Peds EOR Flashcards
True or false: the height and weight of twins are less than singletons on average at 12 months of age
True. On average, the height and weight of twins are lower until 30 months of age.
What is the gold standard test to diagnose lactose intolerance?
Upper GI endoscopy
What may be seen on laryngoscope of a patient with epiglottitis?
A cherry-red epiglottis.
Treatment for moderate croup?
Single dose of dexamethasone and nebulized epi.
Treatment for pyloric stenosis?
Pyloromyotomy
What is the primary diagnostic test for symptomatic patients suspected for EBV?
Heterophile antibody test (Mononucleosis spot)
What EEG findings are diagnostic of absence seizures?
3Hz spike and wave activity.
Prognosis for lichen planus?
Self limiting, resolves in up to 2 years. Treatment can shorten time to resolution.
What physical exam finding is present in most patients with abusive head trauma?
Retinal hemorrhages
Name 3 gluten containing grains.
Wheat, rye, barely
What symptoms are suspicious for chlamydia conjunctivitis?
Infection occurring 5-14 days of life, a pseudomembrane adherent to the orbital surface, chemosis
Large VSDs present with what other manifestations?
Frequent respiratory infections, slow weight, gain, dyspnea, diaphoresis, and fatigue.
What is the most likely causative organism of Tinea versicolor?
Malassezia furfur
A sweat chloride test > __ is diagnostic of cystic fibrosis.
60 mEq/L
What is Jaccoud arthropathy?
A rare late manifestation of rheumatic fever involving painless loosening and lengthening of the joints in the hands and feet.
What vitamin deficiency is associated with the use of isoniazid?
Vitamin B6 (pyridoxine).
What is the most common factor contributing to acute otitis media?
Eustachian tube dysfunction.
What are risk factors for developing oral cadidiasis?
Recent antibiotic use or inhaled glucocorticoids
Status epilepticus is characterized by > __ minutes of continuous seizure.
5
Describe the physical features associated with down syndrome.
Upslanting palpebral fissures, prominent epicanthic folds, brachycephaly, excess skin at the nape of the neck, a flat facial profile, protruding tongue, sandal toes.
When should eruption of all 20 primary teeth occur by?
30-36 months
Which parasite is most commonly associated with bladder cancer?
Schistosoma haematobium.
What condition is described as purple, pruritic, polygonal, papular, and plaques?
Lichen planus
What is the Nikolsky sign?
Epidermal detachment secondary to gentle lateral pressure.
What is a bell clapper deformity and what is likely to happen with this deformity?
A bell clapper deformity is when the testis is not fixed to the tunica vaginalis.
Testicular torsion is likely to occur
Treatment for pinworms in pregnancy?
Pyrantel pamoate
What is the first line pharmacologic therapy for enuresis?
Desmopressin
Which time of wart presents as a exophytic, dome-shaped papule frequently occurring on the fingers, dorsal hands, knees or elbows?
Common warts
What is the rash associated with fifth disease?
Slapped-cheek rash
First line treatment for pinworms?
Albendazole
What ear condition was historically associated with Mycoplasma pneumoniae infection?
Bullous myringitis.
Measles is also know as _______.
rubeola
What is the most important triggering factor for asthma?
Viral upper respiratory infection.
What is the name of the vertical fissures located in the anterior portion of the external auditory canal cartilage that may be a site of infectious extension in malignant otitis externa?
Fissures of Santorini.
First line treatment for symptomatic hypertrophic cardiomyopathy?
Beta blockers
What are the findings on a wright-stained smear of a pustule from erythema toxicum neonatorum?
Numerous eosinophils and occasional neutrophils.
Wilson disease is a disorder of the metabolism of ______.
Copper
What X-ray finding would be noted for a patient with laryngotracheitis, also known as croup?
Steeple sign, which is narrowing of the trachea.
What physical exam finding would you document in a 5 month old infant with shortening of the left femur?
A positive Galeazzi sign
What is the inheritance pattern of sickle cell disease?
Autosomal recessive
What criteria is used to diagnose acute rheumatic fever?
Jones criteria
When should strabismus be referred to an ophthalmologist?
Constant strabismus, or intermitent after 4-6 months of age, asymmetric pupils, torticollis, diplopia, or fatigue.
What is the most common kidney malignancy in teenagers aged 15–19?
Renal cell carcinoma.
What is Todd paralysis?
The presence of focal weakness after seizure activity, typically lasting up to 24 hours.
At what tanner stage does penis girth enlarge?
Stage 4
What is the first line therapy for children with absence seizures?
Ethosuximide
Lymphadenopathy of what nodes is characteristic of rubella?
Posterior cervical and posterior auricular
What are Koplik spots?
small white or gray elevations on the buccal mucosa that develop in individuals with measles 48 hours prior to the exanthem.
What are the most common congenital defects in congenital rubella syndrome?
Sensorineural hearing loss, cataracts of glaucoma, and heart disease
What are the most common bacterial pathogens of mastoiditis?
Strep pneumo, strep pyo, staph aureus
What medication can aid in the passage of a food bolus in adults but is not recommended for use with children?
Glucagon.
What are the findings of an ultrasound on a patient with pyloric stenosis?
Target sign on transverse view and increased pyloric muscle thickness
Which rare complication of Kawasaki disease is characterized by activation and proliferation of macrophages and T cells?
Macrophage activation syndrome.
Second line treatment for GAS pharyngitis?
Macrolide
What are other osteochondroses, in addition to Osgood-Schlatter disease, that affect children and adolescents?
Sever disease, which involves the calcaneal apophysis, and Sinding-Larsen-Johansson syndrome, which involves the proximal insertion of the patellar tendon at the inferior pole of the patella.
Which human papillomavirus strains typically cause common warts?
Types 2 and 4.
What is the causative agent of erythema infectiosum, also known as fifth disease?
Parvovirus B19
What are the symptoms of Waterhouse-Friderischsen syndrome?
Rapidly spreading ecchymosis, gangrene of extremities, bilateral adrenal hemorrhage and fulminant meningosepticemia.
