brain and orbits

Question 317

muscle biopsy with reduced dystrophin is what disease

Answer 317

becker MD

Question 318

hyper IgM syndrome immuno level, inheritance sx

Answer 318

low IgA and IgG with elevated IgM x linked CD40 lignad defect recurrent sinopulmonary infections with encapsulated bacteria increased viral infections and opportunistic infections like PCP

Question 319

what should you do if have urinary incontinence in child over 5

Answer 319

UA to screen for infection, DM, and DI may consider acceleration of continence from alarm or desmopressin therapy

Question 320

any neoate with delayed passage of meconium for 48 hours should be considered to have what disesae

Answer 320

CF | hirschsprungs

Question 321

acute cervical adenitis in children unilateral bilateral

Answer 321

uni: staph, strep pyog, anaerobic bacteria, bartonella, mycobact avium bilat: adenovirus, EBV/CMV

Question 322

infants of diabetic mothers first trimester problems

Answer 322

congenital heart disesae NT defects small left colon spont abortion

Question 323

transient proteinuria in children is most common cause of what and how to evaluate cause

Answer 323

most common cause of isolated proteinuria in children and should be reevaluated with a repeat urine dipstick test on 2 separate occasions to rule out persistent proteinuria can be from fever, exercise, seizures, stress or dehydration

Question 324

osteoid osteoma commonly affects what bone clinical features f/u tx

Answer 324

proximal femur increasing pain that worsens at night without relation to physical activity relieved by NSAIDs****** follow with serial exam and x rays every 4-5 months most go away on own

Question 325

tay sachs or niemann pick has hyperreflexia

Answer 325

tay sachs taylor allison is hyper what the hexosaminidase A is she doing?

Question 326

tracheoesophageal fistula can cause what

Answer 326

permits air entry into the GI tract and stomach and intestines and they can become quite distended with each breath gastric fluid can also reflux into the distal esophagus through the fistula and into the trachea and lungs causing aspiration pneumonia ---> crackles and x-ray inflitrates

Question 327

common variable immunodeficiency manifestations dx management

Answer 327

manifestations: recurrent respiratory and GI infections autoimmune disease chronic lung disease and GI disorders dx: decreased IgG and IgA/IgM, no response to vaccines IG replacement therapy

Question 328

during the first week of life the normal number of wet diapers a day should be what

Answer 328

equal the amt of the days old the infant is 4 day old infant should have 4 or more wet diapers

Question 329

cat like cry is seen in what syndrome characterisitc ____ present other features

Answer 329

cri du chat 5p deletion protruding metopic suture present hypotonia, short, hypertelorism, wide and flat nasal bridge and dumb

Question 330

most life treatening finding in marfan syndrome is what

Answer 330

aortic root dilation and aortic regurgitation monitor for aneurysms and aortic arch dissection

Question 331

common variable immunodeficiency abnormalty increased risk what infections other cell lines growth and other disease

Answer 331

abnormal B cell differentiation results in def of multple IG classes incrased risk encapsulated organisms and Giardia lambilia infection sometime T cell immunity affected, so pts at increased risk for enteroviral encephalitis FTT and chronic rep problems (asthma common)

Question 332

the majority of infants with congenital toxo are asx at birth but experience ___ in adulthood

Answer 332

chorioretinitis

Question 333

osteogensiss imperfecta is caused by mutations in what

Answer 333

type 1 collagen

Question 334

____is ubiquitous where and neonatal __ can result when at risk infants are exposed to it during unhygienic delivery or cord care practices

Answer 334

clostridium tetani, in soil tetanus

Question 335

type of arthritis with lyme

Answer 335

monoarticular or asymmetric oligoarthritis most commonly involving the knee

Question 336

pyloric stenosis is most commonly seen in what pop and what kind of vomit and findings how dx

Answer 336

boys age 1-2 months non bilious projectile vomit visible peristaltic waves and palpable abdominal mass abdominal US

Question 337

biliary cyst is what sx pts by age dx can turn to what so tx

Answer 337

congenital dilation of the biliary tree PAIN, JAUNDICE, PALPABLE mass (PAP got that bily cyst) pts usually under 10 - infants have jaundice and acholic stools - older kids can have pancreatitis dx: US or ERCP if obstruction suspected can turn to cholangiocarcinoma and need surgical resection

Question 338

normal sex behavior in school age kids

Answer 338

AIM to know the most asking questions about sex and repro Increased intrest in sex words and play masturbatory movements

Question 339

in sickle cell pts the predominant hemoglobin type is HbS but HbF concentration is elevated at baseline to what? compared to healthy individuals -so if give hydroxyurea the % of HbF should be above what

Answer 339

5-15% baseline hydroxyurea should raise it above 15%

Question 340

cx features of HSP

Answer 340

palpable purpura, hematuria, abdominal pain, arthralgias, and occasionally scrotal swelling

Question 341

pt with a scrotal mass that is cystic and tranilluminate with light what is this, embryology, and management

Answer 341

hydrocele fluid in processus or tunica vaginalis (peritoneal projection that accompanies the testis during descent into scrotum. when it fails to obliterate, periotneal fluid may accumulate within making a communicating hydrocele. if fluid collects then obliteration then noncommunicating hydrocele) differs from other testicular mases bc of transillumination most resolve spontaneously by age of 12 months, if notthen may need surgery

Question 342

lead tox in houses built before what year

Answer 342

1978 only test if sx

Question 343

tetralogy of fallot consists of what murmur?

