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Peds - kap Flashcards

1
Q

Pt works with his hands and gets occasional cold sores. Presents with warts on his hand. Dx?

A

Herpetic whitlow
HSV 1 or 2
Tx - observation and analgesics
Usually self limiting

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2
Q

Child with multiple infections has low IgG, IgA and IgM. Dx?

A

Bruton’s agammaglobenemia
Mutation in Bruton tyrosine kinase
Low or absent b cells -> panhypogammaglobulinemia
Infections typically start at 6 months of age

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3
Q

Child presents with a painful red knee about a week after a sore throat. Dx and management?

A

Septic arthritis
Get an arthrocentesis STAT
Gram stain and sensitivity essential for successful treatment
high [PMN] suggests bacterial etiology

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4
Q

Infant presents with floppiness, constipation, weak cry, drooling. Dx?

A

Infant botulism
COD = respiratory failure
Equine serum botulism antitoxin in babies over 1 year

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5
Q

AV canal defect is associated with which genetic anomaly?

A

Trisomy 21

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6
Q

Kid with recent camping history, sudden HA, fever, vomiting, lacy red rash. Dx and Tx?

A

Rocky Mountain spotted fever
Rickettsial dz
Doxycycline (allowed in a child despite age because this is a life threatening dz)
Chloramphenical second line

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7
Q

Child being treated for otitis media presents following a seizure. Dx and testing?

A

Cerebral abscess - life threatening complication of otits media/sinusitis (fever, neuro deficits, HA, seizures)
Order a CT or MRI of the brain

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8
Q

Which children should receive palivizumab?

A

RSV prophylaxis

RF’s - Bronchopulmonary Dz (BPD), premature birth, and hemodynamically signficant heart dz

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9
Q

Meningitis pt with GNR rods growing on chocolate agar?

A

H. flu b

Usually in a pt with questionable vax hx

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10
Q

Pt presents with well circumscribed erythematous rash with central clearing and hypopigmented patches. Dx and studies?

A 
Tinea corporis (ringworm)
Studies - KOH prep
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11
Q

During delivery, if time between membrane rupture to birth is >18 hours, what is the baby at risk for?

A

neonatal sepsis (GBS, E. coli, Listeria, HSV, enterovirus)

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12
Q

Newborn presents with bulging fontanel, grunting, tachypnea, cyanosis. Dx?

A

Neonatal sepsis

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13
Q

What serious complication can arise from Varicella infection in the immunocompromised?

A

Pneumonia

Give acyclovir IV in immunocompromised Varicella patients to prevent this

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14
Q

Rash iwth pink-red umbilicated papules. Spreads in linear streaks

A 
Molluscum contagiosum (poxviridae)
Linear streaks due to scratching
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15
Q

Tx of otitis media?

A

10 days of po amoxicillin

Re-evaluate in 48-72 hour

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16
Q

Child presents with FTT, developmental delay, frequent infections, oral thrush should be evaluated for?

A

HIV/AIDS

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17
Q

What is postviral synovitis?

A

<1wk of joint pain, inability to bear weight, following viral infection or vax

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18
Q

Child refuses to bear weight on his leg, localized tenderness, Xray - soft tissue inflammation. Dx?

A

Osteomyelitis

Most commonly Staph aureus

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19
Q

What two conditions can cause a patent PDA?

A
  1. Maternal Rubella infection - also screen for deafness, cataracts, and cardiac dz
  2. Prematurity
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20
Q

Child presents with rash that started on the head and spread down. Also has a red spot with central greying in the buccal mucosa. Dx?

A

Measles
Fever, cough, coryza, conjunctivits. Rash that spreads down.
Koplic spot - small red spot with bluish white center on the mucosal membrane. Usually 1-2 days before the rash

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21
Q

Most common causes of meningitis in a newborn

A

GBS
E. coli
Listeria

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22
Q

Maculopapular rash starting on the face and moving down the body. Incl rash within the mouth

A

Rubella

Can have interuterine transmission

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23
Q

Inheritable immunodeficiency with low T and B cells and no thymic shadow.

