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2 Pediatrics > UWorld - Peds > Flashcards

UWorld - Peds Flashcards

1
Q

Wiskott-Aldrich syndrome:

  • Mechanism
  • Symptoms
A
  • X-linked recessive defect in WAS protein, causing impaired cytoskeleton in leukocytes and platelets
  • Eczema, thrombocytopenia, recurrent infections
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2
Q

Juvenile idiopathic arthritis:

Lab findings

A
  • Anemia (Low HgB)
  • High Ferritin
  • Thrombocytosis (High platelets)
  • High gammaglobulin
  • High inflammatory markers (ESR, CRP)
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3
Q

Corkscrew pattern on barium swallow

A

Midgut volvulus

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4
Q

Most common cause of cyanosis in neonatal period:
Dx
Tx

A 
Dx = Transposition of Great Vessels
Tx = Prostaglandins to keep ductus arteriosus patent
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5
Q

Most common cause of viral meningitis.

A

Enteroviruses (e.g. group B coxsackievirus)

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6
Q

Complete atrioventricular septal defect is most commonly associated with _________

A

Down syndrome

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7
Q

Patent ductus arteriosus is strongly associated with _____

A

Congenital Rubella Syndrome

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8
Q

DiGeorge is associated with what heart defect?

A

Tetralogy of Fallot

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9
Q

Acute unilateral lymphadenitis in a child

A

Staph aureus

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10
Q

Dx: Child with cervical paravertebral mass and Horner’s syndrome (ptosis, anhydrosis, miosis)

A

Neuroblastoma of cervical paravertebral sympathetic chain

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11
Q

Dx: Positive acidified glycerol lysis test

A

The glycerol lysis test demonstrates cellular osmotic fragility. It is used to diagnose hereditary spherocytosis.

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12
Q

Dx: Newborn with X-ray showing fluid in the interlobar fissures
Tx?

A

Transient tachypnea of the newborn

Tx: self resolution in 1-3 days

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13
Q

Dx: genu varum

A

= bowlegged = rickets = vitD defi

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14
Q

Most common cause of acute bacterial rhinosinusitis and the treatment.

A

Cause: Streptococcus pneumoniae OR Haemophilus influenzae.
Tx: amoxicillin-clavulanic acid

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15
Q

Dx: Inspiratory stridor that worsens in the supine position and improves in the prone position

A

Laryngomalacia (Increased laxity of supraglottic structures)

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16
Q

When to use EDTA + Dimercaprol

A

When Pb levels are above 70. OR in lead poisoning accompanied by acute encephalopathy.

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17
Q

When to use succimer.

A

Chelation in Pb toxicity when Pb levels are between 45-69

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18
Q

When to use ferrous sulfate

A

Tx of iron defi

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19
Q

Henoch-Schonlein Purpura pathogenesis and symtpoms

A 
Pathogenesis = IgA vasculitis
Symptoms = Lower extremity purpura, lower extremity arthralgia, abdominal pain / intrussusception, renal disease (hematuria)
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20
Q

Acute bacterial rhinosinusitis:

definition and Tx`

A 
Definition = more than 10 days of symptoms
Tx = amoxiciliin +/- clavulinate
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21
Q

Medical abortion medication

A

Mifepristone and Misoprostol

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22
Q

Medication that prevents pregnancy by delaying ovulation. Effective within 72 hours after intercourse.

A

Levonorgestrel

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23
Q

Genotypical male (46 X,Y), but phenotypical female

A

Androgen insensitivity syndrome

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24
Q

Inactivated vaccines

A

Polio

HepA

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25
Q

Toxoid vaccines

A

Diphtheria

Tetanus

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26
Q

Live attenuated vaccines

A 
Rotavirus
Measles
Mumps
Rubella
Varicella
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27
Q

Conjugated vaccines

A 
HepB
Pertussis
Haemophilus influenzae type B
Pneumococcal
Meningococcal
Human papilomavirus
Influenza (injection)
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28
Q

Dx: Periosteal elevation of femur

A

Codman triangle, demonstrates osteosarcoma

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29
Q

Lytic lesion in bone of pediatric patient

A

Langerhans cell histiocytosis

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30
Q

Location of Osteosarcoma in bone

A

Metaphysis

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31
Q

Location of Langerhans cell histocytosis in bone

A

Skull, jaw, femur

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32
Q

Dx: Bone pain with hypernatremia

A

Central Diabetes insipidus caused by langerhans cell histocytosis

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33
Q

Dx: Blue sclerae

A

Osteogenesis imperfecta

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34
Q

What type of vaccine is the rubella vaccine?

