SILBERT-FLAGG Questions Flashcards
Management of an infant with suspected heart disease and reported cyanotic spell should include:
Prompt referral to cardiologist
And apnea monitor
Instructed the parent to keep a diary of these episodes
Continuous administration of oxygen
Referral to cardiology
A common cause of congestive heart failure in the first year life
Pulmonary stenosis
Ventricular septal defect
Rheumatic fever
Complete heart block
Ventricular septal defect is the most common in children can lead to increase pulmonary bloodflow and overtime can cause congestive heart failure if not medically or surgically managed.
Pulmonary stenosis can cause right heart failure from decrease pulmonary bloodflow.
The least likely physical findings in a two month old with congestive heart failure?
Tachypnea, tachycardia, Hepatomegaly or pedal edema
Tachypnea and tachycardia & hepatomeagly are early signs of congestion
Peripheral Edema is rare and children; children may develop edema but there must be a 10 % increase in weight and the Edema is usually initially noted in the eyelids
Chest pain and young children is usually_____
Non-cardiac in origin
The mother of a four month old infant reports that he turned blue and seem to have fast labored breathing after vigorous crying soon after awakening. He settled down in his color and breathing seem to improve. On physical examination, the mucus membranes of the lips and mouth appear mildly cyanotic. A systolic murmur is heard best at the upper and lower left sternal border. Vital signs are normal with normal peripheral pulses. There is no hepatomegaly. He likely diagnosis is:
Congestive heart failure, apnea, cortication of the aorta, TOF
This is a cyanotic spell related to TOF
Which statement is true regarding innocent murmurs?
The murmur is often Holosystolic
Prompt referral to a cardiologist indicated
Precordial thrill is present
The murmur is low in intensity grade 1 to 3
The murmur is low in intensity and grading do not require urgent referral to a cardiologist normally 1 to 3
When should anabiotic‘s for bacterial endocarditis prophylaxis for children be given? (dental procedures, surgical repair)
Any child with a residual defect at a repair site
Most common cause of myocarditis in North America is:
Viral infection
Enterovirus, adenovirus, parvovirus B19
Diphtheria is common in other countries without immunizations
Drug and toxic reactions can cause Carditis but rare
And a healthy eight month old with diarrhea but no dehydration, what would be the most appropriate advice to give the parents?
Encourage strength formula for 12 hours
Give oral rehydration solution for 12 hours
Give only fluids until stools return to normal
Get bananas and cereal as tolerated
Starvation depresses the digestive system and prolongs diarrhea ORT is only given if dehydration is present
When evaluating a child with abdominal pain what symptom would lead to a likely organic etiology
Night awakening
Pallor
Sweating
Suprapubic pain
Night awakening with abd pain usually does not occur with functional disorders
What is the following appropriate regimen for pinworm medication
Daily x7 days repeat as needed
TID for 10 days repeat as needed
B.i.d. for three days repeat in two weeks
One dose one time repeat in two weeks
Albendazole 400 mg orally as a single dose repeat in two weeks
A two month old johns frequent vomiting has Miss Doyle convinced that something is seriously wrong. Which of the following is my suggestive of GER?
He’s gained 5 ounces this month
He had a slight weeds today
He is hungry after vomiting
He drinks 7 to 8 ounces every 3 to 4 hours
John has been overfed which were predispose as an infant to GER
A more appropriate intake for a two month old is 4 to 5 ounces every 3 to 4 hours
You see Jack a 20-month-old toddler with normal growth and development. For diarrhea. His mother tells you that he is passing up to three loose stools a day and that he drinks 20 ounces of apple juice a day what is the most likely diagnosis?
Crohn’s disease
Giardia Lamblia
Celiac disease
Non-specific toddler diarrhea
Toddler diarrhea is caused by carbohydrate mouth certain rules all the juices removed from the diet. Crohn’s disease is not common in children less than two years. Celiac disease may cause failure to thrive. Giardia causes intermittent diarrhea
Baby Sally has 7% dehydration what would you expect to see on her examination? Normal Refill normal Fontanel cool/mottled skin Dry mucous membranes
Dry mucous membranes, increase heart rate, capillary refill is prolonged
In evaluating Billy a child with bloody diarrhea which of the following would not be an appropriate first action? Check the growth chart Hemoccult test for stools Stool culture Upper G.I.
