2023 PREP Flashcards by Josh Lipsitz

Which ventilator parameters affect oxygenation?

PIP, PEEP, and Ti

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Which vaccine is contraindicated in children with HIV infection and mild immunosuppression?

Combined MMRV

Can receive MMR and varicella separately

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What is considered severe immunosuppression in HIV infection?

T-lymphocyte percentage < 15% and/or CD4 < 200

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Which vaccines are contraindicated in HIV-positive patients with severe immunosuppression?

MMR and varicella

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What is the management of initial acquisition of Pseudomonas in a tracheal aspirate in a patient with CF?

28 days of inhaled tobramycin

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What are the main symptoms of Ehlers-Danlos syndrome?

Skin hyperextensibility, joint hypermobility, and atrophic scarring

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What is the first step in treatment of PTA?

Drainage

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What are the main treatment options for infantile spasms?

ACTH (preferred) and vigabatrin

Vigabatrin preferred for patients with tuberous sclerosis

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What is the presentation of torsion of the appendix testis?

Blue dot sign (blue discoloration of upper pole of testis)

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What is the presentation of Sinding-Larsen-Johansson syndrome?

Tenderness of inferior patella and pain with resisted quadriceps contraction

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Where is the pain with Sinding-Larsen-Johansson syndrome vs. Osgood-Schlatter disease?

Sinding-Larsen-Johansson syndrome: inferior patella
Osgood-Schlatter disease: tibial tubercle

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What is the management of non-severe AOM in children < 2 years of age?

Observation for 24-48 hours with antibiotics subsequently if no resolution

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What defines severe AOM?

Otalgia for > 48 hours and/or temperature of > 39

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What is the duration of AOM treatment by age?

< 2 years: 10 days
2-5 years: 7 days
6 years or older: 5 days

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How do caput succedaneum and cephalohematoma present with respect to suture lines?

Caput succedaneum: may cross suture lines
Cephalohematoma: does not cross suture lines

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What type of anemia is Diamond-Blackfan anemia?

Macrocytic

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Which type of anemia is associated with an elevated adenosine deaminase level?

Diamond-Blackfan anemia

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What is considered a high ANA titer?

> 1:320

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What is suggested by a positive Ebstein-Barr virus nuclear antigen (EBNA)?

Past infection

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What is the indication for fomepizole?

Antidote to ethylene glycol and methanol intoxication

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Which anomaly is commonly associated with renal agenesis at birth?

Pulmonary hypoplasia

Secondary to oligohydramnios (amniotic fluid needed for pulmonary development)

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Which mutation is associated with familial HLH?

Perforin mutation

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What is the difference between run charts and control charts?

Run charts: no upper and lower limit
Control charts: contains upper and lower limits

Both plot data over time

What pain pattern with ankle sprains warrants an x-ray?

Pain over posterior portion of malleolus

When should children be able to sit without support?

6 months

Which diagnosis is associated with positive urine reducing substances?

Galactosemia

Which type of referral is indicated for patients with galactosemia?

Ophthalmology due to risk of cataracts

What are the classic lab findings in organic acidemias?

Metabolic acidosis and elevated ammonia levels

What are the classic lab findings in urea cycle defects?

Respiratory alkalosis and elevated ammonia levels

Which diagnosis is suggested by a newborn screen with low T4 and a reflex TSH that is normal?

Congenital thyroxine-binding globulin deficiency

Which neonates should receive hepatitis B immunoglobulin shortly after birth?

* Positive HBsAg or unknown hepatitis B status * Unknown hepatitis B status and birth weight < 2000 grams

Which ureteral stones qualify for alpha-blocker therapy for expulsion?

Distal stones < 5 mm

What is the management of nephrolithiasis secondary to hyperoxaluria?

Moderate oxalate restriction and avoidance of excess vitamin C intake

What are the symptoms of trisomy X?

Tall stature, developmental delay, and psychiatric comorbidities

Which cardiac anomalies are associated with Turner syndrome?

Coarctation of the aorta and bicuspid aortic valve

What is the treatment of mild mycoplasma-induced pneumonia in the outpatient setting?

Supportive care ## Footnote Can give macrolide for more severe cases in inpatient setting

What is the next step after detecting a white pupillary reflex (leukocoria)?

Confirmation by ophthalmologist

Which other cancer type is associated with retinoblastoma?

Osteosarcoma

Which syndrome is associated with a high risk of developing retinoblastoma?

13q deletion syndrome

What is the earliest lab finding in hemorrhagic disease of the newborn?

Prolonged PT

What is the first step in a patient with type I diabetes who has consistent hyperglycemia in the morning?

Check glucose at 2-3 AM ## Footnote Differentiates between too little nighttime insulin vs. too much nighttime insulin (rebound hyperglycemia after hypoglycemia)

What lab abnormalities are seen in Rocky Mountain Spotted Fever?

Hyponatremia, thrombocytopenia, and elevated transaminases

What are the symptoms of a black widow spider bite?

Abdominal pain, muscle pain, paresthesias

What are the symptoms of a brown recluse spider bite?

Local cellulitis and necrosis

What is the treatment of lamp oil intoxication?

Supplemental oxygen and inhaled beta-agonist if wheezing

What is the main presentation of oil (hydrocarbon) intoxication?

Aspiration pneumonitis

What are the prerequisites for bariatric surgery evaluation in children?

BMI > 40 or BMI > 35 with comorbidities

What further evaluation is required for children with esophageal atresia/TEF?

Echo, renal US, and spinal US ## Footnote Spinal US evaluates for tethered cord

What is the presentation of hyperventilation syndrome?

Anxiety, tachypnea, and paresthesias ## Footnote Paresthesias are caused by decreased iCa in setting of alkalosis

What is the management of thyroid nodules 1 cm or greater if TSH is normal and if TSH is suppressed?

**Normal TSH**: fine-needle aspiration and biopsy **Suppressed TSH:** nuclear thyroid scintigraphy to assess for hyperfunctioning nodule

What is the presentation of Klippel-Feil syndrome?

Short stature, reduced neck mobility, and low posterior hairline secondary to fused cervical vertebrae

What is the presentation of Pierre-Robin sequence?

Micrognathia and macroglossia

What is the treatment of Entamoeba histolytica?

Metronidazole or tinidazole followed by intraluminal amoebicide (i.e. iodoquinol)

What is the main predictor of severity of BPD?

Oxygen requirement at 36 weeks PMA or at discharge (whichever comes first)

Which mutation is associated with X-linked Alport syndrome?

Mutation in type IV collagen

What may be heard on auscultation in pulmonary HTN?

Loud S2

How can LVH and RVH be differentiated in leads V1 and V2?

LVH: V1/V2 with downward R wave RVH: V1/V2 with upward R wave