A 9-year-old boy presents to the clinic for behavioral evaluation. He was recently suspended from school for the third time following a fight with another classmate. His mother states he refuses to listen to her, and he is persistently lying to her and his father. What is the most likely diagnosis?
Conduct disorder
Oppositional defiant disorder typically does not have any violent outbursts.
Necator americanus causes what disease?
Hookworm disease
Describe the murmur of a PDA.
Continuous, rough, machinery-like murmur heard best in the first interspaces of the left sternal border
What is the Samter triad?
A condition defined by aspirin sensitivity, nasal polyps, and asthma.
Which patients are more likely to have coronary complications?
Children younger than 1 year, patients older than 6 years, boys, and those unresponsive to or who received a smaller dose of intravenous immune globulin.
What laboratory findings are common in pyloric stenosis?
Hypochloremia and metabolic alkalosis.
What is the alternative medical term for scalp seborrheic dermatitis or dandruff?
Pityriasis sicca.
True or false: the probability of herpes simplex virus (HSV) recurrence is much higher with HSV-2 than HSV-1 infections.
True.
Which developmental reflexes should have resolved by age 4 months?
Galant reflex, asymmetric tonic neck reflex, and rooting.
What can be ordered if you’re concerned for constitutional delay of growth and puberty?
Bone age determination by radiograph of the hand and wrist
Which class of blood pressure medication is most often associated with drug-induced angioedema?
Angiotensin-converting enzyme inhibitors.
What murmur is described as a continuous murmur heard best over the left or right upper sternal border that is accentuated with head extension while seated?
Cervical venous hum
Describe the distribution over time of the rash caused by Rubella.
Starts on face, spreads to trunk and extremities within 24 hours
What is the deeper form of impetigo called?
Ecthyma.
Is oral or topical antifungals preferred treatment for tinea capitis?
oral
Which reaction is characterized by the development of a generalized dermatitis distal to the original site of allergic contact dermatitis 1 week after the initial reaction?
Autoeczematization, or an id reaction.
How is fifth disease diagnosed?
Clinically, although if aplastic anemia is present, NAAT may be preformed.
What are some vaccinations that should be given to patients before undergoing a splenectomy?
Vaccinations against encapsulated organisms such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.
What is the first line choice of antibiotics for a patient with mastoiditis and no recent antibiotic use?
Vancomycin alone
What disorder is characterized by at least 2 weeks of a major depressive episode and at least one hypomanic episode?
Bipolar 2 disorder.
What is the first line antibiotic for SSSS?
IV nafcillin (or oxacillin)
What skin disorder has appearance similar to acute hot water burns?
Staphylococcal scaled skin syndrome (SSSS)
What are examples of mast cell stabilizers that can be used to treat allergic conjunctivitis?
Cromolyn sodium 4% solution, nedocromil 2% solution, and pemirolast potassium 0.1% solution.
Treatment for scabies?
Topical permethrin
Treatment of Hirschsprung disease?
Surgical resection of the affected bowel
Name some conditions commonly present in patients with down syndrome.
Autism, congenital heart disease, GI tract abnormalities, ophthalmologic disorders
Treatment for allergic rhinitis?
Intranasal corticosteroids and second generation antihistamines
Describe the rash of dermatitis herpetiformis.
Papulovesicular rash on elbows, knees, buttocks, or scalp
Which infection is associated with guttate psoriasis?
Streptococcal pharyngitis.
First line treatment for pinworm infection?
Mebendazole, pyrantel pamoate, albendazole
Which syndrome with an autosomal dominant inheritance pattern can cause patent ductus arteriosus to occur in many members of the same family?
Char syndrome.
What is the duration of antimicrobial therapy for mycobacterium marinum?
1-2 months after symptom resolution for a total of 2-3 months
A patient with a sore throat and development of a rash with a sandpaper like quality is most likely what diagnosis?
Scarlet fever
The double bubble sign on ultrasound is a classic imaging finding of ?
Duodenal atresia
Treatment options for cutaneous warts?
Salicylic acid or cryotherapy
What disease causes mucocutaneous vasculitis most frequently in children between the ages of 3 months and 5 years?
Kawasaki disease
Infantile hypertrophic pyloric stenosis is associated with what medications by the mother or infant?
Macrolide antibiotics
When should the Modified Checklist for Autism in Toddlers (MCHAT) screening questionnaire be given?
18 and 24 months
What are the 3 C’s of Measles (Rubeola)?
Cough, coryza, conjunctivitis
What oral medication used to treat severe acne is associated with an increased risk of birth defects?
Isotretinoin.
What is the most common kidney malignancy in teenagers aged 15–19?
Renal cell carcinoma
What is the treatment for Gilbert syndrome?
Treatment is not required
What is the pathogenesis of infertility in men with cystic fibrosis?
Patients with cystic fibrosis are missing the vas deferens bilaterally, which results in obstructive azoospermia and infertility.
Treatment for bacterial tracheitis?
Broad spectrum antibiotics such as clindamycin or vancomycin plus a second generation cephalosporin.
intubation if indicated
What is the treatment for bacterial meningitis in children 1-18 years?
Ceftriaxone + vancomycin
OR
Cefotaxime + vancomycin
What is the medical term for the fecal pellets present in scabies infection?
Scybala.
When does colic typically resolve?
9 weeks of ago.
How is diagnosis of epiglottitis made?
Direct visualization with a laryngoscope.
Tissue biopsy demonstrates what type of cells in Hodgkin lymphoma?
Reed-sternberg cells
What is the first line antibiotic therapy for whooping cough?
Macrolides
True or false: recovery from strabismus surgery is rapid, and serious complications are rare
True.
What is the most common cause of meningitis in children >10 years?
Neisseria meningitidis
What murmur is described as a vibratory or musical like murmur heard best over the lower left sternal border?
Still murmur
What coagulation factor is deficient in patients with Hemophilia B?
Factor IX
What is congenital dacryocystocele?
It is an obstruction of the proximal and distal portions of the nasolacrimal duct that results in the distention of the lacrimal sac and duct.
