UWorld Facts Flashcards
Intermittent knee pain in a teenager partially responsive to NSAIDS. Location is at proximal tibia.
Osgood-Schlatters Disease (Traction apophysitis of the tibial tubercle). XR shows anterior soft tissue swelling, lifting of the tubercle from the shaft, and irregularity/ fragmentation of the tubercle.
Males 13-14, Females 10-11. Trt: decreased activity, stretch, NSAIDs.
Intermittent knee pain in a teenager partially responsive to NSAIDs. Location at inferior pole of patella.
Patellar tendonitis (overuse). Rest and NSAIDs.
Visible hyper intensity in the A-P radiograph of a 2 year old located in the right upper hilum. Shows a scalloped border in a triangular shape with uniform density.
Thymus - “sail sign.” Kids
Risk factors for Vit D. Deficiency?
Increased skin pigmentation, exclusive breastfeeding, inadequate sun exposure, maternal vit. D. deficiency.
Baby with large anterior fontanel, lethargy, difficulties with feeding, big tongue. Dx?
Congenital Hypothyroidism
3 hour old with choking, coughing, and regurgitation on first feed, tachycardia, tachypneic, and hypoxic. She is in marked respiratory distress, and has abdominal distension. She has an Et and orogastric tube inserted, and each ends above the cardiac shadow on XR. What other anomalies are more likely to be found than the general population?
This patient has Tracheo-Esophageal Fistula. She should be worked up for VACTERL (vertebral, anal atresia, cardiac, TEF, renal, limb). On prenatal ultrasound, polyhydramnios would be seen due to inability to swallow amniotic fluid.
Patient with severe paroxysms of cough shows subcutaneous emphysema in the anterior chest. What is next step and why?
subQ emphysema = air in the subQ tissues due to coughs. XR the child to rule out pneumothorax, which can also be caused by the forceful coughing.
Mom shows up with a 6 week old, complaining of 3-4 hours of crying each evening for the past three weeks. He is not consolable by pacifiers or normal measures, feeds and stools regularly, and is unremarkable on exam. Dx?
Colic. Happens for >2 hrs daily, usually in the evening, or >2 times/wk for ~3weeks. Ddx = Colic, GERD, Corneal abrasion, Hair tourniquet, milk protein allergy, normal crying. Teach parents soothing techniques.
Kid with Hepatosplenomegaly, bright red macula, cervical lymphadenopathy, areflexia, hypotonia.
Niemann-Pick Disease (Sphingomyelinase deficiency). Tay-Sachs (B-Hexosaminidase A deficiency) does not have a large liver and has hyperreflexia.
Risk Factors for Cerebral Pasly?
1 Prematurity, IUGR, IU-infection, antepartum hemorrhage, placental pathology, multiple gestation, maternal EtOH/ tobacco.
Unvaccinated child with with a blanching, reddish-brown maculopapular rash that spreads from the head to the body and then extremities and spares the palms and soles. Also cough, coryza, and conjunctivitis.
Measles (rubeola) - give Vitamin A.
Child comes in with rapidly enlarged, unilateral fluctuant mass on the right neck in the anterior lymph node chain. Name the bug (two most likely) and the best medication.
Staph A. or Strep Pyogenes - give clindamycin due to LN penetration and MRSA coverage.
8 month old with fever, vomiting, sleepiness, full fontanelle, crying with head mvmt, fever of 104, decreased PO, and CBC with cultures pending. In what order should Head CT, IV abx, LP go?
IV Abx, LP, no Head CT in Infants due to decreased risk of herniaton
Risk factors for Intussusception.
Meckel’s diverticulum, HSP, celiac, intestinal tumor, polyps, recent viral illness/Rota vaccine, inspissated stool in CF. Give Air Enema.
Kid with a headache that warrants an MRI or CT; indications include?
Hx of coordination issues, numbness, tingling, focal neuro deficits, HA awakens from sleep, increasing frequency.
