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USMLE Step 2 CK > Surgery > Flashcards

Surgery Flashcards

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USMLE® Step 1 flashcards
1
Q

type of pain experiences with pancreatic cancer?

A

epigastric abdominal pain that is insidious. gnawing, and worse at night

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2
Q

Young male (20s) without trauma has pneumothorax?

A

Primary spontaneous pneumothorax

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3
Q

Varicocele-signs? Diagnostic method?

A

soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine, does not transilluminated Diagnostic- US

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4
Q

Risk factors for acute mesenteric ischemia?

A

Atherosclerosis Embolic source hypercoagulable disorders

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5
Q

What are the signs of arterial occlusion?

A

Pain, pallor, paresthesias, pulselessness, and coolness to the touch

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6
Q

Mediastinal mass with nomral b-HCG and AFP?

A

Thymomas

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7
Q

diaphoretic

A

Sweating heavily

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8
Q

How can you minimize the risk of infection from a PICC?

A

Remove it as soon as treatment/use is complete

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9
Q

How does mesenteric ischemia present?

A

sudden periumbilical abdominal pain out of proportion to examination findings

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10
Q

Signs of esophageal stricture?

A

Dysphagia, no abdominal succussion splash

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11
Q

blunt thoracic trauma, respiratory distress despite bilateral chest tubes

A

Flail chest, demonstrate tachypnea, shallow breaths

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12
Q

Signs of gallstone ileus

A

stuttering episodes of nausea and vomiting, pneumobilia, hyperactive bowel sounds, dilated loops of bowels

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13
Q

Morton neuroma

A

inflammation of the common digital nerve in the third space

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14
Q

Syndrome associated with arterial occlusion at the bifurcation of the aorta?

A

Leriche Syndrome

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15
Q

Cause of pretibial edema?I

A

Increased pulmonary vascular resistance

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16
Q

Elevated serum b-HCG with normal AFP?

A

seminoma

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17
Q

Trochanteric bursitis- definition? Signs?

A

definition- inglammation of the curse surrounding the insertion of the gluteus medius onto the femur’s trochanter signs- hip pain when pressure is applied and with external or resisted abduction

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18
Q

How does an anterior should dislocation occur?

A

forceful abduction and external rotation a the glenohumeral joint; risks damage to the axillary nerve

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19
Q

Back pain in woman who recently has breast cancer?

A

Metastatic spread, diagnose with MRI

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20
Q

borborygmi

A

a rumbling or gurgling noise made by the movement of fluid and gas in the intestines

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21
Q

pneumomediastinum and pleural effusions-cause?

A

esophageal rupture

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22
Q

blunt abdominal trauma, hypotension, right chest/abdominal wall injury, and free intraperitoneal fluid

A

Hepatic laceration

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23
Q

Pulmonary contusion-CXR results

A

patchy irregular alveolar infiltrate

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24
Q

What treatments should be provided for a through-and-through extremity gunshot wound?

A

Tetanus prophylaxis

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25
Q

Uropelvic junction obstruction signs

A

Intense pain when large diuresis occurs (beer drinking)

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26
Q

Signs of primary adrenal insufficiency?

A

hyponatremia and hyperkalemia

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27
Q

“tip of the finger remains flexed when the rest of the fingers are extended

A

Malley

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28
Q

migratory RLQ pain, nausea, vomiting, fever, leukocytosis

A

acute appendicitis

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29
Q

Cause of blood in rectum from child?

A

Merkel’s diverticulum, workup with technetium scan

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30
Q

Initial management of non-displaced scaphoid bone fracture?

A

Wrist immobilization for 6-10weeks, with x-rays in7-10 days

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31
Q

Signs of Zollinger-Ellison disease

A

Refractory to other treatments, multiple ulcers

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32
Q

Amblyopia

A

vision impairment resulting from interference with the processing of images by the brain during the firs t6-7 years of life

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33
Q

Why a newborn does not urinate during the first day after birth?

A

posterior urethral valves

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34
Q

How does venous insufficiency present?

A

worsens throughout the day and resolves overnight when the patient is recumbent

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35
Q

What should be the first step in the treatment of a woman with breast cancer?

A

Resect the mass, then treat with chemo/rad

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36
Q

Sites for ischemic colitis? Imaging signs? How to confirm?

A

Splenic flexure, rectosigmoid junction CT scan may show thickened bowel wall Confirm with colonoscopy

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37
Q

Varicocele treatment?

A

NSAIDS or surgical correction

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38
Q

Physical signs of pulmonary contusions?

A

tachycardia, hypoxia, tachypenea

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39
Q

How to treat acalculous cholecystitis acutely? Definitively?

A

Acutely- percutaneous cholecystostomy and antibiotics Definitively- cholecystectomy with drainage of associated abscessess

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40
Q

If a patient is stable, which test is most sensitive for blood?

A

CT

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41
Q

C6 radiculopathy

A

(one of the most common), causes pain and/or weakness along the length of the arm, including the biceps (the muscles in front of the upper arms), wrists, and the thumb and index finger.

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42
Q

epigastroc pain/tenderness and weight loss with nonspecific systemic symptoms with significant smoking history

A

pancreatic adenocarcinoma

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43
Q

What should be the first step in management of an unknown mass on an HIV patient?

A

Biopsy

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44
Q

C8 radiculopathy

A

causes pain from the neck to the hand. Patients may experience weakness in hand grip, and pain and numbness can radiate along the inner side of the arm, ring, and little fingers.

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45
Q

Femoral nerve innervation

A

hip joint and skin of the anterior and medial thigh and leg

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46
Q

First step in the workup for pancreatic cancer?

A

CT of the abdomen

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47
Q

Signs of cardiac temponade?

A

hypotension (unresponsive to IV fluids), tachycardia, and elevated jugular venous pressure after blunt thoracic trauma

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48
Q

How to treat acute rejection?

A

Tacrolimus or Mycophenolate mofetil with/without steroids

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49
Q

Signs of arterial thrombosis

A

Slow, progressive narrowing of the vascular lumen Pulses are diminished bilaterally (normally)

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50
Q

Signs of PE?

A

pleuritic (sudden onset), sob, diaphoretic, tachycardic, distended veins in neck and face

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51
Q

Long-term growth (> 6 months) on glans penis with negative VDRL test?

A

Penis cancer

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52
Q

In patients with variceal bleeding, what should be the main goal?

A

Fluid resuscitation

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53
Q

Use of NSAIDS with episodic postprandial epigastric pain?

A

Perforated peptic ulcer

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54
Q

When do you give tetanus immune globulin?

A

severe or dirty wound with unsure vaccination history

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55
Q

What does A sengstaken-Blakemore tube do?

A

Balloon tamponade of variceal bleeding if endoscopy is unavailable

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56
Q

How do you test an animal for rabies?

A

Kill the animal and scan its brain

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57
Q

How can heart failure develop from an aneurysm?

A

Lead to the development of a fistula

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58
Q

How do you treat testicular cancer?

A

platinum-based therapies

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59
Q

Gallbladder distension and wall thickening, presence of pericholecystic fluid, without gallstones

A

acalculous cholecystitis

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60
Q

When can early excision and grafting be used?

A

Small (

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61
Q

acute epididymitis- treatment

A

Abx and sonogram to rule out torsion

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62
Q

What is the postoperative cause of fever 1-4 weeks post surgery?

A

Other organisms (nor GAS, C. perfringens), C difficile, drug fever, PE/DVT

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63
Q

Signs of rotator cuff impingement

A

pain with abduction, external rotation subacromial tenderness normal range of motion with positive impingement tests (Neer, Hawkins)

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64
Q

Where do you biopsy a basal cell carcinoma?

A

Edge of the lesion

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65
Q

Diffusely enlarged thyroid gland with neck swelling and no symptoms of decreased thyroid?

A

Chronic lymphocytic thyroiditis (Hashimoto disease)

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66
Q

Contraindication to organ donation?

A

Positive HIV status

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67
Q

Tetanus prophylaxis in a clean or minor wound?