A

Live attenuated

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35
Q

Congenital Rubella 3 clinical findings

A
  • Sensorineural hearing loss
  • Cataracts
  • Patent ductus arteriosus
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36
Q

Congenital Toxoplasmosis 3 clinical findings

A
  • Chorioretinitis
  • Hydrocephalus
  • Diffuse intracranial calcifications
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37
Q

Congenital Cytomegalovirus 2 clinical findings

A
  • Chorioretinitis

- Periventricular calcifications

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38
Q

Congenital varicella syndrome 3 clinical findings

A
  • Limb hypoplasia
  • Cataracts
  • Distinctive skin lesions (scarring)
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39
Q

Congenital syphilis 3 clinical findings

A
  • Nasal discharge
  • Hepatomegaly
  • Osteoarticular destruction
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40
Q

Treatment of pertussis if individual is not vaccinated

A

Macrolides

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41
Q

Treatment for iron poisoning

A

Whole bowel irrigation

Deferoxamine (chelation therapy)

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42
Q

Symptoms of iron poisoning within 30 minutes to 4 days

A
  • Abdominal pain
  • Vomiting
  • Diarrhea
  • Hypotensive shock
  • Metabolic acidosis
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43
Q

Dx when symptoms are dysphagia, drooling and respiratory distress

A

Epiglottitis associated with Haemophilus influenzae type b

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44
Q

Dx: Tympanic membrane with peripheral granulation and some skin debris

A

Cholesteatoma

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45
Q

How does Rubella present in unvaccinated adolescents (3 symptoms)?

A

1) Fever
2) Rash (cephalocaudal spread of maculopapular rash)
4) Arthralgias

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46
Q

How does congenital Rubella (German Measles) present (3 findings)?

A

1) Sensorineural hearing loss
2) Cataracts
3) Paten ductus arteriosus

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47
Q

What is the difference between preseptal cellulitis and orbital cellulitis?

A

Orbital cellulitis is essentially a more severe form of preseptal cellulitis. Both preseptal cellulitis and orbital cellulitis involve eyelid erythema and swelling. However, patients with orbital cellulitis also present with pain with extraocular movements and diplopia. Preseptal cellulitis is treated with oral antibiotics. However, orbital cellulitis is treated with intravenous antibiotics and sometimes surgery.

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48
Q

Sandpaper rash. Dx?

A

Scarlet fever from streptococcus pyogenes.

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49
Q

Scarlet fever:Cause

A

Cause = Strep pyogenes

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50
Q

Scarlet fever: Symptoms

A

Symptoms = fever, pharyngitis, tonsillary erythema/exudates, strawberry tongue, tender anterior cervical lymph nodes, sandpaper rash

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51
Q

Scarlet fever: Lab test

A
  • rapid strep antigen test

- throat culture

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52
Q

Scarlet fever: Tx

A

Tx = Penicillin

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53
Q

“slapped cheek.” Dx and cause?

A 
Dx = erythema infectiosum
Cause = parvovirus B19
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54
Q

Hand foot and moth disease cause.

A

Coxsackievirus

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55
Q

Criteria for diagnosis of Kawasaki

A

5 days of fever and more than 4 clinical criteria:

  • > 1.5 cm cervical node
  • polymorphous rash
  • edema of the hands/feet
  • conjunctivitis
  • mucosal changes (eg strawberry tongue, dry/cracked lips)
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56
Q

Superficial flaccid bullae on the skin of an infant. Dx?

A

Staphylococcal scalded skin, caused by Staph aureus

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57
Q

Symptoms of rubeola (measles) infection

A

Prodrom of cough, coryza, conjunctivitis, fever, Koplic spots)
Followed by maculopapular rash: cephalocaudal, sparing the palms and soles.

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58
Q

Treatment of rubeola infection for hospitalized patients

A

Supportive
and
Vitamin A

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59
Q

When and how to treat nasal discharge with antibiotics?

A

Acute bacterial rhinosinusiitis is treated with amoxicillin and clavulanate. Acute bacterial rhinosinusitis is differentiated from viral upper respiratory infection by worsening of symptoms with more than 10 days without improvement.

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60
Q

Treatment of acute otitis media.

A

Oral antibiotics:
Initial: amoxicillin
2nd-line: amoxicillin-clavulanic acid

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61
Q

Otitis externa. Tx?

A

Otic antibiotic drops

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62
Q

Most common cause of acute otitis media

A

Strep pneumoniae

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63
Q

Criteria for tympanostomy tube placement

A

More than 3 episodes in 6 months.

More than 4 episodes in 12 months.

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64
Q

Sticky stools with streaks of blood. Dx?

A

Intrussusception

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65
Q

What do you see on ultrasound for instrussusception?

A

Target sign

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66
Q

What is the purpose of the Technetium-99m scan?

A

To diagnose Meckel diverticulum

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67
Q

What is the purpose of Anorectal Manometry?

A

To diagnose Hirschsprung disease

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68
Q

Best test for pyloric stenosis

A

Abdominal ultrasound

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69
Q

Triple bubble sign. Dx?

A

Jejunal atresia

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70
Q

Treatment of children with severe dehydration

A

IV normal saline

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71
Q

1 side of body is larger than the other in a baby. Dx? Complications of this Dx? How to monitor for complications?

A 
Dx = Beckwith-Wiedemenn syndrome
Complications = Wilms tumor, Hepatoblastoma
Monitor = Serum alpha fetoprotein (hepatoblastoma) and Abdominal ultrasound (Wilms tumor)
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72
Q

Rare but potentially fatal complication of infectious mononucleosis. Tx?

A

Acute airway obstruction.

Tx = corticosteroids

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73
Q

Acute rheumatic fever is a complication of ______

A

Group A streptococcal (GAS) pharyngitis

aka Strep pyogenes

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74
Q

Complication of Kawasaki disease.

A

Coronary artery aneurysm

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75
Q

Low B lymphocyte count. Dx?

A

X-linked (Bruton) agammaglobulinemia (XLA)

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76
Q

Defect in dynein. Dx?

