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Uworld Step 2 > Peds > Flashcards

Peds Flashcards

1
Q

What is the most likely cause of a maculopapular rash that begins on the trunk and also becomes vesicles?

A

Varicella/chickenpox. Also has a prodrome (fever, malaise).

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2
Q

What are the signs of systemic-onset juvenile idiopathic arthritis?

A

Chronic oligoarthritis, daily fever, and rash. Also shows leukocytosis, thrombocytosis, and elevated ESR/CRP.

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3
Q

What is the first step in evaluation of central precocious puberty (i.e. early sex characteristics and advanced bone age in the setting of high basal LH)?

A

Head MRI.

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4
Q

What are the findings of scarlet fever?

A

Fever, sore throat (erythematous oropharynx w/ exudates), headache, and rash that is more prominent in skin folds (i.e. axilla and groin).

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5
Q

Is maternal diabetes a risk factor for respiratory distress syndrome?

A

Yes, along with prematurity.

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6
Q

What are the signs that leg/msk pain is due to langerhans cell histiocytosis?

A

A lytic bone lesion, rash, and diabetes insipidus (polyuria, hypernatremia) are indications of langerhans cell histiocytosis.

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7
Q

What is the difference between cephalohematoma and caput succedaneum? (both head hematomas that can develop after forceps/vacuum assisted delivery)

A

Cephalohematoma is non-tender and does not cross suture lines, while caput succedaneum does cross suture lines.

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8
Q

What is the treatment of choice for localized impetigo?

A

Topical antibiotics such as topical mupirocin. Systemic antibiotics are reserved for refractory systemic impetigo.

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9
Q

What is a common cause of recurrent cystitis in a toddler that presents with a normal voiding cystogram/ultrasound?

A

Constipation, due to an expanded rectal vault compressing the bladder. May also present with anal fissures.

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10
Q

What are the emergency contraceptive options that can be offered to adolescents?

A

Levonorgestrel and ulipristal.

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11
Q

What can falling with an object in the mouth (such as toothbrush or pencil) cause?

A

A carotid artery dissection, presenting as a gradual onset hemiplegia. (i.e. injury to the posterior pharynx can damage the internal carotid).

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12
Q

In addition to trauma to the posterior oropharynx (object in mouth, ect). what can cause dissection of the internal carotids?

A

Neck strain/manipulation (yoga, sports).

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13
Q

What should raise suspicion for a foreign body ingestion in a toddler?

A

Vomiting, dysphagia, and feeding refusal. (patient also had dry cough which made me think aspiration, but the object was lodged in the esophagus, not trachea. Plus question mentioned lung fields were clear).

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14
Q

What should raise suspicion for foreign body aspiration?

A

Sudden-onset stridor, wheezing, or dyspnea.

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15
Q

What is the management of a toddler with foreign body ingestion?

A

If asymptomatic then observe for 24 hrs. If symptomatic (vomiting, dysphagia) then do flexible endoscopy.

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16
Q

What can be confused for a learning disability in children?

A

Hearing loss. Always repeat hearing testing in a patient with delayed social and language development and a history of recurrent otitis media.

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17
Q

What should always be the first suspicion with leukocoria/white reflex?

A

Retinoblastoma. Put retinopathy of prematurity due to patient being pre-term but this is unlikely.

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18
Q

What aspects make a scald burn suspicious for child abuse?

A

Sparing of flexural creases, sharp lines of demarcation, uniform depth, lack of splash marks.

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19
Q

What is the difference between a nevus flammeus/port wine stain and an infantile superficial/strawberry hemangioma?

A

Nevus flammeus is blanch-able and does not regress while a strawberry hemangioma does regress.

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20
Q

What can be considered in severe cases of strawberry hemangioma?

A

Beta-blockers (i.e. propranolol).

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21
Q

How is transient synovitis differentiated from Leg-Calve-Perthes disease?

