13 ⼀PEDIATRICS COPY

Question 1

What is the treatment for Developmental Dysplasia of Hip?

Answer 1

Pavlik Harness tat holds hip in flexion and ABduction

Question 2

What demographic is affected by Hypertrophic Pyloric Stenosis ?

Answer 2

[3-6 week old boys]

Question 3

describe Puberty timeline for females (4)

Answer 3

[8-12 yof: breast + pubic hair]

–(within 2.5y)–>

growth spurt ->

MENARCHE
_________________

1º amenorrhea = NO MENSES + ([≥15y with F∆] or [≥13y with no F∆])

Question 4

What does Constitutional Short Stature refer to

Answer 4

“late bloomer” but will attain normal adult height later

pts have normal birth wt and ht but ht velocity slows between 6 mo-3 yo, picks back up after and slows again at adolescence. bone radiographs will show delayed bone age

Question 5

[Genu Varum] is normal during age ⬜ and presents as (⬜3) . When should this correct by?

Answer 5

0-2 yo ; [BL symmetric bow leg, normal stature, no lateral thrust]
_________________
should correct by 2 yo

obtain XR if > 2 yo, short stature or uL

Question 6

Newborn failure to pass meconium within 48 hours of birth likely indicates ⬜

MOD

Answer 6

Hirschsprung Disease

________________

[absence of ganglion cells in rectosigmoid (confirmed by rectal suction biopsy)] ➜ transition zone cutoff between

[narrow aganglionic rectosigmoid] and [markedly dilated innervated descending colon] EARLY AFTER BIRTH

Question 7

Craniopharyngioma etx

Answer 7

Calcified low grade malignancy dervied from epithelial remnants of Rathke pouch within the pituitary stalk and reside in the SUPRAsellar region

Question 8

Marfan Syndrome and Ehlers Danlos can present similarly

How do you discern the two?-2 ; What is the etx for Ehlers Danlos?

Answer 8

“Marfan BAATHES a lot! “

BUT Ehlers Danlos does NOT have

1. Ectopia Lentis
2. Arm-to-Height Ratio that’s INC

Ehlers Danlos etx = defective collagen production

Question 9

diagnostic criteria for suspected septic joint
_________________

empiric abx for septic joint​

Answer 9

[WBC >50K^{neutrophil predominance}] in [aspirated joint synovial fluid]
_________________

Vanc IV​

Question 10

cp for [Measles rubeOla] -2

Answer 10

[fever + conjunctivitis + coryza + Koplik spots + cough] prodrome –(2-4days)–> [maculopapular rash sspreading head to body]

________________

tx = supportive +/- [Vitamin A if hospitalized]

Question 11

After successfully treating Acute Otitis Media, how should you manage a patient who p/w persistent middle ear fluid build up?
_________________

Explain why

Answer 11

WATCHFUL WAIT X 3 MO after treatment
_________________

serous fluid may persist in middle ear up to (but usually self limited to) 3 mo after treatment (= [serous otitis media with effusion] ).

further w/u if: infection / BL effusion / sx > 3 mo

Question 12

Risk factors for Developmental Dysplasia of Hip - 3

________________

when should you stop screening for this?

Answer 12

1. Breech Delivery - GET HIP IMAGING IF FEMALE AND BREECHED
2. Female - GET HIP IMAGING IF FEMALE AND BREECHED
3. Fam hx

12 months old

Question 13

Dx Criteria for Kawasaki Disease

Answer 13

{[4_/5 CRASH] + [Burning HIGH Fever ≥ 5 days]}

• Conjunctivitis
• Rash
• Adenopathy uL in cervical region (least likely)
• Strawberry tongue/oral mucosa changes
• Hand/Feet redness or swelling
• THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION*

Question 14

Meckel’s Diverticulum etx

tx = surgery

Answer 14

failure of vitelline duct to obliterate during first 8 WG ➜ leaves behind RLQ [ectopic gastric tissue in a blind pouch] ➜ mucosal irritation and bleeding from gastric acid➜ [PAINLESS HEMATOCHEZIA IN 2 Y/O]

Question 15

Malrotation and Volvulus are both diagnosed with ⬜

Describe how both would look on this diagnostic?

Answer 15

Upper GI Series barium swallow

________________

Malrotation = Ligament of Treitz on the R side of the abd in a gasless abd

________________

Volvulus = corkscrew image on barium swallow Upper GI series

Question 16

management of

pediatric functional constipation (3)

Answer 16

1st: dietary ∆
2nd: Osmotic Laxatives

ACUTE DISIMPACTION: STIMULANT LAXATIVE
_________________

dietary ∆ = [⇪ fiber/water] ​​| [cow’s milk< 24oz]

Question 17

How do you manage infants born to Mothers with Active Hepatitis B (4)
_________________

How do you determine if the infant was vertically infected? ​

Answer 17

infant receives

1. [AT BIRTH (within 12h of delivery) [HBVIG and HBVV₁]]
2. [2 mo HBVV₂]
3. {[6 mo HBVV₃]
4. –(3 months later)–> [9 mo obtain HBV Surface antigen]}​
   _________________

if [HBsAg] positive = HBV VERTICALLY INFECTED!

