May 2021 Flashcards
"Cause of morbidity and mortality in Paracetamol ingestion - A. Metabolic Acidosis B. Hypoxemia C. Gastric bleeding D. Hepatic failure "
D
"A 3 year old male, son of a farmer, was comatose, with weakness, excessive salivation, bradycardia and constricted pupils. These findings are most likely seen in: A. Phenobarbital B. Hydrocarbons C. Mercury D. Organophosphate "
D
“Organophosphate (SLUDGE BBB) - salivation, lacrimation, urination, defacation, gastric emptying, bradycardia, bronchorrhea, bronchospasm
Phenobarbital - difficulty thinking, decreased level of consciousness, bradycardia or rapid and weak pulse, poor coordination, vertigo, nausea, muscle weakness, thirst, oliguria, decreased temperature, and dilated or contracted pupils; coma hypotension, respiratory depression
Hydrocarbon - type of hydrocarbon and the route and amount of hydrocarbon exposure determine the severity and type of clinical toxicity
Mercury - [acute exposure to air concentrations 100-1000mcg/m3] cough, dyspnea and chest pain; stomatitis, inflammation of the gums, and excessive salivation; severe nausea, vomiting, diarrhea (which can lead to shock); conjunctivitis and dermatitis– [>1000mcg/m3] fatal interstitial pneumonitis
“
"Which primitive reflex that persists throughout life? A. Tonic Neck reflex B. Galant reflex C. Parachute reflex D. Grasp reflex "
C
"Paraparesis with autonomic and sensory manifestations suggests affectation of: A. Pons B. Cerebellum C. Spinal cord D. Cortex "
D
"What is the difference between urticaria and angioedema? A. IgE activation B. Depth of involvement C. Duration of lesion D. Response to antihistamine "
B
”- Acute urticaria and angioedema are often caused by an allergic IgE- mediated reaction (21st Nelson page 1222)- so A is wrong
- Angioedema involves the deeper subcutaneous tissues… (21st Nelson page 1225)
- Urticaria occurs more commonly and is less severe than angioedema as it only affects the skin layers whereas angioedema affects the tissues beneath the skin (subcutaneous tissue).https://dermnetnz.org/topics/angioedema
“
"Which of the following is the best screening test for complement deficiency? a. C3 b. CH50 c. Flow cytometry d. C4 "
B
Nelsons 21st ed Chapter 160.1 Testing for total hemolytic complement activity (CH50) effectively screens for the most common diseases of the complement system
". Fulminant hepatitis is frequently seen with: A. B B. A C. C D. E "
A
Nelson 21st table 385.1: fulminant hep common in hep B and D
"A 10-year old female had high-grade on and off fever with good activity for 3 days. 1 day prior to consultation, a maculopapular rash on the trunk appeared. What is the diagnosis? A. Erythema infectiosum B. Scarlet fever C. Erythema subitum D. Rubella "
C
Nelsons 21st ed p1724: a history of 3 days of high fever in an otherwise nontoxic 10 mo old infant with a blanching maculopapular rash on the trunk suggests a diagnosis of roseola
"Inheritance of Duchenne muscular dystrophy? A. Autosomal Dominant B. Autosomal Recessive C. X-linked dominant D. X-linked recessive "
D
Nelsons 21st ed p3281. DMD is the most common hereditary neuromuscular disease affecting all races and ethnic groups…clinical features are progressive weakness, intellectual impairment, and hypertrophy of the calves, with proliferation of connective tissue and progressive fibrosis in muscle. Incidence is 1 in 3,600 liveborn infant boys. This disease is inherited as an X-linked recessive trait
"Most common CHD causing brain abscess? A. VSD B. COA C. TGA D. TOF "
D
"In what diagnostics is heterophile antibody present? A. CMV B. Rabies C. Infectious Mononucleosis D. Behcet’s "
C
Nelsons 21st ed p1717. Heterophile antibodies are cross-reactive immunoglobulin M antibodies that agglutinate mammalian erythrocytes but are not EBV-specific. Heterophile antibody tests such as the monospot test are positive in 90% of cases of EBV-associated infectious mononucleosis in adolescents and adults during the 2nd week of illness but in only up to 50% of cases in children younger than 4 yr of age.
". Which one is not affected in congenital varicella? A. Heart B. Skin C. Eyes D. Extremities "
A
Chapter 280, page 1711 Nelson’s: The congenital varicella syndrome is characterized by cicatricial skin scarring in a zoster-like distribution; limb hypoplasia; and abnormalities of the neurologic system (e.g., microcephaly, cortical atrophy, seizures, and mental retardation), eye (e.g., chorioretinitis, microphthalmia, and cataracts), renal system (e.g., hydroureter and hydronephrosis), and autonomic nervous system (e.g., neurogenic bladder, swallowing dysfunction, and aspiration pneumonia).
"Recommended dose of VItamin A for patients 6 months of age? A. 100,000 IU Single dose B. 200,000 IU Single dose C. 100k IU every 6 mos D. 200k IU every 6 mos "
A
“Prev Ped 2018
Vitamin A supplementation as recommended by the DOH
Infants 6 - 11 months: 100,000 I.U. 1 dose only (one capsule is given anytime between 6-11 months but usually given at 9 months of age during the measles immunization.