A

Tetanus toxoid-containing vaccine only if

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68
Q

Signs of adrenal insufficiency?

A

hypoension/shock weakness nausea, vomiting, abdominal pain, fever

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69
Q

Organism most likely responsible for infection from intravascular devices?

A

Coagulase negative s. epi

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70
Q

how to diagnose meniscal tears?

A

MRI

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71
Q

Clinical signs of acute mesenteric ischemia?

A

Rapid onset of periumbilical pain Pain out of proportion to examination findings hematochezia

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72
Q

What is a major complication risk from AAA repair?

A

MI

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73
Q

C5 radiculopathy

A

can cause pain and/or weakness in the shoulders and upper arms. Especially may cause discomfort around the shoulder blades. It rarely causes numbness or tingling.

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74
Q

How to treat rib fractures in the elderly?

A

Local nerve block and epidural catheter

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75
Q

Symptoms in arterial embolism?

A

sudden and severe, with diminished pulses in the affected limb, but normal in the unaffected

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76
Q

Important steps in the preoperative management of a patient taking Warfarin?

A

Check INR, reverse with fresh, frozen plasma

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77
Q

Effects of uncal herniation?

A
  1. Ipsilateral hemiparesis 2. parasympathetic loss (mydriasis (early) ptosis, 3. Contralateral homonymous hemianopdia 4. altered level of consciousness
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78
Q

Signs of urethral injury?

A

blood at the urethral meatus, inability to void, high-riding prostate on DRE

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79
Q

Double bubble with normal gas

A

Malrotation

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80
Q

1 week post- otitis media infection: projectile vomiting, seizures, blurred vision, severe headache

A

Brain abscess

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81
Q

How is duodenal hematoma treated?

A

NG suction and parenteral nutrition

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82
Q

Trashing around with sudden pain?

A

Stone stuck in ureter

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83
Q

What is required when starting Warfarin?

A

Heparin bridge- warfarin activates proteins C and S causing a transient prothrombotic state

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84
Q

Tetanus prophylaxis in a dirty or severe wound?

A

Tetanus toxoid-containing vaccine only if booster > 5 years ago If unsure, tetanus toxoid-containing vaccine plus tetanus immune globulin

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85
Q

Mediastinal mass with elevated AFP and b-HCG?

A

mixed cell germ tumor

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86
Q

In a patient with weakness and decreased pain in both legs, what type of injury is suspected? Action?

A

Lower spinal cord injury, insert urinary catheter to assess for urinary retention and prevent bladder injury

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87
Q

What is the postoperative cause of fever 1-7 days after surgery?

A

Nosocomial infections, Group A streptcoccus, or C. perfringens

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88
Q

Osgood-Schkatter disease

A

Painful lump below the kneecap in children during puberty, can cause a limp

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89
Q

Signs of retroperitoneal abscesses?

A

fever, child, and deep abdominal pain may initially be missed by a CT scan

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90
Q

How do you manage sigmoid volvulus?

A

Sigmoidoscopy-guided placement of a rectal tube

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91
Q

What can cause narrowing of the biliary ducts?

A

cancer (specifically pancreatic), strictures (trauma)

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92
Q

Classic association with pancreatic cancer? Name?

A

migratory thrombophlebitis Trousseau sign

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93
Q

How to treat a pancreatic abscess

A

Immediate placement of a percutaneous drainage catheter, culture of the drained fluid and surgical debridement

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94
Q

Intervention for UPJ stones larger than 7mm

A

extraperitoneal shock-wave lithotripsy

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95
Q

How are intertrochaneric fractures treated?

A

ORIF with anticoagulation

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96
Q

Standard bolus for burns

A

1000mL/hr 30-120mL/hr

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97
Q

Signs of elevated intracranial pressure?

A

HTN, bradycardia, respiratory depression (Cushing’s reflex)

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98
Q

What is the postoperative cause of fever 0-2 hours after surgery?

A

Prior trauma/infection, blood products, malignant hyperthermia

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99
Q

How does pneumonia that is developing into septic shock present? Treatment?

A

acidosis, low urine output, hypotension, tachypnea, fever Tx- IV normal saline

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100
Q

Acute edematous pancreatitis

A

Alcoholics of gallstones Pain after large meal or EtOH _> constant, radiates to back-> nausea, vomiting, retching

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101
Q

Sudden testicular pain, pyuria, fever

A

acute epididymitis

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102
Q

Patient response to atelectasis?

A

Hyperventilation -> respo. alkalosis, decreased pCO2

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103
Q

When do patients show signs of pulmonary contusions?

A

Approx. 4 hours post-injury when hypoxia, respiratory distress, pulmonary edema set in

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104
Q

Signs of compartment syndrome?

A
  1. Pain out of proportion to injury 2. Pain increasing on passive stretch 3. rapidly increasing & tense swelling 4. paresthesia (early)
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105
Q

Leriche syndrome

A

bilateral hip, thigh, buttock claudication impotence symmetric atrophy of the bilateral extremities due to ischemia

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106
Q

soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine; does not transilluminate

A

varicocele

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107
Q

Should volume support or patient transport during traumas come first?

A

Urban areas with close trauma center - transport All other areas- resuscitate

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108
Q

Child class factors to deny surgery

A

albumin below 2, INR 2 x normal, ascites

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109
Q

Signs of diaphragmatic hernia?

A

blunt abdominal trauma with mild respiratory distress and abnormal xray **smaller hernias present with nausea/vomiting and are delayed

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110
Q

Square root sign

A

Chronic constrictive pericarditis

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111
Q

How do you counteract the effects of propofol?

A

Dopamine

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112
Q

Preferred anticoagulant in end-stage renal failure patients?

A

Warfarin

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113
Q

When should you suspect diaphragmatic rupture?

A

History of blunt trauma/MVA, abnormal CXR, left lower lung opacity, elevated hemidiaphragm, and mediastinal deviation

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114
Q

C7 radiculopathy

A

(the most common) causes pain and/or weakness from the neck to the hand and can include the triceps (the muscles on the back of the upper arms) and the middle finge

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115
Q

Signs of abdominal aortic aneurysm rupture?

A

severe back pain, syncope, profound hypotension

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116
Q

How to diagnose bladder trauam?

A

Retrograde cystogram with post-void films

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117
Q

Treatment for impotence-first line?

A

Sildenafil, tadalafil, vardenafil

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118
Q

How do you obtain samples from a breast?

A

US guided imaging

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119
Q

acute abdominal pain followed by lower GI bleeding after an episode of hypotension?

A

Ischemic colitis

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120
Q

How to treat lumbar disk herniation?

A

MRI of L4-S1, pain control with nerve blocks

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121
Q

Child with current-jelly stools?

A

Intussusception

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122
Q

Workup for squamous cell carcinoma of the mucosa?

A

Panendoscopy

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123
Q

How to treat perforated peptic ulcers?

A

NG suction, bowel rest, intravenous fluids, broad-spectrum antibiotics, IV PPI

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124
Q

bilateral pulmonary infiltrates with low PO2

A

ARDS, PEEP

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125
Q

How do you store an amputated limb?

A

Place in saline moistened gauze and then in a plastic bag on ice…bring it wherever the patient goes.

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126
Q

How does cervical impingement present?

A

pain and paresthesias of the neck and arm along with upper extremity weakness

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127
Q

What type of catheter is used for embolectomy of an atrial clot from a. fib?

A

Fogarty

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128
Q

Cause of infertility from varicocele?

A

Increased scrotal temperature

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129
Q

What is mandatory for all abdominal bullet wounds?

A

Ex Lap

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130
Q

Complications from cardiac catheterization

A

pseudoaneurysm, arteriovenous fistular formation, arterial dissection, acute thrombosis

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131
Q

Written description of C- Diff infection?

A

Patchy, white mucosa on colonoscopy

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132
Q

pneumothorax despite chest tube, pneumomediastinum subcutaneous emphysema

A

tracheobronchial perforation (right bronchus is most common

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133
Q

Where are squamous cell carcinoma found?

A

Lower lip and below on face

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134
Q

When should you considerd surgical interventions for anal fissures?

