6

Question 1

When do you consider failure to thrive?

Answer 1

< 5th for weight OR weight for length

crossing more than 2 major lines

Question 2

Organic causes of failure to thrive

Answer 2

Congenital heart defects
Cystic fibrosis
Gastroesophageal reflux
Neurologic disorders
Metabolic disease

Question 3

Typical feeding pattern of a young infant

Answer 3

10-30 minutes every 1-2 hours; bottle-fed may be less frequent because takes more with each feed

Question 4

What is a critical portion of the pediatric cardiac exam?

Answer 4

PULSES- brachial vs femoral pulses = rule out coarctation of the aorta

Question 5

What grade murmur has a thrill?

Answer 5

4

Question 6

What is the number one cyanotic congenital heart defect?

Answer 6

Tetrology of fallot

Question 7

Why do we see hepatomegaly in congestive heart failure?

Answer 7

Decreased renal blood flow leads to fluid retention via RAAS = systemic venous congestion, and hepatomegaly.

Question 8

On an abdominal exam of a newborn you appreciate the liver edge 3 cm below rib border. Is that normal? What is ddx for hepatomegaly?

Answer 8

Not normal - < 1 cm = normal

If > 1cm ddx =
Congestive heart failure
Congenital infections
Inborn errors of metabolism
Anemias, and (less commonly)
Tumors

Question 9

You hear a systolic ejection murmur with widely split, fixed S2. What is this murmur and how old is the patient?

Answer 9

ASD, 3-5 most common age

Question 10

How does coarctation fo the aorta present?

Answer 10

• murmur
• HTN in upper extremities
• discrepancy between the upper and lower extremity pulses and BP

Question 11

You are examining an infant in the nursery and detect a holosystolic murmur beginning with S1 with a blowing quality. What is it?

Answer 11

VSD

Question 12

Describe physical exam of aortic stenosis

Answer 12

Systolic ejection murmur, radiating to the neck (and occasionally a thrill in the jugular notch), with an early systolic click

Question 13

Continuous ‘machine-like’ murmur and bounding pulses (from a widened pulse pressure)

Answer 13

patent ductus arteriosus murmur

Question 14

Why does tetralogy of fallot result in systolic ejection murmur?

Answer 14

RVOT obstruction

Question 15

Why does ASD result in systolic murmur?

Answer 15

increased flow across a normal pulmonic valve

Question 16

How does an innocent murmur sound?

Answer 16

Vibratory, low-pitched, louder when supine

Heard best at the left lower sternal border

Question 17

Which heart murmurs present with signs of CHF in infancy?

Answer 17

VSD
Severe aortic stenosis
Coarctation of the aorta
Large patent ductus arteriosus

Question 18

What are the three embryological components of the ventricular septum?

Answer 18

endocardial cushion
embryologic conotruncus
embryologic trabecular septum

Question 19

What determines the magnitude of left to right shunt in VSD?

Answer 19

size of the defect and pulmonary vascular resistance

Question 20

A child is diagnosed with VSD murmur. Why was it not detected in the nursery?

Answer 20

elevated pulmonary vascular resistance in a newborn

Question 21

3 medications for CHF

Answer 21

Enalapril, furosemide, digoxin

Question 22

What is a potential bleak outcome of untreated VSD?

Answer 22

Pulmonary vascular obstructive disease (Eisenmenger’s syndrome)

Question 23

What is an akinetic/atonic seizure?

Answer 23

Involves loss of motor tone

Question 24

Things a 16 month old should be able to do

Answer 24

Uses 4-6 words consistently
Uses a spoon and cup, spills some
Follows simple commands
Stoops and recovers

Question 25

Are febrile seizures hereditary?

Answer 25

YES

Question 26

vaccinations against which two bugs has contributed to bacteremia as a rare event?

Answer 26

Haemophilus influenzae type b and Streptococcus pneumoniae

Question 27

What is fever without a source?

Answer 27

no localizing symptoms or signs on physical exam

Question 28

What are some SBI to keep in mind?