A

Primary ciliary dyskinesia

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77
Q

When is varicella zoster vaccine given?

A

2 doses at ages 1 and 4

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78
Q

When is postexposure prophylaxis with VZV vaccine indicated?

A

For incompletely immunized child age >1 year who was exposed to chicken pox within the last 5 days.

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79
Q

When do you administer varicella immunoglobulin?

A

Varicella vaccine is made from a live virus, so it is contraindicated in pregnant women, immunocompromised hosts and neonates. In these populations varicella immunoglobulin is used instead (within 10 days of exposure to chicken pox).

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80
Q

Lateral neck X-ray demonstrates widened prevertebral space. Dx?

A

Retropharyngeal abcess (RPA)

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81
Q

What coagulation problem do patients with cystic fibrosis develop?

A

Vitamin K deficiency, due to CF patient’s exocrine pancreas insufficiency, they cannot absorb the fat-soluble KADE vitamins.

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82
Q

What clotting factors are associated with Vitamin K?

A

Factors II, VII, IX, X, proteins C and S

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83
Q

Tinea corporis (ringworm). Tx?

A

Clotrimazole (topical antifungal)

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84
Q

Diaper dermatitis. Cause? Tx?

A 
Cause = candida
Tx = topical nystatin
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85
Q

Teeth appear translucent and gray. Dx?

A

Dentinogenesis imperfecta, due to osteogenesis imperfecta

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86
Q

CBC in idiopathic juvenile arthritis

A

High WBC
High PLT
Low HgB

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87
Q

Limited upward gaze. Dx?

A

Parinaud (dorsal midbrain) syndrome, due to Pinealoma

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88
Q

Respiratory distress syndrome (RDS) in neonate.
Cause?
Risk factors?

A

Cause: immature lungs & lack of surfactant

Risk factors: Prematurity & Gestational Diabetes

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89
Q

Low platelets after a viral infections. Dx?

A

Immune Thrombocytopenia (ITP)

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90
Q

Cough with vomiting. Dx? Tx?

A 
Dx = Bordetella pertussis
Tx = Macrolide (azithromycin, clarithromycin)
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91
Q

Dx? Newborn with left axis deviation on EKG and decreased pulmonary markings on chest radiograph.

A

Tricuspid valve atresia

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92
Q

What heart defect is diGeorge syndrome associated with?

A

Truncus arteriosus, where the aorta and pulmonary artery have a common outflow.

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93
Q

CD3+ is what cell type?

A

T cells

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94
Q

Diagnosis:

Child with abscess that is filled with neutrophils

A

Chronic granulomatous disease

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95
Q

Organisms associated with chronic granulomatous disease

A 
Catalase Positive organisms:
Staphylococcus aureus
Aspergillus
Burkholderia
Serratia
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96
Q

What is the defect and chronic granulomatous disease?

A

Deficiency of oxidative burst (Hydrogen peroxide formation)

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97
Q

What lab testing is used for the diagnosis of chronic granulomatous disease?

A

Neutrophil function testing:

1) Nitroblue tetrazolium test
2) Dihydrorhodamine 123 test

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98
Q

Age of three finger grasp and age of two finger grasp.

A

Three finger grasp at nine months.

Two finger grasp at 12 months.

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99
Q

At what age should a baby be able to turn head to its name.

A

Six months

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100
Q

Yellow, oily scaling on face and scalp. Dx? Tx?

A

Dx = Seborrheic dermatitis, associated with colonization by Malassezia species
Tx primary = Emolient, non-medicated shampoo
Tx secondary = Topical antifungal or glucocorticoids

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101
Q

Recurrent severely pruritic rash not related to any contact, associated with family history of asthma or allergies. Dx?

A

Atopic dermatitis.

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102
Q

Recurrent severely pruritic rash that is related to some contact and may be associated with family history of asthma or allergies. Dx?

A

Contact dermatitis

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103
Q

Scaly lesions that form round or oval plaques typically on elbows and knees. Dx?

A

Psoriasis

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104
Q

Fine white scales on scalp only. Dx?

A

Tinea capitis

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105
Q

Painful, non-pruritic pustules with honey-crusted adherent coating. Dx? Organism?

A

Impetigo

  • Staph aureus
  • Strep pyogenes (Group A Strep)
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106
Q

Painful vescicular rash with “punched-out” erosions and hemorrhagic crusting. Dx? Organism?

A

Eczema herpeticum

- Herpes simplex type 1

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107
Q

Flesh-colored papules with central umbilication. Dx? Organism?

A

Molluscum contagiosum
- Poxvirus
(NOT chicken pox, which is caused by varicella zoster)

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108
Q

Pruritic circular patch on body with central clearing and raised, scaly border. Dx? Organism?

A

Tinea corporis

- Trichophyton rubrum

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109
Q

Fever, blisters, epidermal shedding with light pressure. But NO involvement of mucous membranes. Dx? Organism?

A

Staphylococcal Scalded Skin Syndrome

- Staph aureus

110
Q

Pt with fever and well demarcated area of erythema, but NOT epidermal shedding. Dx? Organism?

A

Erisypelas

- Strep pyogenes (group A strep)

111
Q

Pink sand-paper rash in a child that has recently had pharyngitis. Dx? Cause?

A

Scarlet fever

- Strep pyogenes (Group A Strep)

112
Q

Skin blistering that covers >30% of body with involvement of mucous membranes, after starting a new medication. Dx?