A

When medical management has failed

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135
Q

Hoe do you treat anal fissures?

A

topical anesthetics, vasodilators (nifedipine) Sitz baths stool softeners high-fiber diet & adequate fluid intake

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136
Q

How do patients with duodenal hematomas present? Etiology?

A

epigastric pain and vomiting d/t blood collection between the submucosal and muscular layers of the duodenum

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137
Q

How to treat intussusception?

A

Control enema

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138
Q

What someone falls from a height, what X-rays should be ordered?

A

C-spine

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139
Q

Holosystolic murmur heart of the left sternal border?

A

Pulmonary regurgitation

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140
Q

How do you counteract a decrease in blood pressure after administration of propofol?

A

Administer dopamine

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141
Q

What are burns near the eyes covered with?

A

Triple abx ointment

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142
Q

Etiology of adrenal insufficiency?

A

adrenal hemorrhage/infarction acute illness/injury/surgery in patient with chronic adrenal insufficiency or long-term glucocorticoid use

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143
Q

Patient passing stone suddenly spikes a fever

A

ER immediately, nephrostomy tube placement

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144
Q

cardiac catheterization, anticoagulation, sudden hypotension, tachycardia, flat neck veins, back pain

A

retroperitoneal hematoma

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145
Q

Signs of meniscal tears?

A

pain, clicking, or catching

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146
Q

What is erythema nodosum?

A

Acute, nodular, erythematous eruption on the extensor aspects of the lower legs. Associated with hypersensitivity reactions

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147
Q

Chubby 13 year old boy limping, complaining of knee pain, sole of affected foot points towards the other one

A

slipped capital femoral epiphysis

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148
Q

arm held close to the body

A

Posterior shoulder dislocation, axillary/scapula xrays needed for diagnosis

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149
Q

Torus palatinus? Tx?

A

benign, bony growth located on the mid-line suture of the hard palate No treatment necessary unless systemic effects develop or it interferes with speech

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150
Q

How do you manage small pneumothorax? Large?

A

Small- supplemental O2 Large- Needle thoracostomy/chest tube

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151
Q

Signs of septal perforation?

A

whistling noise during respiration, caused by post-operative septal hematoma

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152
Q

Best management of acute appendicitis?

A

Laparoscopic appendectomy

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153
Q

Physical signs of a meniscal tear?

A

joint line tenderness, pain or catching in the provocative tests (Thessaly, McMurray

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154
Q

Initial management for perforated peptic ulcer

A

NG suction, bowel rest, intravenous fluids, broad spectrum Abx ad intravenous PPI

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155
Q

Knee to chest position in children?

A

Ependymoma

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156
Q

When are US and CT used in acute appendicitis?

A

when classic presentation/signs are not present

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157
Q

5 days after pancreatoduodenectomy , what type of feeding should be used?

A

Enteral tube feedings

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158
Q

Postoperative cholestasis-signs?

A

hypotension, blood loss into tissues, massive blood load (transfusion), decrease liver functionalty, decreased renal bilirubin excretion with normal ALT/AST

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159
Q

In an ejection, what should always be imaged?

A

C-spine (CT scan)

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160
Q

What is the cause of postoperative fever more than 1 months post-surgery

A

Viral infections, indolent organisms

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161
Q

Differential for anterior mediastinal mass?

A
  1. Thymoma 2. teratoma 3. thyroid neoplasm 4. Lymphoma
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162
Q

post-operative thoracic surgery, fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge?

A

Acute mediastinitis, TX- surgical debridement and antibiotic therapy

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163
Q

Signs of fat embolism?

A

severe respiratory distress, petechial rash, subconjuctival hemorrhage, tachycardia, tachypnea, and fever

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164
Q

Classic description of pain in pancreatic cancer?

A

Abdominal pain that is insidious, gnawing, and worse at night

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165
Q

Vascular rings

A

stridor, “crowing”, baby assumes hyperextended neck Bronchoscopy shows segmental compression of the trachea Tx- surgical division

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166
Q

Signs of SBO strangulation?

A

peritoneal signs (rigidity, rebound) signs of shock (fever, tachycardia, leukocytosis)

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167
Q

What is the first step in management of damage to the urethral meatus?

A

retrograde urethrogram

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168
Q

NSAID use with several-day history of epigastric pain followed by acute-onset sevfere constant pain?

A

perforated peptic ulcer

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169
Q

Signs of sepsis

A

worsening hyperglycemia, leukocytosis, thrombocytopenia, milk hypothermia, tachypnea, tachycardia

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170
Q

Most common organism causing lymphangitis?

A

Strep pyo (group A)

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171
Q

Small, raised, waxy lesion

A

Basal cell carcinoma

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172
Q

When should conservative management be used for menscal tear? Examples?

A

Short-term pain, elderly Example: rest, NSAIDs

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173
Q

Initial management of coughing with large amounts of blood (>600mL or 100mL/hour)?

A

Secure airway

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174
Q

Legg-Calve-Perthes disease

A

Blood flow is interrupted to the femoral head in children, can cause necrosis

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175
Q

Signs of deep vein thrombosis?

A

alf tenderness with pain worsened by passive stretching of the calf.

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176
Q

Cause of subcutaneous emphysema?

A

Tension pneumothorax

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177
Q

Signs of acute adrenal insufficiency?

A

Severe and often refractory hypotension, vomiting, abdominal pain and fever

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178
Q

Common cause of coma in a cirrhotic patient with bleeding varices?

A

Ammonium toxicities

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179
Q

What degree of angulation is unacceptable in children (compared to adults)

A

Larger amounts

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180
Q

Hemoptysis with upper lung lobe involvment? Initial step?

A

TB, Isolation

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181
Q

What should be done with all gunshot wounds to the abdomen?

A

Exploratory Laparotomy

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182
Q

Complications associated with supracondylar fracture of the humerus

A

Brachial artery injury Median nerve injury Cubitus varus deformity Compartment syndrome/Volkman ischemic contracture

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183
Q

Old man with blood on the outside of his stool?

A

Hemorrhoids

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184
Q

First step in workup for a palpable breast mass?

A

US guided core biopsy

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185
Q

Sources of inflammation in the left lower quadrant of women?

A

Diverticulitis, tube, ovary Diagnose with CT

186
Q

Stumbling around and truncal ataxia in children?

A

Medulloblastoma

187
Q

periumbilical pain out of proportion to examination and hematochezia?

A

acute mesenteric ischemia Gold standard diagnosis is mesenteric angiography

188
Q

Liters of drainage from an upper GI wound?

A

fluid replacement, nutritional support, protection of the abdominal wall

189
Q

non-healing ulcer?

A

Basal cell carcinoma

190
Q

Signs of pyloric strictures

A

postprandial pain, vomiting with early satiety, succussion splash on the epigastrium

191
Q

How to treat trigeminal neuralgia?

A

Anti-convulsants (carbamazapine)

192
Q

Epigastric pain/tenderness, weight loss in the setting of nonspecific systemic symptoms and significant smoking history?

A

Cancer of the upper GI or associated organs…think gallbladder, liver, pancreas

193
Q

What is the drop arm test?

A

Detects a tear in the supraspinatus; arm is abducted passively above head and they are instructed to lower it slowly

194
Q

Abdominal mass that moves up and down in a baby

A

Malignant tumor of the liver ie-hepatoblastoma or hepatocellular carcinoma

195
Q

What is a pneumatocele?

A

cavity in the lung parenchyma filled with air that may result from pulmonary trauma during mechanical ventilation

196
Q

How to workup claudication?

A

Doppler studies

197
Q

When giving large amounts of packed RBC’s, what must be added?

A

Platelets

198
Q

How to granulosa cell tumors present in children?

Post-menopausal woman?

Diagnostic findings?

A

Children: Precocious puberty, Large adnexal mass

Post-menopausal: bleeding/endometrial hyperplasia

Diagnostic findings: Inc. estrogen,

Pelvic US: ovarian mass, thickened endometrium

199
Q

Adolescent with nasal obstruction, visible nasal mass, frequent nosebleeds, and bony erosions on hte back of the nose, suspect?

