amboss

Question 1

what are characteristic mulluscum contagiosum

Answer 1

nontender, skin-colored, pearly, dome-shaped papules with central umbilication. They are usually 2–5 mm in diameter and commonly occur on the trunk, face, and genitalia.

Question 2

what is the treatment for mulluscum

Answer 2

nothing. usually revolves within 6-9 months

Question 3

measles presents how

Answer 3

cough coryza koplik spots.

Question 4

what are the stages of chickenpox

Answer 4

papules, vesicles, crusts

remember severe pruritus.

Question 5

what is the course of the measles rash

Answer 5

face, downward and outward

Question 6

what is the typical course of measles

Answer 6

10-12 self-limited. can cause severe pneumonia, acute otitis media, diarrhea, encephalitis

Question 7

what is the typical presentation of roseola infantum

Answer 7

characterized by a 3-day high fever (causing a tonic-clonic febrile seizure in this child) that ends abruptly (“3-day fever”) and is immediately followed by a blanching, maculopapular, nonpruritic rash. The rash appears mainly on the trunk but may spread to the face and extremities. It is commonly associated with cervical, postauricular, and/or occipital lymphadenopathy.

Question 8

what is roseola caused by

Answer 8

herpes virus 6

Question 9

/what is the first line treatment for ectopic dermatitis or eczema

Answer 9

topical emollients

Question 10

what is used to treat mild impetigo

Answer 10

mupirocin

Question 11

what is muprocin

Answer 11

this is an antibiotic ointment used for the

Question 12

what is the course of action if a pregnant mother has a child that is sick with parvovirus B19/fifths disease

Answer 12

check the mothers immune status. If she is immune with IgG then nothing is required.

Question 13

Is someone with fifths contagious after the rash has appeared

Answer 13

no.

Question 14

what is the course of action for a mother with confirmed parvovirus infection who is pregnant

Answer 14

monitor with serial ultrasounds

Question 15

Bullous impetigo is

Answer 15

a disease caused by the exfoliative toxin A from Staphylococcus aureus and is characterized by a pruritic rash that predominantly affects the trunk. The rash is typically comprised of flaccid and superficial bullae, which may rupture and leave thin brown crusts. Lateral traction causes sloughing of the skin, which indicates a positive Nikolsky sign.

Question 16

Bullous impetigo is treated with

Answer 16

first-generation cephalosporins such as cephalexin.

Question 17

eczema herpeticum is

Answer 17

symptoms (fever, malaise, lymphadenopathy) cutaneous manifestation of herpes infection (usually HSV-1 or HSV-2). This condition is associated with pre-existing skin conditions, most often atopic dermatitis.

Question 18

is eczema herpeticum serious

Answer 18

this is a medical emergency as it can spread rapidly

Question 19

what is the treatment for eczema herpeticum

Answer 19

IV acyclovir

Question 20

Tinea corporis is

Answer 20

a skin infection caused by dermatophytes of the Trichophyton (most common), Microsporum, and Epidermophyton genera.

Question 21

what is the treatment for tinea corporis

Answer 21

topical anti fungal such as miconazole

Question 22

what is the treatment of choice for tinea capitis

Answer 22

oral griseofulvin

Question 23

what is the normal treatment for cat scratch disease in an immunocompentant

Answer 23

nothing. it is self limiting

Question 24

what is the treatment for someone with cat scratch disease that has bulky lymphadenopathy and

Answer 24

azithromycin

shown to reduce lymphadenopathy and length of disease

Question 25

what is the presentation of measles

Answer 25

cough, coryza, conjunctivitis and an erythematous maculopapular, blanching, and partially confluent exanthem on his entire body, generalized lymphadenopathy, and high-grade fever,

Question 26

what is the test of choice for measles

Answer 26

IgM for measles

Question 27

what is the treatment for strep throat

Answer 27

oral penicillin.

Question 28

what is the alternative therapy to penicillin for strep throat

Answer 28

azithromycin

Question 29

what is the rare complication of measles virus

Answer 29

subacute sclerosing pan encephalitis

Question 30

what treatment should be administered to all children with measles

Answer 30

vitamin A

Question 31

why is vitamin A given to children with measles

Answer 31

because it reduces the risk of complications

Question 32

what are the complications of measles

Answer 32

otitis media, viral pneumonia, encephalitis, or corneal ulceration

Question 33

Estimated maintenance requirements follow what rule and what is it

Answer 33

4/2/1 rule: 4 cc/kg/hr for the first 10 kg, 2 cc/kg/hr for the second 10 kg, and 1 cc/kg/hr for every kg above 20. Based on patient’s weight, using the same 4/2/1 rule as used to calculate preoperative maintenance requirements.

Question 34

what fluid should be used to maintain a burn victim

Answer 34

dextrose with LR

Question 35

what is the presentation of chicken pox

Answer 35

This patient’s constitutional symptoms (fever, headache, and myalgia) along with a highly pruritic, generalized rash with multiple lesions in different stages (macules, papules, vesicles, and crusted lesions) is characteristic of chickenpox.

