Peds

Question 1

Meconium aspiration CXR

Answer 1

Term or post-term

Patchy infiltrates, coarse streaking, flat diaphragm

Question 2

TTN CXR

Answer 2

Bilateral perihilar linear streaking

Resolves by day 2

Question 3

RDS CXR

Answer 3

Diffuse, reticulogranual GROUND GLASS appearance
Air bronchograms
Low lung volumes

Question 4

PPH CXR

Answer 4

Clear lungs with decreased pulmonary vascularity

Question 5

Tetralogy murmur (if R->L shunt)

Answer 5

Murmur and severity due to pulmonic stenosis: Systolic murmur at LUSB, Single S2
Tx: Knee to chest, inhaled O2, surgery < 6 months

Question 6

VSD murmur (L->R)

Answer 6

Holosystolic murmur along sternal border

Rumbling diastolic murmur (increased flow across MV due to increased return)

Question 7

Turner syndrome cardiac defects

Answer 7

Bicuspid aortic valve > coarctation of aorta > aortic root dilation

Question 8

Sensorineural deafness, cardiac defects (PDA), and cataracts

Answer 8

Congenital Rubella

Tx: supportive

Question 9

Chorioretinitis, hydrocephalus, intracranial calcifications

Answer 9

congenital Toxoplasmosis

Also: hyperbilirubin and thrombocytopenia

Question 10

QT prolongation

Answer 10

Hypocalcemia
Hypomagnesium
Hypokalemia
Drugs: K blockers (amiodarone, sotalol), Na blockers (quinidine, procainamide, flecainide); antiemetics; opioids (methadone, oxycodone), psychotropics (antipsychotics, TCA, SSRI); antibiotics (macrolides, FQs)
Inherities: Jervell and Lange-Nielsen; Romano-Ward
Tx: Beta blocker and pacemaker

Question 11

Neonate with central cyanosis, L axis deviation, systolic murmur at LLSB, clear lungs

Answer 11

Tricuspid atresia

Question 12

Cyanosis and tachypnea in first day of life, normal CXR, single loud S2 without murmurs

Answer 12

Transposition

Question 13

Cyanosis with increased pulmonary flow

Answer 13

Transposition, truncus arteriosus, total anomalous pulmonary venous connection

Question 14

Cyanosis with severe heart failure

Answer 14

Hypoplastic left heart; critical aortic valve stenosis

Question 15

PDA-dependent CHD

Answer 15

Coarctation
Hypoplastic L heart
Transposition
Total anomalous PV connection
Tricuspid atresia

Question 16

SGA infants are at risk of what

Answer 16

polycythemia
hypoxia
hypoglycemia
hypothermia
hypocalcemia

Question 17

Neonatal conjunctivitis sx and tx

Answer 17

Day 1: chemical (silver nitrate, not in US)
2-5 days: gonococcal; px with prenatal screening; tx with IM/IV ceftriaxone or cefotaxime and hospitalize; cx ulceration, scar, blindness
5-14 days: Chlamydial; px with prenatal and erythromycin topical; tx with oral erythromycin

Question 18

UTI <2yo

Answer 18

Renal and bladder US -> VCUG

Question 19

Acute bacterial rhinosinusitis dx

Answer 19

• Symptoms ≥10 days without improvement OR
• Severe symptoms (fever 39, purulent nasal dischare, face pain ≥3 days) OR
• Worsening sypmtoms ≥5 days after initially improving viral URI