An upper G.I. would not be appropriate it looks like anatomy abnormalities. And a child with bloody diarrhea still cultures should be obtained to look for an infectious agent. Hemoccult can be done to prove the presence of blood. Sub optimal growth may point to an inflammatory bowel disease
Lillys family eats at fast food restaurants 4-5 times each week. If you suspect the diarrhea is infectious in nature what is likely the causative organism? Adenovirus E. coli S.aureus Giardia lambila
E. coli is found in undercooked ground beef and leafy greens causing bloody diarrhea
S.aureus Causes vomiting and diarrhea but no bleeding.
Giardia is generally contracted from contaminated water.
Adenovirus is found on the hard surfaces and usually affects children less than three years in daycare
Which of the following conditions would most likely occur in a four-year-old boy?
Pyloric stenosis
Recurrent abdominal pain
Intussusception
Giardia infection
Giardia in children 1 to 9 years of age. Pyloric stenosis affects infants in the first few months of life three weeks to four months. Intussusception mostly in the first two years of life. Functional abdominal pain is uncommon in children younger than four mostly but hers between ages 8 and 15.
Which of the following may occur with suspected appendicitis
Pain not relieved with ambulation
Young children appear very ill in the early phase
Fever of 102°F
Leukopenia with left shift
Children with appendicitis have difficulty ambulating. Young children may NOT APPEAR very ill in the early phases. Fever is absent or low. There may be leukocytosis with left shift
Which of the following serological findings indicates chronic HBV infection.
HBsAG negative 6 months
Anti HBc Positive and HBsAG positive
IGM anti-HBC positive
Anti-HBs positive
HBsAG
Hepatitis B surface antigen is the earliest marker for acute infection and persistence for greater than six months indicates chronic infection. Total anti-HBc (total hepatitis B core antibody) appears in acute infection and persist for life. Positive IgM anti-HBC indicates acute infection. Positive anti-HPS indicates positive immune status after vaccination
Children and child care facilities are at greatest risk for it being exposed to which of the following hepatitis infections
HAV, HBV, HCV, HDV
Hepatitis is the most common form of viral hepatitis and children it is transmitted by the fecal oral route but contaminated shellfish and water
A two day old baby is in the hospital nursery and still has not passed meconium this is a red flag for what condition
Interception, HUS,Hirschsprung’s disease, pyloric stenosis
Hirschsprung’s disease
A 10-year-old boy comes to your clinic for evaluation of a suspected urinary tract infection which of the following signs would lead you to include diagnosis other than a UTI in the differential?
Penile discharge
UTI signs include in recess, frequency, dysuria, urgency, fever, and pain. Discharge may indicate balanitis or a sexual transmitted disease
Jay is a nine-year-old boy who has no significant health problems, but his mother is very concerned because he is wetting himself. As you begin your history and physical, you keep in mind that the most common type of enuresis in school-age children is?
Primary nocturnal enuresis
Occasional daytime enuresis
Secondary nocturnal enuresis
Primary diurnal enuresis
Primary diurnal enuresis
Which of the following statements is not true with regard to primary nocturnal enuresis?
There’s often a positive family history of enuresis
It appears to be related to maturational delay
Some nighttime waiters stop wedding without any form of treatment
The incidence is higher in girls than boys
Primary nocturnal enuresis is seen in almost 3 times more boys then girls
While examining a four month old boy, you are unable to palpate one of the testes. The next most appropriate step is to:
Reassure the parents that this is a normal finding
Refer the child to endocrinologist
Re-examine the baby in two months
Refer to a urologist
Reassure the parents of this is a normal finding
Testes don’t decend until 6 months
Which of the following is not true with regard to hypospadia’s?
Meatus is formed along the dorsum of the penis
It is one of the most common penile abnormalities
Circumcision should be deferred
A referral for an endocrine evaluation may be indicated
The meatus is formed ventrally along penis
A 12 year old girl presents to clinic with symptoms of vaginitis, odor, dysuria, frequency, and discomfort.
From further history in lab screening the girl is diagnosed with Canadian albicans vaginitis. Appropriate treatment would include:
Avoid bubble bath
Topical acyclovir
Rocephin
clotrimazole
Clotrimazole ,micanazole ,ticsnoxole For a yeast infection
A label Adhesion extending from the posterior to the clitoris is noted during a routine assessment of a four-year-old girl. There is no history of difficulty voiding, dysuria, discomfort. The most appropriate initial management is to:
Prescribed a topical application of estrogen cream
Referred to a G.I. specialist
Reassure the parents that no specific treatment is needed
Recommend mechanical lysis using petroleum onitment
Reassuring the parents and no specific treatment is needed at this time most lambila Hwy shouls resolve spontaneously during hormonal changes like at puberty.