A

Transient synovitis doesn’t last longer than 4 weeks. If it lasts longer than that then it is more likely LCP (LCP has restricted hip abduction, internal rotation, and a positive Trendelenberg sign).

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22
Q

What feature is consistent with absence seizures?

A

Simple automatisms (eyelid fluttering, lip smacking).

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23
Q

What does pancytopenia (with megaloblastic anemia), hypo or hyperpigmented lesions (cafe au lait) and hypoplastic thumbs suggest?

A

Fanconi anemia (DNA repair enzyme defect).

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24
Q

What is the first line management for epiglottitis?

A

Endotracheal intubation.

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25
Q

What are some substances that can cause methemoglobinemia in an infant? (cyanosis that does not respond to 100% O2)

A

Oxidizing agents such as nitrites, dapsone, and topical anesthetics.

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26
Q

After NG tube placement, feeding cessation, and IV fluids, what is the next best step for management of a neonate with bilous emesis?

A

Abdominal x-ray (free gas = perforation, dilated bowel = meconium ileus or Hirschsprung’s confirmed with contrast enema, gasless abdomen = malrotation/volvulus conformed with upper GI series).

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27
Q

What is the empiric antibiotic for acute unilateral cervical lymphadenitis in a child (i.e. S. aureus or S. pyogenes)?

A

Clindamycin.

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28
Q

What should be the first step for evaluation of a neonate with poor feeding and lethargy and no fever?

A

Blood, urine and CSF cultures to rule out infection (remember that neonates can have temperature instability meaning sepsis, ect. can present with hypothermia).

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29
Q

What is the management of CVID (recurrent respiratory and GI infections)?

A

Immunoglobulin replacement therapy.

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30
Q

What are potential complication of RSV bronchiolitis in infants under 2 months?

A

Apnea and respiratory failure.

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31
Q

What is a major risk factor for membranous nephropathy?

A

Active HBV infection.

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32
Q

How is allergic conjunctivitis differentiated from viral conjunctivitis?

A

Viral conjunctivitis does not have occular pruitis.

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33
Q

What is the gold standard for diagnosing Duchenne’s muscular dystrophy?

A

Genetic testing.

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34
Q

What is language disorder?

A

Persistent difficulties in language comprehension and production (limited vocabulary, sentence structure, functional use of language).

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35
Q

What is childhood-onset fluency disorder?

A

Stuttering.

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36
Q

What are growing pains?

A

Bilateral lower extremity pain that occurs at night in children ages 2-12. Characterized by no systemic signs, normal activity level, and a normal physical examination.

37
Q

What is a possible presentation of neuroblastoma that does not involve an abdominal mass?

A

A paravertebral mass that results in Horner’s syndrome.

38
Q

What is the treatment for neonatal conjunctivitis?

A

Oral erythromycin (topical is only for prophylaxis, not treatment if an infant then develops Chlamydial conjunctivitis).

39
Q

What is the treatment of choice for Lyme disease in children under 8 and pregnant women?

A

Oral amoxicillin.

40
Q

What are the signs of milk/food protein induced allergic proctocolitis?

A

A young infant with painless bloody stools, eczema, and regurgitation/spitting up.

41
Q

What is metatarsus adductus?

A

A congenital foot deformity where the feet are deviated medially and move laterally upon movement. Regresses spontaneously.

42
Q

Is it possible for there to be late onset GBS sepsis/meningitis?

A

Yes, a GBS colonized mother can still transmit GBS to a neonate horizontally after birth. GBS should still be suspected for neonatal sepsis (younger than one month) even if infant was delivered by c-section or if intrapartum antibiotics were given.

43
Q

How can acute rheumatic fever be differentiated from juvenile idiopathic arthritis?

A

JIA lasts for longer than 6 weeks and is not migratory (ARF meanwhile is migratory polyarthritis i.e. the pain moves from joint to joint such as knees to wrists, ect). Also look for hx of sore throat.

44
Q

What defines a vascular ring?

