Rosh questions Flashcards
You hear a murmur that is continous and heard near the supraclavicular/infraclavicular region. It intensifes with head extension while seated and lessens while suppine. This is likely a _____. Should parents be worried?
Cervical venous hum is an innocent murmur
what murmur has the buzzword “vibratory” or “musical quality” and is often heard over the left sternal border?
Still murmur
what does a diagnosis of abscence seizure require? What does it show?
EEG
generalized 3 Hz spike and wave discharges
what is the first-line treatment of absence seizures?
ethosuximide
what activity can induce an absence seizure?
hyperventilation
which vitamin def is this?
fatigue, malaise, easy bruising, and bleeding from his gums
red swollen tongue, skin pallor, and a raised papular rash with corkscrew hairs on the arms and thighs
Vitamin C
What are the 4 Hs of vit C def?
Hemorrhage
Hyerkeratosis
Hypochondriasis
Heme issues
Abx therapy for bacterial men in pts <= 1 month
Cefotaximine + amp
OR
Gentamicin + amp
Abx therapy for bacterial men in pts 1 month to 18 years
Ceftriaxone + vanc
OR
Cefotaxime + vanc
Abx therapy for bacterial men in pts 18+
Ceftriaxone + vanc
What is Auspitz sign and what is it associated with?
scale removal produces blood droplets
chronic plaque psoriasis
Reed sternberg cells are seen in
Hodgkin lymphoma
owl’s eye appearance
Owls read books
age demographic of Hodgkin lymphoma
15-19 yo
EBV
What type of burns are calculated for infants < 1 yo?
ONLY partial and full thickness burns
what is the formula for burn size in infants < 1 yo
Head = 19%
Arms = 7% each (14% total)
Anterior trunk = 13%
Posterior trunk = 13%
Each leg = 10.5% (21% total)
edit this card
what is the murmur associated with valvular disease of rheumatic fever and why
pansystolic
Because mitral stenosis is the MC heart issue
what is a very common history of a patient with scabies?
Family members with similar symptoms
Not going into the woods or smth like that
MOA of the MC ADHD med
Dopamine and norepinephrine reuptake inhibition
how does the dx of ADHD differ between kids <17 yo and 17+ yo?
< 17 = 5 symptoms needed
17+ = 6 symptoms needed
What are the 2 alpha-2 receptor agonists used for ADHD?
Guanfacine
Clonidine
when might you prefer guanfacine/clonidine in addition to stimulants for ADHD?
adjunctive therapies by targeting symptoms such as insomnia, irritability, and tics
somatic hyperactive sympstoms
t/f the recommended management of sinusitis for persistent/ none improving symptoms for 10 days is augmetin
true
when using a pneomatic otoscope for AOM, there will be __ of the TM
reduced mobility
Characteristics of a benign cardiac murmur in kiddos:
Grade () intensity
softer intensity while the patient is in this position ()
systolic or diastolic
length
radiation ()
This () or this () quality
Grade (<= 2) intensity
softer intensity while the patient is (sitting compared to supine)
systolic and short
radiation is minimal
musical or vibratory quality
t/f all diastolic murmurs are pathologic
I think so
90% sure, but there are always exceptions in medicine it seems
t/f increasing preload increases the murmur with VSD
FALSE
increasing AFTERLOAD does (handgripping for instance)
if a patient has NON-seasonal allergies, what is likely the MC colporate of the symptoms?
Pet dander
a patient comes in with multiple erythematous macules and papules on the trunk, face, and proximal extremities that spare the palms and soles
this came up about48-72 hours after birth
what is the likely corporate?
Erythema toxicum neonatorum (unknown etiology)
appears by the second day after birth.
Benign skin condition, transient eruption
Etiology unknown
Healthy newborns, usually during days 2–7 of life
PE: pustules on an erythematous base
Tx: observation, reassurance to parents
when does milia typically present by?
