Peds1

Question 1

Why is acute bacterial sinusitis so common after a viral URI?

Answer 1

Swelling of nasal turbinates and mucosa allow for secondary bacterial infection because contaminated bacteria can’t be cleared (due to mucosal inflammation).

Rx = Amoxicillin + clavulanic acid

Question 2

Symmetric arthritis in > 1 joint with mild erythema and warmth at joints in a child without rash or fever.

Answer 2

Juvenile Idiopathic Arthritis. Symmetric arthritis for at least 6 weeks. Systemic inflammation with possible inflammatory markers (ESR, CRP), hyperferritinemia, hypergammaglobulinemia, and thrombocytosis.

Anemia is common due to chronic inflammation and iron deficiency and improves with MTX.

Question 3

Young girl with normal development followed by progressive loss of speech, loss of purposeful hand use, gait disturbance, stereotypical hand movements, and head growth deceleration:

Answer 3

Rett Syndrome. Mostly girls. Seizures common and increase with age. Due to mut in X linked MECP2 gene.

Question 4

Fever, inspiratory stridor, barking cough:

Answer 4

Croup/Laryngotracheobronchitis due to Parainfluenza

Question 5

First line Rx for pertussis:

Answer 5

Macrolides

Question 6

Teen with facial puffiness, fatigue, decreased appetite, periorbital and pretibial edema and recent HepB infection. 4+ protein in urine, no RBC/casts. Dx?

Answer 6

Membranous nephropathy (assoc with HepB)

Question 7

Congenital Adrenal Hyperplasia is due to deficiency of:

Answer 7

21a-hydroxylase. Newborn screening with elevated 17 hydroxyprogesterone confirms Dx. Presents as HoTN and hyper K (low aldosterone) and virilization (high testosterone)

Question 8

Conjunctival injection, pale follicles, tarsal inflammation, and thickened conjunctiva in a child in high populated area:

Answer 8

Trachoma. Due to C trachomatis (leading cause of blindness worldwide). Look for low socioeconomic areas. Active phase characterized by follicular conjunctivitis and pannus (neovascularization) formation in cornea. Rx = Azithro

Question 9

Rx for impetigo:

Answer 9

Mupirocin if local/limited.

Cephalexin, dicloxacillin, or clinda if extensive.

Question 10

Definitive diagnostic test for phenylketonuria:

Answer 10

Quantitative AA analysis.

Question 11

Mut in Phenylketonuria:

Answer 11

AR mutation&raquo_space; deficiency of phenylalanine hydroxylase, normally responsible for converting phenylalanine&raquo_space; tyrosine.

Question 12

Enzyme def in fructose metabolism disorder:

Answer 12

Aldolase B is deficient in hereditary fructose intolerance.

Question 13

Atresia of the jejunum or ileum is thought to be due to ___ in utero

Answer 13

vascular accident (due to maternal cocaine use)

Question 14

Enzyme deficient in angular chelitis, glossitis (hyperemic tongue), stomatitis (hyperemic oropharyngeal mucous membrane), normocytic anemia, and seborrheic dermatitis:

Answer 14

B2 (riboflavin). Found in dairy, eggs, meat, veggies

Question 15

Enzyme deficient in dermatitis, glossitis, diarrhea, dementia:

Answer 15

B3 (Niacin)