Answer 28

bacteremia, meningitis, pyelonephritis, osteomyelitis, appendicitis, pneumonia, bacterial gastroenteritis, septic arthritis

Question 29

When is an EEG indicated?

Answer 29

in children who have focal, recurrent, or complex seizures

Question 30

EEG spike 3-Hz spike-and-wave pattern

Answer 30

Absence seizure

Question 31

What is a complex febrile seizure?

Answer 31

More than once in 24-hour period, > 15 minutes

Question 32

If a child has his first febrile seizure before age 12 months, the recurrence risk for a second febrile seizure is about ___

Answer 32

50%

Question 33

What are 6 types of seizure medications?

Answer 33

``` Diazepam Valproic acid Phenobarbitol Phenytoin Primidone Carbamazepine ```

Question 34

red lips, a strawberry tongue, and a light-red sandpaper rash

Answer 34

Scarlet fever

Question 35

A high fever (38.5 to 40.5 C) for 3-5 days in a typically fairly well-appearing child, followed by abrupt resolution of fever and development of a maculopapular rash

Answer 35

Roseola

Question 36

Primary HHV-6 infection is associated with approximately 20% to 30% of first _______

Answer 36

febrile seizure

Question 37

What questions can you ask to evaluate if organ perfusion is being maintained in sickness (evaluate severity of sickness)?

Answer 37

Brain (alert vs. lethargic) Skin (well-perfused, flushed, cool/clammy?) Kidneys (urine output) Lungs (RR, work of breathing, cyanosis)

Question 38

What are some emergency conditions that cause AMS?

Answer 38

Hypoxia, shock, and hypoglycemia

Question 39

What are some CNS causes of AMS?

Answer 39

``` Infection (sepsis, meningitis, or encephalitis) Poisoning/Toxic ingestion Increased ICP (CNS tumor, hemorrhage) Trauma Metabolic disturbance (DKA) ```

Question 40

Why the tachypnea in a child with shock?

Answer 40

Blow off CO2 to compensate for metabolic acidosis from decreased oxygen perfusion of the tissues and cells.

Question 41

Is hypotension a late sign on shock in children?

Answer 41

YES; can usually compensate with RR and HR

Question 42

What are the types of shock?

Answer 42

Distributive Hypovolemic Cardiogenic Septic

Question 43

Patients with septic shock may intitially present in "warm" shock. What are the sx of warm shock?

Answer 43

``` Warm extremities Bounding pulses Tachycardia Tachypnea Adequate urination Mild metabolic acidosis ```

Question 44

A child presents in shock. What is an appropriate fluid resuscitation?

Answer 44

repeated boluses of isotonic fluids (20 ml/kg at a time, total of 60 mL/kg) if still not adequately responding, start inotropic rx

Question 45

How do fluids administered through IO enter the blood stream?

Answer 45

Tibia blood flow = popliteal vein | Femur = femoral vein

Question 46

What are some PEx findings with meningitis?

Answer 46

AMS, fever, neck stiffness, kernig's or brudzinski's sign

Question 47

When does meningococcal disease happen?

Answer 47

Peak incidence occurs in children < 12 months of age, with another peak at age 16 through 21 years.

Question 48

What are risk factors for meningococcal disease?

Answer 48

``` Close accommodations (dormitories, military) Complement deficiency Anatomic or functional asplenia ```

Question 49

Fever and petechiae - what do you need to rule out?

Answer 49

bacterial sepsis, meningococcal disease

Question 50

Does ceftriaxone treat disease and eliminate carrier state of n. meningidities?

Answer 50

YES

Question 51

Should IV abx be ordered on hourly terms?

Answer 51

YES

Question 52

What meds are given as n. meningitis ppx?

Answer 52

``` Adults = Cipro Children = Rifampin ```

Question 53

What vaccines protect against n. meningococcal disease?

Answer 53

MCV4 (first at 11-12, 2nd at 16) | MenB (first at 16, booster 6 mo following)