Question 36

what is herpangina

Answer 36

Herpangina is most common in children between the ages of 3–10 years and infections occur most frequently in summer and fall. As in this case, the first manifestations of the disease are usually oropharyngeal lesions and associated sore throat. Coxsackie A virus is the most common underlying pathogen. presents as fever, malaise, chills, sore throat and oropharyngeal maculovesicular lesions

Question 37

what is the rash caused by carbamazepine

Answer 37

this is DRESS drug reaction with eosinophilia and systemic symptoms
presents as a generalized pruritic rash
t with fever, and a diffuse morbilliform rash that progresses to a confluent erythema with accentuation of the hair follicles, as well as facial edema, and lymphadenopathy.
can also present with pneumonitis, nephritis and hepatitis

Question 38

what is hereditary hemorrhagic telangiectasia

Answer 38

autosomal dominant recurrent episodes of epistaxis and telangiectasias of the lips, nose, and fingers, symptoms that are classic for hereditary hemorrhagic telangiectasia (also known as Osler-Weber-Rendu syndrome). Patients with this syndrome may also present with pulmonary or hepatic arteriovenous shunts, which may lead to high-output cardiac failure.

Question 39

what is cutis marmorata

Answer 39

bluish mottled skin appearance in the newborn

Question 40

what is erythema toxicum and where does it appear on the newborn/spared on the newborn

Answer 40

Erythema toxicum appears within the first week of life as small, The rash appears on the trunk and proximal extremities, but the palms and soles are typically spared.

Question 41

what is the progression of erythema toxicum

Answer 41

red macules and papules that progress to pustules with surrounding erythema.

Question 42

what is the cause of E tox

Answer 42

It is most likely caused by immaturity of the sweat glands and follicles.

Question 43

what is the treatment for e tox

Answer 43

the condition is benign and requires no treatment. Complete resolution of the rash occurs within 7–14 days.

Question 44

what is an absolute necessity before beginning isoretinoid therapy on a female

Answer 44

a pregnancy test
If the initial pregnancy test rules out pregnancy, a primary (e.g., IUD, birth control pill) and secondary (e.g., condoms, cervical cap, diaphragm) contraceptive method must be used starting one month before isotretinoin therapy and continuing until one month after isotretinoin therapy is completed. The patient should also undergo liver function and lipid profile tests (both before and during therapy) since the use of a retinoid is associated with decreased liver function and hyperlipidemia.

Question 45

why are pregnancy tests and birth control a necessity before isoretinoids in females

Answer 45

because they are high teratogenic

Question 46

what is the first line therapy for mild noninflammatory acne

Answer 46

topical benzoyl peroxide

Question 47

Ichthyosis vulgaris is

Answer 47

a common condition (affecting ∼ 1% of the population) that is caused by an autosomal dominant filaggrin mutation, which causes the stratum corneum to dry out. This results in the formation of fine white scales on skin within the first few months of life. Areas of skin that are more moist or less exposed to air, such as the groin, axilla, and cubital and popliteal flexures, are usually spared. During summer or periods of increased humidity, the lesions may disappear as a result of increased hydration of skin by sweat.

Question 48

what is the most significant modifiable risk factors for SIDS

Answer 48

sleeping the prone position is highly associated with SIDS. thus sleeping in supine is recommended.

Question 49

Is smoking associated with SIDS

Answer 49

yes. but not the most important risk factor

Question 50

Should pregnant women be vaccinated for tetanus

Answer 50

yes. protects the baby as well

Question 51

how does neonatal tetanus present

Answer 51

a life-threatening condition characterized by muscle spasms, myoclonus, irritability, and poor feeding.

Question 52

what is the presentation of neonatal listeriosis

Answer 52

The presence of severe systemic disease (e.g., fever, hypotonia, respiratory distress) in this infant suggests early-onset sepsis. The presence of seizures is concerning for meningitis. This patient’s multiple visceral granulomas (granulomatosis infantiseptica) is specific for neonatal listeriosis.

Question 53

what is the best way to avoid neonatal listeriosis

Answer 53

avoiding unpasteurized milk products.

Question 54

Why cant topical erythromycin be used to treat chlamydial conjunctivitis

Answer 54

because this indicates systemic infection which will lead to chlamydial pneumonia

Question 55

what is the presentation and treatment for chlamydial conjunctivitis.

Answer 55

watery or mucopurulent discharge in a neonate with proper postnatal care. conjunctivitis. treat with oral erythromycin

Question 56

what is the presentation of severe airway compromise requiring intubation in the newborn

Answer 56

wheezing, cyanosis, poor respiratory effort

Question 57

what is the empiric treatment for neonatal sepsis

Answer 57

ampicillin and gentamicin

Question 58

when does neonatal gonoccocal infection present

Answer 58

usually 2-7 days after birth

Question 59

Can genital herpes transmit to the baby during childbirth

Answer 59

yes, but usually the infection has to be active.

Question 60

what is the presentation of neonatal herpes

Answer 60

there is usually a vesicular rash and sepsis

Question 61

what does blood gush of fluid indicate

Answer 61

premature rupture of membranes

Question 62

ABO hemolytic disease of the newborn is

Answer 62

a common cause of hemolytic disease of the newborn and can occur even during the first pregnancy. Anti-A and anti-B antibodies are formed early in life, without prior sensitization. IgG antibodies that can enter into fetal circulation during pregnancy and may result in hemolysis when the infant has A or B antigens

Question 63

The clinical presentation of ABO incompatibility is

Answer 63

typically mild, with hyperbilirubinemia developing within the first 24 hours after birth.