What is the treatment for scoliosis with a Cobb angle <20 degrees?
Observation and serial x rays
When is chronic suppressive therapy recommended for genital herpes?
Six or more recurrences within 1 year
What is the first line empiric therapy for pediatric patients with pyelonephritis?
Cephalosporins and aminoglycosides
What antibiotics are used to treat confirmed mycobacterium marinum?
Macrolides, rifampin, ethambutol, or tmp-smx.
What is the most common chromosomal disorder?
Down syndrome 0.5% of all human conceptions
What is the criterion standard for obtaining urine specimens in children who are not yet toilet trained?
Suprapubic aspiration.
What is the inheritance pattern of cystic fibrosis?
Autosomal recessive
What is used to diagnose erythema toxicum neonatorum?
Wright-stained smear of pustular contents.
What exanthema is teratogenic in the first trimester and may result in fetal hearing impairment, infantile glaucoma, and cardiac disease?
Rubella
Its the R in TORCH infections
What is the scientific name for pinworms?
Enterobius vermicularis
What is the most common cause of acute bacterial sialadenitits?
Staph aureus
The absence of which structure is responsible for most cases of male infertility associated with cystic fibrosis?
Vas deferens.
Is PDA more common in males or females?
2:1 females:males
How long after a strep infection does acute rheumatic fever typically occur?
2-4 weeks
What was a serious complication of measles that caused blindness before widespread use of the measles vaccine?
Keratoconjunctivitis.
What should you do if a patients lead level is 25?
Repeat lead levels in 1-4 weeks for levels 15-44
Which syndrome is characterized by the presence of infantile hypertrophic pyloric stenosis and hyperbilirubinemia?
Icteropyloric syndrome
A pediatric cystic fibrosis patient presents with steatorrhea and bulky foul smelling stools should be given what therapy?
Supplement fat-soluble vitamins A, D, E, and K
What are the diagnostic criterion for Kawasaki disease?
Fever of at least 5 days with any four of the following: bilateral nonexudative conjunctivitis, oral changes, peripheral extremity changes, polymorphous rash, or cervical LAD.
How do you reduce a nursemaid elbow?
Pressure over the radial head and hyperpronate the arm
OR
Supinate and fully flex the elbow while applying pressure to the radial head and gentle traction
What congenital infection increases the risk of PDA?
Congenital rubella
Nursemaid elbow involves what ligament?
Annular ligament
Pinworms are tested for with which test?
Cellophane tape test (scotch tape test)
What is the empiric treatment for possible skin infection with mycobacterium marinum?
A macrolide and either a fluoroquinolone, doxycycline, or tmp-smx.
Treatment for severe croup?
Single dose of dexamethasone and repeated doses of nebulized epi. Need admission.
What is the most severe complication of parvovirus B19?
Transient aplastic crisis causing severe anemia in patients with disorders affecting red blood cells.
What is the most common cause of intestinal obstruction in infants between 6 and 36 months of age?
Intussusception
At what lead level is chelation therapy indiciated?
> 45
What are the major(5) and minor(4) Jones criteria?
Major: Carditis, erythema marginatum, syndemham chorea, polyarthritis, and subcutaneous nodules.
Minor: fever, arthralgia, elevated acute phase reactants, and prolonged PR interval on electrocardiogram.
Fine white lines on the surface of lichen planus lesions are known as?
Wickham striae
Is a cervical venous hum an innocent murmur?
Yes
What stool test can be used to rule out inflammatory bowel disease?
Fecal calprotectin.
Wilms tumors are associated with?
Congenital abnormalities
Why is cephalexin preferred over nitrofurantoin in children with UTIs?
Nitrofurantoin is dosed QID
Which acid and base abnormality is most common in children with diarrhea?
Metabolic acidosis because of the bicarbonate lost in stool.
What is the classic progression of symptoms in rocky mountain spotted fever?
Headache, fever, and myalgias with blanching, erythematous, macular rash on wrists and ankles 3-5 days into illness.
What is the most common cause of congenital nasolacrimal duct obstruction?
Incomplete canalization at the end closest to the nose
What is used to measure the magnitude of the curve in scoliosis?
The Cobb angle
Which complication can result from nasal packing and is characterized by fever, hypotension, desquamation, and mucosal hyperemia?
Toxic shock syndrome.
What is the preferred diagnostic test to confirm pyloric stenosis?
Abdominal ultrasound
What are the common manifestations of scarlet fever?
Rash starting in axillae and groin, circumoral pallor and strawberry tongue, linear petechiae over the AC fossa and axillary folds known as Pastia lines.
What virus causes mumps?
Paramyxovirus
Other than supportive care, what should patients diagnosed with EBV be counseled on?
Refraining from contact sports for 4 weeks to prevent splenic rupture
When should the varicella vaccine administered?
12-18 months and again at 4-6 years
What is the allergic salute?
A transverse nasal crease from repeatedly rubbing the tip of the nose with the hand.
A harsh, holosystolic murmur with a palpable thrill describes what murmur?
VSD
What score can be used to assess severity of croup?
Westley croup severity score
What is the treatment for developmental dysplasia of the hip?
Pavlik harness
What is the most common cause of epiglottitis in a child?
H. influenza type B
What finding would you note on a lateral cervical X-ray in a patient with acute epiglottitis?
Thumbprint sign.
What common kidney malignancy found in children is associated with congenital abnormailities?
Wilms tumor
What is Auspitz sign and what is it a sign of?
Punctate bleeding spots when psoriasis scales are scraped off.
What is the most common cause of viral conjunctivitis?
Adenovirus
What is the most important factor in reducing the risk of developing mastoiditis?
Early and sufficient treatment of acute otitis media.
Genital herpes has traditionally been associated with what type of HSV?
Type 2
T/F? Strabismus can be a presenting sign of retinoblastoma.
True
A sweat chloride test > __ is confirmatory for cystic fibrosis.
60mmol/L
What therapeutics are used for chelation therapy?
Succimer, calcium disodium edetate, or penicillamine.
What are allergic shiners?