A

Adenosine deaminase deficiency, SCID
Accumulation of products in the purine salvage system deactivates DNA synthesis and the immune system is sensitive
Tx - BM transplant

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24
Q

Most common cause of meningitis in an infant under 3 months old

A

GBS (S. agalactiae)

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25
Q

Most common causes of Bell palsy

A

HSV, Varicella, EBV

Tx - steroids and eye drops

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26
Q

Lymphadenopathy in a cat owner

A

Bartonella henselae

Scratch, bite, or fleas of an infected cat

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27
Q

Kid has night time anal pruritis and positive scotch tape test

A

Enterobius vermicularis

Tx - Mebendazole, albendazole

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28
Q

Kid presents with itchy flakey scalp and patches of alopcia. Dx?

A

Tinea Capitis

Tx - Griseofulvin

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29
Q

Meningitis pt has a brain abscess. Etiology?

A

Citrobacter

GNR, Tx with ampicillin

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30
Q

Motor function milestones for a 24 month old

A

Pick up objects without losing balance
Jumping up
kicking a ball forward
Going up or down stairs with support

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31
Q

Most common complication of a Very low birth weight infant (<1500g)?

A

Intracranial hemorrhage

Occurs in ~33%

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32
Q

Typical PE findings in a infant exposed to Valproic acid in utero

A

Craniofacial anomalies (high forehead, epicanthal folds, broad and low nasal bridge, etc)
CV anomalies (ie coarctation)
Cleft lip
Meningomyelocele

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33
Q

Newborn with hypotonia, poor Moro reflex, low set ears, enlarged tongue, deflection of the fifth fingers. dx?

A

Trisomy 21

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34
Q

Premature infant with hydrocephaly and downward deviated eyes with retracted upper lids. Dx?

A

Germinal matrix hemorrhage

highly vascularized lining of the ventricular cavities. Vulnerable to hypoxic insults in a premie

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35
Q

What would suggest if a baby was exposed to cocaine during pregnancy?

A 
SGA
Microcephaly
Neurodevelopmental abnormalaties
Very irritable, inconsolable
High pitched cry
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36
Q

Child with hepatosplenomegaly, osteopenia, and flaring of the distal femurs. Dx?

A

Gaucher dz
ar lysosomal dz
Tx - glucosylcermidase replacement

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37
Q

Baby with hx of neonatal jaundice, URI’s, and nasal polyps. Dx?

A

Cystic fibrosis

Tx for acute exacerbation - IV ceftazidime with tobramycin

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38
Q

Developmental milestones for a 4 y/o

A 
Draw a square
Count to 4
Identify 4 colors
4 to 5 word sentences
Draw a picture of a person with 4 parts
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39
Q

A kid w/ meningitis has CSF findings consistent with bacterial etiology but no organisms on gram stain. Dx and management?

A

TB meningitis
RIPE + prednisone
Fatal if not treated

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40
Q

What can cause a kid to develop a rash during a EBV infection?

A

Sometimes EBV is confused with strep and ampicillin is given. This triggers a maculopapular rash. D/c ampicillin and provide supportive care

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41
Q

Slap cheek rash

A

Parvo

Tx - supportive

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42
Q

1st line tx for an atopic kid?

A

Topical emoliant

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43
Q

X linked dz where pts are susceptible to catalase + infections?

A

Chronic granulomatous dz
Defect in NADPH oxidase + catalase organisms -> diffuse granulomas
Staph, Pseudomonas, Serratia, Nocardia, aspergillus
Failt nitroblue tetrazolium test

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44
Q

Mom incidentally finds a mass while bathing her 3 y/o. Dx?

A

Wilm’s tumor
Most common primary malignant tumor of childhood
Also look for HTN, anemia, and hematuria

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45
Q

DDx if renal tumors:
Bilateral
Tumor crossing the midline

A

B/l - Wilm’s

Tumor crossing midline - Neuroblastoma

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46
Q

What do you do with a child <5 y/o that has been exposed to TB?