Most common cardiac abnormalities in Trisomy 21?
50% have Heart Disease: complete AV canal defect (~40%), VSD (~30%), ASD (~15%). Also Hypothyroidism, Hirschsprung, duodenal atresia, ALL/AML
Contraindications to Pertussis?
Anaphylaxis to vaccine ingredients, progressive neuro disorder (epilepsy/infantile spasms), encephalopathy within a week of previous dose of vaccine.
Prophylactic Tylenol before vaccination. Good or bad idea?
Bad - can reduce antibody response to vaccines!
A 4 year old girl comes in with smelly vaginal discharge and bleeding for 1 week. On exam, she has a whitish foreign body in her vaginal introitus. What do you do?
Removal with a calcium alginate swab or irrigation with warmed fluid will likely remove the foreign body - most likely toilet paper. Sedation/anesthesia may be necessary.
Patient is born with a defect in the abdominal wall to the right side of the cord insertion. You lost the phone call after that - is it covered with peritoneum or not?
No - gastroschisis is not covered by membrane or skin, and always occurs to the right of the umbilicus. Omphalocele (covered by peritoneum) is midline. These patients (omphalocele) have increased risk of cardiac disease, NTDs, and trisomy (1/2 of patients), but gastroschisis does not.
Patient with right shoulder pain is found to have a single lytic lesion on Right humerus and mild hypercalcemia - all other labs are WNL. Dx?
Langerhan’s Cell Histiocytosis; bone lesions can be locally destructive, but are typically regarded as benign and treated conservatively. Ddx = metastasis, Ewing Sarcoma.
4 month old w/ history of NICU for hypoglycemia and macroglossia. 99th% for weight, length, head circ. Reducible umbilical hernia, Right extremities are larger than left. What does he have, and whats the next step?
Beckwith-Wiedemann Syndrome - check TSH. Caused by 11p15 imprinting. Often have umbilical hernia or omphalocele. Screen for AFP and do an Abd US /3mo for first 4 years, then just US /3mo 4-8 years, then renal US 8yrs-adolescence due to Wilms and Hepatoblastoma risk.
Unvaccinated minor with an urgent need for tetanus vaccination. Divorced parents disagree over vaccine - what do you do.
You only need one parent to consent, no consent from the patient, only parents with custody can consent. Treat the kid. If both parents refuse, this is an urgent situation and life-saving treatment (vaccination) is warranted without court approval. Chemo in a stable patient (non-urgent) would need court approval, however.
Young boy with eczema, TTP, and has an infection with Neisseria Meningitiditis. He is fully vaccinated including Neisseria, and has a history of Strep Progenies and Strep Pneumo infections. He bled excessively from his circumcision. What is his diagnosis?
Wiskott-Aldrich Syndrome; X-R, low IgM, high IgA and IgE, poor Ab response to polysaccharide Ag and moderately low platelets and T-cells.
Hepatosplenomegaly, partial oculocutaneous albinism, frequent Staph A. infections, and pancytopenia with mild coagulopathy. Dx?
Chediak-Higashi syndrome. Decreased degranulation, chemotaxis and granulopoiesis leads to giant lysosymes in neutrophils in the setting of neutropenia.
Coarse facial features, chronic pruritic dermatitis, eosinophilia, and high IgE with dental abnormalities. Dx?
Hyper-IgE (Job) syndrome. Look for recurrent skin and respiratory staph infections. bone fractures are also common.
Patient with a bug bite to the face has pain with extra ocular movements as well as eyelid edema, erythema, and tenderness. Does he have Pre or Post-septal cellulitis?
Post-Septal (orbital) cellulitis has the same features as perceptual (perioribital), including eyelid edema, erythema, tenderness and possibly fever/leukocytosis. It also has ophthalmoplegia, pain with EOM, and possibly vision impairment and proptosis.
