PEDS from FM

Question 1

Steeple sign

Answer 1

Narrowing of the subglottic airway on chest XR, often seen in Croup

Question 2

17 yo w/ sore throat, difficulty swallowing, and faver. 1 week hc. Temp 103. Upon PE you find lateral deviation of the uvula. What does this raise concern for?

Answer 2

In an adolescent w/constitutional symptoms/signs of an acute infections, lateral deviation of the uvula should raise concern for a peritonsillar abscess. It is a sirgical emergency/urgent case as there is considerable risk for local swelling and obstruction of airway.
These are often caused by strep or staph.

Question 3

What are possible causes of short stature?

Answer 3

constitutional growth delay, familial short stature, chronic steroid use, endocrine abnormalities like hypothyroidism or adrenal insufficiency, cardiopulmonary disease, genetic disorders likel downe or turner.

Question 4

What are the most COMMON causes of short stature?

Answer 4

Constitutional growth delay and familial short stature

Question 5

9 month old coming in for her annual wellness, she has conjunctival pallow and labs concerning for iron deficiency anemia. What is most likely cause?

Answer 5

9 month old=milk predominant diet
Whole mulk and breast milk are low in iron but note that the iron in breast milk has higher bioavailability while cow milk proteins can impair iron absoprtion in human infants, most infants and cow milk is associated w/increased risk of occult bleeding

Question 6

4 yo boy comes in w/ 1day hx of limp and hip pain. Pt had cough and runny nose 10 days ago. Palpation of the hip reveals no tenderness, and hip is not erythematous or hot to the touch. What is the most likely dx?

Answer 6

Transient synovitis of the hip, post infection in young kiddos you can get synovitis on weight baring joints.

Tx w/ibuprofen

Question 7

Painless left scrotal mass in 16 yo boy, mass decreases while supine and has a bag of worms sensation. This is likely ___________ but you can also consider _____________ on your differential

Answer 7

This is MOST likely a varicocele, they can be managed symptomatically or surgically

Hydrocele, this normally presents w/uniform enlargement and not isolated mass

Inguinal hernia

Epididymitis, this is more acute and seen w/tender swelling

Question 8

Tx for otitis externa

Answer 8

Daily use of alcohol acetic ear drops

Most common pathogen is pseudomonas aeruginosa

Question 9

Nonbloody nonbillious emesis adter feedings starting 3-6 weeks

Answer 9

likely pyloric stenosis, assess w/ abdominal US

Question 10

Common/most likely organism to cause acute otitis media

Answer 10

strep pneumoe or haemophilus influenzae

Question 11

First line ABX for acute otitis media

Answer 11

amoxicillin with or without clavulnate

Amoxicillin is a broad spectrum abx, beta lactam, ffram + and - bacteria. Its also commonly used for ped URI, sinus, and ear infections.

Question 12

17 yo male w/ unilateral scrotlal pain and swollen tender mass over the posterior aspect of the testis. He also is sweating, endorses chills, and burning with urination. What is the likely dx?

Answer 12

Acute epididymitis, likely from an STI

Question 13

17 yo male w/ unilateral scrotlal pain and swollen tender mass over the posterior aspect of the testis. He also is sweating, endorses chills, and burning with urination. What tx would you like to start and why?

Answer 13

Start ceftriaxone to cover gonnorhea and start doxy or azithro to cover chlamydial infection b/c this is likely acute epididymitis secondary to STI.
Levofloxacin or trimethoprim-sulfamethox for pts where STI is unlikely.

Question 14

Preterm infant who spent time in the NICU and is exclusively breastfed is at greatest risk for what deficiency after 4 months?

Answer 14

IRON

Prematurity–> low iron stores at birth
NICU–> blood draws reduce iron stores
Breastfed–> iron poor diet

Question 15

How might you differentiate viral from bacterial conjunctivitis?

Answer 15

Viral: bilateral
Bacterial: unilateral, purulent discharge

Question 16

How do you treat viral conjunctivits?

Answer 16

You dont, its just symptom management

Question 17

How do you treat bacterial conjunctivitis?

Answer 17

Topical antibiotics like sulfacetamide but this one has largely been supplanted by newer ones but regocnize this for exam purposes

Question 18

Can you tx infectious mononucleosis with acyclovir?

