Peds NBME Facts

Question 1

defect in which vitamin causes increase in ICP

Answer 1

vitamin A

Question 2

what is pellagra?

Answer 2

def of B3 - Niacin = dermatitis, dementia, diarrhea

Question 3

def of vita B2/riboflavin sx

Answer 3

cheilosis, ocular(keratitis, conjunctivitis), anemia, dermatitis, photophobia

Question 4

what is serous otitis media?

Answer 4

Serous Otitis Media – nonpurplent(clear) effusions of the middle ear
o Usually involves hearing loss and fullness
o Typically does not have pain or fever

Question 5

baby being fed cows milk can be deficient in what…

Answer 5

• Cows milk is a poor source of iron = can cause iron deficiency anemia in children strictly fed this

Question 6

HTN emergencies tx

Answer 6

• Sodium Nitroprusside = #1 for HTN emergencies

Question 7

Neoblastoma Vs Wilms Tumor

Answer 7

*Neuroblastoma = MC extracranial tumor in children. Commonly presents as an abdominal mass.
Often calcified
Doesn’t invade vascular
Poorly marginated
May extend to chest
Elevated aorta away from vertebra
More commonly will cross the midline

Nephroblastoma(Wilms Tumor)
Usually not calcified
Displaces structes
Well circumscribed
“Claw Sign” w/kidney 
May invade vascular = IVC/Renal vein

Question 8

9 yo kid with T1 DM, lethargy, labored breathing, vomiting, flushed appearance and appears severly dehydration, fruity odor to breath, blood glucose is >500. Tx? why high glucose?

Answer 8

DKA = def of insulin = glucose builds = body tries to remove by peeing it out + body hungry = making ketones trying to produce glucose for body

Management:
REPLACE FLUIDS = isotonic saline
When glucose reaches 200 give dextrose + saline
If K <3.3 give K + IVF
If K is above 3.3 and pt is not volume deplete you can give insulin

Question 9

Criteria for Physiologic Jaundice

Answer 9

Physiologic: 
Appears 2-3 day
Peaks 2-3 d
Disappears by day 7
Peak bilirubin <13
Rate of bilirubin rise <5

Question 10

What is Right Middle Lobe Syndrome? causes?

Answer 10

This is “RIGHT MIDDLE LOBE SYNDROME”

Clinical presentation:
Most pt present w/chronic cough
Haemoptysis
Chest pain
Dyspnea

Path: largely unknown!
Chronic bronchitis, Bronchiectasis, granulomatous inflame, pneumonia

Radiographic Shit:
Right middle lobe collapse – linear consolidation, wedge-shaped density
Bronchiectasis obstructing bronchial lesion is usually not found

Question 11

Sx of ALL in 4 yo kid?

Answer 11

fever, recurrent infections, bleeding(bone marrow failure) fatigue, mediastinal mass due ot thymus infiltration, hepatosplenomegaly, lymphadenopathy, TdT+(pre B/T cell marker)

Question 12

heat exhaustion vs Heat stroke

Answer 12

Heat exhaustion is the precursor to heat stroke. Body tries to compensate for excess body heat.
Profuse sweating
Weakness
NV, HA, lightheadedness
M cramps

Heat stroke is a failure of the body to compensate for excess heat = temp will be above 40.
AMS
Lethargic
Seizure
>40 C

Question 13

Galactosemia inheritance pattern? defect?

Answer 13

Galactosemia – AR absence of Galactose-1-P = accumulation in liver, kidney, & brain.

Question 14

when would you see sx of galactosemia?

Answer 14

1st week of life!

Question 15

sx of galactosemia

tx?

Answer 15

Sx:
Enlarged liver(galactose accum)
Vomiting, nausea, irritability
Mental retardation(gala in brain)
Cataracts if dnt stop feeding baby shit
The urine tests positive for reducing substances, indicating the presence of sugars with aldehyde groups

Tx:
Remove galactose & lactose(dairy, breast milk)
Start on soy

Question 16

4yo girl with vaginal bleeding for 12 hours, 3m history of purulent vaginal discharge. pubic hair stage 1. dx?

Answer 16

vaginal foreign body

Question 17

6hr old baby with cyanosis of extremities since birth. temp = 97, bp 80/45, been breast feeding well. whatcha gonna do to her?