Infraorbital edema with darkening under the eyes due to venodilation
What is the most common cause of a peritonsillar abscess?
Strep pyogenes
Treatment for psoriasis <10% of BSA?
Topical corticosteroids such as betamethasone dipropionate or triamcinolone acetonide
What is the first line antibiotic choice for a patient with mastoiditis and recent antibiotic use?
IV vancomycin plus a cephalosporin such as ceftazidime or cefepime.
If the seizure persists for 10 minutes after two doses of lorazepam have been given, what medication is indicated?
Phenytoin, valproic acid, or levetriacetam.
What in utero infection is associated with a patent ductus arteriosus?
Rubella.
What is the treatment for seborrheic dermatitis?
Gentle removal of scale with warm olive or mineral oil and a low strength corticosteroid.
What scale is used to classify androgenic alopecia?
The Hamilton-Norwood scale.
What is the treatment for anorexia nervosa?
Nutritional rehabilitation
What is the genetic inheritance pattern of Wilson disease?
Autosomal recessive.
What antibiotic can be used in a patient with a penicillin allergy who has acute bacterial sinusitis?
Doxycycline or a third-generation cephalosporin.
A harsh, loud, holosystolic murmur at the lower left sternal border describes what diagnosis?
VSD
What lab evidence supports a diagnosis of Kawasaki disease?
Leukocytosis, anemia, elevated ESR/CRP, elevated liver transaminases.
Treatment for recurrent impetigo?
Rifampin
What are some prognostic factors in Legg-Calvé-Perthes disease?
The most important factor is age at presentation, as children under 6 years old have a more favorable prognosis. Negative prognostic factors include female sex, obesity, progressive loss of range of motion, and greater involvement of the femoral head.
What findings are classically seen on electrocardiogram in patients with an atrial septal defect?
QRS pattern suggestive of incomplete right bundle branch block (rSr’ or rsR’).
What is the most common cause of meningitis in children between 3 months and 10 years?
Strep pneumo
First line treatment for nummular eczema?
Topical high or ultra high potency steroids (clebetasol, betamethasone, mometasone)
What are the 4 H’s of scurvy?
Hemorrhage (Petechiae, bleeding gums)
Hyperkeratosis (rough skin, loose teeth, poor wound healing)
Hypochondriasis (Irritability, emotional changes)
Hematologic abnormalities (Easy bruising)
A midsystolic murmur best heard at the second left intercostal space with a fixed and split S2 describes what diagnosis?
Atrial septal defect
What is the whirlpool sign?
A sign diagnostic of volvulus secondary to twisting of the mesentery around the mesenteric pedicle base.
Treatment for Kawasaki disease?
IVIg and high dose aspirin
hat gene is affected in patients with cystic fibrosis?
The cystic fibrosis transmembrane conductance regulator (CFTR) gene.
What are some physical examination findings of hip dislocation in children > 1 year old (walking age)?
Shortening of the leg, a short leg limp (with out-toeing and a toe touch gait), Trendelenberg gait, and limited abduction of the hip.
What is the most appropriate test for whooping cough?
PCR and culture of nasopharyngeal specimens
Treatment for bronchiolitis?
Oxygen therapy and supportive care.
What is the treatment for gonorrhea in a neonate?
IV ceftriaxone
What is a complication of severe pinworm infection?
Acute appendicitis
Treatment for congenital nasolacrimal duct obstruction?
Observation and massage.
Most have spontaneous resolution within 6 months.
When does erythema toxicum neonatorum usually diagnosed?
Within the first 72 hours after birth
What is WAGR syndrome?
It is the congenital abnormalities associated with a Wilms tumor.
Wilms tumor, Anirdia, Genitourinary anomalies, mental Retardation (now referred to as intellectual disability)
Treatment for a febrile seizure?
Supportive care and antipyretics
Which virus is associated with Kaposi sarcoma?
Human herpesvirus 8.
What are the contraindications to using ceftriaxone in neonates?
Infants with clinically significant hyperbilirubinemia and infants who are receiving intravenous calcium.
What genetic disorder is often associated with hypothyroidism?
Trisomy 21.
Describe the rash of erythema toxicum neonatorum.
Erythematous macules and papules on the trunk, face, and proximal extremities.
What nutritional deficiency are exclusively breastfed infants at risk for?
Vitamin D deficiency
What is the treatment for Kawasaki disease?
IVIg and low dose aspirin.
What foods contain vitamin C?
Green vegetables and citrus fruits.
What laboratory test rules out scabies infection?
Mineral oil slide preparation.
About how long does it take to develop protection after administration of the influenza vaccine?
2 weeks.
What is the most common valvular disease caused by rheumatic fever?
Mitral regurgitation
When does tooth eruption typically begin?
7 months
What sign seen on x ray is seen in epiglottitis?
Thumb print sign
What is the causative agent of roseola?
Human herpesvirus 6
What is the hallmark of refeeding syndrome?
Hypophosphatemia
What is the classic triad of congenital toxoplasmosis?
chorioretinitis, intracranial calcifications, and hydrocephalus
Treatment for duodenal atresia?
Duodenoduodenostomy
What are the 3 stages of whooping cough? Which stage has the most severe symptoms
Catarrhal
Paroxysmal - Most severe
Convalescent
What is the best treatment for teething symptoms?
Chilled teething objects
What is the treatment for scoliosis with a Cobb angle >30 degrees?
Bracing
At what tanner stage does penis length enlarge?
Stage 3
Descrive the SSSS sad face sign?
Thick perioral crusting with a dried oatmeal appearance around mouth, nose, and sometimes eyes
At what tanner stage do breast buds develop?
Stage 2
What is the typical empiric therapy for meningitis?
Third gen cephalosporin and vancomycin
What is the most common factor contributing to acute otitis media?
Eustachian tube dysfunction.
First line treatment for UTIs in children?
Cephalosporin
What formula helps to estimate the fifth percentile for systolic blood pressure in pediatric patients?
Systolic pressure (fifth percentile) = 70 mm Hg + 2 x age in years.