Young girl with irregular menses varying from 3-6 weeks in length. UPT is negative, PRL and TSH are normal. What is the most likely cause?
Immature Hypothalamic-Pituitary-Gonadal axis causing insufficient gonadotropin secretion, anovulatory cycles, and breakthrough bleeding.
Patient with family history of migrane headaches comes in with complaints of stereotyped vomiting episodes with many bouts of emesis per episode. Upper GI series was normal. Dx?
Cyclic vomiting syndrome; >2 episodes/6 months, stereotyped, lasts 1-10 days, vomits >3/hr at peak, no symptoms between vomiting episodes, no underlying dz. Give anti-emetics ad migraine agents.
5 year old with sudden-onset weakness on her left with slurred speech. She has developmental delay, eye issues, and is a tall, fair-skinned, thin girl with decreased upper-to-lower segment ratio. She has an upgoing babinski on the left and has joint hyper laxity and skin hyperelasticity. Dx?
Homocysteinuria. Marfanoid body habitis with intellectual disability, fair complexion, and thrombosis (stroke). This is AR vs AD Marfan syndrome. There is less Lens dislocation in homocysteinuria, though it isn’t uncommon. There is also a risk of megaloblastic anemia.
What is the most common cause of congenital hypothyroidism?
Thyroid dysgenesis.
What do the labs look like in Pyloric Stenosis? Note pH, PaCO2, HCO3, K, and Cl.
High pH, PaCO2, and HCO3; Low K and Cl. Its a Metabolic Alkalosis with a respiratory compensation (CO2) and hypochloremia due to loss of gastric HCl. Hypovolemia causes a contraction hypokalemia due to RAAS.
Vaccinations that prevent Cancer?
HBV - prevents Hepatocellular carcinoma.
Patient with Croup desaturates in front of you from 98% on 2L to 92%. What should be the first step?
Start racemic epinephrine.
Patient with presumed (no XR evidence) epiglottitis. Clinically presenting with Distress (inspiratory stridor), Dysphagia, and Drooling. What do you do
Endotracheal intubation in the OR. Steroids and epic are not useful for these patients.
A 7 year old boy comes in with aplastic anemia, short stature, hypogonadism, hypo pigmentation, large freckles, low set ears, strabismus, and middle-ear abnormalities. What is the cause of his disorder?
Chromosomal breaks - leads to Fanconi Anemia, leading to loss of DNA repair. Abnormal thumbs are common. Increased risk of cancers. Can have bleeding issues, fatigue.
Acquired Causes of Aplastic Anemia
Drugs (NSAIDs, Sulfas), Benzene, Glue, Idiopathic, Viral infections (HIV, EBV), Immune disorders, thymoma.
Stroke symptoms in a kid with Sickle Cell Anemia. What do you do?
Exchange transfusion; doesn’t remove the issue, but helps to avoid additional strokes. Fibrinolytics don’t work on Sickled RBC blockages.
Child with rapidly growing head circumference and bulging anterior fontanelle comes in for poor feeding and fussiness for the last month. What is the next step?
Head CT or MRI. Hydrocephalus - give a shunt.
Patient shows up for a 3 week WCC. She has a negative ortolani and barlow, but seems to have one leg longer than the other. The left inguinal fold extends posteriorly beyond the anal orifice. What is the next step?
Hip Ultrasound for Hip Laxity. Age 2wks to 6 months = hip US, ages >4-6months = hip XR. If positive Ortolani or Barlow (Developmental Dysplasia of the Hip or DDH), refer directly to orthopedics.
How often should a kid have AOM before you should consider tubes?
> 2 / 6months, >3 /12months.
Scaly erythematous lessons around the eyebrows and sides of the nose in a 6month old, as well as a scaly scalp that improves with shampoo. Dx?
Seborrheic dermatitis (Cradle cap). Moisturizers, topical antifungals, anti-dandruff-shampoo, topical steroids.