A

Toxic epidermal necrolysis

113
Q

Sharply defined perianal rash. Dx? Organism?

A

Streptococcal perianal dermatitis

- Group A Strep (Strep Pyogenes)

114
Q

Perianal rash with satellite lesions. Dx?

A

Candida dermatitis

115
Q

Treatment of Lyme in child vs. adult

A

Child under 8 = amoxicillin

Over 8 = doxycycline

116
Q

Child with maculopapular rash that spares the palms and soles. Dx? Tx?

A 
Dx = measles (rubeola)
Tx= Vit A + Supportive
117
Q

Koplik spots. Dx?

A

Dx = measles (rubeola)

118
Q

What test to perform if child has psychosis but also proteinuria and hematuria?

A

Test for antinuclear antibodies
BECAUSE child may have
Systemic Lupus Erythematosus

119
Q

Mnemonic and list of findings in SLE

A 
RASH OR PAIN:
Rash (malar or discoid)
Arthritis
Serositis (pleuritis, pericarditis)
Hematologic disorders (cytopenias)
Oral/nasopharyngeal ulcers
Renal disease
Photosensitivity
Antinuclear antibodies
Immunologic disorder (anti-dsDNA, anti-Sm, antiphospholipid)
Neurologic disorder (seizures, psychosis)
120
Q

What type of kidney injury is associated with Sickle Cell Trait?

A

Acute Papillary Necrosis

121
Q

Children aged ________ must receive a renal and bladder ultrasound after a UTI to assess for anatomic abnormalities.

A

< 2 yrs

122
Q

The clinical manifestations of Henoch-Schonlein purpura.

A
  • Palpable purpura
  • Arthritis/arthralgia
  • Abdominal pain - intrussusception
  • IgA nephropathy
123
Q

At what age do symptoms of pyloric stenosis usually present?

A

3-5 wks

124
Q

Keratomalacia.
Definition?
Dx?

A 
Keratomalacia = wrinkling, cloudiness of cornea
Dx = Vit A deficiency
125
Q

Pancreatic pseudocyst is a complication of _________.

A

Pancreatitis

126
Q

Biliary cysts present at what age?

A

< 10 yrs old

127
Q

Classic Triad of symptoms for Biliary cysts.

A

1) RUQ pain
2) Jaundice
3) Palpable mass

128
Q

Anti-tissue tranglutaminase antibody assay.

- Used for diagnosis of what?

A

Celiac disease

129
Q

How to diagnose baby colic.

A

Baby colic is a type of pain that starts and stops abruptly, often occurs at the same time every day. Diagnostic features: Crying for more than three hours per day, more than three days per week, more than three months.

130
Q

Hematochezia and eczema in a one month old infant. Diagnosis?

A

Milk or soy protein induced enterocolitis.

131
Q

Three reasons for physiological jaundice in a newborn.

A

1) Low hepatic UGT activity
2) Low red blood cell lifespan
3) high enterohepatic recycling of bilirubin

132
Q

If an infant has tracheoesophageal fistula, what other conditions are associated with this?

A 
Mn* VACTERL
Vertebral
Anal atresia
Cardiac
Tracheoesophageal fistula
Renal Limb
133
Q

Next step in management, if you suspect UTI in an infant that wears diapers.

A

1) BUN/CR
2) Catheterization
3) Urinanalysis
4) Urine culture

134
Q

Newborn with flattened facies, abdominal distension, clubfeet and decreased aeration of lungs. Dx? Mechanism of disease?

A 
Potter Sequence
Urinary tract anomaly (most often posterior urethral valves) cause oliguria (small urine production) in utero, which causes oligohydramnios (deficiency of amniotic fluid), which causes the 3 findings:
1) Pulmonary hypoplasia
2) Flat facies
3) Limb deformities
135
Q

define: Hypospadias

A

A congenital abnormality where the penile urethra opens on the ventral side of the penis rather than the tip.

136
Q

Most common cause of urinary tract obstruction in newborn boys

A

Posterior urethral valves

137
Q

Normal Urine pH

A

4.5 - 8

138
Q

Normal specific gravity of urine

A

1.01 - 1.03

139
Q

define:Hyposthenuria

A

Inability of the kidneys to concentrate urine, causing low urine specific gravity.

140
Q

Normal Serum Sodium
Low Urine Specific Gravity
Dx?

A

Sickle cell trait

- response to poor renal perfusion is hyposthenuria, but intact ADH results in normal serum sodium.

141
Q

High Serum Sodium
Low Urine Specific Gravity
Dx?

A

Diabetes Inspidus,

- due to insufficient ADH production (central) or poor ADH response (nephrogenic).

142
Q

How to diagnose the type of Diabetes Insipidus. Central vs. Nephrogenic?

A

Water deprivation test

  • hold water, administer ADH
  • measure urine osmolarity in response to ADH
143
Q

After pediatric UTI – what are the indications to perform a renal and bladder ultrasound?

A

If the first UTI is at age 2-24 months
OR
If this is the second or more – UTI

144
Q

Urinary test for Cystinuria

A

Cyanide-Nitroprusside test

145
Q

Severe periodontal infections. What is the immunodeficiecy?

A

Leukocyte Adhesion Deficiency

146
Q

What conditions are associated with cafe-au-lait macules?