Question 64

what are the most likely heart defects present in congenital rubella

Answer 64

patent ductus arterioles and pulmonary hypertension

Question 65

what is the diagnosis and treatment for a baby that feeds for a long time, has failure to thrive and diaphoresis during feeds with a murmur in the pulmonary region (upper left sternal border)

Answer 65

PDA. give indomethacin

Question 66

are NSAIDs effective in treating full term infants

Answer 66

NO. only preterm infants.

Question 67

what is neuhauser sign and what does it indicate

Answer 67

A radiographic finding of a mottled (“soap bubble”) appearance in the distal ileum and/or caecum as a result of meconium mixing with swallowed air, often caused by meconium ileus. It can also been seen with other conditions such as necrotizing enterocolitis or ileal atresia.

Question 68

what is the presentation of meconium ileus

Answer 68

this is failure to pass stool after birth, dilated small bowel with microcolon, infant discomfort

Question 69

what is the presentation of fetal hydantoin syndrome and what is the cause

Answer 69

phenytoin treatment during pregnancy
e intrauterine growth restriction, craniofacial abnormalities (e.g., cleft palate, hypertelorism, slanted palpebral fissures, and low-set ears), a short neck, phalanx/fingernail hypoplasia, and excessive hair on the body and face.
don’t get fooled by turner’s syndrome red herring

Question 70

what is the treatment for fetal hydantoin sydnrome

Answer 70

Treatment is largely supportive and includes surgery to fix the cleft palate in addition to special education.

Question 71

Phenylketonuria is associated with

Answer 71

developmental delay after the age of 4–6 months, blue eyes, pale hair and skin (as tyrosine is a precursor in melanin production), a musty odor, and seizures in ∼ 50% of patients.

Question 72

Management of phenylketonuria involves

Answer 72

dietary restriction of phenylalanine.

Question 73

what heart valve condition is assocaited with fragile X syndrome

Answer 73

mitral valve prolapse

Question 74

what are the characteristics of cephalohematoma

Answer 74

occurs in 1–2% of live births and is palpable as a soft mass that develops slowly over several hours after birth. Being a subperiosteal hematoma, a cephalohematoma is limited by suture lines to the surface of one cranial bone. Forceps delivery and vacuum-assisted vaginal delivery (ventouse) are risk factors. Cephalohematomas usually require no treatment because the hematoma is resorbed within a few weeks.

Question 75

Subgaleal hemorrhage presents as

Answer 75

a fluctuant scalp swelling and is associated with vacuum-assisted delivery. Because the bleeding is not limited by suture lines, subgaleal hemorrhage is located superficial to the periosteum and is usually associated with features of severe blood loss (e.g., tachycardia, hypotension, pallor).

Question 76

which vacuum-assisted delivery complication crosses suture lines

Answer 76

Subgaleal hemorrhage

Question 77

Caput succedaneum presents as

Answer 77

a scalp swelling and is associated with vacuum-assisted delivery. However, a caput succedaneum is usually present at birth, is not limited by suture lines (because it is located superficial to the periosteum), and presents typically as a diffuse, boggy swelling that may shift with movement.

Question 78

which vacuum-assisted delivery complication is under the periosteum

Answer 78

cephalohematoma

Question 79

Edwards syndrome (trisomy 18) is characterized by

Answer 79

Prominent occiput, microcephaly, low-set ears, clenched fists with flexion contractures, and convex deformities of the plantar foot (rocker bottom feet) are all characteristic of Edwards syndrome (trisomy 18).congenital cardiac malformations, particularly ventricular septal defects.

Question 80

when is the booster for pertusis

Answer 80

11-12

Question 81

what is the in utero presentation of Down syndrome

Answer 81

Increased nuchal translucency, decreased levels of PAPP-A, shortened femur length, shortened fifth digits with clinodactyly, and a small nasal bone in a fetus

Question 82

what is the characteristic finding suggestive of trisomy 13 patau syndrome

Answer 82

polydactyly

cleft lip and palate

Question 83

what is required for neonates with a heart rate less than 100

Answer 83

resuscitation with positive pressure ventilation.

Question 84

what is the presentation of a baby born to a mother that smokes

Answer 84

intrauterine hypoxia presents as polycythemia, hypoglycemia, facial plethora, respiratory distress, cyanosis, apnea, poor feeding, hypoglycemia, and plethora (ruddy complexion

Question 85

what are some normal findings of female neonates

Answer 85

swelling and erythema of the vulva and vagina with white to bloody mucousy discharge, firm breast buds. this is due to estrogen exposure in utero

Question 86

Transient tachypnea of the newborn is

Answer 86

a benign condition that usually resolves without treatment within 24-48 hours.

Question 87

therapy for transient tachypnea of the newborn is

Answer 87

supportive care, including providing supplemental oxygen by hood or nasal cannula (with a goal O2 saturation of > 90 %), maintaining a neutral thermal environment, and providing adequate nutrition. Other causes of respiratory distress should also be excluded (i.e., pneumonia, sepsis, congenital heart condition, RDS).

Question 88

what is the treatment for a clavicle fracture in the newborn

Answer 88

reassurance and pinning of the sleeve to the chest

Question 89

what is bronchopulmonary dysplasia

Answer 89

is a chronic lung condition that develops in preterm infants who are exposed to prolonged (>28 days) mechanical ventilation and O2 therapy
presents with respiratory distress sydnrome

Question 90

what is respiratory distress syndrome

Answer 90

evidenced by his tachypnea, decreased O2 saturation, grunting, moderate subcostal retractions, and hypoxic peripheral vasoconstriction. prematurity causes neonatal respiratory distress syndrome (affects 10% of preterm babies) due to insufficient pulmonary surfactant levels, which causes increased alveolar surface tension and atelectasis (decreased breath sounds bilaterally).

