Peds

Question 1

Normal Pubertal development in female. the sequence?

Answer 1

1. breast budding (thelarche) 2. axilary hair, body odor, mild acne (pubarche) 3. growth spurt 4. menarch

Question 2

Normal Pubertal development in male. the sequence?

Answer 2

1. testicular enlargement 2. penile enlargement 3. axilary hair, body odor, mild acne (pubarche) 4. growth spurt

Question 3

ambiguous genitalia. workup?

Answer 3

1. chromosome analysis
2. pelvic ultrasonogram ifMullerian structures are present (uterus)
3. if gonads palpable

• testosterone and dihydrotestosterone (DHT) ratio
• LH and FSH
• hCG stimulation test

if gonads not palpable (most likely congenital adrenal hyperplasia due to 21 hydroxylase deficiency)

• 17-hydroxyprogesterone
• serum electroytes
• plasma renin activity

Question 4

Community acquired pneumonia in children.

Abx?

Abx for severe pneumonia?

what defines severe pneumonia?

Answer 4

• Amoxicillin 30mg/kg TDS 3-5 days
• severe pneumonia means one of following

1. severe respiratory distress
2. severe hypoxia or cyanosis
3. marked tachycardia
4. altered mental state
5. empyema

• children with severe pneumonia require ICU admission and

Ceftriaxone 50mg/kg IV daily

AND

Flucloxacillin 50mg/kg IV 6 hourly

(consider azithromycin if pneumonia progresses)

Question 5

down-slanting papebral fissure, wide spread eyes, low set ears, +- ptosis

Dx? etiology?

what other features?

Answer 5

Noonan’s syndrome

chromosome 11 autosomal dominant mutation

short stature

pulmonary valve stenosis

webbed neck

failure to thrive, mild

abnormal cardiac rhythm,

intellectual disability

Question 6

a toddler with jaundice, lethargy, splenomegaly

Hx of neonatal jauntice, Family Hx of gall stones

Dx and blood film?

Answer 6

hereditary spherocytosis

• microsphercytes on blood flim
• autosomal dominant

Question 7

HCV + mother,

what to do with the baby?

breast feeding ?

Answer 7

HCV-PCR at 2-6months

anti-HCV at 18-24 months

breastfeeding ok except in the presense of cracked or bleeding nipples

Question 8

croup Tx? Management?

Answer 8

1. dexamethasone 0.6mg/kg for all.
2. mild, consider sending home

moderate, observe four 4 hours

severe, add nebulized epinephrine, oxygen, observe 4 hours. If not improved, consider hospitalization.

Question 9

the pattern of inheritance for

Huntington’s disease

cystic fibrosis

G6PD deficiency

Thalassemia

hemochromatosis

hereditary hemorrhagic telangiectasia

Answer 9

Huntington’s disease : autosomal dominant

cystic fibrosis : autosomal recessive

G6PD deficiency : X-linked recessive

Thalassemia :autosomal recessive

hemochromatosis : autosomal recessive

hereditary hemorrhagic telangiectasia : autosomal dominant

Question 10

sore throut 3 weeks ago,

polyarthralgia

fever

Dx? and Management?

Answer 10

acute rheumatic fever

admission. confrim Dx with throat swab

Tx with PO penicillin V or amoxicillin for 10 days, NSAIDS,

IM benzathine penicillin for secondary prevention.

echocardiography

Question 11

pertussis

exclusion from school? how long?

Answer 11

1. 21 days from the onset of any cough (catarrhal period)
2. 14 days from the onset of paroxysmal cough
3. 5 days after starting appropriate antibiotics.

Question 12

congenital infections that affect the fetus or infant?

Answer 12

TORCH (Toxoplasma, others, rubella, CMV, HSV)

others include parvoB19, enterovirus, VZV, coxackie, listeriosis, syphilis

Question 13

5 months old, runny nose, fever 40 C for the past two days, otherwise active and healthy.

Temperature dropped normal and maculopaular rash on trunk.

Dx?

Answer 13

roseola infantum

Question 14

a toddler with lethargy and inactivity,

a fundoscopic exam shows a macular cherry spot.

Dx ? etiologu?

Answer 14

Tay -Sachs syndrome

autosomal recessive

deficiency in beta hexosaminadase A

Question 15

a toddler with

anemia, leukopenia, bone pain, enlarged spleen, thrombocytopenia

+

loss of muscle tone, loss of motor skills, muscle spasm, trouble swallowing

Answer 15

Gaucher disease

autosomal recessive

glucocerebrosidase deficienty

lysosomal disease

Question 16

8 month

a history of sudden bending the trunk and flexion of upper limbs.

episodes happen in a cluster.

Dx and Tx?

Answer 16

Infantile spasm

Tx : steroid, ACTH, vigabatrin

Question 17

pediatric

hypoglycemia Tx

Answer 17

2ml/kg 10% dextrose IV

Question 18

regular, monomorphic wide QRS tachycardia in children

V/S stable.

Tx?

Answer 18

ADENOSINE!!!!

such tachycardia in children are often SVT with abberancy, hence responsive to adenosine.

if adenosin doesn’t work,

consider VT and amiodarone

Question 19

congenital rubella syndrome

the triad of manifestations

Answer 19

microcephaly

PDA

cataract