Answer 343

VSD, RV outflow tract obstruction (pulmonic stenosis) overriding aorta and RV hypertrophy DROP harsh systolic ejeection murmur L upper sternal border

Question 344

infant with hypothermia, lethargy, and low white blood cell count with left shift is highly concerning for what also full fontanelles and apnea is concerning for what

Answer 344

neonatal sepsis meninigitis

Question 345

17a hydroxylase def hormonal abnormalities and sx

Answer 345

hormonal decreased cort and test increased mineral corticoids all pts phenotypically femal, fluid and salt retention and HTN

Question 346

____ is used in combination with desmopressin to incrase bladder capacity in children with daytime incontinence

Answer 346

oxybutynin

Question 347

primary nocturnal enuresis definition

Answer 347

urinary incontinence that occurs at least twice a week age 5 or older

Question 348

things that increase risk of otitis externa

Answer 348

conditions that disrupt skin barrier (eczema, psoriasis) retain foreign material and water in canal (headphones, hearing aids, diving caps)

Question 349

what is the most dangerous SM manifestation in myotonic muscular dystrophy cardiac involvement? other manifestations?

Answer 349

dysphagia can lead to aspiration pneumonia cardiac involvement includes conduction problems and arrhytmias cataracts, testicular atrophy/infertility, frontal baldness, and insulin resistance, foot drop, facial weakness

Question 350

congenital lymphedema in what pts and is what exactly | and can lead to what

Answer 350

turner, lead to cystic hygroma of neck and fetal hydrops dysgenesis of the lymphatic network protein rich interstitial fluid in the hands, feet, and neck

Question 351

diffuse intracranial calcifications in baby dx get how tx

Answer 351

congenital toxo undercooked meat pyrimethamine, sulfadizine, folate

Question 352

aspergillus fumigatus is common in _____ and ____ with CF and treatment is what

Answer 352

older children and adults itraconazole and voriconazole

Question 353

evaluation of neonate with suspected sepsis

Answer 353

CBC, culture, lumbar puncture, UA, and urine culture empiric antibiotics ampicillin and gentamicin after cultures

Question 354

ITP happens how and cx features PS?

Answer 354

after viral infection get autoantiboides that bind to platelets and cause purpura and petechiae, sometimes muscosal bleeds thromboyctopenia and megakaryocytes on PS

Question 355

how to confirm lyme disesae organism test tx

Answer 355

spirochete ELISA and Western blot testing doxy or amoxicillin with no neuro sx

Question 356

triggers of generalized seizures sc features

Answer 356

fever, hypoglycemia, sleep deprivation +/- aura LOC, convulsions, postictal state

Question 357

what is the threshold for phototherapy in a full term healthy 4 day old infant

Answer 357

total billy of 20 or more transfusion if 25 or above and neuro dysfunction from the hyperbilly

Question 358

what is the most effective nonpharmacological treatment for tourettes disorder

Answer 358

habit reversal training

Question 359

the most common pathogen isolated from sputum cultures in infants and young children with CF is what when is the other one most common

Answer 359

s aureus pseudomonas is more common after age of 20

Question 360

h flu meningitis tx with what abx reduces risk of what

Answer 360

dexamethasone sensorineural hearing loss

Question 361

what is the leading cause of death in infants under 1

Answer 361

injury with abusive head trauma

Question 362

what reduces symptoms in TOF and how

Answer 362

squatting may reduce symptoms by increasing SVR and afterload which decreases the right to left shunt across VSD but increases flow across the right ventricular outflow tract obstruction, increasing intensity of systolic murmur

Question 363

preseptal cellulitis

Answer 363

mild infection of eyelid anterior to the orbital septub eyelid edema, redness, tenderness, maybe fever and leuko

Question 364

most common brain tumors in children is what sx

Answer 364

pilocytic astrocytoma supratentorial location: seizures, weak, sensory change posterior fossa location: cerebellar dysfunction ICP too

Question 365

ependymomas found where and cause what

Answer 365

ventricles in posterior fossa obstruction of CSF and increased ICP

Question 366

hemophilia A and B inheritance

Answer 366

x linked recessive

Question 367

antidote to methemoglobinemia

Answer 367

methylene blue accepts electrons for NADPH and is reduced to leucomethylene blue which in turn reduces methemoglobin back to hemoglobin

Question 368

splenic sequestration crisis

Answer 368

acute anemia, splenic engorgement cx: tachy, pallor, LUQ pain, splenomegaly can progress to hypovolemi shock as lots of blood trapped in spleen lab findings: normocytic anemia, compensatory elevated reticulocyte count, and THROMBOCYTOpenia tx: fluid, transfusions, and eventual splenectomy

Question 369

cutis aplasia (absence of epidermis over the skull) and microphthalmia are both classically seen in what? __ defects too

Answer 369

patau syndrome midline defects like holoprosencephaly and omphalocele

Question 370

does cat scratch disease need antibiotic prophylaxis ?

