Random Review

Question 1

Kiddo with new onset abdominal pain, coffee ground vomit and signs of hypovolemic shock.
Low bicarb level and signs of metabolic acidosis
What did he ingest and what do you treat with?

Answer 1

Fe tablets or iron poisoning

Tx: Defuroxamine

Question 2

15 yo took some of her mom’s pills; presents with tachycardia, drowsiness, dry mouth, vomitting, confusion and urinary retention.
What did she ingest and what is the treatment?

Answer 2

Tricyclic ingestion

Tx: Sodium bicarb

Question 3

3 yo found in grandma’s medicine cabinet. Now has n/v, dizziness and confusion and says her ears ‘sound funny’ . She is tachycardic with increased RR
What did she ingest and what is the treatment?

Answer 3

Aspirin overdose
Tx: Sodium bicarb to alkalinize the urine
Patient initially has respiratory alkalosis (from overstim respiratory center) with rebound anion gap metabolic acidosis

Question 4

Parent’s bring their 2 1/2 yo in with concern for decreased appetite and he points to his tummy and head saying it hurts. PE he has conjuctival pallor
What would be the ingestion and treatment?

Answer 4

Lead poisoning
Tx based on venous levels
if >45 give oral succimer
if >75 give calcium EDTA

Question 5

A 16 yo male comes to the ED with N/V, pallor and sweating. The next morning he complains of RUQ pain so you obtain labs and find he has elevated LFTS. What was his ingestion and tx?
What could happen if nothing was done to tx this patient?

Answer 5

Acetaminophen OD
Tx: N-acetylcystine
Hepatic necrosis, coagulopathies, MODS and cerebral edema
(produce NAPQI metabolites which depletes glutathione)

Question 6

Type of meningitis
WBC: >1000
Glucose 250

Answer 6

Bacterial

Most often by Streptococcus Pneumoniae if child is >2 mo and N.Meningitidis in adolescent

Question 7

Type of meningitis
WBC: 100-1000
Glucose:40-70
Protein:

Answer 7

Viral
*also see pleocytosis on LP
Most often by non-polio enteroviris like echovirus or coxsackies; see leptomeninges with low grade fever and prodrome of viral URI sx

Question 8

What would you see on a LP in pt with Guillain barre

Answer 8

WBC of 0-5
Glucose: 40-70
Protein: 45-1000

Question 9

What are common risk factors for polycythemia in a newborn

Answer 9

delayed cord clamping, maternal hypertension, maternal diabetes mellitus
Babies can present with respiratory distress, hypoglycemia and neurologic manifestations

Question 10

you see a triple bubble sign on xray of newborn that doesn’t tolerate feeds. What is the diagnosis and possible cause?

Answer 10

Jejunal atresia from vascular accident in utero; RF poor fetal gut perfusion possible vasoconstrictive meds or mom using cocaine or tobacco

Question 11

What would an abdominal xray look like in baby with Hirschspurng?

Answer 11

See dilated loops of bowel that end at the rectosigmoid junction. Often present with bilious emesis, fail to pass meconium

Question 12

What test should you order in child with breath holding spell?

Answer 12

Get a CBC to assess for Fe deficiency anemia which is often associated w/ breath holding spells.

Question 13

13yo male comes to ED with palpitations; he is diaphoretic with HR of 210 and normal BP; his ECG shows SVT with slurring upstroke of QRS and he recieves an IV bolu of meds that resolve the SVT. What is the most likely cause?

Answer 13

Likely WPW; has accessory atrioventricular pathway causing preexcitation w/ increased risk for tachyarrythmias. Have delta wave on ECG with shortened PR interval

Question 14

3 wk baby with poor feeds, umbilical hernia and hypotonia. See abdominal bloating and jaundice with noisy breathing

Answer 14

Congenital hypothyroidism

Question 15

What are causes of ‘floppy baby’

Answer 15

Congenital hypoT: see umbilical hernia + large tongue
Werdnig-Hoffman; AR disorder; degeneration of anterior horn cells and CN motor nuclei
Infant botulims from honey or canned goods

Question 16

17 yo male comes in with weakness in arms and legs. On PE you notice his testicals are small for age and he’s already been through puberty as well as thinning of his hair

Answer 16

Myotonic Congenital myopathy: Auto Dom; distal muscle weakness with myotonia, testicular atrophy and baldness

Question 17

When do you see Breast milk jaundice and what are the signs?

Answer 17

See it start at 3-5 days but Peak at 2 wks: high levesl of B-glucuornidase in breast milk deconjugate intestinal bilirubin and increases enterohepatic circulation
Baby is gaining weight and has normal PE

Question 18

When do you see breastfeeding jaundice and what are the signs?

Answer 18

See during first week of life; often lactation failure causing decreased bilirubin elimination and increased enterohepatic circulation; baby appears dehydrated and there is suboptimal breastfeeding with wt loss

Question 19

Kiddos with SCD are at risk for what organisms that require vaccinations to decrease incidence of invasive organisms?

Answer 19

S. pneumo, H.influenza, N.men; need the conjugated S.pneumonaie vaccine to decrease incidence; pt may present with abdominal pain and hematuria that could

Question 20

Excess of ____ and _____ are seen in PCOS

Answer 20

LH and androgens

Question 21

What causes irregular menses when girl first starts period

Answer 21

HP-gonadal axis immaturity thus low production of LH and FSH to produce regular ovulation
should have increase in progesteron from corpus luteum after ovulation then degeneration

Question 22

Sx: edema, fatigue, proteinuria, absence of hematuria and hypoalbuminemia

Answer 22

seen with neprhotic syndrome

Often from minimal change disease, FSGS, membranous nephropathy or MPGN

Question 23

Hep B is a big risk factor for what nephrotic sydnrome

Answer 23

Membranous nephropathy; seen in unvaccinated children and see deposition of HBeAg corresponding antiB in glomeruli.
Workup is 24 hr urine sample

Question 24

Pt with hypertension, oliguria, hematuria, proteinuria and casts in urine
most commonly cause in kiddos

Answer 24

Nephritic syndrome
Poststrep glomerulonephritis or HUS
also can see IgA nephropathy or membranoproliferative

Question 25

How do we treat Lymes in child >8 and

Answer 25

less than 8 treat with Amoxicillin

Over 8 use Doxy

Question 26

Young kiddo with CF presents with bad coughing fits, post-tussive emesis after several days of body aches, pains and runny nose. He has nasal flaring and bilateral LL crackels with infiltrates on both lobes on xray, what do you use for tx?

Answer 26

Use Vancomycin; sounds like kid had influenza which can follow with S.Aurues infection in CF children. These kids have lots of hospitalizations thus increased risk for MRSA

Question 27

What therapy is approprate for child with P. aureginosa pneumonia

Answer 27

Amikacin, ceftazidime or cipro; more likely seen in adults with CF vs kiddos

Question 28

Kid that has no PMH is diagnosed with PNA, what do you tx with?

Answer 28

Use high dose amoxicillin for CAP to cover for Streptococcus pneumonaie (will NOT cover staph aureus)