Children 12-59 months: 200,000 I.U. 1 capsule every 6 months.
The World Health Organization (WHO) recommends administration of an oral dose of 200,000 IU (or 100,000 IU in infants) of vitamin A per day for two days to children with measles in areas where vitamin A deficiency may be present.
50,000 I.U. if less than 6mos.
Answer: A. Checked with WHO website and PPS handbook 2018, for PPS usually given at 9 months of age with the Measles vaccine, 100k IU for 6 months to 11 mos. for 12 mos to 59 months we give 200k iu every 4- 6 mos
“
"West Syndrome consists of the triad of infantile spasm, mental retardation and A. Pulmonary hypoplasia B. Hypsarrhythmia C. Hemiparesis D. Encephalopathy "
B
Nelson’s 21st ed p 3098. West syndrome starts between the ages of 2 and 12months and consists of a triad of infantile epileptic spasms that usually occur in clusters (particularly in drowsiness or upon arousal), developmental regression and a typical EEG picture called hypsarrhythmia ( a high voltage, slow, chaotic background with multifocal spikes).
"A negative allergy skin test is most useful and clinically significant in: A. Food Allergy B. Atopic Dermatitis C. Allergic Rhinitis D. Asthma "
C
"SELECT ONE: A. Tuberculosis B. Asthma C. Allergy D. Bronchiectasis "
A
?????
“A 2 yo female diagnosed with PTB. No history of exposure. All household members chest xrays were negative. She plays daily with his 20month old cousin who lives next door. What is the intervention for his cousin?
A. Start preventive H therapy
B. Do TST
C. No necessary intervention at this time
D. Request for CXR
“
B
“MOP 6th ed. If bacteriologic confirmed, treat. If clinically diagnosed, do TST first.
P68. The following eligible groups do not require TST. They may be offered TPT once active TB is ruled out:
a. PLHIV aged 1 year or older;
b. children less than 5 years old who are household contacts of bacteriologically
confirmed PTB; and
c. individuals aged 5 years and older with other TB risk factors (i.e. PLHIV, diabetes,
smoking, those with immune-suppressive medical conditions, malnourished, with multiple TB cases in the same household) and who are household contacts of bacteriologically confirmed PTB.
“
"A 4 year old presented with massive pneumothorax on the right. What is the MOST appropriate intervention? A. observe B. CTT C. Serial needling D. O2 100% "
B
“Nelsons 21st ed p2320. A small or even moderate-sized pneumothorax in an otherwise normal child may resolve without specific treatment, usually within one week..administering 100% O2 may hasten resolution but patients with chronic hypoxemia should be monitored closely during administration of O2. Needle aspiration into the second ICS in the MCL may be required on an emergency basis for tension pneumothorax..if the pneumothorax is recurrent, secondary, or under tension, or there is more than a small collapse, chest tube drainage may be necessary
Addendum: Stable patient small to moderate <30%- Supportive may resolve spontaneously.
Stable Massive/Large >30% pneumothorax- O2 support
Emergency/Unstable Patient-Needling then CTT
“
"Pulmonary radiologic findings in tuberculosis resolve in how many months? A. 6-24 months B. 6-12 months C. 3-6 months D. 3-9 months "
A
PPS TB Guidelines p. 100: “In the small proportion of children with radiologic evidence of the disease, clearing usually occurs within six months to two years after institution of therapy.”
". A mother came into the clinic with her child noted with yellowish discharge on the post BCG site 4 weeks post vaccination. How do you advise this mother? A. Observe this is normal B. Start topical antibiotics C. Diagnose disseminated TB D. None of the above "
A
“A 72 hours-old neonate came into the clinic due to jaundice. No other manifestations noted. Total bilirubin = 10mg/dL. Both baby’s and mother’s blood type are A+. Hgb = 16. What is the diagnosis?
A. Physiologic jaundice
B. Biliary atresia
C. Hemorrhagic disease of the newborn
D. Hemolytic disease of the newborn
“
A
“Physiologic jaundice (Nelsons 21st, Chapter 123.3) - Icterus Neonatorum. Jaundice that first appears on the 2nd or 3rd day is usually physiologic. Under normal circumstances, the level of indirect bilirubin in umbilical cord serum is 1-3mg/dl and rises at a rate of <5mg/dl/24 hours; thus, jaundice becomes visible on the 2nd or 3rd day, usually peaking between the 2nd and 4th days at 5-6mg/dl and decreasing to <2mg/dl between the 5th and 7th days after birth.
Biliary atresia (Nelsons 21st, Chapter 123.3) - Jaundice persisting for > 2 weeks or associated with alcoholic stools and dark urine suggests biliary atresia.