True or false: psoriatic arthritis can be the initial presentation of psoriasis.
True.
Recurrent episodes of jaundice triggered by stresses on the body is most commonly caused by what inherited disorder?
Gilbert syndrome
What is the first time treatment for enuresis?
Behavioral modification with positive reinforcement
What are the three types of cutaneous warts?
Common warts, flat warts, and palmoplantar warts
What is the chromosomal abnormality in down syndrome?
Trisomy 21
Small, firm white papules on the nose and cheeks of an infant describe what rash?
Milia
What is the name for small, white or gray/brown spots in the periphery of the iris, which is commonly seen in down syndrome?
Brushfeild spots
Which murmurs increase with inspiration?
Right-sided heart murmurs (e.g., tricuspid stenosis, pulmonary regurgitation).
What is the only surgical treatment for sensorineural hearing loss?
Cochlear implantation
Treatment for malignant otitis externa?
IV ciprofloxacin transitioning to oral ciprofloxacin after clinical improvement or decrease in acute phase reactants.
Which congenital heart defect is most common in patients with Down syndrome?
Complete atrioventricular septal defect.
What dietary supplements are indicated in lactose intolerance patients?
Calcium and vitamin D
Most drug eruptions are caused by what type of hypersensitivity reaction?
Delayed-type T cell medicated type IV immune reactions
What is the most common pathogen associated with bacterial tracheitis?
Staph aureus
What is the most common CT finding in chronciectasis?
Tram track appearance due to dilated airways, bronchial thickening, and reduced bronchi wall tapering.
Also, signet-ring sign and tree-in-bud sign
What are Pastia lines?
red and linear petechial lines in the skin folds, such as the antecubital fossae and axillary folds. Pastia lines are seen in individuals with scarlet fever.
What maneuver would decrease the intensity of the murmur associated with hypertrophic cardiomyopathy?
Squatting
What is the treatment for complicated mastoiditis?
Mastoidectomy plus IV antibiotics and myringotomy.
Are lichen planus lesions painful?
No
Which congenital condition is Hutchinson teeth, or peg-like incisors or molars, associated with?
Congenital syphilis.
What is the most common etiology of afebrile pneumonia in children aged 1 to 4 months?
Chlamydia trachomatis.
Name the most common organism for the following infections: Epiglottitis Croup Bronchiolitis Tracheitis
Epiglottitis - H influenzar
Croup - parainfluenza virus
Bronchiolitis - RSV
Tracheitis - staph aureus
Where will a patient with osgood schlatter disease have tenderness to palpation?
Over the tibial tubercle
What is the most commonly associated cardiac defect in adults with coarctation of the aorta?
Bicuspid aortic valve.
What is the pathophysiology that causes hives?
Mast cell release of histamine in the superficial dermis.
What is the histopathologic appearance of biopsies consistent with celiac disease?
Flatting or complete loss of intestinal villi.
What is the dermatologic manifestation of inflammatory bowel disease that is characterized by multiple painful red nodules commonly found on the shins?
Erythema nodosum.
What are some serious adverse effects of desmopressin?
Hyponatremia, seizures, and water intoxication
What physical exam finding is likely to be found in the eyes of a patient with Wilson disease?
Kayser-Fleischer rings (brownish rings that encircle the iris.)
Describe the typical osgood schlatter patient.
Male athlete 10-15 years old
What areas does toxic epidermal necrolysis effect that SSSS does not?
Mucous membranes
Which condition should be considered in infants < 1 month of age who develop projectile vomiting within 1 month of taking a macrolide?
Infantile hypertrophic pyloric stenosis.
Symptomatic pediatric patients with hypertrophic cardiomyopathy are treated with?
agents that decrease myocardial oxygen demand, increase left ventricular filling time, and reduce the left ventricular outlet obstruction. These medications include beta-blockers (e.g., metoprolol) and nondihydropyridine calcium channel blockers, to be used singly or in combination.
Acute bronchiolitis is most frequently caused by?
RSV
What is the most common cause of bacterial parotitis?
Staphylococcus aureus.
Which male genitourinary infection caused by Candida is characterized by white patches on the penis and is associated with severe burning and pruritus?
Balanitis.
What differentiates otitis externa from malignant otitis externa?
Malignant otitis externa infects the temporal adjacent bones near the affected ear and typically occurs in immunocompromised patients.
What is the first line treatment for idopathic nephrotic syndrome?
Titrated dose of prednisone
Treatment for impetigo?
Mupirocin
What is the treatment for Pertussis infections?
Azithromycin
What is the most useful laboratory test to assess the degree of dehydration in children?
Serum bicarbonate.
What is the recommended dosage of ferrous sulfate when treating children with iron deficiency anemia?
3 mg/kg once daily.
Allergic rhinitis symptoms in the fall are usually caused by?
Mold and ragweed
What is the starting dose of ethosuximide for treating absence seizures in children younger than 6 years old?
5 to 10 mg/kg/day in two divided doses.
What is the microorganism responsible for scarlet fever?
Streptococcus pyogenes.
What class of medications, when used prior to delivery in women <34 weeks gestation, accelerates lung development by increasing surfactant production and improving lung volume, compliance, and gas exchange in the infant?
Glucocorticoids (betamethasone or dexamethasone)
What is the rash resulting from keratin obstructing sweat ducts that is seen in harm and humid environments?
Miliaria crystallina
What is the preferred method to obtain urine for a urine culture in children who are not toilet trained?
Catheterization or suprapubic aspiration.
What is the most common type of scoliosis?
Adolescent idiopathic scoliosis.
What drug commonly used to treat pinworms is available over the counter?
Pyrantel pamoate.
What is the most common cause of an atrial septal defect?
Ostuim secundum
Why should phenazopyridine not be used for longer than 48 hours?
Because there is an increased risk of methemoglobinemia and hemolytic anemia.
A 13 year old overweight boy presenting with knee pain, antalgic gait, and limited internal rotation of the hip should have what imaging ordered?
X ray of the pelvis for SCFE
What is the first line treatment for UTIs in children?