Answer 18

No

Question 19

General/typical newborn screens include…

Answer 19

newborn state screen, hearing, bilirubin, and congenital heart disease

Question 20

WHen screening kids for hocum before spots physicals, what symptoms/hx/and PE findings would you look for?

Answer 20

Symptoms/Hx: personal hx of syncope and chest pain, fam hx of sudden young death

PE: left ventricular outflow obstruction–> systolic murmur that radiates along left sternum that worsens w/preload

note that innocent murmurs are often soft, systolic murmurs 2/6 w/out palpable thrill

Question 21

Lens shaped hematoma

Answer 21

Epidural hematoma

Question 22

crescent shaped hematoma

Answer 22

subdural hematoma

Question 23

What might lead to a subdural hematoma in a kid?

Answer 23

Shaken baby or HIGH SPEED trauma

This will be a ‘crescent shaped’ hematoma

Question 24

For burns in kids, how do we calc body surface area %?

Answer 24

Head - The head is 18%, 9% each for the front and back.

Arm - Each arm is 9% of the body surface area (front and back are 4.5% each)

Thorax - The front and back thorax are 18% each (36% for the whole thing).

Legs - The total surface area for the legs is 27% (so 13.5% for each leg).

Question 25

there’s usually a nonspecific prodrome that gives rise to an erythematous rash. It’sisolated to the face bilaterally (slapped-cheek).You may see some spread to the trunk/limbs, which willbelacy or reticular in appearance.Thisdisease is benign on its own in a normal healthy baby andresolvesspontaneously

Answer 25

Erythema Infectiosum Caused by parvovirus B19

Question 26

an obvious prodrome of low grade fever and the “four hard Cs” –cough, coryza (runny nose), conjunctivitis, and Coplik Spots (Koplik Spots, an enanthem,are small irregular spots with white centers on bright red buccal mucosa). The rash starts on the face, after the prodrome. As it spreads to the body, fever starts with the rash. The rash spreads and clears from head to toe. Later in lifea potentially lethal complication (subacute sclerosing panencephalitis) can occur

Answer 26

MeaslesCaused by a paramyxovirus RUBEOLA

Question 27

It starts on the face, spreadsdownto the toes, and is likewise macular. The prodrome of tender generalized (periorbital, postauricular) lymphadenopathyprecedes the rash.Forchheimer spotson the palate (red enanthem)can be seen

Answer 27

Rubella(aka “German Measles”)Caused by thetogavirusnamedRubella

Question 28

a prodrome of a high-fever (>40 C) that breaks as the rash starts. The rash is a macular rash that begins on trunk and spreads to the face. Febrile seizuresmay result from extreme fever during the prodrome.

Answer 28

RoseolaCaused by HHV-6,

Question 29

A vague, nonspecific viralprodrome indicates contagion. What follows isa rash that starts on the trunkand headfollowed by outward spreadto extremities. Thevesicles are on anerythematous base andare in different stages(eruption, ulceration, crusting). Contagion ends with a final crust. Scarringand secondary infections(Staph and GAS) are two complications.

Answer 29

Varicella(aka “Chickenpox”)Thisiscaused by varicella zostervirus.

Question 30

itcauses bilateral parotid swelling and orchitis in pubertal males.

Answer 30

Mumps

Question 31

has a vague, nonspecific prodromebut may present with oral pain. Like varicella, it has a vesicle on an erythematous base, but will primarily involve only the hands, feet, and mouth (thus the name). It can also involvethe buttocks. Herpanginainvolves vesicular lesions on the soft palate, tonsils, and uvula.

Answer 31

Hand-Foot-MouthDisease (aka “HFMD”)Caused by coxsackie A virus,

Question 32

Slapped cheek appearance

Answer 32

Erythema infectiosum

Question 33

Cough, Coryza, Conjunctivitis, Coplik

Answer 33

Measles/rubeola

Question 34

Aplastic anemia is a concern with what exanthem?

Answer 34

ParvoB19, “slapped cheek” or “fifth disease”, normally its benign but for people with sickle cell or a condition with increased cell turnover it can lead to aplastic crisis!

Question 35

Subacute sclerosing panencephalitis is a concern in the sequelae of which examthem?