A

Angiofibroma

200
Q

Signs of increased intracranial pressure?

A

Morning vomiting and noctural headaches

201
Q

Varicella immunization protocol

A

2 doses, 1st at 1 year, 2nd at 4 years

202
Q

Treatment for vaicella zoster exposure in an individual without complete immunity?

A

Postexposure prophylais with VAV vaccines (if within preceeding 5 days)

If unable to receive live vaccine: varicella immunoglobulin (includes individuals less than 1 year of age)

203
Q
A

Seborrheic dermatitis:

Erthematous plques and/or yellow, greasy scales

205
Q

What is the next step in management after capillary samples tested positive for increased lead?

A

Venous blood lead level

206
Q

What is the treatment for mild lead levels?

Moderate lead levels?

Severe lead levels?

A

Mild: No medication, retest in <1 month (5-44mcg/dL)

Moderate: DMSA (Meso-2,3-demercapto-succinic), (45-69mcg/dL)

Severe: Dimercaprol (British anti-lewisite) plus EDTA (>69mcg/dL)

207
Q

What congenital heart defects are present in patients with Down syndrome? Presentation?

A

Complete atrioventricular septal defect

Signs: Loud S2 d/t pulmonary hypertension

Systolic ejection murmur (increased flow across pulmonary valve from left to right shunt)

Holosystolic murmur of VSD (soft or absent if defect is large)

208
Q

First step in management for a harsh, holosystolic murmur best heart at the left lower sternal border?

A

Echocardiogram to evaluate ventricular septal defect

209
Q

What should all sexually active women under 24 be screened for?

A

Chlamydia trachomatis and neisseria gonorrhoeae

210
Q

Most common cause of pneumonia in children?

Adults?

A

Children: S. aureus

Adults: Pseudomonas

211
Q

Children under 8 years of age should be treated for erythema hronicum migrans from lyme disease with?

Over 8?

A

Under 8: Amoxicillin

Over 8: Doxycycline

212
Q

When should IV ceftriaxone be used to treat lyme disease?

A

Lyme meningitis and heart block

213
Q

How to determine B lymphocytes from total lymphocytes?

A

Subtract T-lymphocytes from total lymphocytes

214
Q

X-linked agammaglobulemia?

Alternative name?

A

Low B-cells, low Ig levels

AKA: Bruton’s agammaglobulinemia

215
Q

Job syndrome?

A

Normal levels of B-cells, Ig, except with hyper IgE

216
Q

When does neonatal conjunctivitis from Chlamydial infections occur? Treatment?

A

5-14 days after delivery?

Treatment: ORal erythromycin

217
Q

Signs of hemophilia?

A

Hemarthrosis and Deep tissue hematomas

Increased aPTT

218
Q

What diseases can lead to a vitamin K deficiency?

A

Cystic fibrosis, IBS, Celiac, biliary atresia, frequent Abx use, malnutrition

219
Q

Infectious mononucleosis, signs?

Test?

A

Fever, Tonsillitis/pharyngitis, psterior or diffuse cervical lympadenopathy, significant fatigue, hepatosplenomegaly

Test: Heterophile antibody test

220
Q

Aplastic anemia vs aplastic crisis?

A

Aplastic anemia: pancytopenia due to bone marrow failure

Aplastic crisis: Chronic anemia with compensatory reticulocytosis

221
Q

Croup vs Epiglottitis

A

Croup: Bark-like cough, stridor, hoarse voice

Epiglottitis: Unvaccinated children, sore throat, dysphagia, drooling, tripod position

222
Q

2 days fever and facial swelling with delayed vaccination schedule? Most common complication?

A

Mumps

Common complication: Aseptic meningitis, orchitis, parotitis

223
Q

How do you confirm the type of leukemia?

A

Bone marrow biospy

224
Q

Signs of HIV in infancy?

A

Failure to thrive, chronic diarrhea, lymphadenopathy, pneumocystis pneumonia

225
Q

Severe combined innumodeficiency: Signs

A

lymphopenia, recurrent infections, and failure to thrive,

ADA deficiency

226
Q

Signs of sepsis?

A

Fever, chills, hypotension, leukocytosis, bandemia

227
Q

Most common cause of sepsis in sickle cell patients?

A

S. pneumoniae

228
Q

condensed nuclear chromatin, small nucleoli with scant agranular cytoplasm

A

Lymphocytes

229
Q

High blast count with strongly positive periodic acid schiff (PAS) reaction, in a 2-10 year old?

A

Lymphoblastic leukemia

230
Q

Aeur rods are found in which type of cancer/

A

Acute myelocytic leukemia`

231
Q

What infections are common in sickle cell patient?

A

H influenza, N meningitidis, S. pneumoniae

Al

232
Q

What type of vaccination prevents S. pneumoniae?

A

Conjugate capsular polysaccharide

233
Q

Signs of Diamond-Blackfan syndrome?

A

Macrocytic anemia, low reticulocyte count, congenital anomalies

Average age of onset is 3 months

234
Q

Clincal features of pineal gland masses?

A

Limited upward gaze, upper eyelid retraction, puils non-reactive to light, reactive to accomidation

235
Q

Clinical features of medulloblastomas?

A

Ataxia and truncal instability

236
Q

Patient with meningitis and petechial rash?

A

Neisseria meningtides

237
Q

What type of CT should be ordered for head trauma?

A

Non-contrast

238
Q

Marfan syndrome vs Homocystinurea

A

Marfan: AD, normal intellect, Aortic root dilation,

upward lens dislocation

Homocystinurea: AR, intellectual disability, thrombosis, downward lens dislocation, megaloblastic anemia, fair complexion

239
Q

Ehlers-Danlos syndrome

A

scoliosis, joint laxity, skin hyperelasticity

240
Q

Breath-holding spells

Types?

A

Episodes of apnea precipitated by frustration, anger, pain.

Types

Cyanotic: crying followed by breath-holding, cyanosis and loss of consciousness

Pallid: Minor trauma followed by breath-holding, pallor, diaphoresis, and loss of consciousness

241
Q

Neuroblastoma?

A

Most common extracranial tumor of childhood

  • Adrenal gland or retroperitoneal ganglia
  • Calcifications and hemorrhages are seen on xray/ct
242
Q

What are the catecholamines?

A

homovanilic acid and vanillylmandelic acid

243
Q

Infants born to diabetic mothers are at risk for?

A

Hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia

Cardiomyopathy, GI atresia, urinary malformations, hyaline membrane disease

244
Q

Galactosemia

A

“mouse-like” odor, hyperbilirubin, elevated liver function tests, low glucose, cataracts, ascities

Increased risk for E. Coli sepsis

245
Q

Maple syrup urine disease

A

dystonia, poor feeding, lethargy, vomiting, ketouria

246
Q

Ornithine transcarbamylase deficiency

A

vomiting and poor feeding, seizures, increased ammonia, altered mental status

247
Q

Signs of hypothyroidism? Lab?

A

Decreased activity, horse cry, jaundice

*However, majority are asymptomatic at birth

Lab: Increased TSH, decreased T4

248
Q

Todd paralysis

A

self-limited, focal weakness that occurs after focal or generalized seiure; presents in the postictal period with partial or compelte hemiplegia involving ipsilateral arm

249
Q

What can cause isolated adrenarche? Clincal manifestations? Lab findings?

A

Adrenal angrogen secretion in obese individuals

Signs: oily hair/skin, acne, pubic hair, axillar hair

Lab findings: Increased DHEA-S, low testosterone

250
Q

Mental retardation, pronounced startle reflex, serizures, hyperacusis, loss of vision, macrocephaly

A

Tay sachs disease, beta-hexosaminidase A

251
Q

Tests used to screen for DM Type 2?

A

Hemoglobin A1c, fasting glucose, 2 hour oral glucose, 1,5-anhydroglucitol

252
Q

Tests used to diagnose DM type 1?

A

glytamic acid decarboxylase (GAD65), IGF-1, IGFBP

253
Q

Signs of pinworm infections?