Question 91

what does a chest X show for neonatal RDS

Answer 91

Chest x-ray showing diffuse, ground-glass densities with atelectasis will confirm the diagnosis.

Question 92

what is the treatment for neonatal RDS

Answer 92

This newborn would benefit from nasal CPAP to minimize lung atelectasis.

Question 93

what does gestational diabetes put the fetus at risk for with respect to serum electrolytes

Answer 93

hypocalcemia

hypomagnesemia

Question 94

what does gestational diabetes put the fetus at risk for with respect to cardiac anamolies

Answer 94

hypertrophic cardiomyopathy

Question 95

what does gestational diabetes put the fetus at risk for with respect to serum cellular components

Answer 95

polycythemia

n an increased metabolic demand that can lead to fetal hypoxia and increased RBC production to compensate.

Question 96

For HIV-positive mothers with a viral load of ≤ 1,000 copies/mL, infant HIV PEP

Answer 96

with zidovudine for 6 weeks is effective in preventing neonatal transmission of HIV.

Question 97

If the viral load is > 1,000 copies/mL (or if the mother is not on antiretroviral therapy during pregnancy), BLANK is recommended for PEP.

Answer 97

a three-drug regimen (such as zidovudine, lamivudine, and nevirapine)

Question 98

what additional step can be taken to prevent transmission to fetus from mothers with poor HIV contorl

Answer 98

Additionally, delivery via cesarean section would have likely been recommended in this child to further reduce the risk of transmission, although vaginal delivery may be considered in cases of low viral load.

Question 99

what additional supplement do preterm infants require

Answer 99

iron
Preterm infants have lower iron stores than infants born at term and, due to their rapid growth, require more daily iron than infants born at term. As breast milk does not contain enough iron to meet these requirements, daily iron supplementation is necessary until 6 months of age to prevent the development of iron deficiency anemia.

Question 100

infants born at home are at higher risk for hemorrhage because

Answer 100

they didn’t receive the vitamin K shot at the hospital

Question 101

marijuana use during breast is

Answer 101

contraindicated because cannabinoids accumulate in the breast milk. but we dont know what it does.

Question 102

what is the treatment of choice for a < 1year old with botulism

Answer 102

human derived immune globulin

the equine derived will have a higher chance of reactivity in such a young patient

Question 103

what is the treatment of choice for botulism in a >1 year old

Answer 103

equine-0derived antitoxin

Question 104

what is used for postexposure prophylaxis in individuals with an unknown immunization history who have wounds that are neither clean nor minor.

Answer 104

A combination of TIG and Tdap

Question 105

Orbital cellulitis is most commonly caused by

Answer 105

bacterial spread from ethmoidal or maxillary sinusitis as these sinuses are most proximal to the orbits.

Question 106

is used for empirical treatment of community-acquired meningitis

Answer 106

A combination of vancomycin and ceftriaxone.
to cover the most likely pathogens in patients between the age of one month and 50 years, including S. pneumoniae, N. meningitidis, and H. influenzae.

Question 107

what is given for prophylaxis for community acquired meningitis

Answer 107

Rifampin is indicated for PEP in all close contacts (e.g., the patient’s brother and parents).

Question 108

Treatment of mastoiditis consists of

Answer 108

intravenous antibiotic treatment (e.g., with vancomycin) as well as tympanostomy and subsequent tympanostomy tube insertion in mild cases or mastoidectomy in more severe cases.

Question 109

what is needed to diagnose mastoiditis

Answer 109

CT scan

Question 110

what are people with bacterial meningitis at risk for and what are the endocrinological consequences of that

Answer 110

waterhouse-friedichsen sydnrome and adrenal hemorrhage which leads to acute adrenal insufficiency

Question 111

what is the presentation of Guillain barre syndrome

Answer 111

peripheral neuropathy and ascending paralysis following URI. –absent deep tendon reflexes
protein-cytological dissociation in the CSF

Question 112

what is the treatment for Guillain barre

Answer 112

IVIG and supportive

Question 113

empirical treatment for bacterial meningitis in infants younger than 1 month

Answer 113

ampicillin plus an aminoglycoside (e.g., gentamicin) and/or a third-generation cephalosporin (e.g., cefotaxime).

Question 114

the empirical treatment of community-acquired bacterial meningitis in patients > 50 years of age.

Answer 114

A combination of vancomycin, ampicillin, and cefotaxime is used.
A different antibiotic regimen is used for the empirical treatment of meningitis in neonates.

Question 115

Ceftriaxone is contraindicated in neonates with hyperbilirubinemia because

Answer 115

it displaces bilirubin from the albumin binding site and is therefore associated with an increased risk of kernicterus.

Question 116

Trachoma conjunctivitis initially presents

Answer 116

as follicular conjunctivitis and then progresses to a mixed papillary and follicular conjunctivitis, as seen in this case. The patient’s corneal haziness with neovascularization is called pannus and is a classic presentation of active trachoma.

Question 117

Contraindications for administering pertussis-containing vaccinations include

Answer 117

severe allergic reaction to the vaccine (or to one of its components) and encephalopathy not due to any other cause within 7 days of a prior vaccination. Uncontrolled neurological disorders should prompt a delay of the vaccination until the condition has been sufficiently assessed.