A

Prophylactic Isoniazid

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47
Q

Rash + recent hiking hx + migratory arthralgias

A

Lyme dz
Get serologic testing
If < 8 y/o - amoxicillin
All others, doxycycline

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48
Q

Tx of scabies?

A

Permethrin cream applied o/n

Wash all clothing

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49
Q

Amniotic fluid is bron and murky. Skin bx of neonate shows granulomas with central necrosis

A

Neonatal listeriosis
Confirm with blood and CSF cultures
Pleomorphic Gram + bacillus

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50
Q

Split S2
Murmur over Pulmonic and Tricuspid valve
RVH w/ impulse

A

ASD
Commonly presents with exercise intolerance in adolescence
L-R shunt is fixable but Eisenmenger syndrome is not

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51
Q

HR>180
Narrow QRS
Absent or abn P waves

A

SVT
stable - IV adenosine
Unstable - Cardioversion

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52
Q

Cardiogenic shock due to infection in a neonate

A

Viral myocarditis

Most common: Coxsackie B and adenovirus

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53
Q

Most common congenital heart anomaly?

A

Aortic stenosis
Usually bicuspid valve
Crescendo-decrescendo Systolic ejection murmur over RSB and LVH

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54
Q

On PE neonate has precordial hyperactivity, loud S2, and weak pulses.

A

Hypoplastic left heart syndrome with closed PDA

Dusky skin color during feedings

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55
Q

What can mimic appendicitis in a young child?

A

Meckel diverticulitis
Incomplete obliteration of the omphalomesenteric duct. Can also have painless rectal bleeding
Test - Meckel scan
Manage - excision

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56
Q

Rule of 2’s in Meckel diverticulitis

A 
2% of population
2x more likely in male
w/in 2 feet of ileiocecal valve
2" long
2% will develop complications
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57
Q

Etiology of SVT in a ped?

A

Wolff-Parkinson-White

Ebstein anomaly

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58
Q

Downward displacement of an abn tricuspid valve into the RV

A

Ebstein anomaly
Increased volume of the atrium may lead to cyanosis. One or more accessory conduction pathways predisposes to arrhythmias (SVTs, WPW, a fib)

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59
Q

Most common cardiac anomaly in infants of DM moms?

A

Asymmetric septal hypertrophy
Septum in the LV is hypertrophied causing decreased systemic circulation and pulmonic congestion
Present in RDS due to decreased production of surfactant
Tx- supportive, will resolve over time

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60
Q

Murmur that is heard during times of stress (ie fever, infection, anxiety) in kids 3-7y/o

A

Innocent murmur

Structures are NL but murmur is heard due to increased CO

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61
Q

What congenital malformations are associated with children born to women with uncontrolled DM?

A

Heart (VSD, transposition of the great arteries, dextocardia)
CNS (open neural tube defects)
Kidneys (low set ears)
Skeleton (rib and vertebral column malformations

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62
Q

If a baby has retinal hemorrhages, what must be ruled out prior to hospitalization or reporting to CPS?

A

Coag studies

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63
Q

Which primitive reflexes are the first to disappear (around 2-3 months of life)

A

Palmar grasp

Rooting reflex

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64
Q

A baby that becomes cyanotic when feeding is suggestive of?

A

B/l choanal atresia

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65
Q

retinoscopic finding of cleft in the optic disc?

A

Coloboma

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66
Q

CHARGE syndome includes?

A 
Colobomas
Heart Defects
Choanal atresia
Retardation (growth or mental)
Genitourinary abn
Ear anomalies
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67
Q

Cyanotic Diseases of the Newborn

A 
The T's
Truncus arteriosus
Tricuspid atresia
Tetralogy of Fallot
Transposition of the great arteries
Total anomalous pulmonary return and pulmonary stenosis
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68
Q

What is risky about a woman that receives meperidine during delivery?

A

If baby is born 2-3 hours post administration, baby may have respiratory depression and require intubation. Give naloxone

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69
Q

What are the most common clinical features of fetal alcohol syndrome (FAS)?

