Random/Questions

Question 1

At what level would a lead test be positive?

Answer 1

A level of 10 µg/dL is considered positive

Question 2

If basophilic stippling is seen what type of exposure should be suspected?

Answer 2

Lead

Question 3

Tx of lead poisoning

Answer 3

Treatment includes preventing further exposure, chelation therapy, and dietary measures

• Dimercaprol, CaNaEDTA, penicillamine, and succimer are all agents that can be used to treat lead toxicity.
  
  • Typically chelation therapy is only indicated if a patient has a blood lead level of ~45 μg/dL

Question 4

Most common PRIMARY childhood CNS tumors

Answer 4

Astrocytoma = develop from astrocytes; Most commonly benign

Question 5

Most common MALIGNANT posterior fossa tumor in children and represents about 20% of all pediatric CNS cancers

Answer 5

Medulloblastoma

Question 6

Dx of medulloblastoma

Answer 6

MRI and histologic evaluation of biopsy

Question 7

3rd most common CNS tumor in children

Answer 7

Ependymoma

Question 8

Hemophilia A affects which factor, what about Hemo B

Answer 8

A = Aight = 8

B comes after A, so B = factor 9

Question 9

2 MC types of leukemia in children

Answer 9

ALL and AML

Question 10

How can you tell the difference between ALL and AML on peripheral smear?

Answer 10

AML = Auer rods +/- Blast cells

Question 11

tumor derived from lymphocytes - specifically B-cells which mainly reside in lymph nodes

Bimodal (seen at ages 15 and 65)

Answer 11

Hodgkin Lymphoma

Painless cervical or supraclavicular lymphadenopathy

Upper body lymph nodes: neck, axilla, shoulder, chest (mediastinum)

Question 12

Reed-Sternberg Cells are pathognomonic - B cells fused together forming a large cell with two nuclei “owl eye”

Answer 12

Hodgkin Lymphoma

Question 13

Neutropenia is classified with what lab value

Answer 13

ANC <1000

Absolute neutrophils

Question 14

How to differentiate between pathologic and familial/normal causes of short stature?

Answer 14

Bone age (AP x-ray of the left wrist) helps delineate familial short stature from constitutional delay

Question 15

The most common cause of juvenile or acquired hypothyroidism is

Answer 15

Hashimotos thyroiditis

Question 16

Children younger than two years of age are particularly likely to have a delay in diagnosis. In these patients, a history or presence of prolonged _________ infection should prompt consideration of diabetes mellitus

Answer 16

Candidal

Question 17

What is the recommended target glycated hemoglobin for children and adolescents with diabetes

Answer 17

(A1C) of <7.5 percent

Question 18

Main difference between conduct and oppositional defiant disorder?

Answer 18

Conduct =Aggression/mean to animals +/- hitting people

Oppositional defiant disorder is a less intense form of conduct disorder. Children who continue with the chronic behavior are at risk of developing conduct disorder. This disorder is most often seen in boys

Question 19

When are apgar scores performed?

Answer 19

1 & 5 minutes

Question 20

Hemolytic uremic syndrome triad

Answer 20

acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia

Question 21

MCC of acute kidney injury in children

Answer 21

Shiga toxin : E.coli O157

Question 22

What blood smear finding is suggestive of microangiopathic hemolytic anemia?

Answer 22

Schistocytes

Question 23

Immunoglobin A vasculitis (aka Henoch Schonlein Purpura) sx

Answer 23

Palpable purpura (lower extremities + buttocks)

Abdominal pain +/- intussusception

Heme-positive stool

Microscopic hematura, proteinuria, Elevated Bun/Cr

Periarticular dz of knees and ankles aka joint pain

Question 24

Rule of 5s for Neonatal conjunctivitis

Answer 24

0-5 days = Gonorrhea

5 days to 5 weeks = Chlamydia

5wks to 5 years = Strep or H. Flu

Question 25

**low-grade** **mid-systolic murmur** **localized near the apex** to **lower left sternal border**. It **decreases in** **intensity with inspiration**, **sitting up**, or **standing**

Answer 25

Stills murmur

Question 26

What is the most specific to confirm the diagnosis if urinalysis is positive?

Answer 26

Nitrites

Question 27

What is the most common organism isolated on respiratory cultures in bacterial tracheitis?

Answer 27

***Staphylococcus aureus*** **the most common isolated species**

Question 28

bilateral lymphadenopathy in the posterior cervical chains with splenomegaly on palpation of her abdomen Should make you think of what diagnosis?