Question 118

what causes duchennes muscular dystrophy

Answer 118

truncated dystrophin gene –X-linked

Question 119

strabismus interventions include what

Answer 119

either patching the healthy eye or blurring it with cycloplegic eye drops (penalization), such as cyclopentolate. The increased use of the weaker eye results in the formation of neural pathways and prevents amblyopia.

Question 120

Can clindamycin or cephazolin cross the BBB

Answer 120

NOPE

Question 121

what is the empiric treatment for brain abscess

Answer 121

surgery immediately after imaging

Question 122

what is a child more likely to have a pituitary adenoma or a craniopharyngioma

Answer 122

cranio.

pituitary adenomas are more common in 3-60 age range

Question 123

what is the most common malignant brain tumor in children

Answer 123

Medulloblastoma

Question 124

when are Medulloblastomas usually found

Answer 124

with a peak incidence between the ages of 3 and 5.

Question 125

where are medullobastomas found

Answer 125

The mass is characteristically located in the cerebellum.

Question 126

symptoms of medulloblastoma

Answer 126

Patients typically present with symptoms of hydrocephalus/increased ICP and involvement of the cerebellar vermis such as vomiting, morning headaches, ataxia, and cranial nerve dysfunction.

Question 127

Spinal drop metastases are in what percentage of medulloblastomas

Answer 127

found in about 40% of cases.

Question 128

diagnostic criteria for otitis media with effusion (OME).

Answer 128

A history of recurrent ear infections, language developmental delay, and conductive hearing loss with retracted tympanic membranes that do not move briskly on pneumatic otoscopy

Question 129

what test is the preferred method for determining the extent of hydrocephalus

Answer 129

ultrasound

Question 130

what is the treatment for communicating hydrocephalus

Answer 130

VP Shunt

Question 131

what presentation is most consistent with recurrent complex partial seizures

Answer 131

(focal seizures with impaired awareness), which are caused by abnormal electrical activity arising within the temporal lobe. The muddy taste in her mouth (gustatory aura) marks the onset of the seizure. The ictal phase consists of her staring, non-responsiveness to external stimuli, and automatisms such as facial grimacing and hand gestures. The postictal phase of the complex partial seizure is characterized by lethargy, temporary confusion, and amnesia.

Question 132

can have young children have migraines and what is the therapy

Answer 132

yes

NSAIDs or acetaminophen are the first line therapy fro abortives in children

Question 133

what should be done if first line therapy for migraines in children is ineffective

Answer 133

use the other first line therapy. IE if acetaminophen was used then add NSAIDs

Question 134

type 1 myotonic dystrophy presents as

Answer 134

Abduction of the thumb followed by slow relaxation upon percussion indicates myotonia. Myotonia in a 9-year-old boy with muscle aches and weakness in the distal muscles (hand and/or foot), face, as well as extraocular muscles
Reduced fetal temporalis and pterygoid muscle growth results in a high-arched palate. About 50% of patients with myotonic dystrophy have some degree of cognitive impairment.

Question 135

what are thee signs indicating Friedreich’s ataxia (FA).

Answer 135

girl presents with progressive bilateral limb ataxia and weakness, loss of deep tendon reflexes, pallhypesthesia, dysarthria, and skeletal deformities, Pes cavus (inverted feet), hammer toes, and kyphoscoliosis are all typical skeletal deformities seen in FA

Question 136

what is a neurological sequelae of bacterial meningitis

Answer 136

hearing loss

Question 137

characteristics of Sturge-Weber syndrome.

Answer 137

Most patients with the disorder are born with a port-wine stain (nevus flammeus), as seen in this patient, which usually lies over the region of the trigeminal nerve. The left-sided focal seizures, hypotonia, and absent reflexes are likely due to a right-sided leptomeningeal angioma, which classically occurs on the same side as the port-wine stain. Developmental delay is also common. Abnormal blood vessels of the eye lead to glaucoma, resulting in the cupped optic disc seen in this patient.

Question 138

A laboratory test in which nonhuman erythrocytes (e.g., from sheep or horses) are exposed to human serum. Aggregation of erythrocytes indicates

Answer 138

the presence of heterophile antibodies (e.g., as a result of infectious mononucleosis).

Question 139

The physical exam findings are also classic for rickets are

Answer 139

including erosion of tooth enamel, frontal bossing, widened joints, varus knee deformity (genu varum), and beading of the ribs (“rachitic rosary”). this can cause developmental delay and prolonged time to walking

Question 140

what is leukocytoclastic vasculitis

Answer 140

umbrella term for vasculides such as henoch-scheinlon Purpura

Question 141

henoch-scheinlon Purpura

Answer 141

HSP is an acute immune-complex mediated vasculitis of the small vessels that is often preceded by an upper respiratory infection. The patient’s history of pharyngitis 2 weeks ago and palpable nonblanching skin lesions with arthritis and abdominal pain are classic signs of HSP. HSP can also manifest with bloody stools or occult bleeding (as in this patient) and is accompanied by a raised platelet count, which helps to differentiate it from thrombocytopenia leading to intestinal bleeding and petechiae. Renal disease is seen in up to 50% of all patients with HSP and manifests with features of nephritic syndrome (e.g., hematuria, proteinuria),

Question 142

does erythema migrans itch

Answer 142

it can be slightly itchy.

