Rosh Flashcards
What is an indication for an implantable cardioverter defibrillator in a kid with hypertrophic cardiomyopathy
Unexplained syncope, previously aborted sudden cardiac arrest, strong family history of sudden death, ventricular wall and diastolic dimensions of greater than 3 cm, non-sustained ventricular tachycardia, hypotensive response to exercise
What is a contributing factor for bone loss in a patient with anorexia?
Low levels of oxytocin
Which line carries the lowest risk of a catheter associated bacterial infection
Peripherally inserted midline catheter
Symptoms of hematuria, edema, and hypertension are suggestive of what dx? And what is the most common ideology?
Poststreptococcal glomerulonephritis.
Group A Strep
What is the approved drug for agitation in autism?
Risperidone
A boy has HUS and CBC, coags, CMP are fine and there’s blood in the urine. Next step?
Random urine for protein and creatinine so disease progression can be monitored
Recurrent mucosal bleeding, mild thrombocytopenia, and giant platelets on peripheral smear. What’s the dx and diagnostic work up?
Bernard-Soulier syndrome, which is a qualitative disorder in platelet function caused by a deficiency of glycoprotein 1b in the platelet membrane.
Inheritance is autosomal recessive.
Diagnosis is confirmed by flow cytometry of the missing glycoprotein.
Episodes of fever, cervical
lymphadenopathy, pharyngitis, and aphthous ulcers occur every 2 to 8 weeks with an average of 4 weeks between episodes.
Periodic fever with aphthous stomatitis, pharyngitis, and adenitis (PFAPA syndrome), which is a form of periodic fever and an autoinflammatory disease.
A fever diary can be helpful in establishing the periodicity of fever.
Lab findings include leukocytosis and elevated inflammatory markers during episodes,
When giving IVF for hypothermia, what temperature should they be given at?
104-111
Immunoglobulin A vasculitis (Henoch-Schönlein purpura) is the result of a small-vessel vasculitis with symptoms directly related to what etiology?
IgA deposition in vessel walls with a resultant leukocytoclastic vasculitis,
What is a failure mode and effects analysis?
A quality improvement tool that is used to identify factors that may cause a process to fail. It is a preventative rather than a reactive analysis. It is used proactively to anticipate challenges rather than to evaluate the cause of a system failure after it has occurred. Failure modes refer to potential ways that a project could go wrong, while an effects analysis predicts the downstream effects of the failures.
Which complication is associated with hydroxychloroquine use?
Vision impairment
Pt has long-standing poor weight gain and linear growth, as well as steatorrhea and recurrent bacterial infections. The family history is positive for a relative who is short and has similar issues. His physical exam reveals an abnormally shaped rib cage. Finally, his laboratory evaluation reveals neutropenia (neutrophils 600/microL), a low fecal elastase indicating pancreatic insufficiency, and normal sweat test and nasal nitric oxide test.
Shwachman-Diamond syndrome
Risk factors for type 2 diabetes mellitus?
female sex, positive family history, obesity, certain ethnic and racial groups, and prenatal exposures including low birth weight or being the infant of a mother with gestational diabetes.
Risk factors for type 2 diabetes mellitus?
female sex, positive family history, obesity, certain ethnic and racial groups, and prenatal exposures including low birth weight or being the infant of a mother with gestational diabetes.
Serum measurement of which of the following is most likely to be decreased in maple syrup urine disease?
Alanine
They will have increased levels of Leucine, isoleucine, and valine
Pt who has a slowly progressive unilateral cervical adenopathy and papular lesions on his arm suggestive of a diagnosis of…what dx?
cat scratch disease (CSD)
Warthin-Starry stain of the lymph node specimen may be helpful in demonstrating the presence of pleomorphic gram-negative rods, consistent with B. henselae.
Pt with hyperthermia, tachycardia, mydriasis, constipation indicates what ingestion?
Anticholinergic Toxidrome
• Antipsychotics, tricyclic antidepressants, antihistamines, jimsonweed, deadly nightshade
A child’s tracheal length correlates best with their…
Weight
Protective interventions that improve outcome or reduce the risk of preterm infants going on to develop bronchopulmonary dysplasia include…
antenatal glucocorticoid therapy, protective ventilation strategies, use of mother’s breast milk for nutrition, caffeine, fluid restriction, and supplementation with vitamin A.
Contraindications to the use of noninvasive ventilation in children.
altered mental status, high aspiration risk, significant facial injuries, upper gastrointestinal bleeds, and the need for airway support during
cardiopulmonary arrest, significant hemodynamic instability, or any upper airway process that may compromise the airway such as burns or epiglottitis.
In the setting of agitation that is known to be secondary to acute cocaine intoxication, the treatment of choice is
A benzodiazepine such as intravenous diazepam.
A number of factors increase the risk for early neonatal hypocalcemia, including
fetal growth restriction, prematurity, birth asphyxia, maternal diabetes, hypoparathyroidism, genetic syndromes, hypomagnesemia, and maternal hyperparathyroidism.
EEG finding in infantile spasms? Treatment?