Question 18

Annual Influenza vaccine is recommended for kids age ⬜ for what purpose?

Answer 18

≥6 month old ; prevent [infection and spread] to at-risk populations (asthma/chronic illness/<2 yo)

Question 19

Hypetrophic Pyloric Stenosis cp (6)

Answer 19

1. age 3-6 weeks old
2. [POSTPRANDIAL PROJECTILE NONBILIOUS EMESIS]
3. [“Hungry Vomiter” (hunger immediately after vomiting)]
4. [Epigastric Palpable Olive mass]
5. Visible peristalsis
6. [hypOchloremic hypOkalemic metabolic alkalosis]

​
_________________
[dx = US] | [tx = IVF ➜ Pyloromyotomy]

Question 20

FPIAP is a ⬜ reaction to ⬜ that presents in normal infants as ⬜ . The treatment in formula-fed infants is ⬜

FPIAP = Food Protein Induced Allergic Proctocolitis

Answer 20

[non-IgE allergy] ; [milk protein (cow’s milk or soy protein)] ; blood-streaked stools ; Extensively Hydrolyzed Formula

FPIAP = non-IgE rxn to milk protein (casein/whey) = no skin/pulm rxn

Question 21

Slipped Capital Femoral Epiphysis is a complication of childhood obesity

When does this present?

________________

How does this present?

________________

dx?

Answer 21

puberty (most common hip disorder in fat teens!)

________________

[M: Months of vague hip/knee pain] without acute onsets

________________

pelvis XRay

fat teen ➜ [ANT SUP slippage of femoral neck] ➜ [POST INFERIOR displacement of Femoral head] ➜ [Months of vague hip/knee pain]

Question 22

Oligohydramnios –> ⬜ sequence.

Name the 3 most common causes of Oligohydramnios

Answer 22

Oligohydraminos –> POTTER Sequence

POSTERIOR URETHRAL VALVES are the most common cause of obstruction in newborn boys (which causes renal damage –> oligohydramnios during utero)

Question 23

Oligohydramnios –> ⬜ sequence.

Name the 3 most common causes of Oligohydramnios

Answer 23

Oligohydraminos –> POTTER Sequence

POSTERIOR URETHRAL VALVES are the most common cause of obstruction in newborn boys (which causes renal damage –> oligohydramnios during utero)

Question 24

What is [Impetigo Diaper Dermatitis]?

________________

Tx? -3

Answer 24

secondary bacterial diaper infection (by Staph > GASP) characterized by honey-crusted papules and pustules (and in neonates can be c/b sepsis)

________________

• skin :* [Topical Mupirocin] or [PO Cephalexin]
• [skin+ sepsis s/s]*: [Admit for IV Abx and sepsis w/u]

________________

sepsis s/s = [neonatal fever/irritability/lethargy]

Question 25

Both Croup Laryngotracheitis and Epiglottitis can cause inspiratory stridor How do you discern the two?

Answer 25

Epiglotitis causes **Drooling!**

Question 26

Language delay in any child warrants ⬜

Answer 26

Audiology

Question 27

2 main sx of Bronchiolitis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ cause?

Answer 27

1. [Wheezing w/respiratory distress] 2. Fever \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ RSV

Question 28

[Clubfoot Equinovarus] is a deformity of the ⬜ bone which results in what clinical presentation? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx for this?

Answer 28

Talus; *PIA* BL feet [**P**lantar flexed + **I**nverted + **A**DDudcted] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ serial Foot Cast

Question 29

In a neonate, when should compressions be started?

Answer 29

HR \<60

Question 30

There are 5 major complications of Kawasaki Disease In order of GREATEST to least, list them

Answer 30

{[4_/5 **CRASH**] + [**B**urning HIGH Fever ≥ 5 days]} * * * [CNS ∆(irritability/aseptic meningitis)] \> [**CORONARY ARTERY ANEURYSM** **(within 1-4 wks!)**] \> Liver dysfxn \> Arthritis \> GallBladder Hydrops \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION*

Question 31

In Infants, what is "Periodic Breathing" ?