First generation cephalosporin such as cephalexin.
Treatment for testicular torsion?
Detorsion and orchiopexy
Which condition caused by coxsackievirus A serotype is characterized by fever and painful papulovesicular lesions on the soft palate, tonsils, and uvula?
Herpangina.
What is the first line treatment for androgenic alopeica?
Topical minoxidil and oral finasteride
What systemic diseases are associated with intussusception?
Crohn disease, celiac disease, and cystic fibrosis.
What conditions are associated with encopresis without constipation according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)?
Oppositional defiant disorder and conduct disorder.
What are indications for admission for a pediatric patient with suspected pneumonia?
<90% O2 sat on room air, dehydration, inability to maintain hydration or to feed, RR >50.
A figure 3 sign seen on chest x ray is a sign of?
Coarctation of the aorta
What is the test of choice to confirm lactose intolerance?
Hydrogen breath test after ingesting lactose
What coagulation factor is deficient in patients with hemophilia A?
Factor VIII (“A”ight (8)))
Physical exam finding indicative of Measles?
Koplik spots
What lung component is responsible for surfactant production?
Type 2 pneumocytes.
True or false: during the puberty growth spurt, the trunk grows before the limbs.
False, the limbs grow before the trunk.
What is the treatment for oral candidiasis?
Nystatin oral suspension
What type of wart is described as a skin colored or pink papule with a smooth surface?
Flat wart
Honey colored crusts describes infection?
Impetigo
What is the diagnostic imaging for vesicoureteral reflux?
Voiding cystourethrography.
What is the most common congenital heart defect?
Ventricular septal defect.
Bilious vomiting, hemodynamic instability, and abdominal distention are classic signs of?
Intestinal malrotation
What is the treatment for bacterial meningitis in patients < 1 month old?
Cefotaxime + ampicillin
OR
Gentamicin + ampicillin
Which two aortic disease states, in addition to coarctation of the aorta, may cause blood pressure to be lower in the lower extremities than the upper extremities?
Aortic dissection and supravalvular aortic stenosis.
Which pathogen is most likely to cause tympanic membrane perforation?
Group A Streptococcus.
A bluish-gray macule on the sacrococcygeal area of an infant is most likely to be?
A Mongolian spot
Name a specific dermatologic finding in patients with celiac disease.
Dermatitis herpetiformis
Treatment for genital herpes?
Valacyclovir or acyclovir x 7-10 days
What is the amount of protein in the urine typically seen in nephrotic syndrome?
> 3 g.
What is the most common complication of cryptorchidism?
Testicular cancer.
Diagnosis of testicular torsion is made by?
Ultrasound
When is the pertussis vaccination given?
2 months 4 months 6 months 15-18 months 4-6 years
What is the leading cause of nonhereditary sensorineural hearing loss in newborns?
Congenital cytomegalovirus infection
What is the name for the short mid-diastolic murmur that indicates moderate-severe mitral regurgitation secondary to increased blood flow across this valve?
Carey Coombs murmur.
Empiric treatment for children with bacterial pneumonia?
amoxicillin or a macrolide for presumed atypical pneumonia
Which disease caused by Epstein-Barr virus presents with white patches on the sides of the tongue that cannot be scraped off?
Oral hairy leukoplakia.
What is the most common type of psoriasis in children?
Chronic plaque psoriasis
What is a blueberry muffin rash?
This is the nickname given to the purpura or petechial rash of cytomegalovirus (CMV) due to its spotted blue or purple appearance on the skin, resembling a blueberry muffin.
What is the second line therapy for enuresis?
Alarm therapy
What are Dennie-Morgan lines?
Accentuated lines below the lower eyelids associated with allergic conjunctivitis.
Treatment for epiglottitis?
Maintain airy way and antibiotics: third gen cephalosporins such as ceftriaxone or cefotaxime and an antistaphylococcal agent such as vancomycin.
What skin findings may be present in meningitis?
Petechiae or purpura
What cause of conductive hearing loss is characterized by a growth of stratified, squamous epithelium that may occur after repeated ear infections?
Cholesteatoma.
What drugs are most commonly associated with toxic epidermal necrolysis?
sulfonamides, anticonvulsants, NSAIDs, and allopurinol.
At what tanner stage does the scrotum change in color and texture?
Stage 2
What is the proper treatment for diaper dermatitis caused by Candida albicans?
Topical zinc oxide.
At which one of the following sites does herpes simplex virus establish latent infection?
Neurons
Pediatric obesity is defined by a BMI percentile > ___
95
What is the suspected cause of seborrheic dermatitis?
Malassezia yeast
What illness causes 5 days of fever followed by development of a rash?
Roseola
Cutaneous lichen planus most commonly effects what locations?
ankles and wrists
What is the treatment for chalmydia conjunctivitis?
Oral erythromycin
What is the treatment for uncomplicated diaper dermatitis?
Frequent changes, gentle cleaning with warm water, and allowing the infant to go without a diaper for a few hours each day to expose the skin to air
What artery is primarily responsible for posterior epistaxis?
The sphenopalatine artery.
What is the treatment for intestinal malrotation?
Ladd procedure
What disease is characterized by lack of peristalsis and involuntary relaxation of the internal anal sphincter, leading to bowel obstruction?
Hirschsprung disease
Treatment for hemophilia B?
Factor IX replacement, with recombinant factor IX being the replacement of choice.
What is Jaccoud arthropathy?
A rare late manifestation of rheumatic fever involving painless loosening and lengthening of the joints in the hands and feet.
First line treatment for children with otitis media?
Amoxicillin
What medications are used for PDA closure in a preterm infant?
Indomethacin
What is the difference between bulbar and tarsal conjunctiva?
The bulbar conjunctiva is the part that covers the globe of the eye, while tarsal conjunctiva covers the eyelids.
Treatment for mild croup?
Humidifier, fever reduction, and fluids
Complications of mumps?
Orchitis, Oophoritis, meningitis, encephalitis, deafness, pancreatitis, and arthritis.
Patients with a positive screening test for down syndrome should be offered what test?