A

Perianal puritus, especially at night, may extend into the volvula in pre-pubertal women

254
Q

Signs on leukocyte adhesion deficiency?

A

Recurrent skin and mucosal infections, no pus, poor wound healing

255
Q

Signs on defective intracellular killing?

A

No neutrophilia, infections with catalse-positive organisms

256
Q

Common complication of individuals with sickle cell trait?

A

Hematuria

257
Q

Inability to extend the beck and widened prevertebral space suggests?

A

Retropharyngeal abscess

258
Q

Signs of syphilis in a newborn?

A

Profuse rhinorrhea, desquamating skin rash, abnormal long-bone radiographs (metaphyseal lucencies)

259
Q

Signs of congenital CMV?

A

pericentricular calcifications (microcephaly, if severe)

260
Q

Hereditary spherocytosis

A

Inc. mean corpuscular hemoglobin concentration

Spherocytes on peripheral smear

Negatove coombs test

Increased osmotic gragility on acidiied glyceral test

Abnormal eosin-5-meleimide binding test

261
Q

Measles vs Rubella

A

Measles: High fever (>104), cephalocaudal rash over multiple days , cervical adenopathy

Rubella: maculopapular cephocaudal rash over 24 hours (sparing palms and soles), polyarthralgia

262
Q

Complications of hemophilia A and B

A

Hemophilic arhropathy -> iron/hemosiderin deposition leading to sunovitis and fibrosis

263
Q

Herpangina: cause, signs

A

Cause: Coxachie A virus

Signs: Feverm pharyngitis, gray vesicles/ulcers on posterior oropharynx, hands, feet

264
Q

Herpetic Gingitcostomatitis: Cause, Signs

A

Cause: HSV1

Signs: Fever, Pharngitis, Erythematous gingiva, Clusters of small vescicles on anerior oropharynx

265
Q

Causes of aplastic anemia?

Most common in children?

A

Acquired causes: Drugs (NSAIDS, sulfonamides)

Toxic chemicals (benzene, glue)

Idiopathic

Viral infecitions (HIV, EBV)

Immune Disorders

Thymoma

Most comon in children: Fanconi anemia (chromosomal break)

266
Q

Signs on Gonadotropin-independent precocious puberty?

A

Boy under 9 with severe facial ance, advanced pubic and axillary hair, normal testicular volume

267
Q

Non-classical congenital adrenal hyperplasia (late-onset)

A

Premature adrenarche/pubarche, sever cystic acne (resistent to treatment), accelerated linear grwoth, advanced bone age

268
Q

What gross motor milestones should occur at 18 months?

A

Run, kicking a ball

269
Q

What can cause flaccid paralysis? How?

A

Infant botulism- ingestion of C. botulinum spores from dust

Foodborne- C. botulinum toxin from food

Guillain-Barre syndrome- Autoimmune peripheral nerve demyelination

270
Q

Signs of botulisism?

A

Bilateral bulbar palsies (ptosis, sluggish pupillary response to light, poor sucking), constipation, drooling, and summetric descending flaccid paralysis

271
Q

Clincal signs of glucose-6-phosphatase deficiency?

Lab Findings?

A

Doll-like face, thin extremities, short stature, protuberant abdomen

Lab findings: Hypoglycemia, high blood uric acid, total cholesterol, triglymerides, lactic acid levels

272
Q

Aldolase B deficiency causes?

A

Fructose intolerance- vomiting, poor feeding, lethargy, serizures or enxephalopathy

273
Q

Signs of hydrocephalus

A

Tense and bulging fontanelle, prominent scalp veins, poor feeding, irritability, rapidly increasing head size

274
Q

Cephalohematoma

A

subperiosteal hemorrhage, not visable until several hours after birth

275
Q

Caput seccedaneum

A

diffuse, sometimes ecchymotic swelling of the scape. Usually involved the portion of the head presenting during vertex delivery. May extend across midline and suture lines

276
Q

What is the most common event prior to a seizure? During?

A

Prior: Aura

During: Tongue Laceration

277
Q

What factors increase the risk for intraventricular hemorrhages?

A

Preterm and loss birth weight

278
Q

Signs of intraventricular hemorrhage?

A

Hypotension, cyanosis, seizures, focal neurological signs, bulding or tense hontamel, anpea, and bradycardia; however, may be asymptomatic

279
Q

How to diagnose intraventicular hemorrhage?

A

transfontanel ultrasound

280
Q

How to diagnose hereditary spherocytosis?

A

Osmoti gragility on acidified glycerol lysis test

281
Q

Erythrocte CD55 and CD59 are present in which disease?

A

Paroxysmal noctural hemoglobinuria

282
Q

Clinincal manifestations of PNH?

A

hemolytic anemia, cytopenias, and hypercoagulability

283
Q

Clincal manifestation of Edwards Syndrome?

A

Trisomy 18

Signs: Closed fists, with overlapping fingers, micrognathia, prominent occiput, rocker-bottom feet, severe intellectual disability

284
Q

Signs of hyper-IgM syndrome?

A

Normal B cells, decreased IgG/IgA, increased IgM

285
Q

What are signs of turner syndrome?

A

Coarctation of aorta, broad chest, short stature, horse-shoe kidney, streak overies

286
Q

What are turner’s syndrome at increased risk for?

A

Osteoporosis- they lack protective estrogen production -> increased bone reabsorption

287
Q

How to manage epiglottitis?

A

Endotracheal intubation, antibiotics

288
Q

How to treat a patient with a “barky” cough?

A

Racemic epinephrine and corticosteroids

289
Q

What type of rash spares the palms and soles? What type of precaution should be used for this infection?

A

Measles, should use airborne precaution

290
Q

Cough, coryza, conjunctivitis with subsequent exanthema?

A

Measles

291
Q

Howell Jolly bodies?

A

nucleated remnant of red blood cells

292
Q

Heinz bodies

A

Aggregates of denatured hemogobin, seen in patients with hemolysis due to G6PD deficiency and thalassemia

293
Q

What is a patient with recurrent infections and congenital heart disease at risk for?

A

Brain abscess

294
Q

Triad of brain abscesses

A

Headaches (noctural and/or morning), focal neurologic changes, fever

295
Q

Signs of refeeding syndrome? Cause?

A

Arrhythmia, congestive heart failure, seizures, wenicke encephalopathy

Cause: Increased insulin secretion -> decreased phosphorus, magnesium, potassium, thiamine, with increased water and sodium

296
Q

What is the defect in duchenne and becker muscular dystrophy?

A

Deletion of dystrophin on chromosome Xp21

297
Q

Neimann-Pick vs. Tay sachs

A

Neimann-pick: Sphingomyelinase deficiency with hyporeflexia/areflexia and hepatosplenomegaly

Tay Sachs: beta-hexosaminidase A with hyperreflexia without hepatosplenomegaly

298
Q

Most common cause of orbital cellulitis?

A

Bacterial sinusitis

299
Q

Early onset puberty iwth high basal LH? Next step?

A

Gonadotropin-dependent precocius puberty

Next step: Brain MRI wtih contrast

300
Q

What causes the trendelenburg sign?

A

Weakness of the gluteus medius and gluteus minimus muscles, where are innervated by the superior gluteal nerve

301
Q

What are cholesteatoma? Cause? Complications?

A

retraction pocket in the tympanic membrane that fills with granulation tissue and skin debris

Cause: Chronic middle ear infections or congenital in nature

Complications: Hearing loss, cranial nerve palsies, vertigo, brain abscesses or meningitis

302
Q

Meniere’s disease?

A

Ear condition associated with fluid in the inner ear that leads to hearing loss, vertigo, tinnitus

303
Q

Signs of foreign body ingestion?

A

Difficulty swallowing, feeding refusal, vomiting

304
Q
A

Erythema marginatum of Rheumatic fever

305
Q

What is spondylolisthesis? Signs?