Answer 31

***BENIGN*** physiologic breathing pattern in young infants in which they demonstrate (➜ [**breath pause x 5-10 seconds**] ➜ [rapid shallow breaths x 10-15 seconds] ➜) x several cycles before returning to normal breathing

Question 32

Which diseases in kids involve rash involving palms and soles - 4

Answer 32

1. Kawasaki 2. Enteroviruses 3. Syphilis 4. Rocky Mountain Spotted Fever

Question 33

⬜ is a [pediatric renal tumor that crosses the midline] and presents in the ⬜ year of life

Answer 33

Neuroblastoma \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ first

Question 34

Explain why [unconjugated Bilirubin] in newborns is physiologically elevated -3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How does phototherapy treat this?

Answer 34

- liver immaturity - lack of intestinal bacteria to catabolize bilirubin - high hgb turnover (will ⇪ if cephalohematoma present) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ phototherapy converts bilirubin ➜ [water soluble bilirubin] ➜ excrete in urine and stool

Question 35

The 2 major causes of [bloody stool \< 6 month old are **FPIAP**] and **⬜** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What is the long term prognosis of an infant with FPIAP? *FPIAP = Food Protein Induced Allergic Proctocolitis*

Answer 35

Anal fissure \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [self limited to 2 weeks] & they will be able to tolerate milk protein **BY 1 YEAR OLD** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *FPIAP = non-IgE rxn to milk protein (casein/whey) = no skin/pulm rxn*

Question 36

A child comes in with neonatal conjunctivitis DDx?-3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How do you differentiate each?

Answer 36

Question 37

Based on PECARN rule, name the [high risk Pediatric TBI features] for [2 -18 yo] (5)

Answer 37

*high risk Ped TBI = [noncontrast head CT (or 5h obs if med risk)]*

Question 38

List the Vaccines that are *Live Attenuated*

Answer 38

**RM V RM** **R**ubella **M**easles rubeOla **V**aricella **R**otavirus **M**umps \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Pregnant Women should NOT get Live attenuated vaccines but their household contacts SHOULD as this is less severe than wild-type*

Question 39

explain why early environmental exposure for newborns is important

Answer 39

Normal newborn immunity is polarized toward [Th2 response ( which will ➜ ATOPY = IgE, mast cell, eosinophil production) = Asthma/Eczema/Allergic Rhinitis] BUT this is balanced by the [Th1 cytokine profile] you can only develop from **exposure to nonpathogenic microorganisms**

Question 40

*APGAR is used to assess newborn status immediately postpartum* Describe the grading system for **A**ctivity & tone?

Answer 40

APG**A**R ## Footnote 0 = no motion 1 = arms & legs **flexed** but not active 2 = Active Motion of extremities

Question 41

*infant presents with refractory candidiasis* suspected diagnosis?

Answer 41

infant HIV

Question 42

PSGN-PiG is a compliation of ⬜ that typically presents with (⬜3) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What's the treatment for PSGN-PiG? (2)​

Answer 42

GASP ; [(Hematuriiia with low complement) / Edema/ HTN] Tx = Supportive + Furosemide​ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ MOD: [IgG-C3-antigen] lodges into glomerular capillaries and recruits C5a complement ➜ damage ➜ gross hematuria + inappropriate RAA activation ➜ Na+ retention ➜ fluid retention]

Question 43

Malrotation and Volvulus are both diagnosed with ⬜ What would Volvulus look like on this diagnostic?

Answer 43

[Upper GI series barium swallow] corkscrew image *Try not to use CT scans in kids*

Question 44

What is the treatment for BreastMilk Jaundice?

Answer 44

**OBSERVATION** | (*BMJ is self limited to 3 mo :-)*)

Question 45

What microbes are the most common causes of serious bacterial infection in [neonates LOE 28 days]? -3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Name abx for each -3

Answer 45

1. GBS = Ampicillin 2. Listeria = Ampicillin 3. E Coli = [Gentamicin {or CefoTaxime/CefTazidime if meningitis suspected}]

Question 46

Precocious puberty is (premature) development of 2º sex characteristics in girls age ⬜ and boys age ⬜ ​ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What's the treatment of *central* Precocious puberty?​

Answer 46

g\< 8 ​| b\< 9 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [GnRH R agonist]​ ## Footnote (*binds to hypothalamus GnRH Receptors ➜ negative feedback ➜ ⬇︎GnRH secretion ➜ ⬇︎LH/FSH*)

Question 47

clinical features of Down Syndrome (7)

Answer 47

**SHALA H**as **D**own syndrome ## Footnote 1. [**SEPTAL ENDOCARDIAL CUSION DEFECT]** 2. **H**irschsprung's disease 3. **A**tlanta-axial instability 4. [**L**eukemia (LATER IN LIFE!)] 5. [***A***ltered Psyche (Autism/ADHD/Alzheimer-like dementia)] 6. **h**ypOthyroid 7. **D**uodenal atresia

Question 48

diagnostic criteria for SIDS \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Sudden Infant Death Syndrome*

Answer 48

[Sudden *unexplained* (Infant\<12 mo) Death with inconslusive autopsy]

Question 49

What are the recommendations regarding Patient Confidentiality and Adolescents?