A

Microcephaly
Short palpebral fissures
Midfacial hypoplasia
Possible cardiac defects

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70
Q

Most common cause of a neck mass appearing shortly after birth?

A

Torticollis
SCM tumor of infancy
Usually regress after 4-8 months w/o treatment
PT recommended to promote FROM of the neck

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71
Q

Infant can lift head to 90 degrees, eyes cross the midline, laughs, and slight awareness of parent. Age?

A

4 months

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72
Q

Infant can lift head to 45 degrees, follow to midline with eyes, vocalize, smile, state of half-waking conciousness. Age?

A

2 months

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73
Q

Infant can roll over, grasp, turn to voice, feed self, and differentiate b/w parent and not parent. Age?

A

6 months

74
Q

Infant can sit up w/o support, pull to stand, pincer grasp, babble, indicate wants, stranger anxiety. Age?

A

12 months

75
Q

Infant can walk, make a tower of two blocks, say 3 words, use a spoon and cup, temper tantrums, brings objects to parent. AGe?

A

18 months

76
Q

If a family has a child with IDD due to Fragile X, what testing should be done on their other children?

A

Sisters should receive cytogenic testing

Het females can have similar behavior and cognitive problems as those with ADHD

77
Q

What is breast milk jaundice?

A

increase in indirect bili during the second week of life
Caused by glucuronyl transferase inhibitor in the milk of some mothers
D/c breast milk x 48 hours

78
Q

Child failed to pass meconium in first 48 hours and has chronic constipation

A

Hirschsprung disease
defect in neural crest migration leading to absence of ganglioin cells
Distal intestinal obstructions
Suspect any time a child fails to pass meconium

79
Q

Epigastric pain radiating to the back, fever, n/v

A

Pancreatitis

80
Q

What is the treatment for imperforate anus in a neonate?

A

Diverting colostomy

81
Q

Neonate with drooling and violent choking with their first feeds?

A

Esophageal atresia

Often accompanied by tracheoesophageal fistula

82
Q

Infant has episodes of distress interrupted with quiet playful peroids

A

Intussuscepation

Air enema for those with symptoms less than 48 hours

83
Q

new born optic exam revealed g/l gray-white opacities and no red light reflex. Dx?

A

Congenital cataract

Caused by congenital rubella or galactosemia

84
Q

How do you manage a vaccinated child with a dirty deep wound

A

Just clean and suture, no vax needed since he has had them within the last 10 years

85
Q

Most common causes of meningitis in babies <3 months old

A

GBS
E. coli
Listeria

86
Q

Child has itchy rash of the scap with small, oval, white nodules firmly attached to the hair shafts

A

Pediculus humanus capitis (head lice)

Tx - lindane, pyrethrins + piperonyl butoxide, malathion, permethrin

87
Q

Multiple shiny dome-shaped papules with central umbilications in a child w/ a hx of atopic dermatitis

A

Molluscum contagiosum
Viral
More common in pts w/ atopy, HIV, immunocomp
Common in childhood, can be sexually transmitted
Tx - none, self limiting

88
Q

Management of bloody diarrhea with protozoa w/ ingested RBC’s

A

entamoeba histolytica
Get an abdominal u/s for liver abscesses
Tx - metronidazole, follwed by paromyomycin or iodoquinol

89
Q

New born had late decels and meconium stained amnio, low apgars, cyanotic and limp. Hours later child has seizure

A

Hypoxic-ischemic encephalopathy due to perinatal asphyxia
Causes low Apgar, abn conciousness, RDS, feeding difficulty, weak cry, poor tone, seizures
Late decels on FHM is a sign of hypoxia

90
Q

Diaper rash is caused by

A

Irritant contact dermatitis (feces and urine)

Tx - looser diaper, bth with mild soap, frequent diaper changes, low strength steroid cream

91
Q

Pt has swollen lips and rash with erythematous patches with pale center after taking NSAIDS

A

Uticaria, angiodema
Rash lasts up to 24 hours
IgE mediated

92
Q

What is a serious complication of juvenile RA?