A

Developmental disporder characterized by forward slip of vertebrae (L5 over S1)

Signs: Chronic back pain, neurological dysfunction, palpable step-off

307
Q

Acute Rheumatic fever: Major and minor signs

A

Major: Migratory Arthritis, Carditis, Subcutaneous nodules, Erythema marginatum, Sydenham Chorea

Minor: Fever, arthralgias, Elevated ESR, CRP, Prolonged PR interval

308
Q

Henoch-Schonlein purpura: Signs?

A

transient migratory arthritis (lower extremities) and rash (puritic)

309
Q

Cause of edema in a child with turners syndrome? Type of edema?

A

Dysgenesis of the lymphatic network

Type: Non-pitting

310
Q

What signs should suggest possible child abuse

A

Abrupts onset of mood changes, bedwetting, and/or academic difficulties

311
Q

Trachoma? Signs?

A

Chlamydia trachomatis serotype A-C, major cause of blindness

Signs: follicular conjunctivitis and pannus (neovascularization) of the cornea

312
Q

Signs of orbital cellulitis?

A

Abrupt onset of fever, proptosis, restriction of extraocular movements and swollen, red eyelids

313
Q

Clincal manifestations of medulloblastoma?

A

increased intracranial pressure, trucal and gait ataxia

314
Q

Short statute, primary amenorrhea, abscent thelarche

A

Turner’s Syndrome

315
Q

Head tilt to one side with chin deviation away

A

Congenital muscular torticolis

316
Q

Eczema, regurgitation/vomiting, and painless bloody stools

A

Milk protein-induced enterocolitis

317
Q

ill-appearing neonate with bilious emesis and poor apetite?

A

malrotation with mid-gut volvulus

318
Q

First step in the evaluation of a neonate with emiesis?

A

Cessation of enteral feeds, NG tube decompression, IV fluids, XRay to rule out pneumoperitoneum

319
Q
A

Mongolian spots, beling flat, blue-grey patches

Fade spontaneously, reassure parents

320
Q

Acute management of a sickle cell patient with signs of stroke?

A

Exchange transfusion, dilutes amount of sickled cells in blood

321
Q

Cafe au lait spots, precocious pubert, multiple bone defects (polyostotic fibrous dysplasia)?

A

McCune Albright syndrome, remember the 3 P’s: Precocious puberty, pigmentation, polyostotic fibrous dysplasia

323
Q

Heroin intoxication in a fetus, signs?

A

Interuterine growth retadation, irritability, high-pitched cry, poor sleeping, tremors, sweating, sneezing, diarrhea

324
Q

Phenttoin exposure in-utero

A

Fetal hydantoin syndrome- nail and digit hypoplasia, dysmorphic facies, mental retardation

325
Q

Fetal exposure to cocaine

A

Jitteriness, excessive sucking, hyperactive moro reflex

326
Q

Chediak-Higashi syndrome

A

AR disorder characterized by oculocutaneous albinism and recurrent cutaneous infections

Staph. aureus and Strep pyogenese are most common

327
Q

Cyanosis that is aggrevated by feeding and improved by crying

A

Choanal Atresia

328
Q

Cyanotic when stressed and asymptomatic at rest?

A

Tetralogy of Fallot

329
Q

Defect in Prader-Willi syndrome

A

Deletion of the paternal copy of chromosome 15q11-q13

330
Q

Clinical manifestations of Prader-Willi? Common complications?

A

Poor suck and feeding problems in infancy, compulsive binge-eating and obesity-related problems

Complications: Sleep Apnea, DM type II

331
Q

Alternative name for Wilms tumor?

A

Nephroblastoma

332
Q

How do you management Autism spectrum disorders?

A

Early diagnosis and intervention (speech, behavioral), adjunct pharmacotherapy for psychiatric comorbities

333
Q

How to manage a hydrocele in a newborn? 2 year old?

A

Newborn: Observation

2 year old: Surgical correction

**Most spontaneously recover within 12 months

334
Q

Wiskott-Aldrich syndrome: Clincal manifestations? Defect? Problem?

A

Eczema, recurrent infections, thrombocytopenia

Defect: WASP protein

Conequence: Impaired cytoskeleton changes in leukocyte, platelet

335
Q

Linear lesions with pruritus and erythematous streaks with edema and vesicles after camping?

A

Poison Ivy- Contact Dermatitis

336
Q

Cause of intussusception in children younger than 2? Older?

A

< 2: recent viral illness or rotavirus vaccination

>2: Meckel’s diverticulum, HSP, Celiac disease, intestinal tumor, polyps

337
Q

When should formula supplementation be considered?

A

Greater than 7% loss of birth weight

338
Q
A

OsGood-Schlatters Disease; traction apophysitis

339
Q

What are pink stains or “brick dust” in neonatal diapers?

A

Uric Acid crystals

340
Q

Adolescent male

A

Benign bone tumor, osteoid osteoma

Pain is relieved by NSAIDS

341
Q
A

Osteosarcoma

Findings: Soft tissue mass, “sunburst pattern”, periosteal elevation (Codman traingle)

342
Q
A

Tinea Capitis, dermatophyte infection

Tx: Oral terbinefine, friseofulvin, itraconazole, fluconazole

343
Q

Beckwith-Wiedemann syndrome: Cause? Clincal Manifestations? Complications? Surveillance?

A

Cause: Desregulation of imprinted gene expression on 11p15

Manifestations: Fetal meacrosomia, rapid growth, macroglossia, hemihyperplasia, medial abdominal wall defects

Complications: Wilms tumor, hepatoblastoma

Surveillance: Serum AFP, abdominal/renal US

344
Q

Risk factors for ARDS in a newborn?

A

Prematurity, maternal diabetes, male sex, perinatal asphyxia, c-secton without labor

346
Q
A

Ewing Sarcoma

“onion skin”, “moth eaten”, extension into soft tissue

347
Q

How to assess pulmonary function in a guilllain-barre patient?

A

Spirometry, peak flow could be used as an alternative

351
Q

What is the squirt sign?

A

Explosive gas and stool associated with Hirsprung Disease

352
Q

Signs of breastfeeding faliure jaundice?

A

1st week of life,

Filaure of transition to yellowish or green stools (inadequate milk ingestion), decreased wet diapers

353
Q

When does alloimmune hemolytic disease occur?

A

“A” and “B” offspring of “O” mothers

355
Q

Glomus tumor triad

A

severe intermittent pain, tenderness, sensitivity to touch

benign tumor of vascular system

356
Q

Fibrosarcoma

A

Malignant spindle cell neplasm found in patiens 30-60. Painful mass. Osteolytic lesion whose margins can be well-defined or ragged and moth-eaten

357
Q

Focal Serizures

A

Originated from 1 cerebral hemisphere +/- loss of consciousness

Cannot respond to stimuli during episodes with confusion afterwards

>2-3 minutes in length

358
Q

Lennox-Gastaut syndrome

A

Presents by age 5, intellectual disability and sever seizures of varying types. EEG demonstrated a slow spike-wave pattern

359
Q

How to follow-up an incidental urine proteinuria in an adolescent?

A

Repeat dipstick testing on two subsequent occaisions to determine orthostatic, persistent, or transient proteinuria

360
Q

Risks of maternal diabetes?

A

Macrosomic getus, shoulder dystocia (crepitus, asymmetric moro reflex), clavicle fracture, brachial nerve palsies, perinatal asphyxia, neonatal hypoxic encephalopathy, polycythemia

361
Q

Red flags for type 1 DM

A

Polyuria, polydipsia, enuresis (increased urinary incontinence)

362
Q

Difference between iron deficiency anemia and thalassemia?

A

Iron deficiency: Increaed RDW, decreased MCW, RBC #

A-thalassemia: Normal RDW, RBC #; decreased MCV, normal hemoglobin electrophoresis

B-thalassemia: Normal RDW, RBC #; decreased MCV, increased hemoglobin A2 with electrophoresis

363
Q

Hemiparesis, aphasia after injury tot he posterior pharync

A

Cervical internal cartid artery

**Can occur when falling with an object in mouth

364
Q

When should chilren be toilet trained?

A

daytime: around 3

Nighttime: Any time up until 5 is considered normal

365
Q

Most common cause of abnormal uterine bleeding in adolescents?