Chorionic villus sampling through 14 weeks gestation, amniocentesis is >15 weeks, or plasma basted test for cell-free DNA.
Which medication can be used to treat both allergic rhinitis and asthma?
Montelukast.
Yellow, greasy, adherent plaques on a child’s head describes what condition?
Seborrheic dermatitis
What is the most common cause of a peritonsillar abscess?
Strep pyogenes
Which disease is caused by the variola virus within the Poxviridae family?
Smallpox.
Which stage of syphilis presents with a rash on the palms and soles?
Secondary syphilis.
What diagnostic test for HSV would you choose for a patient with crusted over vesicles?
Serologic testing
Group A strep is what species of strep?
Strep pyogenes
What are the most commonly used antibiotics for a retropharyngeal abscess?
Ampicillin-sulbactam or clindamycin
What syndrome is characterized by jugular vein suppurative thrombophlebitis that is caused by Fusobacterium necrophorum and is characterized by high fever, rigors, respiratory symptoms, and unilateral neck swelling or pain.
Lemierre syndrome
What is the primary cause of serum sickness in modern times?
Medications.
Ingestion of ____ before the age of 1 is a risk factor for IDA.
unmodified cows milk
Which Mycobacterium species causes Hansen disease?
Hansen disease, also known as leprosy, is caused by Mycobacterium leprae.
Children with impetigo should not return to school until ___ hours after initiating antibiotic therapy.
24
What is the most common cancer of childhood?
ALL
Which two organs are responsible for converting vitamin D into calcitriol?
The liver and kidneys.
What is the diagnostic test of choice for HSV?
Depends on the clinical presentation
What oral antibiotics are indicated for impetigo?
Doxycycline or cephalexin
Treatment for severe diaper dermatitis?
Low potency topical glucocorticoid.
What is the treatment for congenital cytomegalovirus infection?
IV ganciclovir or valganciclovir
What organism is the most common cause of a peritonsillar abscess?
Streptococcus pyogenes.
What do you expect to see on physical exam for a testicular torsion?
Absent cremasteric reflex
Which neonatal dermatologic condition occurring around 3 weeks after birth and caused by a reaction to Malassezia species is characterized by inflammatory pustules on the cheeks without the presence of comedones?
Neonatal cephalic pustulosis.
What is the causative agent of whooping cough?
Bordatella pertussis
What are the components of the quadruple test for down syndrome in the second trimester?
AFP
Unconjugated estriol
Inhibin A
beta-hCG
Lung infection with what pathogen is common in patients with cystic fibrosis?
Pseudomonas
What are some treatments for osteogenesis imperfecta?
Bisphosphonates, especially pamidronate, are commonly used off-label for treatment and have been shown to increase bone mineralization and decrease the rate of fractures. Surgery is indicated to prevent or correct deformities.
What are Forchheimer spots?
Petechiae on the soft palate seen in Rubella
Treatment for encopresis due to fecal impaction?
Fecal disimpaction followed by long term oral laxative therapy.
Describe the murmur you would expect to hear in a patient with rheumatic fever.
Late systolic rumbling murmur
What is the hallmark sign of hemophilia B?
Hemorrhage in the joints that is painful.
What is a potential adverse effect of the use of chloramphenicol in the third trimester of pregnancy?
Gray baby syndrome. It is characterized by abdominal distention, cyanosis, vasomotor collapse, and death of the infant.
What species is the most common cause of tinea capitis in the United States?
Trichophyton tonsurans.
First line treatment for psoriasis on the face or intertriginous areas?
Topical calcineurin inhibitors such as pimecrolimus
Why is topical benzocaine avoided in managing ear pain in children < 2 years of age?
There is a risk of methemoglobinemia.
When is the measles, mumps, rubella vaccination given?
12-15 months first dose
4-6 years second dose
What is the Koebner phenomenon?
Plaque formation on sute of prior trauma 1-2 weeks after skin injury
Is imaging necessary before attempting to reduce a nursemaid elbow?
No
What is the most common pathogen found in noncystic fibrosis patients who are presenting with bronchiectasis?
Haemophilus influenzae.
Which class of medications should be avoided within 5 weeks of discontinuing fluoxetine?
Monoamine oxidase inhibitors.
Treatment of a retropharyngeal abscess includes?
Securing airway, I and D, and empiric antibiotics
What is Eisenmenger syndrome?
It occurs when the pulmonary pressure becomes so high that it causes a reversal of blood shunting to right to left, leading to cyanosis in an acyanotic heart disease.
True or false: car safety seats are an appropriate place for infants to nap while at home.
False, sleeping in car safety seats is not recommended outside of the car.
What is an elevated lead level?
> 5
What is the most common cause of malignant otitis externa?
Pseudomonas
What medication can be given to decrease risk of hospitalization for RSV in infants born prematurely?
Palivizumab - humanized monoclonal antibody against a RSV glycoprotein
What tests are used to screen for down syndrome in pregnancy? When can it be completed?
Ultrasound to measure fetal nuchal translucency, beta hCG and pregnancy associated plasma protein A (PAPP-A)
This is done during the first trimester.
What is the Barlow maneuver?
What is the Ortolani maneuver?
Barlow is hip flexion and adduction. Positive test is posterior dislocation of the femoral head from the acetabulum.
Ortolani test is hip flexion and abduction. A positive test is the femoral head reducing into the acetabulum.
What is the rash the can occur in infants affected by congenital rubella syndrome?
Blueberry muffin rash
How is Hirschsprung disease diagnosed?
Rectal biopsy.
What is the major undesirable side effect of the first-generation antihistamines?
Drowsiness.
How is colic defined?
An infant <3 months who cries for >3 hours per day for > 3 days per week without a clear explanation.
What is the traditional drug of choice for tinea capitis?
Griseofluvin
True or false: oral lichen planus is associated with an increased risk of oral cancer.
True.
What are the most commonly affected sites of plaque psoriasis?
Elbows and knees
Which neonatal dermatologic condition occurring around 3 weeks after birth and caused by a reaction to Malassezia species is characterized by inflammatory pustules on the cheeks without the presence of comedones?