A

Uveitis

Get a slit lamp exam

93
Q

Male neonate has failed to void in the first day of life. Palpable mass in the suprapubic area

A

Posterior urethral valves
Place a catheter to drain bladder
Voiding cystourethrogram is diagnostic
Tx - surgery in first few days of life

94
Q

Initial Tx for a kid with nephrotic syndrome

A

Prednisone

95
Q

Initial test for a kid you are suspicious of T2DM

A

Get a fasting glucose

96
Q

Fever malaise parotitis

A

Mumps
Most common complication - meningoencephalomyelitis
Orchitis is less common in kids, more common in adults

97
Q

On Xray a knee has nonspecific irregularities of the tubercle contour

A

Osgood-Schlatter
Common cause of anterior knee pain, associated with aports
Stress rxn at the insertion of the patellar tendon into the tibial tubercle causing osteochondritis

98
Q

Pt has bone pain worse at night. Xray radiolucent nidus with surrounding reactive sclerotic bone

A

Osteoid osteoma
5-24 y/o
Can cause leg length discrepency
Tx - surgical excision

99
Q

What is associated with T1DM

A

Celiac

Initial screening should include IgA against tissue transglutaminase Ab

100
Q

Infant has frequent vomiting, no diarrhea, dry mm

A

Intracranial HTN due to vasogenic edema
Caused by mass effect (tumor, abscess)
Tx - IV corticosteroid to lower the intracranial pressure

101
Q

Serologic findings in ulcerative colitis?

A

Elevated p-ANCA (perinclear Antineutrophil cytoplasmic Ab)

onset of bloody diarrhea, no skip lesions

102
Q

Characteristics of Crohn’s

A

Ulcers can form anywhere in the GI (including mouth)
More severe abd pain than UC (frequently worse in RLQ)
Transmural inflammation
Skip lesions
Granulomas
Fistulas

103
Q

Febrile child with extensive blistery rash, flaccid blisters that seems to slide off with pressure

A

Staphylococcal scalded skin syndrome (SSSS)
Usually in children <5 y/o
Never involves intraoral mucosa
Tx - IV naf or oxacillin, IVF, keep skin moist with saline, emollients

104
Q

Defect in fibrillin gene

A

Marfan syndrome
AD
Abnormalities in the eye, skeleton and cardiac system
Skin - striae
eyes - upward displacement (ectopia lentis), myopia

105
Q

Which medication should be avoided in a kid w/ a viral illness?

A

Aspirin

106
Q

Migratory polyarthritis + erythema marginatum + sub q nodules over affected joint

A

Strep
look for elevated ASO titer
Can also have chorea, carditis
tx - penicillin + aspirin

107
Q

Is HCV passed through breast feeding?

A

No

108
Q

Teething: when, how, where?

A

When - 6 to 8 months
How - bluish gums, poor feeding, drooling
Where - Mandibular central incisors com in first

109
Q

Hormone finding in Turner’s syndrome

A

High FSH, LH
Low estradiol
Because ovaries aren’t responding

110
Q

Grade IV systolic murmur radiating to the clavicle. Wide pulse pressure w/ bounding pulses

A

PDA
Consider ligation
“machine like murmur

111
Q

Erythematous macules with purpuric centers on two or more mucosal surgaces

A

Stevens-Johnson syndrome, 10-29% of body involved
1 mucosal surface - erythema multiforme <10% of body involved
if >30% involved - toxic epidermal necrolysis

112
Q

Premmie has poor weight gain and poorly formed bulky stools

A

Steatorrhea due to insufficient bile acid pool (common in premmies)
Provide formula with medium-chain triglycerides (not long) since these do not require bile acids for absorption

113
Q

Following dental work, pt develops a new heart murmur

A

Strep viridians

Subacute infective endocarditis, only affects heart valves with prior damage (congenital, rheumatic)

114
Q

Pathophys of type 1 DM

A

AutoAb production against pancreatic Ag (glutamic acid decarboxylase)

115
Q

How do you manage a baby born in meconium stained fluid?