Answer 28

Infectious mono aka Epstein Barr Virus

Question 29

The most common causes of infectious **lymphadenitis** in children are

Answer 29

***Staphylococcus aureus*** and *Streptococcus pyogenes*

Question 30

A previously healthy 3-week-old male born full-term presents with sudden onset bilious emesis. There appears to be abdominal tenderness and distention on exam MCC and dx

Answer 30

Intestinal malrotation w/ midgut volvulus Dx= **diagnosed with an upper GI series** and **confirmed by observing failure of the duodenal-jejunal junction to cross midline.**

Question 31

Patient presents with fever, **bloody** and **mucoid diarrhea**, and **seizures** (more common in children) ## Footnote **What bacteria is suspected?**

Answer 31

**_Shigellosis_**

Question 32

**generalized nonbullous**, **nonvesicular rash vs fine maculopapular “sandpaper rash”**

Answer 32

Kawasaki vs sandpaper = Scarlet fever

Question 33

What would you expect to see on CSF with a pt with GBS

Answer 33

**increased CSF protein** but a normal cell count * Risk Factors: recent minor respiratory or GI illness * Sx: **Symmetric**, progressive **ascending** muscle weakness, can lead to respiratory failure * PE: **lack of deep tendon reflexes,** symmetric weakness * Lumbar puncture: **increased CSF protein** but a normal cell count * Most commonly caused by ***Campylobacter jejuni*** * Treatment is supportive, plasmapheresis, or IVIG

Question 34

**How is diagnosis of Hirschsprung Disease made?**

Answer 34

**Rectal biopsy** **_Hirschsprung Disease_** * Patient more likely to be a boy or have Down Syndrome * History of **delayed meconium passage** * Diagnosis is made by **rectal biopsy** * Most commonly caused by an **absence of ganglion cells** in the submucosal and myenteric plexus

Question 35

What causes an increased risk of

Question 36

What causes an increased risk of developmental dysplasia of hips

Answer 36

**Female in breech position during delivery**

Question 37

What is the SALTER classification for fractures (mnemonic)

Answer 37

* SALTER mnemonic * I: **s**lipped epiphysis * II: fracture **a**bove physis, **most common** * III: fracture be**l**ow physis * IV: fracture **t**hrough physis * V: **er**asure of the growth plate

Question 38

How is appendicitis diagnosed in pediatrics?

Answer 38

**Ultrasound in pediatrics** CT in Adults

Question 39

What age is at an increased **risk of developing coronary artery aneurysms in Kawasaki disease**

Answer 39

**Children under 1 year of age.**

Question 40

Progressive left-sided limp over the previous three weeks. The patient states that he has pain in his knee. On exam, you elicit pain on ***internal rotation*** of the hip

Answer 40

**Slipped capital femoral epiphysis (SCFE)**. SCFE is a **Salter-Harris type 1 fracture** of the **femoral capital epiphysis**. The X-ray will show the classic **posterior and inferior displacement of the head (capital) of the femur**. **SCFE occurs in males twice as often as females**, is commonly seen in **children** \> **10 years of age**, and classically presents in **obese children** as subacute **hip pain** with a **limp**.

Question 41

At what age is the peak incidence of SIDS?

Answer 41

Between 1 & 2 months of age

Question 42

What is the is most characteristic of a complex febrile seizure?

Answer 42

Convulsions focal in nature

Question 43

Which neonatal reflexes is present at birth and remains for life?

Answer 43

The nociceptive **_withdrawal reflex_** or cutaneous withdrawal reflex is the ability of an infant to move the hand or foot from painful stimuli. This reflex is present at birth and remains for life.

Question 44

Patient presents with the gradual onset of **dry cough**, dyspnea, and **extrapulmonary symptoms** such as headache, myalgias, fatigue, and GI disturbance

Answer 44

Atypical pneumonia

Question 45

Sx of Lyme dz in stages

Answer 45

* Stage 1 **occurs 3–30 days after exposure**: **erythema migrans (pathognomonic)**, viral-like syndrome (fever, fatigue, malaise, myalgia, headache) * Stage 2 **days to months after exposure; multisystem involvement**: myocarditis, **bilateral Bell palsy -peripheral facial palsy** * Stage 3 months to years: chronic arthritis, chronic encephalopathy

Question 46

Complications of **_Immunoglobulin A Vasculitis (formerly Henoch-Schönlein Purpura)_**

Answer 46

* Complications include nephropathy (ESKD more common in adults), intussusception (more common in children)

Question 47

**_Tx of Chlamydial Conjunctivitis_**

Answer 47

Oral erythromycin

Question 48

Mono or EBV most likely affects which lymph nodes?

Answer 48

Posterior cervical adenopathy

Question 49

2 methods for reduction of radial head subluxation (nursemaids elbow)

Answer 49

* **Hyperpronation method**: apply pressure to the radial head and hyperpronating the forearm * **Supination-flexion method**: supinate and fully flex the elbow while applying pressure to the radial head and pulling with gentle traction

Question 50

Tx of ***_Neisseria gonorrhoeae_*** **_Conjunctivitis in neonates_**

Answer 50

IV Ceftriaxone