Hemorrhagic disease of the newborn (Nelsons 21st, Chapter 124.4) - known as Vitamin K deficiency bleeding, results from transient but severe deficiencies in the vitamin K-dependent factors and is characterized by hemorrhage that is most frequently GI, nasal, Mo subgaleal, intracranial, or post-circumcision. (Since the baby had no other s/sx other than jaundice, this is less likely)
Hemolytic disease of the newborn (Nelsons 21st, Chapter 124.2) - also known as erythroblastosis fetalis, is caused by the transplacental passage of maternal antibodies directed against paternally derived RBC antigens causing hemolysis in the infant; associated primarily with incompatibility of ABO blood groups and the RhD antigen. (Since both baby’s and mother’s blood type are A+, this is less likely)
“
"35-year old G1P1 diabetic mother with BT O+ delivered 5 weeks before EDC. Baby limp and gasping, with cyanotic face, pale body, weak pulses and no response to stimulation/suctioning. APGAR score? A. 1 B. 3 C. 4 D. 2 "
D
Gasping is 1
"Who is at risk to develop HMD? A. Diabetic mother B. Hypertensive mother C. Maternal use of opiates D. Prolonged rupture of membrane "
A
The risk factors for development of RDS increases with maternal diabetes, multiple births, CS delivery, precipituous delivery, asphyxia, cold stress, and maternal history of previously infected infants. - (21st Nelson, page 932)
"Which of the following is characterized by intractable neonatal hypoglycemia, ear creases, macroglossia, facial nevus flemens, increased risk for Wilm’s tumor, renal medullary dysplasia…? A. Turner Syndrome B. Pierre-Robin Syndrome C. Pierre-Robin Syndrome D. Beckwith-Wiedemann Syndrome "
D
Beckwith-Wiedemann syndrome (BWS) is a growth disorder variably characterized by neonatal hypoglycemia, macrosomia, macroglossia, hemihyperplasia, omphalocele, embryonal tumors (e.g., Wilms tumor, hepatoblastoma, neuroblastoma, and rhabdomyosarcoma), visceromegaly, adrenocortical cytomegaly, renal abnormalities (e.g., medullary dysplasia, nephrocalcinosis, medullary sponge kidney, and nephromegaly), and ear creases/pits. (From Genetics NCBI website)
“What is the characteristic ocular change after prolonged exposure to oxygen among premature neonates?
A. Blood vessels in vitreous
B. Papillary edema in the optic nerve root
C. Corneal ulcers
D. Microaneurysm of the retinal arteriole
“
B
"What months does Moro, asymmetric tonic neck reflex disappears? A. 2 months B. 4 months C. 3 months D. 5 months "
B
"First tooth to erupt? A. lateral mandibular incisor B. central maxillary incisor C. lateral maxillary incisor D. central mandibular incisor "
D
"Most common cause of preventable mental retardation: a. Iron deficiency b. Iodine deficiency c. Lead poisoning d. Vitamin A deficiency "
B
"A 2 year old girl who has been given vitamins, minerals, and supplements has begun to experience alopecia, seborrheic dermatitis, and loss of appetite. Most likely cause? A. Excessive biotin B. Excessive pantothenic acid C. Hypervitaminosis A D. Hypervitaminosis D "
C
Nelson’s 21st, p. 364: Signs of subacute or chronic toxicity can include headache, vomiting (early signs), anorexia, dry itchy desquamating skin, and seborrheic cutaneous lesions. With chronic hypervitaminosis A, one may observe fissuring at the corners of the mouth, alopecia, and coarsening of the hair, bone abnormalities and swelling, enlargement of the liver and spleen, diplopia, increased intracranial pressure, irritability, stupor, limited motion, dryness of the mucous membranes, and desquamation of teh palms and the soles fo the feet.
"Neonate 4th hour of life tachypneic cyanotic. Narrow superior mediastinum, globular heart, hyperinflated lungs on CXR. What is the best palliative procedure? A. Mustard Procedure B. Rastelli Procedure C. Balloon Atrial Septostomy D. Fontan Procedure "
C
“Narrow superior mediastinum, globular heart and hyperinflated lungs indicate that this is a TGA (egg-on-a-string).
Mustard procedure is atrial switch. This is the earlier procedure that used to be definitive for TGA but has been superseded by the arterial switch.
Rastelli procedure is to relieve pulmonary obstruction in mga DORV, d-TGA but usually at 2 years old.
Fontan procedure connects the IVC to the pulmonary artery but is usually for hypoplastic left heart diseases and is performed after the Glenn procedure.
“
"Which of the following causes relaxation of infundibular spasm during hypercyanotic spells? a. Sodium bicarbonate b. Morphine c. Digoxin d. Indomethacin "
B
Nelson 21st p2397. Depending on the frequency and severity of hypercyanotic attacks, 1 or more of the following procedures should be instituted in sequence: (1) placement of the infant on the abdomen in the knee-chest position while making certain that the infant’s clothing is not constrictive, (2) administration of oxygen (although increasing inspired oxygen will not reverse cyanosis caused by intracardiac shunting), and (3) injection of morphine subcutaneously in a dose not in excess of 0.2 mg/kg. Calming and holding the infant in a knee-chest position may abort progression of an early spell. Premature attempts to obtain blood samples may cause further agitation and may be counterproductive
"3. What is the additional deficit in pentalogy of Fallot? a. ASD b. RV hypertrophy c. PDA d. VSD "
A
Pentalogy of Fallot is a rare congenital cyanotic heart disease and a variant of tetralogy of Fallot, in which tetralogy of Fallot is associated additionally with an atrial septal defect
"Paraparesis with autonomic and sensory manifestations suggests affectation of: A. Pons B. Cerebellum C. Spinal cord D. Cortex"
C
“Characteristic features of Grade 2/6 murmur?