Answer 49

MD should honor [Adolescent Patient Confidentiality] for care regarding [**SEX**, **DRUGS** and **PSYCH**] **BUT MUST BREAK AND ALERT PARENTS IF AT RISK FOR HARM TO SELF OR OTHERS** *(pregnancy/contraception, STI, substance abuse/mental health)*

Question 50

# Kawasaki dx = [4/5 CRASH] + [Burning HIGH fever ≥5d] Recite the very important caveat regarding incomplete diagnostic criteria for Kawasaki Disease (4)

Answer 50

KD dx normally requires: {[4/5 *CRASH*] + [*Burn*ing HIGH fever ≥5d]} ## Footnote * * * ▶but Because Kawasaki Disease sx do NOT manifest simultaneously → _[dx caveat]_ = ▶if {[\<4 *CRASH*] is present **BUT** pt does have [*Burning* HIGH fever ≥5d]} ▶= ["*febrile vasculitis of uncertain etiology"*]→ ⭐[obtain CRP, ESR and f/u daily to reassess for onset (or not) of final criterion]

Question 51

Congenital Toxoplasmosis is given to baby via ⬜ but acquired by Mom via ⬜-3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Sx-4

Answer 51

Transplacental - Raw undercooked meat - unwashed produce (contaminated soil) - cat feces \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Tox- **HICH*** **H**ydrocephalus **I**ntracranial Calcifications **C**horioretinitis (also **H**earing impairment)

Question 52

*child presents with 2º enuresis* DDx? -2 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *2º enuresis = bed wetting ≥5 yo after established period of nighttime dryess*

Answer 52

DM (*order CBC/CMP*) vs psychological stressor (*I.e. parents' divorce*)

Question 53

What is the most common cause of hip pain in kids? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Dx?

Answer 53

Transient Synovitis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Clinical **but obtain Xray to r/o Legg Calve Perthes** *may have ⬆︎inflammatory markers but xrays will be normal*

Question 54

Because of serious possible sequelae associated with Kawasaki disease (*Coronary artery aneurysms*), ⬜ must be performed at ⬜ , ⬜ and ⬜.

Answer 54

TTE; [baseline, 2^{w after tx}, 6^{w after tx}] * * * [4/5 **CRASH**] & [**B**urning HIGH Fever ≥ 5 days] sl;l

Question 55

What is the mngmt for an ingested coin? - 3

Answer 55

1. Obs for up to 1 day after ingestion UNLESS 2. Pt is symptomatic = flexible endoscopy 3. Pt has no recollection of ingestion time = flexible endoscopy

Question 56

Risk factors for Developmental Dysplasia of Hip - 3 ; when should you stop screening for this?

Answer 56

1. **Breech Delivery** - GET HIP IMAGING IF FEMALE AND BREECHED 2. Female - GET HIP IMAGING IF FEMALE AND BREECHED 3. Fam hx 12 months old

Question 57

Why can't Ceftriaxone be used during the 1st month of life?

Answer 57

Ceftriaxone can displace albumin-bound bilirubin ➜ allows free bilirubin to cross blood brain barrier ➜ Kernicterus

Question 58

*Cerebral Palsy is a group of clinical syndromes generally characterized as ⬜* How does it present? - 3

Answer 58

Nonprogressive motor dysfunction (Prematurity\>EtOH = RF) ; ## Footnote Cerebral Palsy is **SAD** 1. BL equinovarus club feet (image) 2. UMN signs LE \>UE 3. Mental Retardation *Greatest RF = prematurity ( \< 32 wks gestation)*

Question 59

In Infants, what is [Apnea of Prematurity]?

Answer 59

[**TRUE** apnea episodes ≥20 seconds] in premature infants, that resolves by [corrected gestational age 37 WG]

Question 60

What is Osgood Schlatter Disease

Answer 60

**Traction apophysitis of the tibial tubercle** from Self-limited irritation of the growth plate at the tibial tuberosity (front of tibia) possibly --\> hard nodule, relieved with rest/growth spurt ## Footnote *xray: lifting of tubercle from the shaft*

Question 61

Dx for Intussuception

Answer 61

**AIR** contrast enema ultrasound guided ## Footnote Intussuception age = 3-36 mo Look for the Target Sign on US!

Question 62

DDx for neonatal rectal bleeding - 4

Answer 62

1. **[\*\*Milk/Soy ALLERGIC Proctocolitis\*\* = PAINLESS]** 2. Meckel Diverticulum = PAINLESS 3. Volvulus (bloody stool from intestinal ischemia) 4. Intussuception (dx= AIR contrast enema)

Question 63

*APGAR is used to assess newborn status immediately postpartum* Describe the grading system for **G**rimace & reflex irritability?