1 day old; blue when he feeds, pink when he cries. Not fixed by bottle-feed. No retractions, clear lung sounds, normal rate and rhythm, though tachycardic.
Choanal atresia = failure of the posterior nasal passage to canalize, leaving bony (90%) or membranous (10%) obstruction. Part of CHARGE syndrome; Coloboma, Heart defects, Atresia of Choanae, Renal anomalies, Growth impairment, and Ear abnormalities/deafness. Dx with failure to pass a catheter through nose to oropharynx.
Mother comes in with her 6 y/o due to hemiplegia of cut onset. He was playing alone, and when she returned, he was unconscious. He slowly regained consciousness, but could not move his right arm and leg. He regains full function after 24hrs in the ED. CT scan is normal. Dx?
Seizure with postictal paralysis (Todd paralysis). This is an indication that a structural abnormality underlies the seizure.
Patient with constipation and a UTI. What is the cause of the UTI?
Urinary stasis caused by fecal retention compressing the bladder. Treat the constipation with laxatives, limit cows milk, and increase fiber. Fear, milk, and school entry often contribute.
A 12 year old girl comes in complaining of left-sided ear drainage for the last three weeks. She completed two courses of Abx on her previous two visits without improvement, and feels like she is loosing some hearing on the left. Left TM has peripheral granulation with skin debris. Dx?
Cholesteatoma; acquired form, as here, presents with chronic ear drainage, congenital shows up at 5 years old. Complication include hearing loss, CN palsies, vertigo, and infections (abscess, meningitis).
A girl presents with annorexia nervosa with a low K and low phos. What should you do with her? Hospitalize, CBT outpatient, or Olanazapine?
Hospitalize for patients with electrolyte disturbances, bradycardia, severe weight loss, or dehydration. Watch for refeeding syndrome; electrolyte depletion, arrhythmias, and HF. Also look for Vitamin deficiencies. Olanazapine for patients who fail CBT and nutritional rehab.
Neonate presents with respiratory distress after an uncomplicated vaginal delivery. The pregnancy was complicated with pre-eclampsia. The patient was born SGA (4lb. 4oz), and has been unable to feed due to tachypnea. CBC is significant for a Hemoglobin of 22.8, HCT of 69%, glucose of 50, and a WBC of 5.5. Treatment?
This patient has polycythemia - treat with partial exchange transfusion (remove blood, infuse NS). Caused by IUGR, maternal DM, maternal HTN, smoking, twin-twin transfusion, or delayed cord clamping. Patients are often distended and cyanotic as well as in resp. distress. HCT>65% is diagnostic.
What do we treat Enterobius Vermicularis (pinworm) with?
Albendazole! Can also use Pyrantel Pamoate (pregnant),
Migratory arthralgia after a trip to NE - synovial fluid is ~25k cells/uL.
Lyme Arthritis, still in early localized (first month) disease. Next is Carditis (5%), Neuro (15%), Muscular (60%), conjunctive (10%) and LAD all possible. Late disease is Arthritis (60%) and Encephalomyelitis or Peripheral neuropathy.
Girl with primary amennorhea with an US confirming uterus is present. Next step?
FSH. High FSH -> Karyotype for XO, decreased -> MRI. If Uterus was absent, it would be karyotype. Female = abnormal mullerian development, male = AIS.
Gray vesicles/ulcers on posterior oropharynx. Dx?
Herpangina (Coxsackie A); occurs in summer/early fall, fever pharyngitis, ulcers. Supportive treatment only. Differentiate from HSV - anterior oropharynx/lips.
Birth to a HBV positive mother (acutely), with HBsAG positivity, what do you do to manage the infant?
Hep B IgG followed by HBV vaccine.
Kid with a recent head trauma, headache, 2X emesis, and “isn’t acting right” according to his parents. His CT is positive for Epidural Hematoma. What do you do?
Indications for emergent craniotomy include GCS