Patients with acute nephrotic syndrome may present with all the following except? Edema Hypertension Dark amber colored urine History of weight loss
Patients with nephrotic syndrome can present with Periorbital Adema, hyper or hypotension, tachycardia, weight gain related to fluid overload!
It is important to look for evidence of a preceding streptococcal infection ruling out acute nephritis. This is best done by:
Throat culture
Skin examination
ESR
ASO titer
ASO titer
Anti-streptolysin O
Elevate an 80% of patients with proceeding streptococcal infection, peek around 2 to 4 weeks after an episode
An adolescent boy presents to the clinic with the painless mass in less side of his scrotum what is the most likely diagnosis?
Testicular torsion, epididymitis, incarceration and hernia, hydrocele
Hydrocele, typically manifest as a painless scrotal swelling available size and an inguinal hernia
Foul smelling vaginal discharge that it makes a fishy odor when combined with potassium hydroxide is most likely due to :
GARDNERELLA vaginalis
Candida albicans
Chlamydia
N. Gonorrhea
Bacterial vaginosis, often causes Gardnerella vaginosis, with a mail order us vaginal discharge, positive whiff/fishy, When the discharge is mixed with potassium hydroxide
A 17 year-old sexually active girl with cankers in the general areas noted to have a positive venereal disease research laboratories (VDRL) test. The next step should be to:
Treat with Rocephin
Perform a specific troponemal antibody test
Culture for C.trachomatis
Discuss safer sex practices
Treatment is with benzathine penicillin G. If the VDRL test is positive a specific troponemal Tess such as FTAABS should be done to confirm diagnosis of syphilis
Most common back to your car is a sexually transmitted infection is?
Chlamydia
Which of the following is an absolute contraindication for use of combined hormonal contraception in Adolescent women
History of thromboembolism
Diabetes
Smokes five cigarettes per day
Sickle cell disease
Estrogen containing combined hormonal contraceptive increase a Patek production of intrinsic clotting factors and increase the relative risk for thromboembolic events in women with a history of DVT or pulmonary embolism.
A 15-year-old girl who began menarche at 13 years of age, complains of monthly menstrual pain on the first day of her periods for one year. She has never been sexually active. Which of the following is not a characteristic of this condition?
Increased production of uterine prostaglandins
Pain usually starts with an hours of menstrual flow or may proceed flow by up to two days
Crampy spasmodic pain in the lower abdominal area, which might radiate to inner thighs
Anovulatory cycles
Primary dysmenorrhea usually begins within 1 to 3 years of menarche and is associated with establishment of ovulatory cycles not anovulatory
Cara is a 16-year-old adolescent who has been sexually active with a male partner for six months. They have used condoms consistently. She is interested in a hormonal method as well, your advice include all the following except which one?
Combine oral contraceptives prevent ovulation
Transdermal contraceptive patches must be correctly applied in the site rotated.
The vaginal contraceptive ring must be changed weekly
Long acting progestins might cause weight gain
The vaginal contraceptive ring is worn for three weeks, removed, and then a new ring is inserted one week later
Which of the following is true about LARC‘s (long acting reversible contraceptive)?
Nexplanon is radiopaque
Vaginal bleeding is predictable
Mirena IUD can stay in place for three years
Adolescence should avoid using IUDs
Nexplanon The radiopaque
Is six month old baby girl diagnosed with her first UTI should be treated with an appropriate anti-microbial agent. Which additional intervention should be ordered for this child?
A test of cure
VCUG
An ultrasound of the kidneys and bladder
Prophylactic anabiotic‘s
Ultrasound; six recent studies do not support the use of anti-microbial prophylaxis, Vcug is not recommended routinely after the first UTI
True or false radiology testing are rarely indicated with the first UTI infection
False
Initial UTI or one that is febrile should be followed up with an ultrasound
What is the definitive diagnostic test for diagnosis in UTI
Urine culture
Which is the most likely organism to cause a UTI in pediatric population?
Staphylococcus SAPROPHYTICus, Klebsiella, chlamydia, E. coli
E. coli accounts for 80 to 90% of UTIs
Suzanne a seven-year-old comes to you for a physical exam prior to participation in soccer. Her mother is concerned that the child still has accidents at night. what is your recommendation to her mother?