Answer 63

AP**G**AR ## Footnote *Test response to stimulation (i.e. pinch)* 0 = no rxn 1 = grimace 2 = grimace **AND** cough/cry/sneeze

Question 64

A: **Potters Sequence** etx B: Clinical Presentation - 6

Answer 64

A: [Fetal **R**enal Agenesis bilaterally / Dysfunction] --\> Oligohydraminos (No Amniotic Fluid) B: **POTTER** **P**ulm hypOplasia **O**ligohydraminos **T**wisted Face **T**wisted and shortened Limbs **E**ars set low **R**enal agenesis = cause

Question 65

What is the mngmt for an ingested coin? - 3

Answer 65

1. Obs for up to 1 day after ingestion UNLESS 2. Pt is symptomatic = flexible endoscopy 3. Pt has no recollection of ingestion time = flexible endoscopy

Question 66

by age ⬜ , full term infants should be able to sleep thru the night without overnight feeds If they can't, how do you change this?

Answer 66

6 months old \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ AVOID OVERNIGHT FEEDS (do NOT offer feeding during nocturnal awakenings. Just check on baby)

Question 67

In terms of etiology, what is a difference between Breastfeeding Failure jaundice and Breast Milk jaundice?

Answer 67

B**F**F jaundice within the **F**irst week of life: inadequate feeding --\> inadequate stooling --\> ⬇︎bilirubin elimination --\> ⬆︎Unconjugated bilirbuin recycling with **F**ailure to thrive/dehydration

Question 68

Tx for Croup-2

Answer 68

1. Mild = Humidified air +/- CTS 2. \> Mild = CTS +/- Racemic Epi nebulized ## Footnote *Croup = paraflu that --\> subglottic edema and narrowing*

Question 69

Common characteristics of Down Syndrome pts - 7

Answer 69

the **SHEEPPS** of genetics 1. **S**kin excessive at the nape of the neck = nuchal skin 2. **H**ypOtonia w/ ⬇︎ Startle Moro reflex 3. **E**picanthal folds 4. **E**ars that are small 5. **P**rotruding tongue w/flat face 6. **P**alpebral fissures are upslanted 7. **S**ingle palmar crease *these pts also have ⬆︎risk for hypothyroidism*

Question 70

What are the 2 major complications of Mumps

Answer 70

1. Orchitis 2. Aseptic Meningitis

Question 71

in newborns, bilirubin greater than ⬜ ➜ ⬜. Describe this condition \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ management?

Answer 71

[20-25] ➜ [Kernicterus bilirubin encephalopathy] *(mvmnt DO and hearing loss)* *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* Exchange Transfusion *exchanging [blood with SEVERE HYPERBILIRUBINEMIA and/or DAT+ maternal Ab] from baby and transfusing baby with replacement RBC*

Question 72

cp for neonatal Lactose Intolerance - 3

Answer 72

1. **NONBLOODY** diarrhea 2. flatulence 3. crampy abd pain ## Footnote *Lactose Intolerance = no Lactase ➜ NONBloody Flatulence & Diarrhea*

Question 73

What is the tell tale sign of child abuse

Answer 73

**SUDDEN CHANGE IN BEHAVIOR** ## Footnote (RISQUE SEXUAL BEHAVIOR/IRRITABILITY/CONCENTRATION ⬇︎)

Question 74

[Strabismus ocular misalignment] after the age of ⬜ is abnormal and requires intervention to prevent ⬜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Which intervention is employed for this? - 3

Answer 74

4 mo ; Amblyopia(vision loss from disuse of the deviated eye) 1. CTL eye patch to strengthen deviated eye OR 2. CTL cycloplegic eye drops (blurs normal eye to strengthen deviated eye) 3. Corrective lens Dx = asymmetric corneal light reflex

Question 75

At what age should you be concerned for an infant not walking yet? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What age do infants usually learn to walk?​

Answer 75

\> 16 mo \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ​9-16 mo

Question 76

Pts who've recovered from RSV Bronchiolitis are at ⇪ risk for recurring ⬜. Ergo, ⬜ should be avoided

Answer 76

WHEEZING; cigarette smoke (and other airway reactivity triggers)

Question 77

Osgood Schlatter Disease tx -3

Answer 77

1. NSAIDs 2. Ice 3. self-limited (stops with end of growth spurt) ## Footnote *xray: lifting of the tibial tubercle from the shaft*

Question 78

Peds with untreated iron deficiency anemia are at INC risk for what 2 comorbidites? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How is this mitigated? -3

Answer 78

psychomotor delay neurocognitive impairment \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [universal screening starts age 1 yo] --(if hgb \<11)--\> [PO ferrous sulfate] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *IDA is the most common nutritional deficiency in kids*

Question 79

*Slipped Capital Femoral Epiphysis is a complication of childhood obesity* MOD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ management?