A

Immature hypothalamic-pituitary-ovarian axis -> anovulation cycles

366
Q

Medication treatment of abnormal uterine bleeding?

A

High-dose IV or oral estrogen

High-dose combined oral contraceptive pills

High-dose progestin pills

Tranexamic acid

367
Q

Diagnostic test for Chronic Granulomatous disease?

A

Neutrophil function testing

  • Dihydrohodamine 123 test
  • nitroblue tetrazolium test
368
Q

Purpose of the CH50 test?

A

Determines total complement levels

369
Q

Riboflavin deficiency signs:

A

Angular choelosis, stomatitis, glossitis, normocytic anemia, seborheic dermatitis

370
Q

Niacin (b3) deficiency

A

Pellegra (dermatitis, diarrhea, delusions, glossitis)

371
Q

Pyridoxine (B6) deficiency

A

Cheilosis, stomatitis, glossitis, irritability, confusion, depression

372
Q

recurrent sinusitis, point of maximal impulse displaced to the left, bronchiectasis?

A

Primary ciliary dyskinesia (Kartagener syndrome,

373
Q

What increases the murmur n Hypertrphic cardiomyopathy? Decreases?

A

Increases: Decreased preload: Valsava, abrupt standing, nitroglycerine

Decreases: Increased afterload/preload: Sustained hand grip, squatting, passive leg raises

374
Q

What prophylaxis should be used for cat bites in children?

A

Amoxicillin/Clavulanate due to activity again pasteurella multocida

375
Q

When legal guardians of a patient deny a life-saving procedure, how do you proceed?

A

Obtain a court order to force compliance

376
Q

Most common cause of otitis externa?

A

P. Aeruginosa, S. aureus

Tx: Fluoroquinolone

377
Q

Extraintestinal signs of Celiac disease?

A

Short stature, weight loss, iron deficiency anemia, dermatitis herpetiformis

378
Q

Celiac disease risk factors?

A

First-degree relative

Autoimmune thyroiditis

Type 1 DM

Down syndrome

Selective IgA deficiency

379
Q

Signs on congenital rubella infection?

A

Sensorineural hearing loss

cataracts

PDA

380
Q

Urinary in ontinence in children over 5?

A

Workup: Urinalysis, urological imaging

Management: Avoid caffeine, void regularly, drink fluids early, reward system, enuresis alarm (1st line after behavioral, pharmocotherapy (desmopressin, tricyclic antidepressants)

381
Q

abdominal pain, palpable mass, jaundice

A

Biliary cyst

382
Q

Biliary atresia

A

Obstructive jaundice, acholic stools, presents early in infancy

383
Q

Most common bacterial infection in children with CF?

A

S. Aureus, especially with concurrent influenza.

384
Q

What are risk facors of Henoch-Schonlein purpura?

A

Gastrointestinal hemorrhage or intussusception: Cause by bowel edema and hemorrhage

385
Q
A
386
Q

How does a person with a volvulus present?

A

vomiting (often bilious)

387
Q

Characteristics of oppositional defiant disorder?

A

Angry/urrutale mood and argumentative/defiant behavior towards authority figures

388
Q

Signs of ADHD?

A

Inattentive, hyperactive/impulsive symptoms, prior to age 12

389
Q

Selective mutism

A

Refusal to speak in a specific social situation, but engaged in normal communications where she feels comfortabe.

Diagnosis required 1 month or more in situations where they are required to talk (school), despite speaking in other situations

390
Q

What cardiovascular abnormalities are in turner’s syndrome?

A

Bicuspid aortic valve

391
Q

What disorders are commonly associated with mitral valve prolapse?

A

Connective tissue disorders (Marfan, Ehlers-Danlos sundrome, osteogenesis imperfecta, etc)

392
Q

How should a urine sample be collected in infants with diapers?

A

Urethral catheterization, urinalysis, urine culture

393
Q

Signs of cardiac temponade?

A

Distant heart sounds, distended jugular veins, (scalp veins in infants) and hypotension

394
Q

What complications are CF patients at risk for?

A

Infertility (95% of men, 20% of womeN)

Pancreatitis (~10%)

395
Q

What is the first step in evaluating primary absence of menarche by age 15?

A

Pelvic US, to detect ovaries, uterus, and vagina

396
Q

Signs of Turner’s Syndrome?

A

Narrow, high arched palate, low hairline, webbed neck , broad chest, coarctation of the aorta, bicuspid aortic valve, horse-shoe kidney, streak ovaries, amenorrhea, infertility

397
Q

Congenitial CMV infections signs? Treatment?

A

Growth restriction, microcephaly, periventirular calcification, hepatosplenomegaly, thrombocytopenia

Treatment: Valganciclovir

398
Q

Congenital Toxoplasmosis infection signs?

A

Macrocephaly, diffuse parenchymal calcifications

399
Q

Signs on Shigella infection?

A

Rapid onset, high fever, abdominal pain, watery diarrhea with mucous +/- blood, +/- seizures in children

400
Q

In which population in the cyclic vomiting syndrome the highest?

A

Children of parents who have a history of migraines

401
Q

In a child less than 24 months, what should occur after the treatment of her first febrile UTI?

A

Renal and bladder ultrasound

402
Q

Meconium obstruction at th level of the ileum and narrow, underdeveloped colon?

A

Cystic fibrosis

403
Q

Whem should PEEP be employed in a newborn? Chest Compressions?

A

Heart rate less than 100, irregular breathing

Chest compressions: Less than 60bpm

404
Q

Family history of sudden death, congenital sensorineural deafness, and QT interval of 600ms?

A

Jervell and Lange-Nielsen syndrome

405
Q

Signs of Meckel’s diverticulum? Diagnosis? Treatment?

A

Asymptomatic incidental finding, painless hematochezie, intussusception, intestinal obstruction, volvulus

Diagnosis: Technetium-99m pertechnetalte scan

Treatment: Surgey for symptomatic patients

406
Q

Differences in blood pressure in coarctation of the aorta?

A

Hypertension in the upper body and hypotension in the lower

407
Q

Murmur in Tetralogy of Fallor?

A

crescendo-decreasendo systolic murmur with a single S2 in left upper sternal border

408
Q

Signs of Tetralogy of Fellot?

A

Tet spells-sudden hypoemia and cyanosis during exertion or agitation

409
Q

Why are menstral cycles in pubertal girls irregular?

A

Immaturity of the hypothalamic-pituitary-honadal axis -> decreased gonadotropin secretion

410
Q

What homronal imbalances causes polycystic ovary syndrome?

A

Excess LH secretion

411
Q

Hemolytic uremic syndrome: Signs? Lab findings? Treatment?

A

Signs: Diarrhea, lethargy, irritability, pallor, bruising or petechiae, oliguria, edema

Lab findings: Hemolytic anemia, thrombocytopenia, Incresed hematuria, proteinuria, casts, increased bilirubin

Treatment: Fluid/electrolyte management, blood transfusion, dialysis

412
Q

Presentation of immune throbocytopenic purpura?

A

Thrombocytopenia and purpura, no anemia or renal invovlement

413
Q

Early adolescent obese male that presents with hip or knee pain of insidious onset that causes limping? Treatment?

A

Slipped capital femoral epiphysis

x: surgical pinning

414
Q

Workup for a newborn with bilious vomiting without a bowel movement?

A

Abdominal Xray -> contrast enema

415
Q

What is a small for gestations age newborns at risk for developing?

A

Hypoxia, perinatal asphyxia, meconium aspiration, hypoglycemia, hypothermia, hypocalcemia, and polycythemia (due to hypoxia)

416
Q

Drugs used to treat Tourette disorder?

A

Haloperidol, pirmozide, risperidone (preferred), clonidine, guanfacine

417
Q

Methylphenidate-Use?

A

ADHD

418
Q

Signs of pancreatic deficiency?

A

Bruises (vitamin K), Vitamin D deficiency, poor growth

419
Q

When should you suspect tricuspid atresia?