AT BIRTH
this is how to differentiate it from Erythema toxicum neonatorum
your patient has bilious vomitting, gastric bubble of the right chest wall, and abd distension - what is the likely diagnosis? What would be seen on upper GI with contrast series?
Intestinal malrotation
Ligament of Treitz on the right side of the abdomen
what condition is associated with malassezia furfur?
Tinea versicolor
likely not to tan in the sun
or pityriasis versicolor
what descent is MC for kawasaki disease?
Asian
what infection presents similar to acute sunburn, but sloughs off?
Staphylococcal scalded skin syndrome (SSSS)
what is the buzzword appearance of the perioral region of SSSS?
perioral crusting with a dried oatmeal appearance (aka SSSS sad face)
what is the go to treatment of SSSS?
Naficillin
what color are the scales of plaque psorasis?
silver
what is wilson disease (overview).
a disorder of copper metabolism
most common found from5 - 35
What 2 organ systems are most affected with wilson disease
hepatic and neurologic (with psych as well)
also don’t forget the eyes!
Hepatic issues with wilson may lead to these s/s
Bleeding/ascities/hepatomegaly
MC neurologic symptom of wilson disease
dysarthria
MC psych symptom of wilson disease
depression
the overall mamnagement of wilson is stabilizing, and then preventing. How do you stablize?
Chelating agents
trientine or D-penicillamine
this may be used as maintanence therapy to prevent symptoms of wilson
Zinc
or low dose chelating agents (penicillamine)
inheritance pattern of wilson disease
Autosomal recessive
spells “WAR”
What chromosome is affected with wilson disease?
Chromosome 13
wilson disease = 13 letters!
1st line parenteral abx for pyelo
3rd gen ceph
ceftriaxone, ceftotaxime, cefepime
when do GERD symptoms usually resolve by for infants?
1 yo
when would you give an H2 blocker in a kiddo under 1 yo with gerd?
FTT
evidence of esophagitis
moderate to severe esophagitis diagnosed by endoscopic biopsy and all infants with mild esophagitis on endoscopy, poor weight gain, feeding refusal, or marked irritability that is temporally related to reflux episodes and failure to improve with the conservative measures described above.
treatment of hearing loss at birth
Cochlear implantation
what is more severe, conduct disorder, or oppositional defiant disorder?
Conduct disorder
Oppositional defiant disorder is similar to conduct disorder in that children are defiant, disobedient, and hostile toward authority figures, however, they do not violate societal norms or rules and are not violent toward other people or animals.
t/f hypothermia is a common symptom of hypothyroidism at birth
true
What is the most common type of psoriasis in children?
Chronic plaque psoriasis
which type of hernia descends into the scrotum
indirect inguinal
IN the scrotum
of seizures in a day
difference between a simple vs complex febrile seizure
-time
generalized/focal
Simple = 1 seizure in 24 hours that is < 15 min with no focal features
Complex would be >1 seizure >15 min, focal/nonfocal
for molluscum contagiosum, other than observation, what are the first line therapies
cryotherapy, curettage, and cantharidin
3 Cs
MC symptoms of an osteosarcoma
Pain and a palpable mass on the metaphyses of long bones
MC malignant bone tumor
sunburst appearance on xray from the lesion growing too fast (periosteal reaction)
what size of a bone lesion makes you worried about malignancy (not benign)
> 4 cm in diameter
what are the margins of a unicameral bone cyst on exam?
well-defined margins with no bone destruction
what is the trunk incurvation reflex aka?
galant reflex
two first-line treatments of warts (verruca)
SA
Cryotherapy
same as molluscum but no scorpion med
what is the MC causitive organism for acne vulgaris?
Cutibacterium acnes
sounds like cutaneous bacterium
t/f growth spurts and night pain are common history findings of Osgood-Schlatter disease or osteochondrosis of the tibial tubercle
FALSE
growth spurt is, but not night pain
___ is a lower UTI while ____ is an upper UTI
cystitis = lower (lower in the GU tract)
pyelo = upper (more proximal)
MCC of epistaxis in kiddos
picking your nose / trauma
your 3 day old infant presents with new onset erythamatous macules and papules that progressed to pustules on a erthematous base. What likely is the diagnosis and what would be seen on a wright-stained smear? Treatment?
