Prep Q’s Flashcards
How does GER differ from GERD?
What is the normal formula volume recommended and timing for full-term newborns?
About how much is added per feed for every month above one month
G ER consist of spitting up, regurgitation or even emesis, GER is associated with pain, poor weight gain or dysphasia
2 ounces every 3–4 hours
About ounce – 2 ounces per feed up to 8–12 months and feeds become less frequent
How is GER treated/managed
How does pyloric stenosis present and about what age?
Reduce the feeding, increase the feeding frequency, avoid seated and supine positions after feedings as well as burping
Forceful often projectile non-bloody non-bilious emesis at about 3–4 weeks of age
With respect to mechanical ventilation, oxygenation is a function of mean, airway pressure, which three things are the main drivers of main airway pressure
Ventilation is the clearance of CO2 from the body, minute ventilation can be calculated how?
PIP, PEEP, inspiratory time fraction
Respiratory rate times title volume 
Should all infants with HIV receive the Rothe virus vaccine?
which eight groups of children are at a high-level immuno suppression and should not receive live vaccines
Yes
Ages one – 13 with HIV and a CD4 count less than 15%
14 and older with a CD 4 count less than 200
cancer receiving chemotherapy
Combined B and T cell lymphocyte disorders like SCID
Children on high daily doses of steroids.
Receiving certain biologic agents like TNF antagonist.
Receipt of a solid organ transplant in the last two months receipt of a stem cell transplant in the last two months
Lymphadenopathy where is highly concerning form malignancy
If you see a child with this, which specialist should you refer them to?
Investigation of lymphadenopathy should include which 6 tests
Supraclavicular, cervical is very common
ENT
CBC with differential, EBV and CMV titers, ESR/CRP, LFTs (if positive, support, viral infection, or infiltrative process), LDH, uric acid levels (elevation indicates high cell turnover seen in malignancy)
If there is concern for lymphoma, which type of biopsy is preferred?
If abdominal ultrasound demonstrates the characteristic target sign along with abdominal pain, nausea, vomiting, in a child three months to three years what is the likely diagnosis?
Excisional, not FNA
Intussusception
In intussusception, what is the initial treatment that can be diagnostic and therapeutic if there are no signs of peritonitis or free air?
What should be done if free is visualized or there is evidence of peritonitis
Air enema.
Emergency laparotomy
Which imaging is preferred if Malrotation with midgut volvulus is suspected
Which part of the bowel is most commonly affected by intussusception?
It commonly affects children aged ____ to ___
Upper G.I. series with small bowel series
Iliocecal junction (90%)
Three months to three years
If there is abdominal tenderness and a palpable sausage shaped mass in the right lower quadrant in a child with altered mental status, think of what diagnosis?
Describe the stool that is usually associated with.
Intussusception
Current jelly stool, which is blood mixed with mucus
What is the term for a preventable error that did not result inpatient harm?
What is an event that implies that the patient was harmed as a result of an intervention?
What is an event that is an error that leads to a patient’s death or serious injury?
Medical error.
Adverse event.
Sentinel event
Severe hypocalcemia due to vitamin D deficiency that is so severe that the child presents with seizure should be treated with which three things?
Breastmilk does not provide adequate amounts of which vitamin and needs to be supplemented?
What dose in international units per day do they recommend supplementing
Calcium, vitamin D, calcitriol, which is one, 25 dihydroxy vitamin D, which is the active form
Vitamin D
At least 400 international units daily
In vitamin D, deficiency and hyperparathyroidism, why does phosphorus become low
Why is it difficult to correct calcium if magnesium is low?

Because PTH causes wasting in the kidneys
Magnesium is required for a normal PT response to low calcium levels
An early onset sepsis, which to antibiotics are the empiric antibiotic choice? Which bacteria are covered
In late onset sepsis after six days of life which two should be used? Which bacteria are covered
Ampicillin and gentamycin covers GBS, E. coli, listeria.
Vancomycin and gentamycin, covers coagulation negative staph, E. coli, klebsiella, the main difference is vanc to cover the coag negative staph
An early sepsis in the first week of life, how are organisms usually acquired?
If an otherwise healthy 10-year-old with cystic fibrosis has a positive culture for pseudomonas without any symptoms how should this be managed?
Through vertical transmission
A 28 day course of inhaled tobramycin, studies demonstrate proactive treatment to a eradicate pseudomonas from the airway with CF helps preserve lung function
What is the standard of care with respect to airway cultures in children with cystic fibrosis?
What are three cardinal features of Ehlers Danlos syndrome?
How is the syndrome inherited?
It is recommended to do quarterly airway cultures
Joint hypermobility, skin hyperextensibility, tissue fragility
Autosomal dominant
Which developmental disability demonstrates impairments in cognitive and adaptive skills?