A. Soft murmur that disappears with change in position
B. Loud murmur with palpable thrill
C. Moderate murmur with thrill
D. Persistent soft murmur
“
D
"I - barely audible II - medium intensity III - lud but no thrill IV - loud with thrill V - very loud VI - very loud can be heard even if steth is off the chest "
"Which of the following is the best screening test for complement deficiency? A. CH50 B. C3 C. C4 D. Flow cytometry "
A
“Nelsons 21st ed Chapter 160.1 Testing for total hemolytic complement activity (CH50) effectively screens for the most common diseases of the complement system.
“
“Which of the following cardiac problems require a PDA?
A. Truncus arteriosus
B. Total anomalous pulmonary venous return
C. TGA
D. TOF
“
C
“[Nelsons ch457, 458]
Truncus arteriosus - Pulmonary blood flow may be augmented by or totally dependent on a PDA
TGA - The systemic and pulmonary circulations exist as 2 parallel circuits. Survival in the Immediate newborn period is provided by the foramen ovale and the ductus arteriosus, which permit some mixture of oxygenated and deoxygenated blood
“
"8. Peaked p wave in a 2 year old female signifies: A. RV enlargement B. LV enlargement C. RA enlargement D. LA enlargement "
C
"loud S1 is heard in: A. mitral insufficiency B. mitral stenosis C. aortic insufficiency D. aortic stenosis "
B
“Nelsons p2270-2271 (RHD)
Mitral Insuff - The 2nd heart sound may be accentuated if pulmonary hypertension is present. A 3rd heart sound is generally prominent. A holosystolic murmur is heard at the apex with radiation to the axilla
Mitral stenosis - The principal auscultatory findings are a loud 1st heart sound, an opening snap of the mitral valve, and a long, low-pitched, rumbling mitral diastolic murmur with presystolic accentuation at the apex.
Aortic insuff - The typical murmur begins immediately with the 2nd heart sound and continues until late in diastole. The murmur is heard over the upper and midleft sternal border with radiation to the apex and upper right sternal border
“
"PDA typically closes after \_\_\_\_\_ A. 96 hours B. 48 hours C. 72 hours D. 24 hours "
D
“Nelsons (Chapter 448.3 Neonatal Circulation): 10-15 hours
AAP Article (PDA in Preterm): “In term infants, the PDA normally constricts after birth and becomes functionally closed by 72 hours of age..”
Uptodate: constriction of the ductus arteriousus (DA) results in functional hemodynamic closure within 10-15 hours after delivery. Closure begins at the pulmonary end of the DA, proceeds toward the aortic end and is usually completed by two to three weeks of age. (physiologic closure)
“
"72 hours after iron treatment of IDA A. Erythroid dysplsia (1-2 days) B. Replenished iron stores (1-3 months) C. Reticulocytosis (2-3 days) "
D
“Nelson 21st p2524 Table 482.4
12-24hr - Replacement of intracellular iron stores, subjective improvement, decreased irritability, increased appetite, increased serum iron
36-48hr - Initial bone marrow response, erythroid hyperplasia
48-72hr - Reticulocytosis, peaking at 5-7 days (do repeat retic count at this time)
4-30 days - Increase in hemoglobin level, increase in MCV, increase in ferritin (do repeat CBC at this time)
1-3 months - Repletion of stores (Iron supplements continued for at least 8 weeks) “
"Hereditary anemia involving protein cytoskeleton defect in horizontal interaction of spectrin, protein 4.1, glycophorin C: A. Myelodysplastic syndrome B. Hereditary spherocytosis C. Hereditary elliptocytosis D. Thalassemia "
C
Nelsons p. 2536: Less frequently, elliptocytosis results from mutations in protein 4.1 or glycophorin C, proteins of the junctional complex that link spectrin tetramers to the actin cytoskeleton. These defects in horizontal membrane skeleton protein interactions leave the cell susceptible to shearing forces, leading to the charac- teristic elliptical deformation of the cell and potentially membrane fragmentation.
"Treatment of choice for Severe Factor 8 deficiency is? A. Desmopressin B. FFP C. Cryoprecipitate D. Factor VIII Concentrate "
D
Nelsons 21st p. 2596 Factor VIII concentrate is indicated as treatment and as prophylaxis Mild Factor VIII deficiency may be treated with desmopressin, but is ineffective in moderate to severe Factor VIII.
"Which is NOT a vitamin K-dependent factor A. Factor 9 B. Factor 10 C. Factor 12 D. Factor 7 "
C
“Which of the following statements is TRUE of coagulation defects?
A. The severity of coagulation abnormality appears to be directly proportional to the extent of hepatocellular damage
B. Protime is affected by reduced levels of Factor 8.
C. The bleeding time assesses the function of coagulation factors.
D. All coagulation factors are produced exclusively in the liver including Factor 8
“
A
“PT is not prolonged with deficiencies of factors VIII, IX, XI, and XII.
Bleeding time evaluates platelet function.
Most procoagulants and anticoagulants are produced in the liver except Factors III, IV, and VIII.