A

Neurofibromatosis Type 1

McCune-Albright

147
Q

Symptoms of McCune-Albright syndrome

A

Cafe-au-lait spots (unilateral)
Polyostotic fibrous dysplasia
Precocious puberty
Multiple endocrine abnormalities

148
Q

Solitary hyperpigmented lesion with density of overlying dark, coarse hairs. Dx?

A

Congenital Melanocytic Nevus

149
Q

Newborn with gray-blue patches that are poorly circumscribed. Dx?

A

Congenital dermal melanocytosis (Mongolian spots)

- these fade with time

150
Q

What is nevus flammeus?

A

Port-wine-stain

151
Q

Scaly erythematous patch with hair loss on scalp. Also pt has tender lymphadenopathy. Dx? Tx?

A 
Dx = Tinea capitis (dermatophyte infection)
Tx = Griseofulvin or Terbinafine
152
Q

What kind of rash presents with acute rheumatic fever?

A

Erythema marginatum

153
Q

Describe the rash in that occurs in Scarlet Fever.

A

“Sandpaper” rash

154
Q

What kind of imaging is performed to diagnose hip dysplasia?

A

Age < 4 mo = Hip ultrasound

Age > 4 mo = Hip radiograph

155
Q

X-ray of femur demonstrates cortical layering and a “moth eaten” appearance. Dx?

A

“onion skinning” and “moth eaten” bone = Ewing Sarcoma

156
Q

Where does Ewing Sarcoma present?

A

Diaphyses of long bone

157
Q

A lytic lesion in bone surrounded by concentric layers of new bone. Dx?

A

“Onion Skinning” = Ewing Sarcoma

158
Q

Tumor in the epiphysis with “soap bubble” appearance. Dx?

A

Giant Cell Tumor

159
Q

Most common cause of pneumonia in otherwise healthy patients.

A

Strep pneumoniae

160
Q

Nocturnal perianal pruritis. Dx? Test? Tx?

A 
Dx = Helminth infection (Enterobius vermicularis)
Test = Tape test
Tx = Albendazole or Pyrantel Pamoate
161
Q

Suspect this diagnosis if individual develops a maculopapular rash after amoxicillin.

A

Infectious mononucleosis (Epstein-Barr virus)

162
Q

What type of rash occurs in acute rheumatic fever?

A

Erythema marginatum

163
Q

Describe the rash of Erythema Infectiosum

A

Erythema infectiosum = rash initially involving the face (slapped cheek) progressing to entire body

164
Q

How to diagnose Acute Lymphoblastic Leukemia.

A

Bone marrow biopsy with >25% lymphoblasts

165
Q

Pediatric patient with fever and mediastinal mass on X-ray. Dx?

A

Hodgkin lymphoma

166
Q

Rouleaux formation on blood smear. Dx?

A

Multiple Myeloma

167
Q

Lymphadenopathy, tenderness of bones, splenomegaly, petichiae. Dx?

A

Acute Lymphoblastic Leukemia

168
Q

Franconi Anemia. Mechanism? Symptoms?

A 
Mechanism = Inherited DNA repair defect
Symptoms:
- Short stature
- Hypo/hyper-pigmented macules
- Abnormal thumbs
- Genitourinary malformations
169
Q

Lab findings for Fanconi Anemia

A
  • Pancytopenia
  • Diagnosis of Fancioni Anemia is made by exposing DNA to interstrand crosslinking agents, demonstrating chromosomal breakage
170
Q

Until what age is it normal to see the thymus on X-Ray?

A

< 3 yrs old

171
Q

When to use Palivizumab?

A

Palivizumab is a monoclonal antibody against RSV, used for prophylaxis of children under 2 years old who are at exceptionally high risk. High risk individuals:

  • Preterm <29 wks gestation
  • Chronic lung disease of prematurity
  • Hemodynamically significant congenital heart disease
172
Q

If an infant < 2 months has bronchiolitis – then what complication is the infant at greatest risk for?

A

Apnea (temporary cessation of breathing)

173
Q

First step in management of a newborn with suspected congenital diaphragmatic hernia.

A

Endotracheal intubation to stabilize breathing.

174
Q

Congenital absence of bilateral vas deferens is associated with what condition?

A

Cystic fibrosis

175
Q

Opacification of ocular lens is associated with what condition?

A

Intrauterine rubella infection
OR
Galactosemia

176
Q

Which pediatric tumor crosses the midline and which one does NOT?

A

Neuroblastoma may cross the midline

Wilms tumor does not

177
Q

Neuroblastoma stymptoms

A

Abdominal mass that may cross the midline
Periorbital ecchymosis
Opsoclonus-myoclonus

178
Q

“Owl eyes” on lymph node biopsy.

A

Hogkin lymphoma

179
Q

Bone pain and pancytopenia in Pediatric pt. Dx?

A

Acute Lymphoblastic Leukemia

180
Q

What drug to avoid in G6PD deficiency if trying to treat UTI.

A

Nitrofurantoin

181
Q

Ear canal is red and swollen. Diagnosis? Mechanism?

A 
Diagnosis = Otitis externa
Mechanism = infection with Pseudomonas aeruginos OR Staph aureus, most commonly due to water exposure ("swimmer's ear")
182
Q

Treatment of Epiglottitis

A

Infection with Haemophilus influenzae type b.