Question 143

Major criteria for acute rheumatic fever include

Answer 143

arthritis (migratory polyarthritis primarily involving the large joints), carditis (pancarditis, including valvulitis -murmur due top inflammation of the valve), sydenham chorea (CNS involvement), subcutaneous nodules, and erythema marginatum.

Question 144

Minor criteria for acute rheumatic are

Answer 144

arthralgia, fever, ↑ acute phase reactants (ESR, CRP), and a prolonged PR interval on ECG.

Question 145

To diagnose rheumatic fever how many major/minor criteria are required

Answer 145

two major or one major plus two minor Jones criteria are required

Question 146

what is an alternative treatment to penicillin for acute rheumatic fever

Answer 146

clarithromycin

Question 147

what are the treatments for acute rheumatic fever

Answer 147

first line is penicillin V and NSAIDs + bed rest
alternative is amoxicillin
if allergic to beta-lactams then use clarithropmycin or macrolide

Question 148

what is the appropriate combined empiric antibiotic therapy for a burn victim with hospital acquired infection

Answer 148

Vancomycin and cefepime for antipseudomonal and MRSA coverage

Question 149

Sydenham chorea presents how

Answer 149

In a child with a recent history of a sore throat, rapid onset of involuntary purposeless movements, emotional lability, hypotonia, inability to sustain contraction (“milkmaid grip”), and flexion of the wrist and extension of the digits when the arms are extended (“choreic hand”)

Question 150

what is the cause of pompe disease

Answer 150

A defect in lysosomal acid maltase (also referred to as lysosomal acid alpha-glucosidase)

Question 151

pompe disease presentation

Answer 151

Without this enzyme, the conversion of glycogen to glucose in the lysosome cannot be completed and glycogen buildup becomes toxic to numerous cells, predominantly skeletal and cardiac muscle cells. Notably, the condition does not present with hypoglycemia or metabolic acidosis because glycolysis and gluconeogenesis do not depend on lysosomal glycogenolysis.

Question 152

Prenatal alcohol exposure results in fetal alcohol syndrome, which presents how

Answer 152

microcephaly, flat philtrum, short palpebral fissures, hypertelorism, depressed nasal bridge, and micrognathia. behavioral problems (e.g., hyperactivity and inattention) and intellectual disability (e.g., learning disabilities, memory and reasoning deficits, and impaired language development) , ventricular septal defect

Question 153

von Gierke’s disease (type a) caused by and presents

Answer 153

Glucose 6-phosphatase deficiency
with failure to thrive, lethargy, hepatomegaly, severe fasting hypoglycemia (causing hypoglycemic seizures), hyperlipidemia, and lactic acidosis.

Question 154

The most common form of galactosemia is which leads to what

Answer 154

galactose-1-phosphate uridylyltransferase deficiency, which leads to the accumulation of galactose-1-phosphate and galactitol. Infantile cataracts are caused by accumulation of galactitol in the eye lens.

Question 155

when do the symptoms of galactosemia begin

Answer 155

when the baby starts feeding

Question 156

treatment of galactosemia

Answer 156

avoid lactose

Question 157

what are infants with galactosemia at increased risk for

Answer 157

sepsis from e coli

Question 158

adrenoleukodystrophy characteristics include

Answer 158

Rapidly deteriorating vision, hearing, motor abilities, and cognition in the presence of spastic tetraplegia, sensory loss, and adrenal insufficiency (suggested by hyperpigmented skin) in a young boy . A family history of what was likely the same condition in a maternal relative supports the diagnosis of this X-linked recessive condition

Question 159

cause of adrenoleukodystrophy

Answer 159

peroxisomal ATP-binding cassette transporter dysfunction

Question 160

cri-du-chat syndrome is characterized by

Answer 160

Failure to thrive, difficulty feeding, a squeaky (i.e.high-pitched) cry, and cardiac anomaly (possibly a ventricular septal defect) in a child with down-slanting palpebral fissures, single palmer crease, round face

Question 161

cause of cri-du-chat

Answer 161

micro deletion of chromosome 5

Question 162

is turners syndrome associated with intellectual disability

Answer 162

NO

Question 163

what is associated with turners

Answer 163

hypertension, wide-spaced nipples, aortic insufficiency because of bicuspid aortic valve and coarctation. low set hairline and lymphedema

Question 164

Over 98% of men with what have congenital bilateral absence of vas deferens, which results in azoospermia and infertility.

Answer 164

cystic fibrosis

Question 165

what nasal phenomenon is associated with cystic fibrosis

Answer 165

polyps

Question 166

what coagulopathy is found in cystic fibrosis and why

Answer 166

Exocrine pancreatic insufficiency arising from hyperviscous secretions in cystic fibrosis leads to malabsorption, steatorrhea, and deficiency of fat-soluble vitamins (A, D, E, and K). Vitamin K deficiency causes coagulopathy and an elevated prothrombin time.

Question 167

what acid base disorder is found in cystic fibrosis and why

Answer 167

metabolic alkalosis
Patients with CF may lose an excess of chloride in their sweat (due to defective chloride channels) and GI tract, resulting in chloride-dependent metabolic alkalosis, not acidosis.

Question 168

what pulmonary phenomenon is often found in cystic fibrosis and why

Answer 168

recurrent pulmonary infections and chronic bronchitis in CF lead to obstructive lung disease with increased air trapping and lung hyperinflation, resulting in increased, not decreased, residual volumes.

