Peds

Question 1

Hypothyroidism in Peds: SSx?

Answer 1

Chronic lethargy, poor academic performance, constipation, & slow growth.

Question 2

IBD - Crohn

1) SSx
2) Most common long-term complication

Answer 2

1) Abd pn, Bloody diarrhea, wt loss, perianal skin tags (more common with Crohn), negative stool culture.
2) Bowel strictures: Due to transmural inflammation seen in Crohns.

Question 3

Chronic constipation: Initial Tx

Answer 3

Disimpaction with PO PEG.

Question 4

3-wk term infant with persistent jaundice and pale stool

1) Dx?
2) Mgmt?

Answer 4

1) Biliary atresia: associated with acholic stool (pale or clay-colored, suggesting lack of bile)
2) Urgent surgery

• Bilirubin is the brownish, yellow pigment of bile. Thus jaundice/hyperBili with pale stool suggest obstructive or post-hepatic cause.

Question 5

Temper tantrums: Mgmt?

Answer 5

Ignore the behaviour.

• Behaviour intervention is to ignore disruptive behaviours that do not pose a risk of injury and avoiding responding in a way that reinforces the behaviour (giving attention).
• It is normal part of development and peaks around 3 years of age and resolves around 5 years.

Question 6

Rickets

1) XR
2) Cause

Answer 6

1) Decreased mineralization around eiphyses &
Bowing of lower extremities
2) Dietary deficiency

Cf. Physiological genu verum resolves by 2 yo.

Question 7

4 yo with nocturnal enuresis: Mgmt

Answer 7

Educate and reassurance

• Bedwetting will resolve spontaneously. Interventions (e.g., alarm and med) would be appropriate for older children.

Question 8

Primary humoral immunodeficiencies: SSx

Answer 8

• FTT
• Chronic diarrhea
• recurrent fever
• nodular lymphoid hyperplasia in gut
• hepatosplenomegaly

Question 9

2 yo with infectious colitis with dehydration due to diarrhea: Initial Tx?

Answer 9

IV NS

• Oral rehydration by NG tube if IV cannot be accessed.
• Avoid dextrose and other fluids: Risk of electrolyte derangement

Question 10

2 yo with infectious, bloody diarrhea: AB Tx?

Answer 10

None
- Exception: Fluoroquinolone for Campylobacter or Yersinia

In Acute diarrhea, AB rarely used.

• In EHEC, AB increases risk of HUS
• AB causes C. difficile infection

Question 11

Sz in neonate

1) Immediate Ix
2) Common causes

Answer 11

1) Serum glucose & Ca (Immediately treatable)

2) Hypoglycemia, hypoxia, and hypothermia

Question 12

Neonate supplementation

1) LBW: Most important supplement
2) LBW: Other supplements to consider
2) Exclusively breastfed neonates

Answer 12

1) Iron
2) Ca, Phosphorus
3) Vitamin D

Question 13

Couple of CF child: Counseling

Answer 13

• Chance of future child having CF is 1:4
• Prenatal testing for CF is recommended: Education before birth can prepare the parents better, and Dx allows pediatrician to be better prepared (additional tests to recognize CF-related problems earlier).