Tx = ceftriaxone (against haemophilius influenzae type b and streptococcus species) and vancomycin (against MRSA)

183
Q

What antibiotic to use to treat whooping cough?

A

To treat Bordetella pertussis, use Azithromycin

184
Q

Empiric therapy for neonatal sepsis

A

Ampicillin and gentamycin

185
Q

Tx for atypical pneumonia.

A

Organisms of atypical pneumonia = Mycoplasma pneumoniae, Clamydia pneumoniae)
Tx = Azithromycin

186
Q

How to treat pulmonary infection in cystic fibrosis.

A

CF patients are susceptable to Pseudomona aerguinosa.

Tx = Piperacillin-tazobactam

187
Q

Osteosarcoma
vs
Ewing sarcoma
on X-ray

A

Osteosarcoma = “sunburst” periosteal reaction and Codman triangle
Ewing sarcoma = “onion-skin” appearance

188
Q

Newborn patient demonstrates a preference to tilt hear head to the left while rotating the chin to the right. Dx?

A

Dx = Congenital torticolis
This is a postural deformity of the neck in which the sternecleidomastoid muscle is tight and contracted, likely due to intrauterine crowding.

189
Q

Cystic hygroma

A

A congenital lymphatic malformation located in the posterior triangle of the neck

190
Q

Craniosynostosis

A

Premature closure of cranial sutures, which results in skull deformity

191
Q

Treatment of child with UTI

A

3rd gen cephalosporin

  • Ceftriaxone
  • Cefotaxime
  • Cefpodoxime
  • Ceftazidime
  • Cefixime
192
Q

Age milestone: Babbling

A

6 months (language development)

193
Q

Age milestone: Pincer grasp

A

12 months (motor development)

194
Q

Age milestone: hops and balance on one foot

A

4 years

195
Q

Age milestone: jumps with 2 feet

A

2 years

196
Q

How to treat E Coli O157:H7?

What medications to avoid? Why?

A

Treat with supportive care.
Avoid: Antibiotics and Antimotility meds (loperamide), because they increase the chance of developing Hemolytic Uremic Syndrome

197
Q

Complication of giardia infection.

A

Lactose intolerance

198
Q

Giardia treatment

A

Metronidazole

199
Q

Tx for beta thalassemia major.

A

Transfusion + Chelation

200
Q

What are the key unique features of Rubella infection in children and what are the key features of Measles infection in children?

A

Rubella (German Measles) = Lymphadenopathy, specifically suboccipital, posterior auricular and posterior cervical.
Measles (Rubeola) = 3 Cs = Cough, Coryza, Conjunctivitis. Higher fever (40 C).

201
Q

Which one is a Torches infection – Measles OR Rubella? What are the manifestations?

A

Rubella

Manifestations = Cataracts, Deafness, Patent Ductus Aretriosus

202
Q

If pt has UTI. What is the indication for an ultrasound? What is the indication for a voiding cystourethrogram?

A

Ultrasound = IF fever does not improve with 2 days of antibiotics
Voiding Cystourethrogram = IF 1 of the following is met:
(1) Ultrasound shows abnormality (e.g. hydronephrosis)
(2) Unusual pathogen (Not E. coli)
(3) Chronic kidney injury (Hypertension, Poor growth)
(4) 2 or more febrile UTIs

203
Q

Abdominal pain, diarrhea, seizures in a child.

A

Shigella gastroenteritis

204
Q

What are the values of the pleural fluid analysis that tells you whether the parapneumonic effusion is uncomplicated or complicated? What is the Tx of uncomplicated vs complicated?

A

Uncomplicated = pH >7.2, Glucose>60, WBC<50k
Complicated = pH<7.2, Glucose<60, WBC>50k
Uncomplicated Tx = Antibiotics
Complicated Tx = Antibiotics + drainage

205
Q

Criteria to place ear tubes for patients with Acute Otitis Media.

A
  • 3 or more AOM episodes in 4 months

- 4 or more AOM episodes in 12 months

206
Q

Criteria to give antibiotics to patients with Acute Otitis Media.

A
  • Bilateral AOM
  • High Fever
  • Severe pain
207
Q

Compare the skin findings of Neurofibromatosis type 1, Tuberous Sclerosis and Sturge-Weber

A

Neurofibromatosis type 1 = Neurofibromas, cafe-au-lait spots, axillary freckling
Tuberous Sclerosis = Angiofibromas, Shagreen patches, Ash-leaf spots
Sturge-Weber = port wine stain (along trigeminal nerve distribution)

208
Q

Dimercaprol treats…

A

Lead poisoning

209
Q

Fomepizole treats…

A

Methanol or ethylyne glycol poisoning

210
Q

Glucagone treats…

A

Beta blocker or Ca2+ channel blocker poisoning

211
Q

Methylene blue treats…

A

Methemoglobinemia (exposure to dapsone, nitrates, topical anesthetics)

212
Q

Pralidoxime treats…

A 
Organophosphate poisoning
(use pralidoxime together w/ atropine)
213
Q

Perianal pruritis at night. Dx?