Question 169

what is highly associated with cystic fibrosis

Answer 169

meconium ileus

most infants with meconium ileus have cystic fibrosis

Question 170

what is the presentation of lesch-Nyhan sydnrome

Answer 170

usually asymptomatic for the first few months of life and then present with hypotonia and developmental delay. As the disease progresses, deficient HGPRT leads to neurological symptoms (cognitive impairment, dystonia, spasticity), behavioral symptoms (aggression), and elevated serum uric acid as well as its accumulation in peripheral tissue, which results in gouty arthritis, urate nephropathy, and megaloblastic anemia. A hallmark of the disease is self-injurious behavior including chewing the fingers, biting the lips, and banging of the head or limbs.

Question 171

homocystinuria causes and presentation

Answer 171

Cystathionine synthase deficiency

Marfanoid habitus, high-arched palate, inferior lens dislocation, kyphosis, hyperelastic skin, hypermobile joints, and possibly intellectual disability (as indicated by delayed language, block-building, and drawing abilities). excessive homocysteine and sodium nitroprusside will turn an affected patient’s urine a deep red color,

Question 172

easy way of thinking about homocystinuria

Answer 172

marfans with developmental delay

Question 173

what is the cause of alport syndrome

Answer 173

type IV collagen defect

Question 174

what is the cause of henoch-schonlein purpura

Answer 174

thought to arise from IgA immune complex deposition in vascular walls, which results in activation of complement factors and organ damage.

Question 175

risk factors for febrile seizures

Answer 175

high fever, viral infection (especially HHV-6 and influenza), a family history of febrile seizure, and recent immunization (especially DTP and MMR) are all known risk factors.

Question 176

what is the presentation of herpes conjunctivitis

Answer 176

HSV can cause nonpurulent conjunctivitis, which presents with photophobia, pruritus on the periocular area, and crusts over the eyelashes, as well as conjunctival injection, redness, and watery discharge from the eye on examination. HSV-1 conjunctivitis is more common in children and adults, while HSV-2 often affects neonates. HSV conjunctivitis is usually unilateral and often presents with a vesicular rash.

Question 177

patients with a history of what are particularly susceptible to HSV conjunctivitis.

Answer 177

atopic dermatitis

Question 178

what is the next step for a baby showing signs of sepsis without a source from urinalysis, no signs of intracranial pressure and no neurological signs on exam

In infants < 1 month old with fever, poor feeding, jaundice, and irritability or lethargy, what needs to be ruled out!

Answer 178

lumbar puncture

meningitis

Question 179

what is the most common brain tumor found in children and where is it usually located and how does it present

Answer 179

Pilocytic astrocytoma and is usually located within the posterior fossa. Cerebellar compression can cause falls and dysdiadochokinesia, while increased intracranial pressure can result in lethargy, morning headaches, nausea, and vomiting. Imaging typically shows a well-circumscribed, enhancing cystic mass within one of the cerebellar hemispheres.

Question 180

what is the prognosis (generally) for pilocytic astrocytoma

Answer 180

Since pilocytic astrocytomas are low-grade tumors (WHO grade I), patients usually have a favorable prognosis following surgical resection.

Question 181

what are the nucleotide repeats for friedrichs ataxia

Answer 181

GAA in the FXN gene

Question 182

what is the treatment course for a mild concussion

Answer 182

observation for 6 hours, then discharge. have a responsible individual monitor the patient for 24 hours and return if neurological symptoms occur. refrain from contact for 1 week

Question 183

what is the presentation and management of congenital torticollis

Answer 183

A conservative approach such as stretching program with congenital torticollis, which typically presents with a tilted head, limited range of motion, and a palpable, well-circumscribed mass within the sternocleidomastoid muscle (SCM) due to unilateral fibrosis.

Question 184

how can brachial plexus injuries in the newborn present

Answer 184

horners, reduced movement of the effect limb and reduction of the grasp reflex

A constricted left pupil (i.e., miosis) and drooping left eyelid (i.e., ptosis) suggests neonatal Horner syndrome, which can be caused during birth as traction to the brachial plexus damages cervical sympathetic nerve fibers. Klumpke palsy can also result from brachial plexus injury (due to damage of C8 and T1 nerve fibers that supply the ipsilateral intrinsic hand muscles), causing an absent grasp reflex.

Question 185

trendelenberg sign and what is the cause

what is associated with this in young children

Answer 185

when asked to stand only on one foot, the other sags instead of holding the pelvis linear. this is caused by the active legs superior gluteal nerve damage.
can be caused by misdirected injection of the DTaP vaccine

Question 186

A retracted opacified tympanic membrane is typically associated with

Answer 186

otitis media with effusion (OME). Although OME is observed frequently in toddlers, it is primarily asymptomatic, since the effusion in the tympanic cavity is characteristically non-inflammatory.

Question 187

what do you give babies with severe neonatal abstinence syndrome

Answer 187

oral morphine if the presentation is serious.