Answer 79

fat teen ➜ [ANT SUP slippage of femoral neck] ➜ [POST INFERIOR displacement of Femoral head] ➜ [Months of vague hip/knee pain] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [surgical pinning **within 24 HOURS**]

Question 80

Reconstruction of cleft lip is generally performed at (⬜age)

Answer 80

10 weeks old \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (in accordance with rule of 10s = 10 lbs|10 weeks old|10 g hgb)

Question 81

*APGAR is used to assess newborn status immediately postpartum* Describe the grading system for **A**ppearance?

Answer 81

**A**PGAR ## Footnote 0 = entirely blue 1 = pink with blue extremities 2 = entriely pink

Question 82

What is the most common congenital cyanotic heart defect in the neonatal period?

Answer 82

Transposition of Great Vessels ## Footnote *Look for the **single Loud second heart sound!***

Question 83

Malrotation and Volvulus are both diagnosed with ⬜ What would Volvulus look like on this diagnostic?

Answer 83

[Upper GI series barium swallow] corkscrew image *Try not to use CT scans in kids*

Question 84

What is Erythema Toxicum Neonatorum ; tx?

Answer 84

benign neonatal rash with blanching erythematous papules and/or pustules ; self limited to 2 weeks after birth

Question 85

cp for Reye syndrome - 2

Answer 85

1. [**⇪ ICP** → encephalopathy, seizure, vomiting, lethargy --\>eventually DEATH] 2. **liver dysfunction**

Question 86

Bronchiolitis is an ⬜ respiratory infection that occurs in the ⬜ by the ⬜ virus What are the s/s ? (4)

Answer 86

lower; **W**inter ; RSV \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**W**et nose (rhinorrea)] ​| [**W**heezing (possibly recurring)] ​| **W**OB⇪ *dx = clinical \> nasal/pulmonary antigen test*​

Question 87

[T or F] UNILATERAL cervical LAD in kids (typically from ⬜ bacteria ) is not common and needs further workup

Answer 87

FALSE! \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ped uL cervical LAD (typically from **Staph** \> GASP) is common

Question 88

*APGAR is used to assess newborn status immediately postpartum* Describe the grading system for **R**espiration?

Answer 88

APGA**R** ## Footnote 0 = not breathing 1 = breathing slow/irregular 2 = crying

Question 89

*Slipped Capital Femoral Epiphysis is a complication of childhood obesity* When does this present? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How does this present? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ dx?

Answer 89

puberty (most common hip disorder in fat teens!) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [M: **Months of vague hip/knee pain**] without acute onsets \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ pelvis XRay *posterior displaement of capital femoral epiphysis thru cartilage growth plate*

Question 90

Identify causes of this rash - 3

Answer 90

**THE STRAWBERRY TONGUE!** 1. GASP +/- mononucleosis 2. Kawasaki disease 3. Toxic Shock Syndrome

Question 91

Oligohydramnios --\> ⬜ sequence. Describe this clinical presentation for this Sequence

Answer 91

Oligohydraminos --\> **POTTER** Sequence **P**ulmonary hypOplasia **O**ligohydraminos from renal agenesis/damage (cause) [**T**wisted Face & Extremities] **T**wisted Skin **E**ars set low **R**enal Failure

Question 92

Based on PECARN rule, name the [high risk Pediatric TBI features] for [0 -1y 11m] (5)

Answer 92

Question 93

At what point, should you consider Antibiotic prophylaxis (*continuous vs postcoital*) for young female patients with recurrent UTI? (2)

Answer 93

[≥ 2 UTI in 6 mo] OR [≥3 UTI in 1 year] *obtain further diagnostics if c/f nephrolithiasis or obstruction*

Question 94

Necrotizing Enterocolitis cp - 3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ X ray finding?

Answer 94

1. Bloody stools 2. feeding intolerance 3. abd distension X-ray = Pneumotosis Intestinalis Risk factors= prematurity, congenital heart disease, hypotension

Question 95

Neonatal Respiratory Distress Syndrome is caused by ⬜ What are the major risk factors?-2

Answer 95

Surfactant Deficiency 1. Prematurity 2. Maternal DM

Question 96

What is Legg Calve Perthes Disease? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Demographic? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ mngmt-2?

Answer 96

Avascular necrosis of the Capital Femoral Epiphysis ; [Boys 4-10 yo) ; 1. Self limited but can --\>deformity/degeneration 2. contain femoral head within acetabulum during encounter

Question 97

How do you manage a choking child? (2)

Answer 97

*IF UNCONSCIOUS = CPR!*

Question 98

Name the markers of onset Puberty for Girls \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Boys

Answer 98

[girls: Breast by 12 yo] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [boys: testicular enlargement (≥4 mL) by 14 yo] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *delayed secondary sexual characteristics + delayed XR bone age = [Constitutional Delay of Puberty]*

Question 99

cp for Meckel's Diverticulum \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ dx

Answer 99

PAINLESS hematochezia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ technetium 99 pertechnetate scan

Question 100

What's used to keep the PDA Patent?