Avoid a use of criticism or punishment, use a sticker/star chart, treat with medication, purchase and enuresis alarms
Suzanne has primary nocturnal enuresis
Avoid use of criticism or punishment
Incidence of cryptorchidism at 1 year of age is 1%. The best explanation for this is:
A child can usually stand making the palpation of the testes easier
Examination of the scrotum begins at this age
Surgical repair can know be done in a neonatal period
Spontaneous resolution offer occurs within the first six months
Spontaneous resolution often occurs in the first 3-6. months, really do they descend after 9 months
When counseling a parent with her child diagnosed with hypospadia‘s the following may be a part of the management:
Circumcision, radiography, consult with a pediatric urology, surgical correction it to years of age
Consult with a urologist four surgical intervention timing and outcomes
On an uncircumcised male the foreskin is retracted and discolored. There’s swelling of the glans the most likely diagnosis is?
Balanitis, UTI, phimosis, paraphimosis
Paraphimosis occurs when the narrow tip of the prepuce is withdrawn behind the glans and constricts the penile shaft. This leads to Adema of the distal penis preventing repositioning of over the glans.
Meatal stenosis is seen following:
Orchiopexy, circumcision, epididymitis, hypospadias repair
Meatal stenosis of the nearing of the distal urethra
Occurs after circumcision or for a variety of other reasons in an older male.
A 14 year old male during a track meet falls to the ground during a pole vaulter and start screaming in pain. He complains of tense, searing pain in his right scrotum. He vomits twice. What is the diagnosis??
Orchitis, hydrocele, testicular torsion, acute epididymitis
Testicular torsion
Lady with Asians are relatively common finding among infants and young girls. What’s your following statements about this condition is true?
They are usually present at birth but may be missed on examination
Most cases resolve without intervention
Highest incident is from birth to three years
Simple lysis of the adhesion is often recommended
Most cases resolve without intervention. are usually not present at birth because of mothers hormones.
In the case for occasions are symptomatic or causing your logic issues estrogen cream is applied b.i.d. Resolved in two months
What is the most common form of glomerulonephritis
Poststreptococcal
These patients have Adema, hematuria, decreased urine output, dark urine related to poor kidney function
Most patients with an uncomplicated UTI can be treated on an outpatient basis. The first anabiotic you would want to consider using is?
Trimethoprim sulfamethizole
Cephalexin
Amoxicillin
Amoxicillin- clavulanate
Bactrim is the first line drug of choice
Cryptorchidism is more prevalent in:
Term infants
premature infants
babies at one year of age
toddlers
Premature
The three-year-old boy is in the process of toilet training. The parents come to see you because when the child urinates all the urine goes on the floor. You suspect a certain diagnosis because
It is a rare disorder and would indicate more serious problem
Normally the urine stream is directed at the metal opening at the tip of a penis, and a straight path
The child is circumcised
Fusion of the urethral folds occurred
A downward stream of urine originating from the underside of the glans is always suspicious for hypospadias
Which of the following is used in the management of a child with phimosis?
Ice packs
general stretching when bathing
circumcision in cases of urinary obstruction
good hygiene
Proper hygiene, gentle stretching of the foreskin, and circumcision in cases of urinary obstruction or the main management strategies
You’re examining a toddler who is visiting from Mexico. The mother is very concerned about her child and is hoping that you can treat him. He learned that the mother has been taking her son to a healer in Mexico but his condition has not improved. The child is fatigued and irritable. He is constipated and does not have much appetite. His hemoglobin is 12.0 G/DL, and the lead level is 18 MCG/DL. What is your next step?
Hospitalize the child
Measure the blood levels in one month
Order a blood transfusion
Refer the child for possible chelation therapy
Measure the blood levels in one month
The child’s lead level indicates a class IIB , 15-19; we should be treated by completing an environmental assessment to identify potential sources of lead exposure in monitoring blood levels at recommended intervals. This hemoglobin is normal for the child’s age so blood transfusion is not indicated. Chelation therapy is recommended for children with class VI lead levels greater than 45 MCG/DL. Hospitalization is recommended for class 5lead levels >70 MCG/DL.
Basically management of all neonates with ABO incompatibility includes:
Phototherapy
monitoring of BiliRubin and hemoglobin
Exchange transfusion
Simple transfusion of PRBC‘s
Monitoring of Billi Rubin hemoglobin levels
More severe hyperbilirubinemia or anemia present requires more management
Which of the following is not associated with RH incompatibility?