A

Cyanotic infant with left axis deviation, small or absent R waves,

420
Q

Total anomalous pulmonary venous return

A

4 pulmonay veins fail to make the normal connection to the left atrium. Righ atrium received blood from both pulmonary and systemic venous system.

Signs: right venticle hypertrophy, and right axis deviation

421
Q

Child has a desire to kill his mother and must recite a prayer 10-12 times to overcome it. Diagnosis? Treatment?

A

Diagnosis: Obsessive-compulsive disorder- can be obsessive (symmetry), or compulsive (must hurt mother)

Treatment: First-line: SSRI (Fluoxetine) or CBT

Second-line: Clomupramine and antipsychotic augmentation

Third-line (refractory): Deep-brain stimulation

422
Q

Treatment for migraines in pediatric populations?

A

Acetaminophen or NSAID and supportive mangement (dark room, etc)

423
Q

Burton agammaglobulinemia- Lab findings

A

Normal T-cells, absent B cells, low serum immunoglobulin, absent lymphoid tissue

424
Q

Severe combined immunodeficiency- lab findings? Treatment?

A

Failure of T-cell development, b-cell dysfunction due to low T-cells, absence oflymphoid tissues

Treatment: Stem cell transplant

425
Q

What is the generic name for the plan B pill? MoA

A

Levonorgestrel

MoA: Delays ovulation

426
Q

Most effective form of emergency comtraception?

A

Copper IUD

427
Q

Gold standard for confirming muscular dystrophies?

A

Genetic analysis

428
Q

Heart defect associated with Edwards Syndrome? Murmur description?

A

VSD

Holosystolic murmur that is heard beast at the lower left sternal border

429
Q

Developmental milestones at 12 months?

A

Stands well, walks first steps, 2-finger pincer, says first words, separation anxiety, comes when called

430
Q

Diagnosis?

Treatment?

A

Diagnosis: Atopic dermatitis

Treatment: Emolients +/- steroid topicals

431
Q

Diagnosis?

A

Eczema Herpeticum-complication of atopic dermatitis

432
Q

Painful vescibles with “punched out” erosions and hemorrhagic crusting superimposed on a child with atopic dermatitis?

A

HSV

433
Q

When should gonads be removed in complete androgen insensitivity?

A

After puberty, the benefits of gonad-stimulated puberty outweigh the risk of malignancy

434
Q

Risk of gonad-derived cancer in turners syndrome compared to general population?

A

10-30 times higher (15-30%). Gonad development should be closely monitored and an earlier gonadectomy could be required.

435
Q

Signs of fetal alcohol syndome

A

Small head, small palebrl fissures (eyes), smooth philtrum, thin vermilion border (lip)

436
Q

Alternative name for strawberry hemoangiomas?

A

Superficial infantile hemangioma

437
Q

When is a murmur benign?

A

Normal activity levels, early of mid-systolic, Grade I or II, low-putched muscicle or squeaky tone at LLSB (still’s murmur) or high-pitched at LUSB (pulmonary flow murmur)

438
Q

How to diagnose Laryngomalacia?

A

Confirmation by flexible laryngoscopy for moderate-severe cases

439
Q

Components of DiGeorge’s Syndrome?

A

Conotruncal cardiac defects

Abnormal Facies

Thymic aplasia/hypoplasia

Cleft palate

Hypocalcemia

(t-cell lymphopenia is present)t

442
Q

What findings of a pediatric burn would suggest child abuse?

A

Sparing flexor surfaces

443
Q

What substance maintains the PDA? Closes it?

A

Maintains: Prostoglandin E2

Closes: Indomethicine

444
Q

What type of vasculitis is Henoch-Schlnlein purpura? Complications?

A

Immunoglobulin A-mediated

Complications: renal involvement; microscopic or macroscopic hematuria, red cel casts, mild to moderate proteinuria, with normal-slightly elevated serum creatinine

**Can lead to nephrotic syndrome, HTN, acute renal failure

445
Q

What solutions should be used to resusitate an infant that is hypovolemia, but hypernatremia?

A

0.9% NS

446
Q

Cause of chronic nasal obstruction refractory to conventional treatment?

A

Adenoid hypertrophy

447
Q
A

Tinea Corporis

448
Q

Findings suggestive of hypertrophic adenosis?

A

Postnasal drip, elongated facial heatures, mucopurulent nasal discharge, loud mouth breathing

449
Q

Myotonic musculodystrophy-Onset? Inheritance? Comorbidies? Prognosis?

A
450
Q

Edema, hypoalbuminemia, markedly elevated urine protein in a teen with Hep. B? Pathogenesis

A

Membranous nephropathy (nephrotic syndrome)

Pathogenesis: Deposition of HbeAb and its corresponding antibody in the glomeruli

451
Q

Kallman Syndrome

A

X-linked recessive disorder of migration of fetal gonaotropin-releasing hormoes and olfactory neurons.
Clincal Signs: short stature, delayed or absent puberty, normal genotype and internal reproductive organs, anosmia/hyposmia

452
Q

47 XXY

A

Klinefelter syndome, male phenotype with small testicles.

453
Q

Clinical manifestations of congenital diaphragmatic hernia? Managemtn?

A

Pulmonary hypertension, polyhydramnios, barrel-shaped chest, concave abdomen

Management: Emergency intubation with caution ventilation

454
Q

Treatment for Impetigo?

A

Oral cephalexin (widespread)

mupirocin (topical, localized)

455
Q

Primary dusmenorrhea? Treatment?

A

Lower abomdinal cramping with menses in the absense of other pathology

**pain during the first few days of menses is cause ny uterine contractions triggered by prostaglandins

Treatment: NSAIDS

456
Q

Primary vs.Secondary dysmenorrhea

A

Primary- normal physical examination

Secondary - abnormal physical examination

457
Q

Treatment for Tinea Corporis?

A

First line (localized): Topical (clotrimazole, terbinafine)

Second-line (generalized): Oral antifungals (terbinafine, griseofulvin)

459
Q

Signs of renal tubular acidosis?

A

Normal anion gap acidosis, failure to thrive, alkalotic urine without known etiology of acidosis, low serum bicarb and hypercalemia

460
Q

Type 1 RTA?

A

Defect: Poor hydrogen secretion into urine

pH: > 5.5

Potassium: Low-normal

Cause: Genetic disorder, medication toxitiy, autoimmune

461
Q

Tetralogy of Fallot murmur?

A

Harsh systolic ejection murmur over the left upper sternal border, single S2

462
Q

VSD murmur description?

A

Pansystolic murmur hear loudest at the left lower sternal border and a diastolic rumble at the apex due to increase flow across mitral valve

463
Q

What is the management of an adolescent with suspected fibroadenoma?

A

Observation and reassurance (follow-up shortly after next menses

464
Q

Pyloric Stenosis: Onset age? Characteristics?

A

Onset: 3-5 weeks

Clinical presentatin: Nonbilious, hugry vomiter, poor weight gain, dehydrated, “olive-shaped” abdominal mass

465
Q

Clincal features of Epiglottitis?

A

Abrupt onset Distress (“tripod”, stridor), dysphagia, drooling, thumbprint sign on Xray

466
Q

Alternative name for laryngotracheititis?

A

Croup

467
Q

Legg-calve-perthes disease

A

Average onset 4-10, incisious onset, antalgic gait (less time on one side), long-term pain

468
Q

Signs of vitamin D deficiency in an infant?

A

Delayed fontanel closure, enlarged skull, costochondral joints (achitic rosary), long-bone joint widening, genu varum (bowed legs)

469
Q

VACTER

A

Vertebral, anal atresia, cardiac abnormalities, radial (skeletal) and renal

470
Q

Baby that is cyanotic when feeding, pink when crying? Associated abnormalities?

A

Choanal atresia

Associated: CHARGE: Coloboma, heart defects, retarded growth, GU abnormalities, ear abomalies, deafness

471
Q

Big tongue, umbilical hernia?

A

hypothyroidism

472
Q

Tetralogy of Fallot components?

A

VSD + RA hypertrophy + over riding aorta, pulmonary stenosis

USMLE Step 2 CK (12 decks)

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