Answer 100

Prostaglandin E1

Question 101

Describe the best approach to [Vaccine Refusal/Hesitancy] (4) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 101

1. [**LISTEN** OPENLY to (parental) concerns] 2. [**CORRECT** misinformation (*i.e. Autism/Overload/Natural immunity*)] 3. [**DISCUSS** risk/benefits of immunization] 4. [**CONTINUE** ONGOING DIALOGUE AT SUBSEQUENT VISITS DESPITE INITIAL REFUSAL]

Question 102

cp for Meckel's Diverticulum \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ dx

Answer 102

PAINLESS hematochezia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ technetium 99 pertechnetate scan

Question 103

McCune-Albright Syndrome clinical features (3)

Answer 103

Question 104

cp for Congenital Rubella Syndrome (6)

Answer 104

***[BL cataracts]*** ***[sensorineural hearing loss]*** ***[patent ductus arteriosus]*** [Bluberry muffin rash (purpuric lesions)] low birth weight microcephaly

Question 105

At what age does Bedwetting start to become pathological for kids?

Answer 105

5 yo

Question 106

A Contrast enema demonstrating microcolon is indicative of what condition? ; etx?

Answer 106

Meconium iLeus 2/2 Cystic Fibrosis viscous meconium accumulation obstructs terminal iLeum --\> underused colon --\> contracted microcolon

Question 107

*Typically, for minors, informed consent must be provided by a **legal guardian*** List the 3 exceptions to this

Answer 107

Question 108

cp for Febrile Seizure -4 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ⬜ is the primary management. When do you give [Abortive Antiepileptics]?

Answer 108

1. [child [6 month - 5 year old] with [\< 15m nonfocal seizure]] 2. **NO** previous afebrile seizure within prior 24h 3. **NO** signs of CNS infection (meningismus, bulging fontanelles) 4. **NO** acute metabolic derangement (hypOglycemia) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx = AntiPyretics ➜ [AntiEpileptics if seizure ≥5 min]

Question 109

cp for Bronchiolitis in neonates - 3 ; px for this?

Answer 109

1. **Wheezing and/or Crackles** 2. URI sx 3. Respiratory distress eventually --\> APNEA Px = Palivizumab for kids\<2 yo

Question 110

Why can Moms breastfeed on methadone treatment, but can NOT breastfeed if actively using recreational substances/opioids? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What is the requirement to be candidate for [breastfeeding on methadone tx] -2

Answer 110

[methadone treatment concentration in breastmilk] is low and unrelated to maternal dose but recreational substances have unpredictable pharmacology (mixed with other drugs/inconsistent dosing) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ compliant with methadone treatment throughout pregnancy and after pregnancy/postpartum/breastfeeding + NO active recreational drug use relapse

Question 111

What is [Idiopathic premature pubarche]?

Answer 111

[precocious (male \<9 / female\<8)] and isolated development of pubic hair ***with NO other endocrine*** ∆ ​

Question 112

Diagnosis? ; Name the major risk factor for this

Answer 112

HIRSCHSPRUNG DISEASE ; [Mom ≥ 35 yo] ## Footnote *markedly dilated descending colon*

Question 113

cp for [Radial head subluxation Nursemaid's elbow] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx? (2)

Answer 113

sudden refusal to move arm after arm is forcibily pulled affected arm with forearm pronated \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *extension* ➜ forearm **HYPERpronation**

Question 114

SIDS risk factors for the infant? -4 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ risk factors for Mom *during pregnancy*? -3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Sudden Infant Death Syndrome = [Sudden unexplained (Infant\<12 mo) Death with inconclusive postmortem exam]*

Answer 114

**SLEEPING PRONE** \> \> \> [prematurity | low birth wt | smoke exposure] ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [teen Mom\<20] | pregnant smoking/substance use | spotty prenatal care

Question 115

Diagnostic Criteria for Colic - 4 ; tx

Answer 115

Colic = the 3's excessive crying during first 3 weeks of life that's ≥3hrs/day (usually evenings) for ≥3days / week for ≥3weeks in a healthy infant Tx = Soothing and feeding techniques

Question 116

Describe Metatarsus Adductus

Answer 116

Most common congenital foot deformity in which there is BL medial deviation of the forefoot **usually in 1st born infants** ## Footnote *Tx = this corrects spontaneously*

Question 117

cp for Meckel's Diverticulum \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ dx

Answer 117

PAINLESS hematochezia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ technetium 99 pertechnetate scan

Question 118

clinical features of Neonatal Clavicular fracture (3)

Answer 118

1. self limited with NO LONG TERM SEQUELAE (tx = spportive only) 2. localized clavicular creptius 3. irritability with passive IPL UE movement * dx confirmed by XR*

Question 119

Tx for Kawasaki disease-2 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ when should this be given?