A
  1. Place in radiant warmer
  2. Dry and stimulate the infant
    if still depressed
  3. Intubate
116
Q

Retrograde flow of urine into the ureter/kidney before voiding

A

Vesicoureteral reflux (VUR)
caused by incompetent vesicoureteral valve
Many children outgrow, but some require surgery:
1. Breakthrough UTI while on Ppx abx
2. Renal scaring
3. Failure of VUR resolution
4. B/l and younger pt

117
Q

Newborn has a weak cough, prolonged jaundice, hypotonia, slow respiratory effort, coarse facial features, enlarged fontanelles, poor feeding, somnolence, large tongue, constipation, dry skin, umbilical hernia

A

Congenital hypothyroidism

Most common cause is thyroid dysgenesis

118
Q

Newly adopted baby has diarrhea, scaly rash around the mucous membranes, nail dystrophy, growth restriction and recurrent bacterial/fungal infections

A

Zinc deficiency

Important component in metalloenzymes

119
Q

inflammation at the insertion of a muscle group

A

apophysitis

Common in Osgood-Schlatter

120
Q

When do kids receive the Varicella vaccine?

A

1st dose @ 1 year

2nd @ 4-6 years

121
Q

How do you manage a pregnancy in a family w/ a previous child with CAH due to 21-hydroxylase deficiency

A

Give dexamethasone at no later than 6 weeks
It crosses the placenta to prevent virulization of females
Then do a CVS at 10 weeks to determine genotype and continue therapy if baby is female until genetic analysis can confirm absence of genes

122
Q

How do you treat strep pharyngitis in a pt that is unlikely to be compliant with medications?

A

IM Benzathine penicillin G

123
Q

What should you do for a kiddo hospitalized for a UTI that you suspect has puelo?

A

Renal U/S
Looks for hydronephrosis, renal abscess, urinary calculi, anatomic abnormalities
Get a Voiding cystourethrogram after the UTI has cleared to asses for vesicoureteral reflux (VUR)

124
Q

Tx for pt with lead poisoning + encephalopathy

A

Blood lead level is at least 70 to have syx of Increased intracrainial pressure
Immediate hospitalize and parenteral tx with two chelators (EDTA, BAL, dimercaprol)

125
Q

How do you tx lead poisoning w/o encephalopathy

A

Lead level 45-70

po succimer outpt

126
Q

Once a mother has a Down’s baby, what is her increased risk of having another?

A

Mother’s age related risk + 1%

127
Q

Most common therapy for OSA in children?

A

Adenotonsillectomy

128
Q

Which RF’s increase risk of Developmental dysplasia of the hip

A
  1. Vaginal delivery in breech
  2. Females
    Dysplasia - spectrum of conditions in which the femoral head does not sit in the acetabulum -> hip instability
129
Q

Following URI, pt has morning stiffness, pain, and swelling in one or a few joints. Decreased ROM

A

Juvenile Rheumatoid arthritis
Oligoarticular if 4 or fewer joints are involved
+ ANA associated with good prognosis

130
Q

Asplenic kids are at increased risk for?

A 
Encapsulated organisms:
Strep pneumo
H. flu
N. meningitidis
Should receive pneumovax (23 valant) q5years
131
Q

Asymptomatic child with ejection click that does not vary with respiration followed by an ejection murmur best heard at the apex and upper right sternal border w/ a suprasternal notch thrill

A

Bicuspid aortic valve -> mild aortic stenosis

132
Q

Following a trauma baby has a mass in the groin, does not reach inguinal ring, light passes easily through the sac. Now what?