Mother’s is Rh negative, baby is Rh positive
Mother’s is Rh positive, babies RH negative
More severe and subsequent sensitized pregnancies
Hemolysis may occur up to 6 weeks or more
Incompatibilities only occur if mother is Rh negative and baby is RH positive
Clinical jaundice of the distal extremities will be noted at a BiliRubin level of:
<5
5
10
>15
Mg/dL
Jaundice proceeds in a progressive fashion starting at the head down to the chest abdomen and I extremities when the Billy Rubin level which is >15 mg/dL
Diagnostic findings inconsistent with B thalassemia would be
Hemoglobin normal
Reticulocytes increased
Hgb > 3.6
Hypochromia, microcytosis
Hemoglobin is usually decreased in patients with B thalassemia
Aspenic children are often increased risk for which of the following?
Bacterial infections
Viral infections
Parasites
Fungal infections
Bacterial, particularly those with encapsulated organisms can be life-threatening to asplenic children
Expected hemoglobin range for sickle cell anemia is:
- 5 to 9.5 G/dL
- 5 to 16.5 G/DL
- 5 to 12.5 G/DL
- 5 to 13.5 G/DL
Higher hemoglobin‘s are associated with sickle cell c; 6.5 to 9.5
Those with sickle cell trait have normal hemoglobin
Normal hemoglobin for a child
12/13 G/DL ——15/17 G/dL
Prophylactic penicillin should be initiated in children with sickle cell anemia by:
3 years of age
12 Years of age
9 months of age
2 to 3 months of age
Penicillin prophylaxis is critical because of the risk of potential life-threatening infection with encapsulated bacteria should be given to sickle cell children at 2-3 months of age
Which of the following blood levels is not considered lead poisoning?
<5
10-14
>15
>70
ug/dL
<5
Which of the following is not considered preventive management for iron deficiency anemia?
Iron fortified cereal from 6 to 12 months of age
If breast-feeding, supplemental iron drops or iron fortified cereal by 4 to 5 months of age
Iron fortified formula until 6months of age
No cows milk until 1 year of age
Iron fortified formula should be given until 12 months of age if not breast-feeding
A newly circumcised if it is still bleeding an hour after the circumcision. Your differential diagnosis would include all except:
Hemophilia
Von Willebrand disease
Sickle cell anemia
WiScott Aldrich syndrome
Von Willebrand’s disease is a disorder where clotting is impaired and would cause bleeding
Hemophilia is a bleeding disorder with the absence of the clotting factor VIII
WiScott Aldrich syndrome X linked disorder caused by dysfunctional platelets, eczema, and abnormal B/T cell function—bleeding
Sickle cell anemia does not usually cause a cute bleeding problems
Which medication should be avoided with a child with ITP?
Decongestants
Acetaminophen
Aspirin
Sulfa drugs
Aspirin can cause bleeding problems
You will see the results of a newborn screening and find out your TSH is done at day two is 82 mIU/L what is your best option?
Have a child come to the clinic next week for a reevaluation
Rescreen the child in one month
Begin thyroid supplementation immediately
Reassure the family that this is a normal finding
Congenital thyroid screening is included and every newborn screening done prior to discharge by seven day a life
If the free T4 <6.5 and the TSH is >20
If it should be started immediately on thyroid replacement referred to endocrinology; delay can result in mental retardation
You’re evaluating a 13-year-old girl for Graves’ disease. Which of the following signs would not support the diagnosis?
Elevated TSH
Exophthalmos
Positive family history
Enlarged thyroid
Elevated TSH; hyper thyroid has low TSH elevated T3 T4
The routine screening of a newborn your practice indicates that a baby has congenital hypothyroidism and is in need of a referral to endocrinology. The treatment of choice for congenital or acquired hypothyroidism is:
Potassium iodine
Levothyroxine
Radiation therapy
methimazole
Levothyroxine
A child in your clinic is being a valuated for short stature, findings include delayed bone age, delayed onset of puberty, stature that is normal for the child’s bone age. Mom reports father grew taller in college and wonders if this will happen with their son. The most likely cause of these findings is:
Familial short stature
Chromosomal abnormality
Endocrine abnormality
Constitutional delay of growth and puberty
Constitutional delay of growth in puberty, is characterized by bone age that is delayed for chronological age and normal growth velocity for bone age.
Familial Short stature is slow growth during the first 2-3 years followed by low normal growth velocity
Which chromosomal abnormality is associated with short stature in girls?
Down syndrome
Turner syndrome
Klinefelter syndrome
Prader Willi syndrome
Turner syndrome
Newborn infant with birth length less than the 50th percentile in micropenis should be suspected of having
Growth hormone deficiency
Most common cause of myocarditis viral or bacterial ?
Viral