“
“Splenectomy in ITP is reserved for
A. Older children with severe ITP lasting more than 2 years
B. Children whose symptoms manifest before 10 year old
C. Patients whose symptoms are not easily controlled with therapy
D. Females beyond the reproductive age
“
C
“Nelsons 21st pg.2613 “The role of splenectomy in ITP should be reserved for 2 circumstances: 1. Older child (>or equal to 4yo) with severe ITP that lasted for more than 1 year (chronic ITP) and whose symptoms are not easily controlled with therapy;
2. When life-threatening hemorrhage (ICH) complicates acute ITP, if the platelet count cannot be corrected rapidly with transfusion of platelets and administration of IVIg and corticosteroids
“
“Hallmark of Hodgkins Disease
a. Birbeck? Granules- langerhans histiocytosis
b. Pseudorosettes- Ependymoma
c. Flexner-Wintersteiner rosette- Retinoblastoma
d. Reed-sternberg cells
“
D
"What is the classic radiographic sign of osteosarcoma? A. Sunburst appearance B. Onion Skin C. Periosteal Inflammation D. Codman triangle "
A
Nelsons 21st ed p.10555 Bone tumor should be suspected in a patient who presents with deep bone pain, often causing nighttime awakening, and has a palpable mass with radiographs that demonstrate a lesion. The lesion may be mixed lytic and blastic in appearance, but new bone formation is usually visible. The classic radiographic appearance of osteosarcoma is the sunburst pattern
"Most common pediatric soft tissue sarcoma a. Ewing sarcoma- t11:22 b. Fibrosarcoma c. Osteosarcoma d. Rhabdomyosarcoma "
D
"Bilateral flank masses, oligohydramnios, and hypertension history in infancy is suggestive of what disease? A. Polycystic kidney disease B. Multicystic kidney disease C. Wilm’s tumor D. Hydronephrosis "
A
"Heme-positive urine without RBC is seen in: A. Methamphetamine toxicity B. Idiopathic calciuria C. Rhabdomyolysis D. Pyelonephritis "
C
"Which of the following is a characteristic of non-glomerular hematuria? A. Blood clots B. Tea-colored urine C. Heavy proteinuria D. Presence of dysmorphic RBCs "
A
"Major cause of hypertension in postreptococcal GN A. Hyperreninemia B. Fluid overload C. Hyponatremia D. None of the above "
B
". Duration of latency period in days of pyoderma-related post-streptococcal AGN: A. 22-28 B. 10 C. 14-21 D. 14 "
A
Nelsons p. 2723: The typical patient develops an acute nephritic syndrome 1-2 wk after an antecedent streptococcal pharyngitis or 3-6 wk after a streptococcal pyoderma.
"Most consistent finding in Post-strep AGN
A. Hematuria
B. Edema
C. Protenuria
D. Hypertension
"A
Nelsons 21st p2723: Severity of kidney involvement varies from asymptomatic microscopic hematuria with normal renal function to gross hematuria with acute renal failure. Depending on the severity of renal involvement the patient can develop varying degrees of Edema, Hypertension and oliguria.
"Persistent Hypocomplementenemia is a feature of a. Acute PSGN b. Alport Syndrome c. IgA Nephropathy d. Idiopathic MPGN "
D
“PSGN- low c3 BUT NOT PERSISTENT, normal c4
Alport syndrome and IgA nephropathy→ normal complement
Fundamentals p.1417. MPGN is also characterized by persistent hypocomplementemia (low serum C3) and the presence of anti-complement C3 nephritic factor (C3NeF) which clearly distinguish it from PSAGN.
“
“Recurrent gross hematuria is seen in:
a. Membranous nephropathy
b. Goodpasture Disease
c. Thin Glomerular Basement Membrane Disease
d. Post-streptococcal Glomerulonephritis
“
C
“Isolated glomerular diseases with recurrent gross hematuria include: IgA nephropathy, Alport Syndrome, Thin Basement Membrane Disease, and PSGN. —> PSGN is not recurrent though
Membranous nephropathy presents as nephrotic syndrome, more common in adults than in children.
Goodpasture disease presents with pulmonary hemorrhage, acute glomerulonephritis (so may also present with hematuria), nephritic urinary sediments with cellular casts, proteinuria and hypertension.
PSGN is the classic example of acute nephritic syndrome characterized by the sudden onset of gross hematuria, edema, hypertension, and renal dysfunction.
Pero keyword dito gross vs microscopic, so not PSGN not MN, end stage na din GPD so more on nephrotic na din.
“
"Most common presenting sign of urolithiasis in pre-school children A. UTI B. Hypertension C. Debilitating flank pain D. Hematuria "
D
“Nelson’s page 2836: “ Children with urolithiasis usually have gross or microscopic hematuria.”
But specifically for pre-school children according to AAP, “Gross or microscopic hematuria is found in 33% to 90% of children who have urolithiasis and occurs equally across age groups. Urinary tract infection frequently is the presenting sign of urolithiasis in preschool-age children.”
Nelsons p2600 (Urinary Lithiasis) Children with urolithiasis usually have gross or microscopic hematuria. If the calculus causes obstruction, then severe flank pain (renal colic) or abdominal pain occurs. The calculus typically causes obstruction at areas of narrowing of the urinary tract—the ureteropelvic junction, where the ureter crosses the iliac vessels, and the ureterovesical junction.