Erythema toxicum neonatorum
it would show numerous eosinophils
No treatment
t/f evaporative coolers are good for reducing allergen exposure
False - These coolers increase humidity, which can increase mold or dust mites in the house.
why is it a good idea to wash sheets regularly for asthmatics?
It reduces dust mite exposure
what is the classic presentation of rocky mountain spotted fever?
Nonspecific
blanching, erythematous macular rash that begins at the wrists and ankles, spreads to the trunk, and may become petechial over time. Rash on the palms and soles is highly characteristic of RMSF but usually occurs later in the disease progression
history of being in the woods with a tick bite
treatment = doxy
what is the bacterium that causes rocky mountain spotted fever?
Rickettsia rickettsii
What are the two hosts that can transfer Rickettsia rickettsii to humans (for rocky mountain spotted fever)
Dermacentor andersoni or Dermacentor variabilis (wood or dog ticks)
What are the two causes of elevated INdirect bilirubin?
Gilbert syndrome
Crigler-Najjar syndrome (seen more at birth and more severe)
Abx for cat scratch disease
azithromycin
what is the rash of Neisseria meningitidis
macular, non blanchable rash
seen in children > 10 yo
difference between herpes zoster and varicella
Herpes zoster is the REACTIVATION of varicella (chicken pox) along a dermatome
HZV = shingles
difference in the therapy for intussception vs pyloric stenosis
intussception = pneumatic reduction to stop ballooning
pyloric stenosis = pyloromoty
what steroid specifically is used to reduce fetus likelihood/severeity of hyaline membrane disease?
Dexamethasone
what is CMV aka? HHV ___
5
cyto
What is varicella aka? HHV ___
3
What is HHV 4?
EBV
What is HHV 6?
roseolovirus (6th disease)
What is HHV 7?
Also roseolovirus?
What is HHV 8?
rhadinovirus - kaposi’s sarcoma (KSHV)
Mneomnic for herpes 3-8
ZEC triple R K
zoster
EBV
CMV
Roseola x 2
rhadinovirus/kaposi’s
what specifically is the pathophys of Osgood-Schlatter disease?
osteochondrosis from adolescent growth spurt paired with repeated contraction of the quads muscles leading to repetitive tension produces strain at the tibial tubercle apophysis
activity-related pain of gradual onset (10-15 yo)
leads to an enlarged tibial tubercle
this PE action shows tenderness of the tibial tubercle for Osgood-Schlatter disease
resisted knee extension
t/f systemic juvenile idiopathic arthritis often involves systemic symptoms including fevers and rash
TRUE
when does the rash of systemic juvenile idiopathic arthritis appear and disappear?
With the appearance and disappearance of fever
Lab findings of systemic juvenile idiopathic arthritis
no specific laboratory tests for the disease, but markedly elevated inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), elevated white blood cell count, marked thrombocytosis, and normal findings on urinalysis, antinuclear antibody, and rheumatoid factor are typically seen.
Mild anemia is common.
treat with NSAIDs
big vital sign difference between roseala and rubella
roseola is a very high fever while rubella (German measeles) is a low grade fever (or none)
First line treatment of perioral impetigo mild
Mupirocin
MCC of intestinal obstruction
Intussusception
MCC of endocarditis
staph aureus
what is the color of the base of oral thrush?
Erythematous
white plaques above it
what age are lozenges CI?
< 4 yo
choking hazard
t/f if you highly suspect strep based on PE, you do not need to get a Rapid antigen detection test
FALSE
according to Rosh at least
what is the RDW of iron deficiency anemia?