Answer 17

put her under a warming lamp!

Acrocyanosis – blue hands and feet due to vasomotor instability = warm baby up and they will be fine. Often seen w/Cutis Marmorata(lattice like mottling seen when baby gets cold)

Question 18

You should be concerned about —– murmers in kid or murmers that are grade — +.

Answer 18

diastolic, 3

Question 19

congenital hypothyroidism

Answer 19

Thyroid Dysgenesis(Cretinism) – 
Increased TSH
Decrease T4
Normal APGAR
Prolonged Jaundice/indirect hyperbili
Large posterior fontanelle
6-12 weeks:
Poor feeding
Lethargy
Hypotonia
Coarse facial features
LARGE PROTRUDING TONGUE
Developmental delay

**TX by replacing hormone!!

Question 20

gynocomastic in boys is normal till….

Answer 20

Normal in prepubertal boy! Usually subsides within 1 year. If mass doesn’t regress by 16-17 yoa then it should be removed.

Question 21

7yo boy with progressively worsening HA, difficult walking over the past 6 weeks, bilateral papilledema, right abductions palsy & gait ataxia. dx?

Answer 21

Medulloblsatoma can impair CSF flow = causing the papilledema

Question 22

17 yo Low WBC, splenomegaly, hepatomegly, lymph nodes enlarged, and now has diarrhea.
Leukocytes = 2100
IgA 340(low) others are normal
Platelet 180,000

dx?

Answer 22

Low WBC, splenomegaly, hepatomegly, lymph nodes enlarged, and now has diarrhea! = immunocomp! Since hes 17 its prob due to HIV

Question 23

14 yo girl w/lower ab pain, intermittent pain in knee & hips for 6wks, cramps relieved by bowel movements. 6-10 urgent, bloody bowel movments daily. PE: swollen, tender L knee. WBC 16K, Platelet 790,000 joint fluid: straw colored, wbc = 2000. dx?

Answer 23

UC! = bloody stools, leukocytosis, thrombocytosis, ab pain, arthralgias.

Any of the IBDs can be associated with joint pain & can be relieved with bowel movement!

*knee aspirate <10,000 = not likely infection

Normal Synovial Fluid = ~200 wbc & <25%PMN

Non-inflammatory = 200-2,000
Inflamm = 5,000-50,000
Septic = >50,000

Question 24

12 yo boy is concered he is the shortest kid in the class. father says he was short untill his senior year in high school. Which test would you do to confirm the dx?

Answer 24

check bone age to distinguish constitutional vs familial

Question 25

Standard regimen of care for TB

Answer 25

4 for 2 then 2 for 4.

So start INH, Rifam, Pyrazin, Etham. stop pyra+etham after 2 months and continue INH + Rif for another 4 months.

Question 26

Tx for TB if PPD+ but CXR-. dx?

Answer 26

thsi is latent TB = tx with INH for 6-9months

Question 27

3yo comes in with 2month hx of r sided limp, most obvious when she waked up and plays. Rknee is swollen + warm but not tender. ESR is elevated. What other exam should you perform on this kid? why?

Answer 27

This child presents with pauciarticular juvenile rheumatoidarthritis (JRA). Characteristics of pauciarticular JRA include chronic asymmetric arthritisof four or less large weight-bearing joints. Systemic features are uncommon, but themost feared complication is the development of asymptomatic iridocyclitis, which cancause blindness if untreated. Iridocyclitis/uveitis may be present in all subtypes of JRA,but it is particular to the pauciarticular disease of early childhood, in which approximately30% of patients develop the complication. All children with JRA should have regularophthalmologic examinations, including slit lamp examinations,to ensure promptmanagement with corticosteroids.

Question 28

15 month old girl with 1day hx of rash & fever for the last 3 days. got MMR vaccine 10 days ago. dx?

Answer 28

normal! this is just the replication of the live vaccine virus strain. it will pass

Question 29

DX criteria for Lupus

Answer 29

The ACR’s diagnostic criteria for SLE include the following:

Malar rash
Naso-oral ulcers
Photosensitive rash
Discoid rash
Arthritis
Pleuritis or pericarditis
Proteinuria (>500 mg/d) or evidence of nephritis in urinalysis
Hemolytic anemia, thrombocytopenia, leukopenia, or lymphopenia
Seizure or psychosis
Positive ANA finding
Positive anti–double-stranded DNA, anti-Smith, or antiphospholipid antibody/lupus anticoagulant

Question 30

kid brought in by baby sitter with appendicitis. do you need consent to operate?

