SILBERT-FLAGG Questions Flashcards
Management of an infant with suspected heart disease and reported cyanotic spell should include:
Prompt referral to cardiologist
And apnea monitor
Instructed the parent to keep a diary of these episodes
Continuous administration of oxygen
Referral to cardiology
A common cause of congestive heart failure in the first year life
Pulmonary stenosis
Ventricular septal defect
Rheumatic fever
Complete heart block
Ventricular septal defect is the most common in children can lead to increase pulmonary bloodflow and overtime can cause congestive heart failure if not medically or surgically managed.
Pulmonary stenosis can cause right heart failure from decrease pulmonary bloodflow.
The least likely physical findings in a two month old with congestive heart failure?
Tachypnea, tachycardia, Hepatomegaly or pedal edema
Tachypnea and tachycardia & hepatomeagly are early signs of congestion
Peripheral Edema is rare and children; children may develop edema but there must be a 10 % increase in weight and the Edema is usually initially noted in the eyelids
Chest pain and young children is usually_____
Non-cardiac in origin
The mother of a four month old infant reports that he turned blue and seem to have fast labored breathing after vigorous crying soon after awakening. He settled down in his color and breathing seem to improve. On physical examination, the mucus membranes of the lips and mouth appear mildly cyanotic. A systolic murmur is heard best at the upper and lower left sternal border. Vital signs are normal with normal peripheral pulses. There is no hepatomegaly. He likely diagnosis is:
Congestive heart failure, apnea, cortication of the aorta, TOF
This is a cyanotic spell related to TOF
Which statement is true regarding innocent murmurs?
The murmur is often Holosystolic
Prompt referral to a cardiologist indicated
Precordial thrill is present
The murmur is low in intensity grade 1 to 3
The murmur is low in intensity and grading do not require urgent referral to a cardiologist normally 1 to 3
When should anabiotic‘s for bacterial endocarditis prophylaxis for children be given? (dental procedures, surgical repair)
Any child with a residual defect at a repair site
Most common cause of myocarditis in North America is:
Viral infection
Enterovirus, adenovirus, parvovirus B19
Diphtheria is common in other countries without immunizations
Drug and toxic reactions can cause Carditis but rare
And a healthy eight month old with diarrhea but no dehydration, what would be the most appropriate advice to give the parents?
Encourage strength formula for 12 hours
Give oral rehydration solution for 12 hours
Give only fluids until stools return to normal
Get bananas and cereal as tolerated
Starvation depresses the digestive system and prolongs diarrhea ORT is only given if dehydration is present
When evaluating a child with abdominal pain what symptom would lead to a likely organic etiology
Night awakening
Pallor
Sweating
Suprapubic pain
Night awakening with abd pain usually does not occur with functional disorders
What is the following appropriate regimen for pinworm medication
Daily x7 days repeat as needed
TID for 10 days repeat as needed
B.i.d. for three days repeat in two weeks
One dose one time repeat in two weeks
Albendazole 400 mg orally as a single dose repeat in two weeks
A two month old johns frequent vomiting has Miss Doyle convinced that something is seriously wrong. Which of the following is my suggestive of GER?
He’s gained 5 ounces this month
He had a slight weeds today
He is hungry after vomiting
He drinks 7 to 8 ounces every 3 to 4 hours
John has been overfed which were predispose as an infant to GER
A more appropriate intake for a two month old is 4 to 5 ounces every 3 to 4 hours
You see Jack a 20-month-old toddler with normal growth and development. For diarrhea. His mother tells you that he is passing up to three loose stools a day and that he drinks 20 ounces of apple juice a day what is the most likely diagnosis?
Crohn’s disease
Giardia Lamblia
Celiac disease
Non-specific toddler diarrhea
Toddler diarrhea is caused by carbohydrate mouth certain rules all the juices removed from the diet. Crohn’s disease is not common in children less than two years. Celiac disease may cause failure to thrive. Giardia causes intermittent diarrhea
Baby Sally has 7% dehydration what would you expect to see on her examination? Normal Refill normal Fontanel cool/mottled skin Dry mucous membranes
Dry mucous membranes, increase heart rate, capillary refill is prolonged
In evaluating Billy a child with bloody diarrhea which of the following would not be an appropriate first action? Check the growth chart Hemoccult test for stools Stool culture Upper G.I.
An upper G.I. would not be appropriate it looks like anatomy abnormalities. And a child with bloody diarrhea still cultures should be obtained to look for an infectious agent. Hemoccult can be done to prove the presence of blood. Sub optimal growth may point to an inflammatory bowel disease
Lillys family eats at fast food restaurants 4-5 times each week. If you suspect the diarrhea is infectious in nature what is likely the causative organism? Adenovirus E. coli S.aureus Giardia lambila
E. coli is found in undercooked ground beef and leafy greens causing bloody diarrhea
S.aureus Causes vomiting and diarrhea but no bleeding.