Fundamentals p1442 (Urolothiasis) “As a rule, UTI is the presentation in most children but pain is more common among adolescents "
"Nephrotic range proteinuria > \_\_\_ mg/kg/day a. 30 b. 40 c. 50 d. 20 "
C
“Pedia Nephro book
Proteinuria is detected by dipstick testing 3 or 4+. Quantitative evaluation gives figures ranging from less than 1g to more than 10g/day. The nephrotic range proteinuria is defined as (careful sa units) >50mg/kg/day or >40mg/m2/hr or >30mg/dL "
"What is TRUE about primary nephrotic syndrome? A. Occurs during infancy B. Absence of hypertension C. Absence of systemic disease D. Normal complement levels"
C
“Nelson 21st p2757.
The idiopathic nephrotic syndrome is more common in males than females and most commonly appears between the ages of 2 and 6 years. However it has been reported as early as 6 mo of age and throughout adulthood. MCNS is present in 85-90% of patients <6 years of age
Important features of minimal change idiopathic nephrotic syndrome are the absence of hypertension and gross hematuria.
The urinalysis reveals 3+ or 4+ proteinuria, and microscopic hematuria is present in 20% of children. A spot urine protein:creatinine ratio should be >2.0. The serum creatinine value is usually normal. The serum albumin level is <2.5g/dl, and serum cholestrol and triglyceride levels are elevated. Serum complement levels are normal. A renal biopsy is not usually performed if the patient fits the standard clinical picture of MCNS “
“A 6 week old male, preterm, exclusively breastfed is for discharge from NICU. Which of the following statements does NOT apply to him?
A. He should be on iron supplements
B. He should be given multivitamins
C. He can have as much as 6 bowel movements per day
D. He can feed from his mother as often as he wants.
“
B
"Which breastfeeding position is best for small babies and with feeding difficulties? A. Cradle hold B. Cross cradle hold C. Side lying D. Football hold "
B
Di ko na alam kung saan nila to pinulot.Not in fundamentals, di ko rin mahanap sa nelsons. Found this in a parenting/family website. “The cross-cradle hold, works well for nursing premies, newborns, and babies that have trouble getting latched on.”
“How much Vitamin A should be given to a toddler with measles?
A. 200,000 IU today, tomorrow, and 4 weeks after
B. 200,000 IU one week apart
C. 200,000 IU single dose
D. 200,000 IU 2 consecutive days
“
D
Vitamin A therapy is indicated for all patients with measles. Vitamin A should be administered once daily for 2 days at doses of 200,000 IU for children 12 months of age or older; 100,000 IU for infants 6 months through 11 months of age; and 50,000 IU for infants younger than 6 months of age. (Nelson 21st Chapter 273: Measles)
"Highest specific dynamic action A. Margarine B. Milk C. Meat D. Rice "
C
“Which of the following is TRUE:
A. Breastmilk is low in protein if mother is poorly nourished
B. It contains 1.1% fat, 5% protein, 7% lactose
C. Foremilk is low in fat and high in water content
D. Fat is highest at night
“
C
“https://www.ncbi.nlm.nih.gov/books/NBK539790/
“The breast milk can be divided into the bluish-grey foremilk, present at the beginning of a feed which contains less fat, and the creamy white hindmilk secreted towards the end of a feed that is rich in fat. Breast milk can differ depending on maternal health and diet, environmental exposure, gestational age, and the infant’s age.[5] The breast milk generally consists of 87% water, 3 to 5% fats, 6.9 to 7.2% lactose, 0.8 to 0.9% proteins, vitamins, minerals, and bioactive substances.[6][4][5] It can yield up to 60 to 75 kcal per 100 ml.”
→ Lactose (~7%) > Fats (~4%) > Proteins (~1%), so B is false
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/
“Human milk protein concentration is not affected by maternal diet, but increases with maternal body weight for height, and decreases in mothers producing higher amounts of milk”
→ so A is false
“Fat is the most highly variable macronutrient of milk. Hindmilk, defined as the last milk of a feed, may contain two to three times the concentration of milk fat found in foremilk, defined as the initial milk of a feed”
→ supports C
“A study of milk from 71 mothers over a 24-hour period found that the milk fat content was significantly lower in night and morning feedings compared to afternoon or evening feedings”
→ D is false
Fat content shows significant changes during the night(9); this may, however, be related to changes in frequency of feeding rather than circadian rhythms brought about at a cellular level.(10) In short, researchers are just beginning to discover the many new implications of day/night variation in breast milk.- https://www.llli.org/breast-milks-circadian-rhythms-2/
→ D is false
“
"What are the factors that are inversely related to the water requirements of the body? A. Respiratory rate B. Specific gravity C. Age D. High body temperature "
C
C. Age. Infants have higher water requirements due to larger BSA compared to older children and adults. Inverse relation means as the option goes up, the water requirements go down or vice versa. Increased RR and high body temperature (fever) increase water requirements because of higher insensible losses. A high specific gravity can suggest dehydration, meaning, it needs a higher water requirement
“Which of the following statements defines RDA
A. The amount of various nutrients recommended for individuals
B. The amount of nutrient intake required to promote health in 97.5% of the population
C. The amount of energy required to raise the temperature of water in the body
D. The lowest amount of energy required for optimum health in an individual
“
B
[Nesons] The RDA is an estimate of the daily average nutrient intake that meets the nutritional needs of more than 97% of the individuals in a population, and it can be used as a guideline for individuals to avoid deficiencies
"Which of the following micronutrients should be given in children with recurrent respiratory infections? A. Zinc B. Ascorbic Acid C. Selenium D. Vitamin A "
A
“Measures recommended for teeth protection
A. capping temporary teeth to prevent dental caries
B. fluoride once teeth erupts
C. delay fluoride treatment til 5 yeras to prevent fluorosis
D. dental visit at 2 years of age
“
B
“Which is TRUE about breastfeeding?
