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Pediatric Residency > PREP 2016 Review > Flashcards

PREP 2016 Review Flashcards

1
Q

Which growth chart is best to use for monitoring growth of children ages 24 months and younger?

A

WHO (world health organization) growth charts

-ideal growth based on longitudinal study of breastfed infants of nonsmoking moms with no underlying disease born FT

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2
Q

What is the difference between the WHO and CDC growth charts?

A

WHO: based on breastfed infants (gain more weight in first 3 months and then slow weight gain velocity)

CDC: based on formula fed infants in US?

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3
Q

What is the best assessment of acute under-nutrition in a child 3 years old or younger?

A

weight for height below 5th %ile

BMI is not a good indicator in children 2 years or younger

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4
Q

True or False. Many normally growing infants cross 1 or 2 major percentiles lines between 6 and 18 months of age as their growth changes from reflecting intrauterine environment to reflecting genetic potential.

A

True

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5
Q

What is the best diagnostic test for suspected gonococcal cervicitis?

A

nucleic acid amplification testing

except in cases of child-abuse, then culture is best

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6
Q

A sexual active female presenting with mucopurulent cervical discharge, intermenstrual bleeding, cervical friability and lower abdominal pain without cervical motion tenderness most likely suffers from …

A

Uncomplicated gonococcal cervicitis

complicated if associated with cervical motion tenderness

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7
Q

What is the current recommendation treatment for gonococcal cervicitis?

A

ceftriaxone 250 mg IM once with either azithromycin 1g PO single dose or doxycycline 100 mg BID for 7 days

(azithromycin is preferred for risk of possible co-infection with Chlamydia)

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8
Q

What is the treatment for scabies?

A

permethrin topically

treat asymptomatic household contacts as well
(can use hydroxyzine and hydrocortisone for itching) and

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9
Q

An infant presents with generalized erythematous papules involving the hands, palms, feet and soles as well as the trunk and extremities who is otherwise well appearing without other symptoms most likely suffers from …

A

Scabies (due to Sarcoptes scabiei)

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10
Q

What is the best initial step in management of a pt with signs and symptoms of increased intracranial pressure?

A

hypertonic saline (3% saline at 5ml/kg) or mannitol

(monitor intravascular fluid status as mannitol causes osmotic diuresis)
(hypertonic saline is better b/c decreases ICP while replenishing intravascular fluid)

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11
Q

At what age should meningococcal vaccination be started in a pt considered to be in high risk group (asplenic, complement component deficiency)?

A

2 months old

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12
Q

Which serogroup of meningococcus is responsible for infection in young children?

A

serogroup B

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13
Q

What is the recommendation regarding meningococcal vaccination and travel to endemic areas (sub-sahara africa)?

A

9 months or younger: 3 doses completed prior to travel (at 2, 4, and 6 mos)

9-23 months old: 2 doses completed prior to travel

24 months or older: single dose before travel

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14
Q

What is the most sensitive diagnostic test for suspected nephrolithiasis (kidney stones)?

A

non contrast helical CT

(perform pregnancy test in all females prior to radiograph)

(ultrasound is reasonable alternative if concerned for radiation exposure)

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15
Q

What is the most likely deficiency in a pt with ileum resection, on long term TPN and macrocytic anemia on lab findings?

A

vitamin B12 (absorbed in ileum)

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16
Q

A newborn who develops poor feeding, obtundation, hypothermia, seizures, hyperventilation, hyporeflexia, unusual posturing within 24 to 72 hours of birth in the setting of respiratory alkalosis and normal anion gap and glucose level most likely suffers from …

A

Urea Cycle Disorder

(carbamoyl phosphate synthetase I- CPS I: low urine orotic acid level)

(Ornithine transcarbamylase deficiency OTC: high urinary orotic acid levels)

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17
Q

What is the best initial diagnostic test for a newborn with suspected urea cycle disorder?

A

ammonia level

18
Q

What is the treatment for severe hyperammonemia? (4/5)

A

1) dialysis and hemofiltration (rapidly reduce level)
2) IV arginine hydrochloride
3) nitrogen scavenger drugs
4) protein restriction for 12-24 hours
5) IV fluids and ionotropic drugs if needed

19
Q

What is the best initial step in management for chronic granulomatous disease (recurrent bacterial infections involving skin, lung, sinuses)?

A

test the neutrophil oxidative burst by flow cytometry and start prophylaxis with trimethoprim and sulfamethoxazole (Bactrim)

20
Q

What is the next best step in management of a newborn with a positive newborn screen for congenital adrenal hyperplasia (21- hydroxylase deficiency)? (2)

A

1) obtain BMP (assess electrolyte and glucose)

2) 17 hydroxyprogesterone level (to confirm)

21
Q

What is the best treatment for a pt in adrenal crisis (salt wasting, dehydration, possible low glucose)? (3)

A
  1. IV fluids (NS bolus 20 ml/kg)
  2. hydrocortisone hemisuccinate 100 mg/m2 (max 100 mg)
  3. IV dextrose (if hypoglycemic)
22
Q

What is the dosing of hydrocortisone in patients with congenital adrenal hyperplasia in the setting of a) physiologic stress dose, b) oral stress dose for minor illness taking PO well, c) IV stress dose for surgery or major illness, d) adrenal crisis?