HIGH
A red blood cell distribution width (RDW) blood test measures the variation in size and volume of red blood cells (RBCs) in a blood sample
apart from being short, what is often seen on the neck of someone with down syndrome?
excess skin on the nape of the neck
mneomonic to remember barlow maneuver
BAD
Barlow ADduction
First line treatment of irritant diaper dermatitis
DFrequently changing the diaper and leaving it off for a few hours each day
OM is a common complication of ___.
flu
crash and burn mneomnic is for
Kawasaki disease
what is the crash and burn mneumonic
CRASH and burn: conjunctivitis, rash, adenopathy, strawberry tongue, hand or foot edema, uncontrolled high fever
t/f not manipulating warts helps them heal?
true
MC spread from sinuses for preseptal cellulitis
ethimoid sinus
what are the ages to use MCHAT? When is Developmental Behavior Checklist used instead for ASD screening?
MCHAT = 18-24 months
Developmental Behavior Checklist = 4-18 yo with an intellectual disability
moderate risk MCHAT
3-7
In a patient with anorexia nervosa, you overly treat, leading to refeeding syndrome. The hallmark of this syndrome is this electrolyte abnormality ____
hypophosphatemia
what is severe obesity (BMI percentile or #)
120% of 95th percentile
OR
> 35 BMI
Samter triad
- asthma
- nasal polyps / chronic sinusitis
- aspirin hypersensitivity
MC complication of chicken pox
bacterial/ soft tissue infection
What ROM is decreased in slipped capital femoral epiphysis (SCFE)
Decreased internal rotation of the left hip
90% of colic resolves by
9 weeks
study of choice for Vesicoureteral reflux
Voiding cystourethrography
tactile fremitus of PNA
increased
treatment of Congenital nasolacrimal duct obstruction (dacryostenosis)
nonsurgical management, including observation and massage (Crigler massage)
resolves by 6 months
how to diagnose a Congenital nasolacrimal duct obstruction (dacryostenosis)
clinically
dye disappearance test can confirm the diagnosis
MCC of Congenital nasolacrimal duct obstruction (dacryostenosis)
incomplete canalization at the end closest to the nose
synovial fluid analysis of late lyme disease
Synovial fluid white blood cell count is typically elevated in the inflammatory range of 20,000 to 60,000 cells/µL but is not as high as in septic arthritis
What differs tanner 1 from 2?
Tanner 2 = enlargement of scrotum and testes with change of color and reddening
What differs tanner 2 from 3?
Lengthening of the the penis
What differs tanner stage 3 from 4?
Increase in everything with scrotum skin darkening
at stage 5 = adult morphology
what is the only tetragenic one of these: mumps, roseola, rubella, and rubeola
rubella
eye, heart, rubella
ella = female
MC presentation of CMV in utero
In utero, periventricular calcifications, ventriculomegaly, microcephaly, hyperechogenic fetal bowel, fetal growth restriction, ascites, hepatosplenomegaly, or pleural effusion may be seen on ultrasound imaging. At the time of birth, approximately 10% of neonates have symptoms. The most common manifestations include petechiae, jaundice, hepatosplenomegaly, small size for gestational age, microcephaly, sensorineural hearing loss, lethargy, poor suck, chorioretinitis,
what vit def is MC in exclusively BF babies?
Vit D
400-600 IU/day
lesions of HFM disease
The exanthem associated with hand, foot, and mouth disease may be composed of macular, maculopapular, and vesicular lesions. These lesions are usually nonpruritic and nonpainful. Lesions on the buttocks are more commonly seen in infants compared to older children.
which serotype of HFM is atypical and more severe?
coxsackievirus A6 serotype
MCC of Peritonsillar abscess
Streptococcus pyogenes
MC antecedent condition of orbital cellulitis
bacterial rhinosinusitis
UA of nephrotic syndrome often shows ___ bodies
Oval fat bodies
what are mongolian spots aka?
Slate gray nevus
congenital dermal melanocytosis
goes away, but can do cosmetic laser treatment if needed
Are scabies infections caused by male, female, or both sexes of mites?
Females. They burrow into the epidermis to lay their eggs before dying.
what differs bacterial trachietis from croup?