Chaotic interictal tracing with an
electrodecremental response during episodes
Tx w high dose ACTH
ingestions that may result in anion gap metabolic acidosis
ingestion of metformin, ethylene glycol, ethanol, methanol, salicylates, iron, cyanide, cocaine, and amphetamines.
Metformin increases the anion gap via lactic acidosis.
Normal anion gap (AG) causes
Hyperalimentation, Addison Disease, renal tubular acidosis, diarrhea, acetazolamide, spironolactone, saline infusion (HARDASS)
Increased anion gap (AG) causes
• Methanol, uremia, DKA, propylene glycol, iron or INH, lactic acidosis, ethylene glycol, salicylates (MUDPILES)
• Tachypnea
Which of the following is the most predominant cell type found in breastmilk during the first two months of lactation?
Macrophage
Causes of SJS/TEN
Drugs
• Sulfonamides
• Phenobarbital, carbamazepine, lamotrigine
• Allopurinol
・ NSAIDS
Infection
• Mycoplasma pneumoniae
In a sickle cell patient presenting with stroke like symptoms, which should be your first step?
Red blood cell transfusion.
They will eventually need exchange transfusion, but a simple blood transfusion is the first temporizing measure
What is the diagnostic modality for kids with Duchene muscular dystrophy?
Molecular genetic testing to look for a mutation in the DMD gene
Who should be excluded from the AAP guidelines on the care of infants 8 to 60 days old with fever?
Patients born before 37 weeks, maternal fever, have clinical bronchiolitis, HSV infection, focal bacterial infection, history of surgery, congenital malformations, got vaccines in the last 48 hours, medically fragile
SGA male infant with no prenatal care fails hearing screen, microcephalic, hepatosplenomegaly, exam with salt and pepper retinopathy. Dx?
Rubella
Pigmented retinopathy a.k.a. salt and pepper retinopathy. Also, cataracts
CMV presents the same but with chorioretinitis
Teen abusing cough medicine. What is the mechanism by which the drug act?
Intoxication by dextromethorphan, which works by inhibition of N-methyl-D-aspartate receptor
What are the cut offs for evaluation of neonatal fever for elevation of inflammatory markers: pro calcitonin, CRP, ANC, temperature
pro calcitonin >0.5
CRP >20
ANC >4000
temperature >38.5
What body temperature does severe hypothermia typically occur?
Less than 82°F
A burn may be classified as minor if it meets what criteria
Partial thickness burn less than 10% of BSA
cannot involve the face, hands, perineum, feet, can’t cross major joints, not circumferential, must be isolated
What is the pathological process behind myocarditis?
Myocyte necrosis within the myocardium
What is the main stay of therapy for Bruton type (X-linked) agammaglobulinemia?
Replacement of immunoglobulin G through IVIG
Rapid onset ataxia, dysarthria, nystagmus, vomiting with a history of prodromal viral infection
Acute cerebellar ataxia
Red purple rash on arms and legs, short stature, petechiae, café au lait macules, pancytopenia, hyper or hypo pigmentation with macrocytic anemia. Absent or hypoplastic thumb. Dx and work up?
Fanconi anemia.
Congenital, progressive bone marrow failure
VACTERL Association.
A chromosome breakage test followed by Gene sequencing confirms diagnosis
Infant found apneic and pulseless. Team starts bag mask ventilation and chest compressions. Next step?
IV epinephrine every 3 to 5 minutes
Patient presents with a pulse and narrow QRS complex tachycardia (super ventricular tachycardia) or symptomatic ventricular tachycardia. Next step in management?
Synchronized cardioversion
Diagnosis of Cushing syndrome?
24 hour urinary free cortisol.
Late night salivary cortisol
Dexamethasone suppression test.
ACTH levels
Most common non-iatrogenic cause of hypercortisolism in Cushing syndrome?
ACTH secreting pituitary tumor
Hyper immunoglobulin E syndrome or Job syndrome is caused by what pathophysiology
Impaired neutrophil chemotaxis
What ingestion can cause lateral nystagmus, somnolence, vomiting, and hypoglycemia with a metabolic acidosis that does not respond to glucagon
Ethanol
For a case control study and a cohort study, which method should be used for each to describe the relationship between two risk factors? Relative risk and odds ratio.
Case control = odds ratio
Cohort study = relative risk
Treatment for cat scratch fever? Treatment for neuroretinitis due to cat scratch fever?
Treatment is mainly supportive, azithro if needed.
Neuroretinitis is treated with doxycycline and rifampin plus glucocorticoids
Which test would be helpful in diagnosing Graves disease
Thyroid stimulating immunoglobulin
What is the four hour acetaminophen level threshold?
150 µg/mL
Patient admitted for surgery, cardiac condition, or hematologic/oncologic conditions are high risk for what metabolic abnormality?
Hyponatremia
Group a strep bacteremia treatment
Penicillin and clindamycin to suppress toxin production
Kidd with Cushing syndrome who was found to be hypertensive, hyperglycemia, and ACTH levels are low. What is the most likely cause?
Adrenal tumor
Most common cause of bacterial tracheitis? What intercurrent illness is it most often associated with?
Staph aureus
Influenza
AKI with muddy brown urine and red blood cell cast
Acute tubular necrosis
