Peds

Question 1

What are the two major features of autism?

Answer 1

Persistent deficits in social communication and interaction

Restricted, repetitive patterns of behavior, interests, and/or activities

Question 2

What are the core features of ADHD? (3)

Answer 2

Hyperactivity
Inattention
Impulsivity

Question 3

What percentage of weight loss is appropriate after birth?

Answer 3

10% - however should regain bw by age 10-14 d age

Question 4

Definition of FTT

Answer 4

Weight < 3rd
Fall across 2 major percentile lines
<80% of expected weight for height and age

Question 5

Differential to short stature

Answer 5

ABCDEFG:
Alone (neglect)
Bone dysplasias (rickets, scoliosis)
Chromosomal (Turner, Down)
Delayed growth (constitutional)
Endocrine (low GH, Cushing, hypothyroid)
Familial
GI malabsorption (celiac, Crohn’s)

Question 6

Presentation of Epiglottis

Answer 6

Drooling, tri-pod position, inspiratory stidor

Question 7

Complication GABHS pharyngitis

Answer 7

Scarlet fever (rash initially appears on the neck and chest, then spreads over the body. 
May develop Pastia's lines, bright red coloration of the creases under the arm and in the groin.

Question 8

What should an infant’s weight be at two weeks of age

Answer 8

birth weight

Question 9

Colic

Answer 9

Rule of three:
Unexplained paroxysmal bouts of fussing and crying that lasts at least three hours a day, at least three times a week, for longer than three weeks.

Question 10

Common reason for infant FTT

Answer 10

Improper feeding - make sure to ask about formula preparation, food insecurity

Question 11

Acceptable APGAR Score at birth?

Answer 11

7 or higher (most babies do not get 10), assess at 1 min and 5 min, and if less than 7 at 5 min, every 5 min until >7

Question 12

Clinical signs of dehydration in child/infant

Answer 12

Sunken fontanelles, dry oral mucosa, sunken eyes, decreased skin turgor, may see decreased urine output, weight loss and drop in BP as well as tachycardia

Question 13

Hourly maintenance fluids for child?

Answer 13

4:2:1 
1-10kg = 4cc/hour 
\+ 
11-20 kg = 2cc/hour 
\+ 
>20kg = 1cc/hour 

Infants may need a dextrose solution added to NS. This maintenance fluid should be considered along with ongoing losses and fluid replacement

Question 14

Fever work up in infant less than 28 days old?

Answer 14

Complete work up with admission - LP, blood C&S, CBC and differential, urine, CXR if resp , stool if GI sx and start empiric abx

Question 15

Fever in infant between 28 days and 3 months of age?

Answer 15

Non-toxic appearing - consider is follow-up reliable? Consider Rochester criteria.
Toxic appearing - Admit, full work up and empiric abx

Question 16

Fever in infant 3 months to 3 years

Answer 16

Non-toxic and no focus of infection - urine (add CBC if temp >39), observation and Tylenol, if high WBC (>15) empiric abx. Otherwise observe and follow up regularly

Question 17

Prophylaxis for febrile seizures?

Answer 17

No, in most cases simply provide counselling for family, fluid and antipyretics
Features of high risk seizures - warranting further work up: longer than 15 mins, focal, recurrent (>1 in 24 hours), hx of neurological impairment, neurological deficit after seizure

Consider LP if child is <12mo

Question 18

Neonatal vomiting - what feature of the vomitus should be considered?

Answer 18

Is it bilious or not?
- if green - indicates obstruction below bile duct (Hirshprung’s, duodenal atresia, volvulus). If not then obstruction above (GERD, pyloric stenosis, TEE)

Question 19

Tx for intussusception?

Answer 19

Barium enema

Question 20

Tx for functional constipation?

Answer 20

Education, dietary modifications, encourage activity and behavioural modification - such as regular reminders to toilet and allowing enough time for toiletting
Dis-impaction can be achieved via oral or rectal PEG
PEG can also be used as a long-term treatment
Follow-up and consult gastroenterologist if refractory

Question 21

ED Tx for children with vomiting likely due to gastroenteritis?

Answer 21

Oral ondansetron is preferred over gravol (less drowsiness S/E) give ).15mg/kg up to 8mg in oral liquid form and commence rehydration therapy 15-30 mins after oral ondansetron - only need to give one dose.

Question 22

Nutrition for healthy term infants - up to 6 months

Answer 22

1. Breast feed exclusively if possible, confers great benefits
2. Daily Vit D supplements (400IU)
3. First foods should be iron-rich (meat, meat alternatives and iron fortified cereal)
4. Routinely monitor growth

Question 23

What is the most common congenital heart defect?

Answer 23

Ventricular Septal Defect

Question 24

Ductus Arteriosus closure

Answer 24

Functional closure within first 15 hours of life

Anatomic closure within first days of life

Question 25

Diminished femoral pulses could indicate

Answer 25

Coarctation of the aorta

Question 26

Acute Asthma exacerbation Tx?

Answer 26

Escalate method of corticosteroid delivery based on severity
Mild - salbutamol + ICS
Moderate - salbutamol + Oral CS consider ipratropium
Severe - salbutamol and ipratropium and oral steroids if possible consider IV CS, magnesium, and nebulizers
Severe to impending respiratory failure - salbutamol and ipratropium nebulized continuous, IV CS may need intubation - call PICU

Question 27

Initial tx for anaphylaxis?

Answer 27

Give epinephrine IM 1:1000 ratio (0.01mg/kg) into lateral thigh repeat every 5-15 minutes

Question 28

Screen time for children?

Answer 28

None under 2 years of age, <1 hour for 2-4 years of age and <2 for children any older

Question 29

Physical activity guidelines?

Answer 29

Pre-school - 180 minutes per day of PA at varying activities
School - 60 minutes per day of moderate to vigorous levels - aiming to have vigorous activity at least 3 times a week and bone strengthening activities at least 3 times a week

Question 30

Caloric requirement of term babies

Answer 30

100-120 kcal/kg/day

Question 31

Absence of red reflex

Answer 31

Retinoblastoma
Cataracts
Glaucoma
Chorioretinitis

Question 32

Otitis Media managment?

Answer 32

Amoxicillin - PO 10 days of therapy for children less than 2, 5 days for older children

Question 33

Uncomplicated pneumonia sx and DX?

Answer 33

Commonly overlap with sx of reactive airway disease or other viral respiratory disease, DX of bacterial pneumonia should be supported with a CXR

Question 34

Tx for uncomplicated bacterial pneumonia

Answer 34

Amoxicillin or ampicillin 7-10 days as empirical therapy

Question 35

True or false breastfed infants are more at risk of developing Hyperbilirubinemia than formula fed

Answer 35

True. Important to ensure breast feeding support is set up prior to discharge from hospital and that there is frequent follow up in first days of life.

Also important to do RBC testing and Coombs to ensure that there is not blood reactivity.

Breastfeeding can continue while infant is in phototherapy

Question 36

Inheritance pattern of achondroplasia

Answer 36

Autosomal dominant (so if the parents both do not have it then the risk is the same as general population)