Which is defined by social communication defects, including nonverbal communication?
In addition to defects in social communication, which two other things are required for a diagnosis of autism.
Intellectual disability
Autism spectrum
Repetitive and restrictive behaviors, like not making eye contact
Which test is crucial for evaluation of children thought to have language delays or concerns for autism?
Adolescence, using medication’s for non-medical reasons are likely to obtain them how?
Audiology evaluation
From a friend or family member
If a patient has bloody diarrhea with exposure to well water, which bacteria is the most common pathogen?
If a patient has a Peri tonsillar abscess, what is the most appropriate first step in treatment?
What are the two most common bacteria to cause a PTA?
E. coli
Drainage of the abscess
Streptococcus and fusobactrium
What are six common presenting findings with a peritonsillar abscess
What is the treatment of an uncomplicated PTA?
Fever, sore throat, dysphasia, muffled voice, asymmetric, tonsils, uvula deviation
Incision and drainage with a 10 day course of oral antibiotics
What are eight reasons for hospital admission for peritonaillar abscess
Complications, including airway obstruction
Aspiration, ammonia
Carotid artery, pseudo, aneurysm or rupture.
Septic thrombophlebitis of the IJ vein
Need for intravenous hydration due to poor oral intake.
Pain management
No reliable outpatient follow up
Management severe bleeding
Management of respiratory distress, secondary to aspiration of abscess contents
Which cardiac pathology presents with tachycardia, a gallop rhythm, signs of pulmonary edema, and hepatomegaly with chest pain?
What would be the first imaging test that should be done?
Myocarditis
TTE
What are some common EKG findings with myocarditis?
The voltage, QRS, abnormal tea waves, rarely there can be ST elevations
What is the initial step in evaluation of children with G.I. bleeding?
What are seven common causes of lower G.I. bleeding in pediatrics?
assessment of hemodynamics stability based on vital signs, capillary, refill, and mental status
AVM, coagulopathy colitis, fissure, ,intussusception, Mekel diverticulum,polyp
Painless, lower G.I. bleeding should make you think of doing what type of scan?
Colicky pain and vomiting in a young child would suggest which diagnosis
Meckel scan
Intussusception
Infantile spasms is the most common epilepsy syndrome in infancy, what is the classic triad?
If all three of these are met or what is this called?
Epileptic spasms.
EEG with background of hypsarrhythmia
Accompanying developmental plateau and regression
West syndrome
What is the peak age of onset of infantile spasms?
Which two genetic syndrome can be associated with infantile spasms?
During the first year with a peak age of onset between three and seven months
Trisomy 21 tuberous sclerosis
Describe a classic infantile spasm episode
suspicion for infantile spasms should prompt. What work up?
Symmetric contraction with flexion of the trunk, neck, arms lasting up to five seconds and occurring in clusters
Urgent, neurology, evaluation, and EEG
Once the diagnosis of infantile spasms is confirmed, which three main test should be done to find the underlying cause?
How is IS treated?
While AC TH is considered first line, vigabatrin is the preferred initial choice with which disease?
MRI, genetic, metabolic testing
Administering acth or vigabatrin as soon as possible
Tuberous sclerosis
Which vaccination should be delayed for six months after treatment with ACTH
Which treatment should be used for infantile spasms linked to menkes disease?
Live vaccines
Copper histidinate
Cremasteic reflex is negative In which testicular injury?
Which is associated with the blue dot sign?
Torsion
Torsion of appendix testes
Orchitis occurring between 2–13 years old are usually due to which to main causes?
Which three infections?
Greater than 13-year-old is usually due to which two causes.
Post infectious or henoch schonlein purpura
Mycoplasma, enterovirus, adenovirus
UTI bacteria or STI
All children with testicular pain should undergo what test?
In addition to urine infections, VUR can present with what in toilet trained children
Ultrasound to rule out torsion.
Bladder bow dysfunction
What are the two main indications for VCUG testing for VUR?
What are the three main indications for prophylactic antibiotics with VUR?
First February UTI with abnormal or recurrent febrile UTI
VUR in non-toilet trained children
Low-grade VUR with recurrent UTI.
High-grade VUR
What are the three main antibiotics for prophylaxis with VUR?
What are two main indications for surgical treatment with VUR?
After initial finding of VUR and initiation of treatment, how long afterward should VCUG be repeated?
Bactrim, Macrobid, amoxicillin
Recurrent UTI while on prophylactic antibiotics, persistent, high-grade VUR with risk of scarring.
After 9–15 months
Which orthopedic syndrome is involved with insidious symptom onset, bilateral symptoms, tenderness over the inferior pole of the patella and pain with quadriceps contraction?
What age range does this usually affect?