Answer 370

not in immunocompetent people in ICP yes

Question 371

comorbidities with duchenne musc dyst and becker and myotonic

Answer 371

DMD: scoliosis and cardiomyop becker: cardiomyop myotonic: MD: CAT Bald - cataracts, arrhymias, testicular atrophy/infertility, baldiing

Question 372

deep brain stimulation for tx of severe or refractory cases of ___ target what area in brain

Answer 372

OCD, nucleus accumbens

Question 373

recurrent UTIs in infants and children is often from what dx what to evaluate long term renal scarring follow renal function monitor pts closely for what complications

Answer 373

vesicoureteral reflux dx: voiding cystourehtrogram (VCUG), then renal US to see hydronephrosis reanl scintigraphy with dimercaptosuccinic acid to evaluate renal scarring long term renal function followed by seriel cr pts monitored closely for complications of chornic renal insufficiency, like HTN and anemia

Question 374

what would you see on a muscle biopsy in someone with doucheanes muscular dystrophy what about beckers

Answer 374

absent dystrophin becker would show reduced dystrophin

Question 375

clinical manifestations of refeeding syndrome

Answer 375

arrhythmias CHF seizures wernicke encephalopathy phosphorus K,MG uptaken phosphorus is primary deficient electrolyte for nrg cardiac arrhythmias from mg and potassium

Question 376

most common cause of subacute unilateral LAD in young children is from what

Answer 376

mycobacterium avium

Question 377

risk factors for brain abscess

Answer 377

OM, mastoiditis frontal or ethmoid sinusitis dental infection bacteremia from other sites of infection, cyanotic heart disease (TOF)

Question 378

Spinal muscular atrophy (werdnig-hofffman disease) cx by what

Answer 378

Symmetric proximal m weakness and hyporeflexia Does not affect the pupils Greater weakness in lower extremeties

Question 379

all sexually active women under age what should undergo testing for chlamydia and gonorrhoeae

Answer 379

25

Question 380

septic arthritis of the hip in children tx

Answer 380

septic arthritis has fever of 101 or more cannot bear weight WBC count over 12,000 ESR over 40 CRP over 2 if have 3 or more of above then immediate arthrocentesisis

Question 381

what tumor can aphasia and hemiparesis occur in

Answer 381

pts with brain tumors in cerebral hemispheres most common in children is low grade astrocytomas

Question 382

disease with low IgG, IgM, and IgA and low or absent B lymphocytes

Answer 382

bruton agammaglobulinemia low MAG

Question 383

galactocerebrosidase deficiency | retard, blind, deaf, paralsis, neuorpathy, seizures

Answer 383

krabbe disease id be krabbe if i was deaf, dumb, blind, and paralyzed

Question 384

treatment for cat scratch disease another name sx

Answer 384

bartonella henselae azithromycin localized popular or nodular skin lesion that may go unnoticed fever of unknown origin and or regional LAD

Question 385

phsyical exam in older children with x linked agammaglob shows what

Answer 385

underdeveloped lymphoid tissue (tonsils and LNs)

Question 386

laryngomalacia is caused by what and sx what makes worse

Answer 386

colapse of supraglottic structures during inspiration choronic inspiratory stridor that begins in neonatal period and is worse in supine position

Question 387

hypertoiprhied peyer patch can lead to what

Answer 387

intussusception happens in AGE

Question 388

treatment for croup (laryngotracheitis) and why it works

Answer 388

parinfluenza virus causes tracheal inflammation leading to subglottic edema and narrowing mild cases use single dose corticosteroids (dexamethasone) if mod or severe use corticosteroids and nebulized epinephrine (constricts mucosal arterioles in upper airway and alters cap hydrostatic pressure)

Question 389

Breast milk jaundice timing pathophysi cx features

Answer 389

starts days 3-5 and peaks at 2 weeks high levels of b glucoronidase in breast milk deconjugates intestinal bilirubin and increases its circulation adequate breast feed and normal exam

Question 390

pts with tourettes syndrome have high rates of comorbid conditions like what

Answer 390

ADHD and OCD

Question 391

precocious puberty uworld

Answer 391

look up

Question 392

risk factor for development of respiratory distress syndome what decreases risk

Answer 392

prematurity maternal diabetes mellitus, increased insulin antagonize cortisol and block the maturation of sphingomyelin IUGR, mathernal HTN decrease risk

Question 393

what is the most common pathogenic organism in young children with CF? especially in the concurrence of ___ infection

Answer 393

staphylococcus aureus influenza

Question 394

chediak-higashi syndrome inheritance and characteristics

Answer 394

AR oculocutaneous albinism and recurerent cutaneous infections with staph aureus and srtrep pyogenes

Question 395

growing pains happens in what age group?

Answer 395

2-12

Question 396

Age group for osteod osteoma?

Answer 396

10-20