Answer 30

nope! this is an emergency

Question 31

18 hr old f has jaundice, difficulty feeding, no bowel movement and dark urine. Tbili = 11. direct = 0.1. is this physiologic jaundice or hemolytic dz of the newborn? why?

Answer 31

HEMOLYTIC DZ OF THE NEWBORN! = <24 hrs!!!!

*physiologic will only present >24h

Question 32

2yo boy w/fever, r elbow pain + swelling and redness. HX of GBS @5m & septic arthrits caused by HFlu B @9yoa. Had a brother and 3 uncles taht died in infancy of septicemia. all immunization are up to date. Luekocytes = 34,000. Seg Nutrophils = 60% Bands = 15%, Lymphocytes = 15% dx?

Answer 32

history of effecting males! + has bacteria infections = B, Boys, Bacteria BURTONS!

Burtons XL Agammaglob

Question 33

7 yo girl w/7day hx of bloody diarrhea, fatigue, no fever, pallow, scleral icterus, normal liver, Hg 6, MCV 80, Leukocytes 18,000, retic 12%, platelets 50,000. dx?

Answer 33

Bloody diarrhea + hemolysis + low platelets = HUS. This patient probably had enterohemorrhagic E. Coli (O157:H7 blablabla) colitis. The picture of icterus, anemia, and increased reticulocytes showed you hemolysis was occurring. ALL is suggested against by a leukocytosis better explained by hemorrhagic diarrhea and a bone marrow that is responding well with reticulocytosis.

Question 34

14 yo girl never had a period, breast development at 12, high is equilvalent to that of a 8yo. bp 140/100. breast stage 2, pubic hair stage 4, weak femoral pulses. dx?

Answer 34

This is Turner syndrome. There are two tip-offs in this question: 1) She’s as tall as an 8-year-old (it actually doesn’t say bone age, it only mentions her height). 2) What you didn’t put in your excerpt is that she has decreased femoral pulses, indicative of a coarctation of the aorta. Coarctation is associated with Turner’s. In summary: Coarctation + short stature + primary amenorrhea = Turner syndrome.

Question 35

2yo boy, 2hr onset fever + difficulty breathing, Rhinorrhea for the past 24 hrs. noisy breathing most noticabble when inhalation, sx improved when she took him outside to come to teh ED, supraclavicular retraction, inspiratory stridor. wheres the edema? epiglottis edema? or subglottic edema?

Answer 35

LOOK AT THIS KIDS AGE!!! He is only 2yo.

Edema of the epiglottis = HiB/epiglottis
Subglottic edema = croup!
+ cold air imporves sx

Question 36

2 yo girl w/hx of irritabiltiy, poor appetitis, occational cough & reluctance to walk, 4.4lb weight loss over last 6 months, fever, bluish discoloration under eyelids. low neutrophils, elevated lymphocytes + mass in posterior mediastinum. dx?

Answer 36

Neuroblastoma = posterior mediastinum mass
vs
thymoma = anterior mediastinum mass

Question 37

7yo girl, fainting during feild trip, progressive lethargy over the past winter + darkened complextion. bp 80/40. what test to determine dx?

Answer 37

plasma cortisol = this is addisons! = adrenal insufficiency

*ACTH stim test to see if there is a change in cort. a + test will be no change in cort = addisons

Question 38

When do you do an exchange transfusion for jaundice?

Answer 38

Bilirubin >20 do exchange is sx. Bilirubin >25 = do exchange. This case the bilirubin is approaching 25 = should prob just do the exchange

Question 39

6month old kid with 1 wk hx of unprovoked startle-like movements. sudden quick flexion of the head,arms and legs/ cries during these movements which usually occur in clusters after awaking from sleep. heart murmer since birth. father has mental impairment. PE: 3 areas of skin hypopigmentation. for periventicular nodules that disort the normally smooth venticular margins on CT. dx?

Answer 39

F. Tuberous sclerosis – hamartomas of skin and CNS. MR is the murmur heart (holosystolic high-pitched blowing murmur). Cardiac rhabdomyoma. Mental retardation (seen in father)