A. It promotes high levels of estrogen, promoting a contraceptive effect.
B. The best galactagogue is regular pumping of milk
C. Mothers on anti-TB drugs should not breastfeed.
D. 95% of an infant’s milk needs is provided during the first 5 minutes of breastfeeding.
“
D
“A. It promotes high levels of estrogen, promoting a contraceptive effect. - False! Estrogen levels are LOW when breastfeeding, while prolactin levels are HIGH.
B. The best galactagogue is regular pumping of milk. - False! The best galactagogue is per-demand suckling.
C. Mothers on anti-TB drugs should not breastfeed. - False! They can breastfeed after 2 weeks of TB treatment
Nelson 21st ed. Chapter 113.5: “Nursing at first for least 5 min at each breast is reasonable, allows a baby to obtain most of the available breast contents, and provides effective stimulation for increasing the milk supply.””
"Characteristic of transition milk: A. phosphorus and calcium content similar with colostrum B. 1-4 days postpartum C. lower sugar and fat content D. high immunoglobulin, especially IgA "
A
"Transmitted through breastmilk: A. Cephalexin B. Mefenamic acid C. Cefuroxime D. Cotrimoxazole "
D
“Cephalexin: “̌Limited information indicates that maternal cephalexin produces low levels in milk that are usually not expected to cause adverse effects in breastfed infants.”
Mefenamic acid: “Milk samples taken 2 hours after the first dose of each day found average mefenamic acid milk levels of 170 mcg/L (range 30 to 660 mcg/L), although these levels might be inaccurate because the concentration measured in blank milk samples in this study was 200 mcg/L and potentially active metabolites were not measured.”
Cefuroxime: “Limited information indicates that cefuroxime produces low levels in milk that are not expected to cause severe adverse effects in breastfed infants.”
Cotrimoxazole: “In 20 mothers in the immediate postpartum period given oral trimethoprim, peak milk levels occurred 3 hours after the dose. In 14 of these women who received a daily dosage of 320 mg, the peak milk level averaged 2.4 mg/L and the trough averaged 1 mg/L. In 6 other women who received a daily dosage of 480 mg, the peak milk level averaged 4 mg/L and the trough averaged 1.5 mg/L. The authors calculated that a breastfed infant would receive a daily dosage of 0.75 mg with a maternal dosage of 320 mg daily and 1.7 mg with a maternal dosage of 480 mg.”
“
"Which micronutrient is supplemented in all breastfeeding babies? A. Iron B. Vitamin D C. Vitamin A D. Zinc "
B
"Atypical pneumonia in neonates is commonly caused by: A. Chlamydia B. RSV C. Streptococcus D. Mycoplasma "
A
“Nelsons 21st ed Chapter 129
In contrast to the rapid progression of pneumonia caused by pyogenic organisms, an indolent course may be seen in nonbacterial infection. The onset can be preceded by upper respiratory tract symptoms or conjunctivitis. The infant may demonstrate a nonproductive cough, and the degree of respiratory compromise is variable. Fever is usually absent or low grade, and radiographic examination of the chest shows focal or diffuse interstitial pneumonitis or hyperinflation. Infection is generally caused by C. trachomatis, CMV, Ureaplasma urealyticum, or one of the respiratory viruses. Rhinovirus has been reported to cause severe respiratory compromise in infants, particularly those who are preterm. Although Pneumocystis (carinii) jiroveci was implicated in the past, its etiologic role is now in doubt, except in newborns infected with HIV
“
"Which of the following drugs is NOT recommended for maintenance therapy in asthma? A. Budesonide B. Fluticasone C. Salmeterol D. Montelukast "
C
"What is the FiO2 at 5lpm via face mask? A. 50 B. 40 C. 60 D. 30 "
B
Formula: FiO2= 20% + (4 X oxygen liter flow)
"1 week old with 6 episodes of loose stools with good suck and activity A. Common in age group B. Consider sepsis C. Change to lactose free formula D. ORS "
A
“Nelson 21st p1901
Stool frequency is extremely variable in normal infants and can vary from none to 7 per day. Breastfed infants can have frequent small, loose stools early (transition stools), and then after 2-3 wk can have very infrequent soft stools. Some nursing infants might not pass any stool for 1-2 wk and then have a normal soft bowel movement. The color of stool has little significance except for the presence of blood or absence of bilirubin products (white-gray rather than yellow-brown)”
"Which among the pairs of breastmilk storage and duration is correct? A. Room Air - 4 hours B. Cold storage freezer - 6mos C. Refrigerator -48h D. Freezer -8mos "
B
“Room temp (<25C) - 4 hours
Room temp(>25C)- 1 hour
Refrigerator (4C)- 8 days
Freezer compartment of a 1-door ref- 2 weeks
Freezer compartment of a 2-door ref- 3 months
Deep freezer with constant temp (-20C)- 6 months
“
"Which of the following components of breastmilk help in protecting the infant against bacterial infection? And diarrhea A. Oligosaccharide B. Lysozyme C. Lactobacillus D. Lactoferrin "