A

Do a U/s w/ doppler to exclude testicular torsion or hemorrhage

133
Q

Immunodeficiency with low Ig’s especially IgG

A

Common variable immunodeficiency
B cells proliferate into plasma cells
Recurrent sinopulonary, GI, and Giardia infections

134
Q

Neurologic deficits and primary adrenal insufficiency secondary to accumulation of very long chain fatty acids

A

Adrenoleukodystrophy
X-linked
Defect in peroxismal membrane protein
Neuro - weakness/spasticity -> dementia, blindness, quadrapalegia
Adrenal -> hyponatremia, orthostatic hypotension, hyperkalemia

135
Q

Child has deafness, long QT syndrome, and FHx of long QT

A

Jervell-Lange-Nielsen

ar

136
Q

Within minutes of birth, baby has cyanosis and metabolic acidosis

A

Transposition of the great arteries
Chest Xray = narrow mediastinum, narrow heart base, absence of pulmonary a.
“egg on a string”

137
Q

Child is being evaluated for short stature and decreased growth velocity. Where do you start?

A

Bone age and blood levels of Insulin-like growth factor q (IGF-1) and its binding protein (IGF-BP3)
Child may require GH

138
Q

Endocrine levels in Turners?

A

High FSH/LH due to ovarain failure

Estradiol low

139
Q

Cyanosis during feeds

A

choanal atresia

140
Q

Most common cause of a acidosis with normal anion gap?

A

Acute viral diarrhea

  • Loss of bicarb
  • decreased renal excretion of acid
141
Q

Most common cause of meningitis in a kid with VP shunt

A

Staph epidermidis
Biofilm
tx - vanco

142
Q

Kid presents with allergic like syx and rash after taking cefaclor for the 3rd time in a year

A

serum sickness like reaction

not true serum sickness because there aren’t circulating immune complexes

143
Q

Abdominal mass, urine catec holamines, positive MIBG study

A

Neuroblastoma
MIBG accumulates in catecholaminergic cells
Good prognosis

144
Q

AD defect in fibrillin 1

A

Marfan

145
Q

Congenital defects in infants born to diabetic mothers

A 
CNS, cardiac anomalies
Small Left colon
Sacral agenesis (caudal regression syndrome)
Renal v. thrombosis (polycythemia)
Electrolyte abnormalaties
146
Q

Tx of SVT

A

Adenosine
Cardioversion if you do not have IV access
Narrow QRS, P waves may not be visible
Long term therapy with Bblock or dig

147
Q

Adolescent boy with painful limp, limited abduction and internal rotation

A

Legg-Calve-Perthes dz
Form of avascular necrosis
Dx with Xray
Tx - obs, PT, surgery but usually self-limited

148
Q

Constipated baby, DRE leads to explosion of poop

A

Hirschsprungs
Failure of migration of neurocrest cells
Bx - no ganglia

149
Q

IDD kid with choreathetosis, gout, self injury

A

Lesch-Nyhan
Dx - HPRT enzyme activity
Tx - supportive, try to prevent nephrolithiasis
COD - RF

150
Q

Newborn with tachypnea, but no RDS

A

Transient tachypnea of newborn (TTN)
Caused by delayed resorption of fetal lung gluid
CXR - increase lung expansions, interstitial fluid in the fisures
Self resolves, give O2 as needed

151
Q

Downward displacement of cerebellum and medulla through foramen magnum

A

Arnold Chiari type II

Associated with syringomyelia and myelomeningocele

152
Q

Definitive dx of foreign body aspiration

A

Rigid bronchoscopy

Xray cant see everythin

153
Q

How do you correct hypernatremia?

A
  1. Bolus 20mL/kg of NL saline or LR

2. Give calculated solute and free-water deficits + daily maintenance over 48 hours

154
Q

Tx for scabies

A

Permethrin cream o/n

155
Q

Abd pain, abd mass, microscopic hematuria, mild HTN

A 
Wilms tumor (nephroblastoma)
incidental finding in kids ~4y/o
156
Q

Newborn, hypotonia, oblique palpebral fissures, simian crease, big tongue, white spots on iris

A

Down’s
Complications: VSD, Hirschprung’s, intestinal atresia, annular pancrease, imperforate anus, hypothyroidism, atlanto-axial instability, alzheimer’s, ALL