A

Both inspiratory and expiratory stridor that improves with neck extension. (laryngomalacia is only inspiratory stridor).

45
Q

What is the next step for patients with a severe asthma attack unresponsive to maximal medical therapy and with signs of respiratory failure (hypercapnea, respiratory acidosis, ect.)?

A

Endotracheal intubation and mechanical ventilation.

46
Q

What is the first step for evaluation of primary amenorrhea?

A

Pelvic ultrasound.

47
Q

What is the greatest risk factor for cerebral palsy?

A

Prematurity.

48
Q

What should be suspected in a child with a diet consisting mostly of dairy and with microcytic anemia?

A

Iron deficiency.

49
Q

What heart murmur can be heard with tetralogy of fallot?

A

A single S2 and crescendo-decrescendo systolic murmur at the upper left sternal border (pulmonic stenosis from an over-riding aorta).

50
Q

What is a potential life-threatening sequelae of infectious mononucleosis?

A

Acute airway obstruction from tonsillar enlargement. Treatment is corticosteroids.

51
Q

What is a pathognomonic finding of abusive head trauma (shaken baby syndrome)?

A

Retinal hemorrhages.

52
Q

How are bruises differentiated from congenital dermal melanocytosis (Mongolian spots)?

A

Bruises would vary in color and show in patterns suggestive of abuse. CDM would have flat blue-grey patches on the buttocks and lower back that are the same color.

53
Q

What does a maculopapular rash that begins on the face and auricular/posterior cervical lymphadenopathy suggest?

A

Rubella.

54
Q

What is acrocyanosis?

A

Blue extremities with a pink body. Usually a benign finding caused by peripheral vasoconstriction. Perform routine neonatal care/screening (screen for congenital heart disease and pre/post ductal pulse oximetry).

55
Q

What does mammary gland enlargement, engorged labia, and leukorrhea (vaginal discharge) in a newborn indicative of?

A

Benign effects of maternal estrogen.

56
Q

What is a common cause of cholestasis (jaundice, abdominal pain, RUQ mass) and/or pancreatitis in children?

A

Biliary cysts.

57
Q

What is the best next step for management of an innocent/benign childhood murmur?

A

Reassurance. A grade I/II systolic murmur with no signs (healthy child eating fine, ect) will likely regress and is from blood flowing through a structurally normal heart (no echocardiogram needed).

58
Q

Can Von Willebrand Disease have a normal aPTT?

A

Yes. A patient with dysmenorrhea who has normal PT. aPTT, and platelet counts may still have a bleeding disorder and needs further workup.

59
Q

What is the first step of management in pyloric stenosis?

A

Correction of electrolyte abnormalities. After stabilization then surgery can happen.

60
Q

What is bronchopulmonary dysplasia? (i.e. chronic lung disease of the neonate)

A

A oersistent oxygen requirement most commonly seen in premature infants with RDS who have been on long term mechanical ventilation and oxygen supplementation.

61
Q

What are the radiographic findings of bronchopulmonary dysplasia?

A

Haziness of the lung fields with decreased lung volumes.

62
Q

What is the first step for management of androgen insensitivity syndrome?

A

Elective gonadectomy due to increased risk of testicular cancer (cryptorchid testicles).

63
Q

What is breastfeeding jaundice?

A

An unconjugated hyperbilirubinemia that occurs in the first week of life caused by insufficient milk consumption (either decreased maternal production or a latching issue). Shows signs of dehydration (decreased urine output, weight loss).

64
Q

What is breast milk jaundice?

A

A continuation of physiologic jaundice caused by high levels of beta-glucoronidase in breast milk. Differentiated from breastfeeding jaundice in that there are no signs of dehydration.

65
Q

What is the first step for suspected developmental dysplasia of the hip?

A

Hip ultrasound.

66
Q

What is streptococcal perianal dermatitis?

A

An erythematous, sharply demarcated perianal rash associated with pruitis and pain caused by GAS. Presents in infants and young children and is treated with a beta-lactam.