Sinding Larsen Johansson syndrome
Age 9–13
Which orthopedic syndrome presents with pain and tenderness at the tibial tubercle where the patellar tendon attaches?
What are the three diagnostic criteria of acute otitis media?
Osgood Schlatter
Recent ear pain less than 48 hours, bulging TM, decreased mobility of the TM with pneumatic otoscopy or tympanometry
Which orthopedic syndrome presents with pain and tenderness at the tibial tubercle where the patellar tendon attaches?
What are the three diagnostic criteria of acute otitis media?
Osgood Schlatter
Recent ear pain less than 48 hours, bulging TM, decreased mobility of the TM with pneumatic otoscopy or tympanometry
In acute otitis media in children less than 24 months old, what is the recommended initial treatment?
What are the two criteria for severe otitis media?
Initial monitoring for 48–72 hours with pain medication and no antibiotics
Ear pain that is moderate or severe for more than 48 hours or a temperature greater than or equal to 102.2/39° or higher
In acute otitis media in children less than 24 months old, what is the recommended initial treatment?
What are the two criteria for severe otitis media?
Initial monitoring for 48–72 hours with pain medication and no antibiotics
Ear pain that is moderate or severe for more than 48 hours or a temperature greater than or equal to 102.2/39° or higher
How long do you treat children less than two years old with antibiotics for acute otitis media?
2–5 years old?
Greater than six years old?
10 days.
Seven days
5–7 days
Which two antibiotics are recommended for initial antibiotic treatment after observation in children with acute otitis media
What are four alternative antibiotics?
Amoxicillin 90 mg per kilogram per day or Augmentin
Cefdinir, cefuroxime, cefpodoxime, rocephin
If initial treatment for otitis media does not have any effect or there is treatment failure, which antibiotic course is recommended?
Augmentin or Rocephin or clindamycin with a second or third generation cephalosporin
Which cranial abdominal is seen just after birth, resolves within 48–72 hours and crosses suture lines?
Which is a large, well-defined area that does not cross suture lines?
After how long does cephalohematoma resolve and what is the risk increased for developing?
Caput succedaneum
Cephalohematoma
2–3 weeks, increased risk of hyperbilirubinemia
Which cranial abnormality is seen after birth, is progressive and may have crepitus or fluid waves?
This is due to what?
It is usually associated with which type of delivery?
How is this treated?
Subgaleal hemorrhage.
Tearing of the bridging of veins
Vacuum assisted delivery.
Monitoring, vitals and hemoglobin, at risk of developing shock
If A drug has first order kinetics after how many half lives, does it reach study state?
How does first order kinetics differ from order kinetics
Five half-lives
First order, a constant proportion is eliminated and zero order a constant amount is eliminated
If the volume of distribution of a drug is increased, what happens to the half-life?
If the clearance of a drug is decreased, what happens to the half-life?
It will increase
it will decrease
What is the number one cause of viral bronchiolitis in infants?
What are four risk factors for severe RSV?
RSV, followed by rhinovirus, human Metapneumo virus, para influenza virus
Birth less than 29 weeks, chronic lung disease, congenital heart, disease, immuno deficiency
What is the recommended treatment for RSV?
What is the vaccine for RSV?
Respiratory support, fluids, nutrition management, broncho dilators, steroids, antibiotics are not recommended
Pavalizumab
How much urine in a day defines polyurea
Which for lab tests will be abnormal in primary polydipsia and what will they be compared to normal?
Greater than 2 L per meter, squared per day.
Sodium will be normal or low, serum osmolality will be normal or low, urine specific gravity will be low, urine osmolarity will be low due to the loss of the concentration gradient from excess water
In diabetes insipidus, how will the sodium differ from primary polydipsia?
How do you differentiate diabetes insipidus from primary polydipsia and what will this test show?
Sodium will be normal or high in diabetes insipidus.
Water, deprivation, test, in diabetes insipidus there will be no change and in primary polyps the polyurea will decrease and urine osmolality will increase
How is primary polyps treated?
How is it treated if sodium is less than 120 with symptoms such as seizure
Water restriction
Give 3% normal saline
Which genetic syndrome will present with pure RBC, a pleasure with severe macrocytic anemia, and no reticular sites with high fetal hemoglobin after six months?
Which lab test will also be elevated?
Diamond, black fan anemia
Adenosine deamonase
Diamond black fan anemia is associated with which three other findings?
How is this treated?
Abnormal thumbs, genito urinary abnormalities, cardiac abnormalities
Long-term transfusion, iron chelation, stem cell transplant is curative
Which pure red blood cell aplasia is common after viral infections and associated with other cytopenia?
It usually affects children of what age?
What is the treatment?
Transient erythroblastopenia of childhood.
Less than one year of age
Transfused, if symptomatic, otherwise monitor, and this will resolve spontaneously