SAME as croup but toxic appearing
treat with IV abx
MCC of atypical PNA and presentation
Mycoplasma pneumoniae
low grade symptoms
Best initial treatment of encopresis
Colonic disimpaction followed by an oral laxative (not fiber)
classic presentaiton of nummular eczema
highly pruritic, round, coin-shaped patches.
dull red, exudative, and crusted appearance during the acute phase and a dry, scaly appearance with a central clearing in older lesions.
what temp should a teething obj be for teething remedy?
cold
Maternal RF for pyloric stenosis
erthromycin
also infant exposure to cow milk or soy proteins, and infant exposure to caregivers with diarrheal disease
Which pathogen is most likely to cause tympanic membrane perforation?
Group A Streptococcus
t/f hair loss is common with tinea capitis
true
itchy + hairloss = think this
1st line treatment of AOM
amoxicilin
What is the difference between bulbar and tarsal conjunctiva?
The bulbar conjunctiva is the part that covers the globe of the eye, while tarsal conjunctiva covers the eyelids.
what is hyaline membrane disease aka?
Respiratory distress syndrome
What does the pathophys of decreased surfactant lead to for Respiratory distress syndrome
Inadequate surfactant leads to increased alveolar surface tension
sweat chloride test needed to be dx with CF
> 60
60 fibrosis = mneomonic
is there dullness or hyperresonance to percussion with CF?
hyperresonance
because fluid
common findings of scarlet fever and treatment
rash
strawberry tongue
pastia lines (petechiae on axilla)
amoxicillin over penicillin cuz it tastes good
your 12 week pt has yellow, greasy, adherent plaques on the head. This is ___ and should be treated with ___ at first
Seborrheic dermatitis
mineral oil
Brittle bone disease is aka ____ and has this inheritance
osteogenesis imperfecta
autosomal dominant
MC complication of kawasaki disease
coronary artery abnormalities
difference in causitive organisms for otitis externa vs AOM
Otitis externa = psedomonas (think swimming)
AOM = SMH (not typically pseudomonas)
if your patient complains of pruiritis of the ear, are you thinking AOM or otitis externa?
swimmer’s ear
What is the step after discovering IGF is low paired with a decrease in height velocity? What is the step after the next step?
1st order GH stimulation testing
Then, order an MRI of the brain
is barky cough epiglottitis or croup? What about drooling?
Barking = croup
Drooling = epiglottitis
which disease has linear petechiae over the axillary folds?
Scarlet fever
complication of strep throat
Which class of blood pressure medication is most often associated with drug-induced angioedema?
ACE inhibitors
-pril
can 2 yo have Zofran?
yes
DOC for short term treatment of enuresis and how this differs from the long term treatment plan
Desmopressin is most effective short term
Alarm therapy is best long term
Earliest location of androgenic alopecia hairloss
Temporal scalp or vertex
what is the dx test of choice for herpes
PCR
use to be tzank
KNOW THIS (only 27% of test takers got right)
what venous blood lead level should be rechecked?
15 and 44 mcg/dL
in 1-4 weeks
if > 45, then urgent chelation therapy typically
what is used to prevent gonococcal infection of the eyes after birth in baby’s?
Topical erythrmoycin
RF for bronchiliotis
preterm
I guess BF is not a preventitve factor
murmur of TOF
harsh systolic crescendo-decrescendo murmur at the left sternal border, a palpable thrill, and a prominent right ventricular impulse
how to dx pertussis (whooping cough)
Clinically
2 weeks of cough + one of the following (paroxysms, whoop, apnea in infants < 1 year of age, or posttussive vomiting.)
what causes more force directed laterally during knee flexion and leads to retropatellar pain
increased q angle
“palpable right ventricular lift” makes you think of
TOF
by what age should the posterior fontanel be closed
birth
2 mos at the latest
Hypercalcemia can lead to constipation t/f
True
MCC of aortic stenosis
Bicuspid aortic valve
what is the hallmark presentation of symptoms associated with mycobacterium marinum?