A

Pinworm = Enterobius vermicularis

214
Q

Ivermectin treats…

A
  • Strongyloides (intestine and lung)

- Onchocerca (river blindness)

215
Q

Metronidazole treats…

A
  • Trichomoniasis and bacterial vagenosis (Vagina)
  • Giardia (GI)
  • Entamoeba (GI –> liver abscess)
216
Q

Praziquantel treats…

A
  • Cestodes (tapeworms) like Taenia solium from pork or Diphyllobothrium from fresh fish
  • Tematodes (flukes) like Schistosoma (which can lead to bladder cancer) from fresh water or Chlonorchis sinesis (which can lead to gallbladder cancer)
217
Q

Permethrin treats…

A

Scabes

218
Q

Pyrantel pamoate treats…

A

Enterobius vermicularis (pinworm) that causes anal pruritis

219
Q

When is MMR vaccine given?

A

1 year
and
4 years old

220
Q

What rheumatological comorbidity is associated with Down’s syndrome?

A

Atlantoaxial instability (laxity between C1 and C2)

221
Q

Treatment for lead poisoning depending on lead level.

A

Less than 45 = remove from environment
45 - 70 = Succimer (Dimercaptosuccinic acid
> 70 or sings of encephalopathy = EDTA + Dimercaprol (British anti-Lewisite)

222
Q

Hamartomas on the iris –> what is the genetic condition?

A

Lisch nodules = NF1

223
Q

White-grey spots on periphery of the iris - what is the genetic condition?

A

Brushfield spots = Down’s

224
Q

Renal angiomyolipoma - what is the genetic condition?

A

Tuberous sclerosis

225
Q

Retinal hemangioblastoma - what is the genetic condition?

A

von Hippel-Lindau

226
Q

What are the 3 conditions that have cafe-au-lait spots? What symptoms help to differentiate between the two?

A

NF1 (iris hamartoma - Lisch nodules, cutaneous neurofibromas)
and
McCune-Albright (multiple endocrine abnormalities, precocious puberty)
and
Fanconi anemia (thumb defect, anemia)

227
Q

Skin condition associated with Celiac disease

A

Dermatitis herpetiformis

228
Q

What is the difference between the location,symptoms and treatment of preseptal cellulitis and orbital cellulitis?

A

Preseptal cellulitis is anterior to the orbital septum, while orbital cellulitis is posterior.
Symptoms that point to orbital cellulitis are extraocularr muscle defect like painful or weak eye movements AND proptosis (bulging eyes).
Treat preseptal with oral antibiotics, treat orbital with IV antibiotics and possible surgery.

229
Q

What can cause megaloblastic anemia other than B12/Folate deficiency? What other symptoms to look for and mechanism of disease.

A 
Fanconi anemia (DNA repair defect leads to PANcytopenia, not just anemia; Also look for thumb defect, cafe-au-lait spots)
AND
Orotic aciduria (UMP synthase defect, which leads to orotic acid in urine)
230
Q

Anal fissure in a toddler. Dx? Tx?

A 
Dx = pediatric constipation
Tx = laxative (e.g. polyethylene glycol, mineral oil)
231
Q

Most common complication for patients with Sickle Cell Trait.

A

Humaturia
and
Hyposthenuria (impairment in urine concentrating ability, which can present as nocturia and polyuria)

232
Q

Glomerular basement membrane thickening. Dx? Symptoms?

A 
Dx = Membranous nephropathy
Symptoms = Edema, proteinuria
233
Q

Glomerular basement membrane thining. Dx? Symptoms?

A 
Dx = Alport Syndrome
Symptoms = Hearing, Vision problems
234
Q

Linear deposition of IgG on basement membrane. Dx? Symptoms?

A 
Dx = Goodpasture syndrome
Symptoms = Pulmonary hemorrhage, glomerulonephritis
235
Q

Localized areas of mesangial sclerosis. Dx? Symptoms?

A 
Dx = Focal Segmental Glomerulosclerosis (FSGS)
Symptoms = Edema, proteinuria
236
Q

Mesangial deposition of IgA. Dx? Symptoms?

A 
Dx = Henoch-Schonlein Purpura
Symptoms = Abdominal pain (intrususeption), Renal disease, Arthralgias, Lower extremity rash
237
Q

Podocyte fusion. Dx? Symptoms?

A 
Dx = Minimal Change Disease
Symptoms = Edema, proteinuria
238
Q

Limited upward gaze. Where is the tumor?

A

Pinealoma

239
Q

Special organisms associated with Chronic Granulomatous disease.

A

Serratia
Burkholderia
Aspergillus

240
Q

Tests used to diagnose Chronic Granulomatous Disease

A

Dihydrhodamine 123 Test
Nitbroblue Tetrazolium Test
(These are tests for neutrophil function)

241
Q

Medications for Tourette Disorder

A 
Alpha-2 agonists (Guanafacine, Clonidine)
Dopamine depleter (Tetrabenazine)
Antipsychotic (Risperidone, Haloperidol)
242
Q

Common causes of anion gap metabolic acidosis

A 
Mn* MUDPILES
Methanol
Uremia
Diabetic Ketoacidosis
Propylene glycol/paraldehide
Isoniazid / Iron
Lactic Acidosis
Ethylene glycol (antifreeze)
Salicylates (aspirin)
243
Q

Most common cause of pneumonia in healthy patients vs Cystic Fibrosis patients.

A

Healthy patients = Strep pneumoniae
CF before 20 months of age = Staph aureus
CF after 20 months of age = Pseudomonas

244
Q

Until what age is bed wetting OK?

A

5 years. After 5 years old start enuresis alarm therapy.