Answer 35

Measles

Question 36

IgE mediated reaction

Answer 36

Type 1 Hypersensitivity

Question 37

Unilateral ear pain, releif w/pulling of the pinna, dx’d w/pneumatic insufflation showing a tense immobile membrane

Answer 37

otitis media

Question 38

How do we treat otitis media?

Answer 38

Amoxicillin!

If it recurs, amoxicillin-clauvanate

If penicillin allergy, try a cephalosporin like cefdinir

Anyphylaxis hx, try azithromycin

Question 39

What tends to lead to otitis media?

Answer 39

URIs mostly caused by:
–s pneumoniae
–H influenzar
–M. cararrhalis

Question 40

WHen is a tympanoplasty warranted?

Answer 40

3 infections in 6 months or 4 in a year

Question 41

Two major causes of otitis externa?

Answer 41

Swimming–> psedomona
Digital–> staph

Question 42

Pinna pulling increases pain!

Answer 42

otitis externa

Question 43

How do we treat otitis externa?

Answer 43

Alcohol Acetate ear drops
Bad symptoms Cipro drops and steroid drops

Question 44

When should mastoiditis be considered?

Answer 44

Acute otitis media and mastoid swelling! Its a clinical dx.

People w/ear tubes are at increased risk

Question 45

How do we know when to test for strep?

Answer 45

Sore throat w/ CENTOR criteriaL
Cough+1
Exudates+1
Nodes+1
Temp over 38C+1
OR less than 14 yo +1 or over 44 yo -1

only 1=viral
2-3 get a swab it may be bacterial

Question 46

how do we tx for strep a?

Answer 46

Amox-clav

Question 47

When should you consider mono when you get a strep throat like presentation?

Answer 47

–SPLENOMEGALY or party with sharing cups and what not

Question 48

There is purulent discharge. The illness has been going on for more than 7 days. There is a high fever and maxillary tenderness. All of these signs point to viral or bacterial sunusitis?

Answer 48

Bacterial! worsening symptoms, fever, over 7 days–> likely they had a cold that improved, then became superinfected with bacteria

Question 49

persistence of a bony/mucosal membrane in the nasopharynx that obstructs air flow in babies

Answer 49

choanal atresia

Question 50

Cyanosis while feeding should make you think of

Answer 50

choanal atresia, eval w/looking at nasopharynx/catheter

Question 51

What are pts w/strep a infection at risk for even if you tx correctly?

Answer 51

Post-Streptococcal glomerulonephritis (PSGN) can happen whether or not the patient is adequately treated or not. Just the exposure to the antigen puts him at risk for the mimicry which can result in the renal disease. There is no protection from having treated the infection (unlike Rheumatic fever).

Question 52

The patient will present with a viral prodrome for ~1-2 daysbefore the development of a barking,seal-like coughthat’sinterspersed with inspiratory stridor. The cough is worse at night. The diagnosis is clinicalbut an AP film will show clear lungs and a steeple sign (subglottic narrowing). If causing significant respiratory impairmentsupplement with oxygen and give racemic epinephrineand steroids(usually dexamethasone)

Answer 52

Croup (laryngotracheobronchitis)

Question 53

Steeple sign can be indicative of…

Answer 53

CROUP!
or
Bacterial Tracheitis!

Question 54

Thumb print sign

Answer 54

Epiglottitis

Question 55

Drooling, tripoding, sudden onset dyspnea, high fever, sick as shit

Answer 55

Epiglottitis

caused by Hib, not as common due to vaccination

Question 56

3month old-3 year olf w/barking cough improved w/racemic epi

Answer 56

croup

also remember croup and dexamethosone

Question 57

How do you differentiate epiglottitis from retropharyngeal abscess?

Answer 57

Look for mass/abscess!

Both pts have rapid onset of dyspnea, drooling, hot potatoe voice, maybe tripoding

Question 58

Uvular deviation in a kid

Answer 58

peritonsillar abscess

Question 59

In an asthmatic who came to the ER for an exacerabtion, they have stopped wheezing. If you have rising CO2 in the setting of tachypnea you should strongly consider….

Answer 59

Intubation, this is respiratory failure!
If there is sufficient air trapping the wheezes “go away” because there is NO air movement. The respiratory acidosis tells you that ventilation is impaired.

Question 60

Under 2 years of age + wheezing =

Answer 60

bronchiolitis. Most common etiology is RSV. For the love of all that is holy, do not treat with steroids.