157
Q

Omphalocele, rocker-bottom feet, hammer toe, microcephaly, clenched hand

A 
Edwards syndrome
Trisomy 18 (elect)
158
Q

Holoprosencephaly, severe mental retardation, microcephaly, cleft lip/palate

A 
Patau's syndrome
Trisomy 13 (puberty)
159
Q

Adolescent female, no boobs, short, high FSH

A

Turner’s
XO
Horseshoe kidney, coarctation, bicuspid aortic valve
Tx - estrogen

160
Q

Tall lanky teen male with mild IDD, gyno, hypogonadism

A

Klinefelter’s

161
Q

Cafe-au-lait spots, seizures, large head

A

Neurofibromatosis

AD

162
Q

Mandibular hypoplasia, glossoptosis, cleft palate, w/ FAS or Edwards

A

Pierre Robin sequence

“Bird face”

163
Q

Broad square face, short, self injurious

A

Smith Magenis

Deletion on Chr 17

164
Q

Hypotonia, hypogonadism, hyperphagia, skin picking, agression

A

Prader Willi

Deletion on paternal Chr 15

165
Q

Seizures, strabismus, social w/ episodic laughter

A

Angelman

Deletion on maternal Chr 15

166
Q

Elfin appearance, friendly, increased empathy and verbal reasoning

A

Williams

Deletion on chr 7

167
Q

IUGR. hypertonia, distinctive facies, limb malformation, self-injurious, hyperactive

A

Cornelia de Lange

168
Q

Microcephaly, smooth philtrum, thin upper lip, ADHD like behavior

A

FAS

169
Q

Most common IDD in males. Macrocephaly, macroorchidism, large ears

A

Fragile X

CGG repeats on X chromosome with anticipation

170
Q

Short palpebral fissures, white forelock, deafness

A

Waardenburg syndrome

AD w/ advanced paternal age

171
Q

Kiddo w/ multiple OM’s and PNA’s, no tonsils. Low levels of all Ig’s and B cells

A

Brutom agammaglobulinemia
X linked
infections start at 6-9 months

172
Q

Pt has NL levels of B cells but low levels of all Ig’s

A

Combined variable immune deficiency (acquired)

Increased risk of lymphoma due to increased lymphoid tissue

173
Q

Most common B cell defect, recurrent URI’s, diarrhea

A

Selective IgA deficiency

Anaphylaxis to blood containing IgA

174
Q

Infant/neonate, Seizures, truncus arteriosis, micrgnathia

A

DiGeorge syndrome
Microdeletion on Chr 22
Frequent candida, viral illness, PCP pneumo

175
Q

Infant w/ severe bacterial, viral, and opportunistic infections. No thymus or tonsils

A

SCID
Deficiency in ADA, ar
Peds emergency. Need a bone marrow transplant before age 1

176
Q

Male toddler with recurrent swollen lymph nodes in groin and staph aureus skin abscesses

A

Chronic granulomatous dz
PMN’s ingest but do not kill catalase + bugs
Dx - Nitrotetrazolium blue (yellow = +) or flow cytometry with DHR-123

177
Q

Infant with severe eczema, petechiae, ear infections

A

Wisckott-Aldrich syndrome
Presents with prolonged bleeding after circumcision
Low IgM, IgA, IgE, low to NL IgG

178
Q

The leading known cause of autism

A

Fragile X

Also most common cause of IDD. If you see both in a tall male with a long face, square jaw -> fragile X

179
Q

Boy w/ hematuria, hearing loss, FHx with the same

A

Alport syndrome
Progressive glomerular dz w/ sensorineural hearing loss (never congenital) and ocular abn (anterior lenticonus -> extrusion of central portion of lens into the anterior chamber, pathgnomonic).
Dx based on FHx and syx, skin bx, renal bx (mesengial proliferation, capillary wall thickening -> glomerular sclerosis)
X-linked

180
Q

kid w/ head trauma w/o LOC and NL neuro exam

A

Just have parents observe for neurologic status changes x 24 hrs (somnolence, vomiting, seizures, severe HA)

181
Q

If you suspect entamoeba histolytica order

A

U/S, Serum Ab tests

Tx - metronidazole

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