245
Q

Until what age is genu varum normal?

A

Age 2

246
Q

Percent Fetal Hemoglobin in Sickle Cell Disease.

A

SCD pts = 5-15% HgF

SCD pts on Hydroxyurea = > 15%

247
Q

What therapy should be used in strabismus and at what age?

A

Until 4 months strabismus is OK. Afterwards need therapy such as eye patch on the good eye

248
Q

What medications are used as emergency contraceptives to prevent pregnancy by delaying ovulation? Timeline to take.

A

Levonorgestrel (Plan B) - within 72 hrs of unprotected intercourse
Ulipristal - within 5 days

249
Q

Most common cause of meningitis depending on age.

A

Before 6 months = Group B Strep

After 6 months - to old age/death = Strep pneumoniae

250
Q

Longitudinal splitting of glomerular basement membrane. Dx?

A

Alport syndrome

251
Q

Why does bruising and epistaxis occur in cystic fibrosis patients?

A

Cystic fibrosis patients have pancreatic insufficiency. This leads to decrease absorption of fat soluble vitamins K A D E. Lack of vit K increases PTT, which increases bruising and epistaxis.

252
Q

Retinal hemorrhages on fundoscopy. Dx?

A

Dx = shaken baby syndrome (Subdural venous shearing)

253
Q

Cystinuria. What type of crystal in nephrolythiasis? What is the diagnostic test?

A

Crystals = hexagonal

Diagnostic test = Cyanide-nitroprusside

254
Q

Tourette syndrome often presents with what 2 other comorbid conditions?

A

1) ADHD

2) Obsessive-compulsive disorder

255
Q

Treatment of UTI in pediatric patient.

A

Third gen cephalosporin.

Cefixime, Ceftriaxone, Cefotaxime, Cefpodoxime, Ceftazidime

256
Q

What are the two conditions that cause cherry-red macula? What is their mechanism? What symptoms help you to differentiate between the 2 conditions?

A

Niemann-Pick and Tay-Sachs have cherry-red macula.
Niemann Pick is Sphingomyelinase deficiency.
Tay-Sachs is beta-hexosaminidase A deficiency.
Niemann Pick symptoms = Heptosplenomegaly and Arreflexia
Tay-Sachs symptoms = NO hepatosplenomagaly and Hyperreflexia.

257
Q

Patient with hip pain after a mild viral illness. CBC is normal. Patient can bear weight on the affected leg. Dx? Prognosis?

A

Transient synovitis

Prognosis = Full recovery in up to 4 weeks

258
Q

Timing of IgA nephropathy vs Poststreptococcal glomerulonephritis.

A

IgA nephropathy = 1-2 days after URI

Poststrep Glomerulonephritis = 1-4 wks after URI

259
Q

Another name for “Eczema”

A

Atopic Dermatitis

260
Q

An antibiotic that will cover both pseudomonas and MSSA.

A

Cefipime (4th gen cephalosporin)

261
Q

Mechanism of Reye syndrome

A

Aspirin is a mitochondrial toxin. Causes liver damage. Results in microvesicular steatosis on liver biopsy.

262
Q

Aspirin is usually contracindicated in children except in the treatment of what?

A 
Kawasaki Disease
Rheumatologic disease (e.g. juvenile idiopathic arthritis)
263
Q

Complications of infectious mononucleosis

A

Splenic rupture
Acute airway obstruction
Autoimmune hemolytic anemia and thrombocytopenia

264
Q

Criteria to diagnose Acute Rheumatic Fever

A 
JONES (major) + (minor)
Joints (mygratory arthritis)
O Carditis
Nodules (subcutaneous)
Erythema marginatum
Sydenham chorea
\+ High CRP/ESR
\+ High PR interval
\+ Fever
\+ Arthralgia
265
Q

Turner syndrome: Estrogen, FSH and LH (high or low?)

A

Low Estrogen, High FSH, High LH

266
Q

Kallman syndrome: Estrogen, FSH and LH (high or low?)

A

Normal Estrogen, Low FSH, Low LH (due to Low GnRH)

267
Q

Androgen Insensitivity syndrome: FSH and LH (high or low?)

A

Normal to high FSH and LH

268
Q

5 alphar reductase insufficiency: FSH and LH (high or low)

A

Normal to high FSH and LH

269
Q

How to tel Androgen Insensitivity Syndrome from 5 alpha reductase, since they are both 46XY?

A

Androgen Insensitivity Syndrome will have breast development. 5-alpha reductase deficiency will NOT have breast development. 5-alpha reductase deficiency will have Virilization.

270
Q

APGAR scoring system

A

Appearance: - +2 pink; +1 blue extremities; 0 all blue
Pulse: +2 >100; +1 <100; 0 absent
Grimace: +2 crying; +1 to grimace; 0 absent
Activity: +2 active; +1 some flexion; 0 limp
Respiratory: +2 good dry; +1 weak cry; 0 absent

271
Q

When infant is crying or eating cyanosis appears. Dx?

A

This is a “tet spell” of Tetralogy of Fallot

272
Q

The tetralogy of Tetralogy of Fallot

A

1) Ventricular septal defect (VSD)
2) Overriding aorta
3) Right Ventricle Hypertrophy
4) Right Ventricle Outflow Obstruction (pulmonary stenosis)

2 Pediatrics (3 decks)

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