Neonatal cephalic pustulosis.
What malignancy has a high rate of concurrent infection with epstein barr virus?
Hodkin lymphoma
What is the most commonly associated cardiac defect in adults with coarctation of the aorta?
Bicuspid aortic valve.
Treatment for erythema toxicum neonatorum?
No treatment required
What viral exanthem is associated with a high fever of 3-4 days.
Roseola
What is the best test to confirm the diagnosis of bronchiectasis?
CT scan of the lungs
What is the first line treatment for status epilepticus?
Lorazepam.
Scoliosis is defined by a Cobb angle of > ___.
10 degrees
Treatment for lichen planus?
Topical corticosteroids, oral antihistamines for pruritis.
What is the recommended treatment duration for infants with severe esophagitis on endoscopic biopsy?
3–6 months.
How long after starting a medication does a type IV sensitivity reaction typically occur?
If not previously sensitized, around 1 week after starting the medication.
(days if sensitized previously)
What organism is most often associated with acne vulgaris?
Cutibacterium acnes
Treatment for RMSF in children?
Doxycycline
What maneuver would increase the intensity of the murmur associated with hypertrophic cardiomyopathy?
Valsalva
How can hair casts be differentiated from nits?
Hair casts are benign tubular sheaths, which unlike nits, slide easily up and down the hair shaft.
True or false: chemosis is a common sign of viral conjunctivitis.
False. Chemosis is a red alarm sign, typically seen in more serious conditions, including hyperacute bacterial conjunctivitis or orbital cellulitis.
Roseola is caused by?
Human herpes virus 6
A wide, fixed split S2 is most characteristic of?
An atrial septal defect
Roseola is most commonly seen in what age group?
< 2 years
Which pathogen that frequently causes gastroenteritis in children can be vaccinated against?
Rotavirus.
What are the most common manifestations of congenital cytomegalovirus infection?
Petechiae, hepatosplenomegaly, small size for gestational age, microcephaly, sensorineural hearing loss.
Allergic rhinitis symptoms in the spring are usually caused by?
Tree pollens and flowering shrubs
Which patients warrant inpatient nutritional rehabilitation and medical stabilization?
Those who weigh less than 75% of their ideal body weight or have a body mass index < 15 to 16 kg/m2.
Laryngotracheitis is also known as?
Croup
First line treatment for GAS pharyngitis?
Penicillin or amoxicillin
What is the initial serologic test of choice for celiac disease?
Tissuse transglutaminase immunoglobulin A (tTG-IgA)
What is the most common site of origin for nose bleeds?
Kiesselbach plexus
What is the appropriate treatment for otomycosis, a fungal infection of the external ear canal?
Clotrimazole otic solution applied twice a day for 10 to 14 days.
What are the 3 first line treatment options for molluscum contagiosum?
Cryotherapy, curettage, and cantharidin.
True or false: nummular eczema commonly involves the face and neck.
False. If these areas are involved, alternative diagnoses should be suspected.
Which medications, when given to patients with mononucleosis, are known for causing a characteristic prolonged, pruritic maculopapular rash?
Penicillins
Describe the rash distribution over time for roseola.
Rash starting on the neck or trunk and spreading to the face or extremities. Rash starts after a fever goes away.
How long does the acute phase of toxic epidermal necrolysis last?
8 to 12 days
Treatment for lice?
Permethrin
What murmurs may be heard due to rheumatic fever?
Aortic or mitral regurgitation
What is the most common cause of croup?
Parainfluenza virus
What symptom of mumps differentiates it from other viruses?
Bilateral parotitis 48 hours after onset of fever
What are the symptoms of roseola?
3-5 days of high fever followed by a maculopapular rash when the fever resolves
What symptoms of bacterial tracheitis differ from that over other respiratory infections in children?
Toxic appearance and drooling is uncommon.
History of cold symptoms followed by rapidly progressive sore throat, fever, respiratory distress, and hoarseness
Subluxation of the radial head is known as?
Nursemaid elbow
What bacteria is responsible for erysipelas?
Streptococcus pyogenes.
How long after birth should infants double their birth weight? Tripple?
Infants double their birth weight by 4 months and triple their birth weight by 12 months
Abdominal x-ray findings in Hirschsprung disease?
Dilated loops of bowel without gas or stool present in the rectum.
Treatment for vesicoureteral reflux?
Many children have spontaneous resolution, but open antireflux surgery is a common procedural treatment.
Which prescription medication used for asthma and severe seasonal allergic rhinitis has a black box warning for agitation, depression, sleeping problems, and suicidal ideation?
Montelukast.
Hirschsprung disease is associated with what genetic syndrome?
Trisomy 21
What diagnostic test for HSV would you choose for a patient with unroofed vesicles?
PCR or viral culture of the vesicular fluid.
PCR is preferred because it is more sensitive
Which microorganism is associated with neonatal cephalic pustulosis?
Malassezia spp.
What treatment is used for impetigo caused by MRSA?
Doxycycline and TMP-SMX
What medications can be used in patients with ongoing seizures despite use of first- and second-line therapies?
Midazolam, propofol, or pentobarbital.
What is the treatment for uncomplicated mastoiditis?
IV antibiotics and middle ear drainage.
Avascular necrosis of the proximal femoral epiphysis in a growing child is known as what disease?
Legg-Calve-Perthes disease
What are the signs of epiglottitis?
The three D’s: dysphagia, drooling, and respiratory Distress
Are first generation or second generation antihistamines the first line pharmacologic treatment for hives?
Second gen (cetirizine, loratidine, fexofenadine)
What is the first line topical vasoconstrictor for nose bleeds?
Oxymetazoline
How many Jones criteria must be present to make a diagnosis of acute rheumatic fever?
Two major or one major and two minor and confirmed or suspected history of a recent group A strep infection.
What laboratory findings are common in pyloric stenosis?
Hypochloremia and metabolic alkalosis.
What type of oropharyngeal cancer is most commonly associated with human papillomavirus?
Squamous cell carcinoma.