67
Q

What are the facial dysmorphisms associated with fetal alcohol syndrome?

A

Small palpebral fissures, a smooth philtrum (groove above upper lip), and a thin vermilion border.

68
Q

What are some warning signs for the development of compartment syndrome following a supracondylar humerus fracture?

A

Increased swelling and pain that is unresponsive to analgesics.

69
Q

What is a young SCD patient with splenomegaly and signs of shock (hypotension) suggestive of?

A

Splenic sequestration crisis, which commonly occurs prior to autosplenectomy. Would have increased reticulocytes and decreased platelets.

70
Q

A newborn with respiratory distress, a history of polyhydramnios, absent breath sounds on the left, and heart sounds heard louder on the right is indicative of what?

A

Congenital diaphragmatic hernia. Perform emergent intubation, followed by NG or OG tube, then diagnostic studies (airway, breathing, and circulation always take precedence over diagnostic studies).

71
Q

What is the most common cause of anemia in preterm infants?

A

Anemia of prematurity, a normocytic anemia with decreased reticulocytes caused by decreased EPO production. Treatment includes minimizing blood draws and ensuring adequate iron intake.

72
Q

What antibiotic should be given empirically to cystic fibrosis children with pneumonia?

A

Vancomycin to cover for MRSA (S. aureus most common in CF children).

73
Q

What is a breath-holding spell?

A

An episode of apnea triggered by frustration, anger, or pain that occurs from ages 6 months to 2 years. Are benign and come in two types, cyanotic and pallid.

74
Q

What are scattered erythematous pustules and papules on an otherwise healthy neonate indicative of?

A

Erythema toxicum neonatorum, a benign rash that is common in the first 2 weeks of life. Resolves spontaneously.

75
Q

What should be the first step when evaluating potential thalassemia?

A

Iron studies first to rule out iron deficiency. Then you can do hemoglobin electrophoresis.

76
Q

What is the next best step for childhood ITP with petechiae but no bleeding?

A

Observation (usually spontaneously regresses in 3 months). If there is mucosal bleeding then corticosteroids and IVIG are first line.

77
Q

What are potential complications of SGA neonates?

A

Polycythemia, hypothermia, hypoglycemia, hypoxia, hypocalcemia.

78
Q

What are the arthrocentesis findings in Lyme’s oligoarthritis?

A

Inflammatory synovial fluid (leukocytes) but negative gram stain.

79
Q

What does a woman with no uterus but has pubic/axillary hair most likely have?

A

Mullerian agenesis. If no pubic/axillary hair then it may be AIS.

80
Q

What percentage of a healthy neonate’s weight is lost in the first week of life?

A

7% weight loss is normal in the first 5 days of life. This weight should be regained by 2 weeks.

81
Q

What are pink spots in an infants diaper most likely?

A

Uric acid crystals (normal for infants).

82
Q

What is the first step in the management of a hemodynamically stable patient with suspected Guillian-Barre Syndrome?

A

Spirometry to assess respiratory function.

83
Q

What is the typical presentation of a ductal-dependent heart disease? (i.e. presents as ductus arteriosus closes from decreased prostaglandins).

A

A day old neonate with sudden onset hypotension, cyanosis, and hypoxia non-respondent to 100% O2.

84
Q

What is a secondary treatment needed for those receiving chronic transfusions (thalassemia, ect)?

A

Chelation therapy to prevent secondary hemachromatosis.

85
Q

What is the treatment for a congenital long OT syndrome?

A

Propranolol and pacemaker. Avoid QT prolongating drugs like class III (sotalol, ect).

86
Q

At what age range is bedwetting considered normal?

A

Before age 5.

87
Q

Does the risk of testicular cancer from cryptorchidism remain increased even after orchioplexy?

A

Yes.

88
Q

When is visual acuity testing usually routinely performed?

A

Age 3-4.

Uworld Step 2 (6 decks)

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