A

a) 6-10 mg/m2/ day
b) 30 mg/m2/day divided TID
c) 50 mg/m2 1 hour before procedure and 50 mg/m2/day divided QID
d) 100 mg/m2

23
Q

What is the most common cause of ambiguous genitalia in males (distended testes, small phalus, hypospadias with bifid scrotum) and X-linked inheritance (maternal aunts with infertility, blind vaginal pouch with no ovaries)?

A

Androgen insensitivity

most common cause of 46 XY DSD- disorder of sex development

24
Q

What diagnostic tests can be done to determine if a pt has Cushing syndrome (hypercortisolism)? (4)

A
  1. 24 hour urine free cortisol
  2. overnight dexamethasone suppression test
  3. late night salivary cortisol
  4. diurnal variation in cortisol
25
Q

A child presenting with linear growth failure, weight fain, facial plethora, striae, easy brusing, muscle weakness, fat pad on back of neck, central obesity and acne most likely suffers from …

A

Cushing Syndrome (hypercortisolism)

26
Q

What is the next best step in management of a healthy child with normal growth velocity (5 cm/ year), bone age within 2 STD of chronological age and normal final height prediction despite being shorter than expected based on mid-parental height estimations?

A

reassurance

27
Q

What is the next best step in management of a healthy child with short stature with height at/ below 1.2 %ile, normal bone age, history of normal birthweight and birth-length, and predicted height of less than 5’3 in boys and 4’11 in girls?

A

refer to endocrinologist and start growth hormone

child suffers from idiopathic short stature and GH tx will result in 3 inch increase beyond predicted height

28
Q

What is the next best step in management of a girl less than 2 years of age with breast bud formation without other signs of puberty (pubic hair, acne, etc) and has normal linear growth?

A

Reassurance (no testing)

suffers from premature thelarche

29
Q

What is the next best step in management of a newborn who has an abnormal thyroid screening test confirmed by repeat labs showing low T4 and elevated TSH?

A

Levothyroxine started by 2 weeks of age at dose of 10 ug/kg or higher

(to prevent developmental delays associated with congenital hypothyroidism)

30
Q

What is the likely cause of congenital hypothyroidism in a newborn with no uptake on thyroid uptake scan, thyroid present on ultrasound and maternal history of prior thyroid surgery and longterm levothyroxine use?

A

Maternal Grave’s Disease (resulting in anti TSH antibodies crossing placenta during pregnancy turning off neonatal thyroid)

31
Q

A kid who develops abdominal pain, nausea, anorexia, fatigue, weakness, and hypotension after discontinuing prolonged steroid use most likely suffers from …

A

Secondary Adrenal Insufficiency

due to prolonged steroid use suppressing adrenal axis

32
Q

What lab finding is associated with secondary adrenal insufficiency?

A

hyponatremia (without hyperkalemia)

33
Q

What is the most common autoimmune disorder associated with type 1 diabetes?

A

thyroid disorder
(should screen with antithyroid peroxidase, antithyroglobulin, TSH and T4 after diagnosis; and then routinely with TSH and T4 every 1-2 years or if symptomatic)

(celiac disease also associated and should screen after dx, if symptomatic, and if frequent unexplained hypoglycemia)

34
Q

What is the definitive diagnostic test for vitamin D deficiency?

A

25- OH vitamin D level

1,25 OH vitamin D level is in lower concentration and regulated by so many other factors

35
Q

A kid presenting with muscle cramping and contractions, positive Trousseau sign (cramping of hand, MCP joint flexion, and finger adduction with BP cuff inflation) and positive Chvostek sign (facial twitching of nose and lip elicited by tapping angle of jaw) in winter months most likely suffers from …

A

Hypocalcemia secondary to vitamin D deficiency

(pts with dark complexion require 3-5 times more sun exposure to produce same level of vitamin D so more prone problem in winter months)

36
Q

An immobilized kid who is growing presenting with new onset anorexia, nausea, abdominal pain, polyuria most likely suffers from …

A

Hypercalcemia secondary to immobilization

increased release of Ca from bone when high bone turnover

37
Q

What is absorbed in the ileum and can result in chronic diarrhea if pt has ileum resection (such as in the tx of crohns disease)?

A

bile acids

38
Q

What are indications for non-initiation of resuscitation in a neonate? (5)

A
  1. parents wishes if infant born between 23-24 weeks
  2. gestation less than 23 weeks
  3. birthweight less than 400 gram
  4. anencephaly
  5. confirmed lethal genetic disorder/ malformation
    (ultimately parents wishes should be followed)
39
Q

True or False. Accepting monetary gifts for personal use from patients is not recommended in any circumstances, especially because it is likely to disrupt patient-physician relationship and create inappropriate expectations.

A

True

40
Q

A child between the ages of 6-18 months of age who suddenly becomes quiet, turns blue and becomes unconscious for a minute of less a few seconds after crying in response to experiencing anger/ frustration/ pain and are not associated with bowel/bladder loss or post-ictal state most likely suffers from….

A

Breathing Holding Spell

(not voluntary reaction; tx- reassurance; can consider EKG if atypical presentation or EEG if seizure like activity occurs with spell)

41
Q

What is the most effective treatment for school avoidance associated with separation anxiety?

A

immediate unaccompanied return to school

school avoidance becomes more intervention resistant the longer child remains out of school

Pediatric Residency (6 decks)

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