Giardia is generally contracted from contaminated water.
Adenovirus is found on the hard surfaces and usually affects children less than three years in daycare
Which of the following conditions would most likely occur in a four-year-old boy?
Pyloric stenosis
Recurrent abdominal pain
Intussusception
Giardia infection
Giardia in children 1 to 9 years of age. Pyloric stenosis affects infants in the first few months of life three weeks to four months. Intussusception mostly in the first two years of life. Functional abdominal pain is uncommon in children younger than four mostly but hers between ages 8 and 15.
Which of the following may occur with suspected appendicitis
Pain not relieved with ambulation
Young children appear very ill in the early phase
Fever of 102°F
Leukopenia with left shift
Children with appendicitis have difficulty ambulating. Young children may NOT APPEAR very ill in the early phases. Fever is absent or low. There may be leukocytosis with left shift
Which of the following serological findings indicates chronic HBV infection.
HBsAG negative 6 months
Anti HBc Positive and HBsAG positive
IGM anti-HBC positive
Anti-HBs positive
HBsAG
Hepatitis B surface antigen is the earliest marker for acute infection and persistence for greater than six months indicates chronic infection. Total anti-HBc (total hepatitis B core antibody) appears in acute infection and persist for life. Positive IgM anti-HBC indicates acute infection. Positive anti-HPS indicates positive immune status after vaccination
Children and child care facilities are at greatest risk for it being exposed to which of the following hepatitis infections
HAV, HBV, HCV, HDV
Hepatitis is the most common form of viral hepatitis and children it is transmitted by the fecal oral route but contaminated shellfish and water
A two day old baby is in the hospital nursery and still has not passed meconium this is a red flag for what condition
Interception, HUS,Hirschsprung’s disease, pyloric stenosis
Hirschsprung’s disease
A 10-year-old boy comes to your clinic for evaluation of a suspected urinary tract infection which of the following signs would lead you to include diagnosis other than a UTI in the differential?
Penile discharge
UTI signs include in recess, frequency, dysuria, urgency, fever, and pain. Discharge may indicate balanitis or a sexual transmitted disease
Jay is a nine-year-old boy who has no significant health problems, but his mother is very concerned because he is wetting himself. As you begin your history and physical, you keep in mind that the most common type of enuresis in school-age children is?
Primary nocturnal enuresis
Occasional daytime enuresis
Secondary nocturnal enuresis
Primary diurnal enuresis
Primary diurnal enuresis
Which of the following statements is not true with regard to primary nocturnal enuresis?
There’s often a positive family history of enuresis
It appears to be related to maturational delay
Some nighttime waiters stop wedding without any form of treatment
The incidence is higher in girls than boys
Primary nocturnal enuresis is seen in almost 3 times more boys then girls
While examining a four month old boy, you are unable to palpate one of the testes. The next most appropriate step is to:
Reassure the parents that this is a normal finding
Refer the child to endocrinologist
Re-examine the baby in two months
Refer to a urologist
Reassure the parents of this is a normal finding
Testes don’t decend until 6 months
Which of the following is not true with regard to hypospadia’s?
Meatus is formed along the dorsum of the penis
It is one of the most common penile abnormalities
Circumcision should be deferred
A referral for an endocrine evaluation may be indicated
The meatus is formed ventrally along penis
A 12 year old girl presents to clinic with symptoms of vaginitis, odor, dysuria, frequency, and discomfort.
From further history in lab screening the girl is diagnosed with Canadian albicans vaginitis. Appropriate treatment would include:
Avoid bubble bath
Topical acyclovir
Rocephin
clotrimazole
Clotrimazole ,micanazole ,ticsnoxole For a yeast infection
A label Adhesion extending from the posterior to the clitoris is noted during a routine assessment of a four-year-old girl. There is no history of difficulty voiding, dysuria, discomfort. The most appropriate initial management is to:
Prescribed a topical application of estrogen cream
Referred to a G.I. specialist
Reassure the parents that no specific treatment is needed
Recommend mechanical lysis using petroleum onitment
Reassuring the parents and no specific treatment is needed at this time most lambila Hwy shouls resolve spontaneously during hormonal changes like at puberty.
Patients with acute nephrotic syndrome may present with all the following except? Edema Hypertension Dark amber colored urine History of weight loss
Patients with nephrotic syndrome can present with Periorbital Adema, hyper or hypotension, tachycardia, weight gain related to fluid overload!
