Peds Shelf Texas last 1/3

Question 1

Most common cause kid w/ a limp?

Answer 1

Trauma

Question 2

18month old F
Asymmetric gluteal folds
Clunk on barlow: adduct thigh, push posterior on knee to try to push hip out of socket

Answer 2

Development hip dysplasia

Tx: Pavlik harness, surgery

Question 3

5yo painless limp initially

Now pain in knee or thigh

Answer 3

Leg-Calve’-Prethes Disease

- avascular necrosis

Question 4

5yo cold 1 wk ago
Now limp + effusion in hip
Xrays normal
ESR 35 (elevated)
WBCs = 10k

Answer 4

Transient synovitis

- bed rest 1 wk NSAIDs

Question 5

14yo lanky M w/ nagging knee pain

Decreased ROM of hip on exam

Answer 5

SCFE: often overweight

Tx: surgically close + pin the epiphysis to avoid osteonecrosis

Question 6

14yo basketball/volleyball player knee pain + swelling of tibial tubercle

Answer 6

Osgood-Schlatter

- overuse from jumping

Question 7

12yo F 2wk hx daily fevers to 102 + salmon colored evanescent rash on trunk, thighs, shoulders
Left and right knee swollen

Answer 7

Juvenile rheumatoid arthritis

Tx: NSAIDs = 1st line
2nd line = methotrexate
3rd line = steroids

Question 8

2yo F w/ 2wk hx daily fevers to 102, desquamating rash on perineum.
Swollen hands/feet, conjunctivitis, unilateral swollen cervical LN

Answer 8

Kawasaki

Tx: IVIG + high dose Aspirin

Question 9

Good/bad prognostic factor for JRA?

Answer 9

ANA - good

RF - bad

Question 10

Best first test when Kawasaki is suspected?

Answer 10

2D echo + EKG

Then repeat echo after 2-3 wks of treatment

Question 11

Most serious sequellae from Kawasaki?

Answer 11

Coronary aneurysm

MI

Question 12

Onion skinning on Xray

Answer 12

Ewing Sarcoma
- if < 10yo more likely

Onion skinning = layers of perosteal development

Question 13

Treat Ewing Sarcoma?

Answer 13

Rads +/- surgery

Question 14

Sunburst or codman’s triangle on Xray

Answer 14

Osteogenic sarcoma

- if > 10yo more likely

Question 15

Treat Osteogenic sarcoma?

Answer 15

Chemo +/- surgery

Question 16

Bone pain can be presenting sx for?

Answer 16

Leukemia

Question 17

How approach meningocele or myelomeningocele?

Answer 17

Head CT looking for hydrocephalus

Arnold-chiari II

Question 18

Infant w/ head circumference > 95th %

Answer 18

Hydrocephalus

• also consider bulging fontanelle
• increased DTR’s
• HA
• vomiting

Question 19

This AM 1yo fever to 102.4
4 hours later has 3-4 minute tonic-clonic seizure
Dx? Tx?

Answer 19

Febrile seizure

Tx: acetaminophen

(no increased risk of epilepsy)

Question 20

Common EEG finding in kid w/ absence seizure?

Tx?

Answer 20

3hz spike and wave discharge

Tx: Ethosuxamide / valproic acid

Question 21

6mo old w/ multiple symmetric contraction episodes of neck, trunk, extremities that occur in spells

Answer 21

Infantile spasms

Tx: ACTH
Prednisone is 2nd line