B
"Bilateral flank masses, oligohydramnios, and hypertension history in infancy is suggestive of what disease? A. Polycystic kidney disease B. Multicystic kidney disease C. Wilm’s tumor D. Hydronephrosis "
A
"Which of the following drugs can be used by intermittent asthmatics? A. Ciclesonide B. Fluticasone + salmeterol C. Terbutaline D. Budesonide + formoterol "
C
“D can be used as step 1 controller + reliever drug for adolescents based on 2020 GINA, but not for 6-11yo
For 6-11yo, SABA PRN pa rin treatment of choice for step 1
Terbutaline is a SABA→ yes ang answer ko rin dito is Terbutaline, given that the question asked specifically for intermittent
“
“TRUE of Prolactin:
A. Responsible for milk let down
B. Stimulated by decreased progesterone
C. Produced by the posterior pituitary gland
D. Causes contraction of the neuroepithelial cells surrounding the alveoli
“
B
“(Nelson 21st Chapter 572: Hormones of the Hypothalamus and Pituitary)
…Five cell types in the anterior pituitary produce 6 peptide hormones (growth hormone, prolactin, thyroid-stimulating hormone, adrenocorticotropic hormone, luteinizing hormone, follicle-stimulating hormone)…
…The primary physiologic role for Prolactin is the initiation and maintenance of lactation. It prepares the breasts for lactation and stimulates milk production postpartum. During pregnancy, prolactin stimulates the development of the milk-secretory apparatus, but lactation does not occur because of the high levels of estrogen and progesterone. After delivery, the estrogen and progesterone levels drop and physiologic stimuli such as suckling and nipple stimulation signal prolactin release and initiate lactation.
…Oxytocin stimulates uterine contractions at the time of labor and deliv- ery in response to distention of the reproductive tract and stimulates smooth muscle contraction in the breast during suckling, which results in milk letdown. Studies suggest that oxytocin also plays a role in orgasm, social recognition, pair bonding, anxiety, trust, love, and maternal behavior. Most recently, through the interaction with its G-protein-coupled receptor in pancreatic and adipose tissue, oxytocin appears to play a significant role in appetite regulation and obesity by inducing anorexia.
“
"Definitive management pneumothorax A. FiO2 100% B. Chemical pleurodesis C. CTT D. Serial needle aspiration "
C
“Nelson 21st; page 2320:
- If the pneumothorax is recurrent, secondary or under tension, or there is more than a small collapse (other term for big/massive? haha), chest tube drainage may be necessary. - so CTT
- In case of recurrent pneumothorax, a sclerosing procedure may be indicated to induce the formation of strong adhesions between the lung and the chest wall with the introduction of talc, doxy, iodopovidone into the pleural space (chemical pleurodesis). - MASSIVE naman ang sa question, not RECURRENT
“
"A 5-day old preterm neonate who is hospitalized, given IV hydration and antibiotics suddenly developed jitteriness. What is the possible cause? A. Hypokalemia B. Hyponatremia C. Hypomagnesemia D. Hypocalcemia "
D
“A 4 year old female weighing 14kg consulted for pallor. Her hemoglobin is 10mg/dl and hematocrit 0.31 and PBS revealed microcytic hypochromic RBCs. What should be the management?
A. Elemental zinc 20mg for 2 weeks
B. Vitamin D daily
C. Green leafy vegetables and chicken liver regularly
D. Elemental zinc 14mg daily
“
C
"Can lower pulmonary hypertension A. Magnesium B. Chromium C. Manganese D. Copper "
A
"Which among the following is the early sign of Vitamin A deficiency? A. Bitot’s spot B. Xerophthalmia C. Nyctalopia D. Xerosis Conjunctivae "
C
”
Nelson 21st p363.
The most characteristic and specific signs of vitamin A deficiency are eye lesions, but these may manifest rather late in the progression of vitamin A deficiency, develop insidiously, and rarely occur before age 2 yr. An earlier symptom of vitamin A deficiency is delayed dark adaptation, as a result of reduced resynthesis of rhodopsin; this may progress to night blindness.”
"Vitamin D deficiency does not present with A. Frankel line B. Caput quadratum C. Pot belly D. Harrisons groove "
A
“A. Frankel line: dense zone of provisional calcification found in scurvy. Vit C def
B. Caput quadratum-Rounded prominence of the frontal and parietal bones in an infant’s cranial vault from untreated Vit D deficiency.
C. Pot belly-Bowed legs, a waddling gait, pot belly, and disturbed growth in children affected by Rickets.
D. Harrisons groove- Formation of Harrison sulcus (or groove) at the lower margin of the thorax caused by the muscular pull of the diaphragmatic attachments to the lower ribs found in Vit D def.
“
"Acanthosis nigricans is commonly seen in deficiency of which vitamin? A. Vitamin E B. Vitamin K C. Zinc D. Copper "
(NOTA)
Vitamin D deficiency