Infection after exposure to water with pain weeks after
treatment with clarithromycin, -cycline, or Bactrim
papules that progress to shallow ulcers and scar formation
classic triad of congenital toxoplasmosis
chorioretinitis, intracranial calcifications, and hydrocephalus
treatment of toxoplasmsosis
SPF
pyrimethamine, sulfadiazine, and folinic acid
what is the spread of roseola
Rash starting on the neck or trunk and spreading to the face and extremities
if it spared the hands, think scarlet fever
Can kiddos use Mirtazapine for depression
Not approved
is oxymetazoline or phenylephrine used firstline after failed to stop nosebleed?
oxymetazoline
*
A 2-day-old infant boy is evaluated for poor feeding and abdominal distention. He has had several episodes of bilious vomiting and has not passed any meconium since birth. An abdominal radiograph reveals dilated loops of bowel without gas or stool present in the rectum. What is the likely diagnosis?
Hirschsprung disease
Hemophilia A vs B factor deficiency
A = 8 (VIII)
B = 9 (IX)
when do you use a lactose tolerance test for milk allergy work up?
Basically never
Given its poor specificity, it is not the first-line test.
What stool test can be used to rule out inflammatory bowel disease?
Fecal calprotectin.
Sausage shape mass in ____ is dx for ____ while an olive-shaped mass in the ____ is dx of ____
Both RUQ
Sausage = intussception
Olive = pyloric stenosis
your patient has aspirated smth into the lungs - what is the next best step?
rigid bronchoscopy
MC neurologic disorder in early childhood
Febrile seizures
just supportive care assuming that they retun to baseline
no EECG unless two unprovoked seizures
Is oral erythromycn for gonocollcal or chlamydial eye infection in newborn
chlamydial
oral is best
1st line treatment of allergic contact dermatitis
topical triamcinolone
think poison ivy = tree = tri (not accurate at all, just way to remember)
MCC of viral conjunctivitis
Adenovirus
for asthma therapy, do you often switch out meds?
No
typically add meds or make them stronger
treatment of CAH
Hydrocortisone, fludrocortisone, and sodium chloride
treatment of mild Primary immune thrombocyotpenia vs mod
mild = just monitor
moderate = start prednisone
MOA of escitalopram
SSRI
aka lexipro
-opram = SSRI
wickham striae are seen in this condition ___ and look like this buzz word ____.
Lichen planus
Fine white lines
MC sequalea of ASD is which of these:
Left ventricular hypertrophy
Pulmonic stenosis
Right atrial hypertrophy
Ventricular dysrhythmia
RA hypertrophy
what is the common CXR finding of foreign body aspiration of the lung?
Hyperinflation of the affected lung d/t in ability to exhale properly
if you hear decreased breath sounds over that lung field, expect to see this!
MC age for avascular necrosis of the proximal femoral epiphysis
3-12 yo
5-7 yo very common
effects boys > girls
t/f herpetic gingivostomatitis often causes bleeding to the gums
true
If a patient does not respond well with nebulized Epi for sus of croup, what is the likely alternative dx?
Bacterial trachieitis
You have a 9 yo patient who has never had the flu shot - should you reccomend 2 doses?
NO
only 6 months - 8 yo if it is their 1st time
preferred abx treatement for uncomplicated acute cystitis
Cefdinir
what test is done for celiac disease
Serum tissue transglutaminase antibody test
just look for the glut and you are good
what do you use to dx pertussis other than clinicallly?
PCR and culture of the nasaophayngeal specimens (not oropharyngeal)
what characterizes the onset of type IV cell-mediated hypersensitivity (often from contact dermatitis)
Delayed reaction
what type of strep is MC for strep throat?
Group A
what is a characteristic finding upon manipulating the blisters of a superfiscial partial vs deep partial burn?
Deep partial blisters are easily unroofed
also blanch with pressure, but are more sluggish
At what age does HR approach adult values (60-100)?
About 8 yo
1st line treatment for staring spells (abscence seizures)
Ethosuximide
think E = for Eye staring