Answer 119

[4/5 **CRASH**] & [**B**urning HIGH Fever ≥ 5 days] 1. [ASA 80-100 mg/kg/day divided into 4 doses] --\> [3-5 mg/kg/day as one dose after defervescence] --\> DC after 6 wks if no coronary involvement. Cont indefinitely if so. 2. [IVIG 2g/kg given over 12 hours] ⼀*DEC Coronary Aneurysm risk* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *give Kawasaki tx within 10 days of **B**urning HIGH FEver*

Question 120

[Atlantoaxial joint] Instability MOD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Which demographic are at most risk for this?

Answer 120

excessive laxity in the Posterior transverse ligament ➜ ⬆︎mobility between [C2 aXis: dens] and the [C1 atlas] --\> spinal cord compression ➜ UMN signs \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Down Syndrome** (remember pts with down syndrome are *usually* hypOtonic but not with Atlantoaxial instability!)

Question 121

What is Primary nocturnal enuresis? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1st step in evaluation? ​

Answer 121

lack of nighttime dryness in kids age ≥5 y/o *that usually spontaneously resolves over time* ​ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ UA (r/o DM, DI, infection)

Question 122

For a patient receiving ⬜ to diagnose and treat intussusception, what is a potential complication ? ​ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ how is it managed?

Answer 122

[air/water contrast enema] ; intestinal perforation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [abd xr series] (*to assess for free air*)​

Question 123

Name the 7 most common manifestations of **Marfan Syndrome** etx = mutation of fibrillin 1 gene

Answer 123

"Marfan **BAATHES** a lot! " 1. **E**ctopia Lentis 2. **A**rm-to-Height Ratio ⬆︎ 3. **H**eart issues (*MVP or [idiopathic _Aortic_ cystic medial degeneration]--\> _Aortic Dissection and Aneurysm_*) 4. **S**coliosis vs. Kyphosis 5. **B**reastbone structural abnormalities 6. **A**rachnodactyly (Steinberg thumb & wrist) 7. **T**all / slender / flat feet etx = mutation of fibrillin 1 gene

Question 124

Name the 3 major points of misinformation regarding Vaccines ​ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How do you mitigate each one?

Answer 124

1. **AUTISM**: following retraction of the *fraudulent Wakefield study*, many large-scale systematic reviews have consistently shown no association between Vaccines and Autism 2. **"VCCs OVERLOAD IMMUNE SYSTEM?"**: exposure to multiple antigens at once is NOT harmful and will NOT "overload" immune system 3. **"NATURAL IMMUNITY IS BETTER":** Natural immunity/infxn = ⇪ risk for severe complications (i.e. hospitalization)

Question 125

When should ingested batteries be emergently and endoscopically removed?

Answer 125

ONLY when the battery is still **IN** the esophagus and not distal to it. If distal --\> obs ## Footnote *this also includes sharp objects, or multiple magnets*

Question 126

*neonates \> 28 days old* what organisms cause sepsis? -3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Name the empiric abx -2

Answer 126

1. [Ceftriaxone (*Strep Pneumo + Neisseria meningitidis*)] 2. [+/- Vancomycin (*MRSA or meningitis*)]

Question 127

the timing of neonatal jaundice differentiates [G6PD deficiency] from [Hemolytic Disease of Newborn] explain

Answer 127

_neonatal jaudice presenting within first_ HDN: 24 hours of life (*+ direct Coombs | A or B infant born to O mother)* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ G6PD deficiency: 2-3 DAYS of life

Question 128

What is the treatment for Bronchiolitis? ## Footnote *typically from RSV*

Answer 128

supportive ## Footnote *contact + droplet precautions* ​ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *supportive = IVF/nasal bulb suctioning/humidified O2*

Question 129

Pediatric dyslipidemia is a risk factor for adulthood progression of ⬜ and ⬜. Because of this, what is the recommended lipid screening for peds?

Answer 129

atherosclerosis / CVD ## Footnote *note: universal [fasting lipid panel] screening should still be obtained ages 9-11 and 17-21 regardless of CV risk factors*

Question 130

3 classic **Clinical** Manifestations of [Tetralogy of Fallot]

Answer 130

A: 1. [**S**ystolic Ejection HARSH Murmur @ L Sternal 2/3 ICS] from [**RVOO** -R Vt Outflow Obstruction] 2. **S**quatting relieves sx (INC afterload--\> [DEC amount of R to L shunt] 3. [**C**yanotic lethal Tet Spells] (tx: Knee chest positioning and inhaled O₂) "**VOIR** is to have **S**ee + **S**ight & **C**ry"