Question 188

what do you give babies with mild neonatal abstinence syndrome

Answer 188

supportive care by swaddling, fluids, quiet room

Question 189

Can babies have neonatal abstinence syndrome from cough syrup

Answer 189

yes

Question 190

what is a lesser known presentation of hearing impairment

Answer 190

unprovoked episodes of crying and screaming this is usually out of frustration

Question 191

Do absence seizures have a postictal state

Answer 191

not usually

Question 192

how long do absence seizures last

Answer 192

usually 5-10 min

Question 193

what is the characteristic EEG finding for absence seizure

Answer 193

slow spike-wave complexes

Question 194

A chalazion is a

Answer 194

slowly progressing, firm, rubbery, and nonpurulent nodule on the eyelid. a chalazion is classically a nontender chronic lesion that may present with heaviness of the eyelid.

Question 195

what is the best way to assess optic glioma

Answer 195

MRI

Question 196

what is the treatment fort lead exposure

Answer 196

succimer and calcium disodium edetate

Question 197

what is the presentation of lead toxicity

Answer 197

cognitive delay/decline, microcytic/normochromic anemia, fatigue, constipation, abdominal pain (lead colic), gingival hyperpigmentation (Burton line),

Question 198

what is the presentation of fanconi anemia

Answer 198

Pancytopenia is also common and presents with mucocutaneous bleeding, recurrent infections, and anemia (normocytic or macrocytic) include short stature, hypopigmentation and hyperpigmentation of the skin, cafe-au-lait spots, microcephaly and developmental delay, ocular abnormalities including esotropia and hypertelorism, and thumb and forearm malformations.

Question 199

what blood cancers are associated with Fanconi anemia

Answer 199

predisposition for developing acute myeloid leukemia or myelodysplastic syndromes in early adulthood

Question 200

what stone disorders are common in CF

Answer 200

nephrolithiasis and cholethiasis

Question 201

what cardiac manifestations can occur in CF

Answer 201

cor pulmonale

Question 202

what is the presentation of cor pulmonale

Answer 202

right heart failure due to lung disease presents as hepatomegaly, hepatojugular reflux, JVP, pitting edema

Question 203

what extremity findings are there in CF

Answer 203

clubbing in the fingers, scoliosis and failure to thrive

Question 204

Long-term intake of certain antiepileptics (e.g., phenytoin) is associated with

Answer 204

a decrease in serum vitamin D levels, hypocalcemia, secondary hyperparathyroidism, and decreased bone density. Rickets is caused due to impaired calcification and mineralization of bones secondary to a disruption in the metabolic pathway of either vitamin D or phosphate.

Question 205

what is rickets

Answer 205

metabolic abnormality

Question 206

The initial steps in management of caustic ingestion include

Answer 206

assessment of airway, breathing, and circulation as well as removal of contaminated clothes. Early endoscopy (within 12–24 hours) is important as it allows detailed assessment of the damage to the esophageal lining. The severity of that damage will guide further therapy, such as the need for nasogastric tube placement in case of oropharyngeal injury or, in severe esophageal burns, surgery.

Question 207

what is the normal physiology of calcium and phosphorus

Answer 207

PTH and vitamin D regulate the uptake of calcium and expulsion of phosphate. if both are elevated simultaneously then there is usually bone breakdown –check alk phos

Question 208

Oligoarticular juvenile idiopathic arthritis is associated with what ophthalmic disorder

Answer 208

chronic anterior uveitis (often bilateral) in ∼ 25% of cases.

Question 209

what should juvenile idiopathic arthritis be screened for

Answer 209

anterior uveitis treat asymptomatic anterior uveitis early to help prevent further complications, such as cataracts, iris synechiae, glaucoma, and blindness.

Question 210

McCune-Albright syndrome presents how

Answer 210

The patient’s triad of polyostotic fibrous dysplasia, café-au-lait spots, and peripheral precocious puberty (due to excess autonomous testosterone production)
An x-ray of her long bones would show the ground-glass appearance of fibrous dysplasia.

Question 211

Treatment for McCune-Albright syndrome includes

Answer 211

administration of bisphosphonates, surgery of pathological fractures, and administration of antiandrogens and aromatase inhibitors in males.

Question 212

what happens to the ovaries in turners sydnrome

Answer 212

premature ovarian failure.

Question 213

what combination of FSH, LH, and estrogen and androgens occurs in Turner syndrome as a result of

Answer 213

The combination of elevated gonadotropin (FSH and LH) levels with decreased levels of estrogen and androgens characterizes hypergonadotropic hypogonadism

Question 214

what is the treatment for functional constipation

Answer 214

polyethylene glycol for 3-6 days
if persistent try enema
polyethylene can be continued for 2-4 weeks as maintenance therapy

Question 215

what is the diagnosis for blood-tinged and mucus in the stool without signs of obstruction

Answer 215

usually proctocolitis caused by protein allergy

advise mother to refrain from dairy or soy

Question 216

what is the treatment for necrotizing enterocolitis s

Answer 216

surgical emergency requiring exploratory laparotomy if there are peritoneal signs
also provide supportive treatment which includes nasogastric decompression
antibiotics broad spec are warranted here

Question 217

Do we test for rotavirus and does this change management

Answer 217

yes we do and no it doesnt. it is because of the contagiousness that we test. then we can isolate the person

Question 218

enterobius vermicularis infection presents how and is diagnosed with what test

Answer 218

presents as perianal and perivulvar pruritus with erythema. cellophane tape test to confirm

Question 219

what is required of post exposure prophylaxis for a child with hepatitis A

Answer 219

nothing. they should be vaccinated

Question 220

what can prevent pyloric stenosis

Answer 220

breast feeding

Question 221

what is the most likely underlying cause of intussusception

Answer 221

meckels diverticulum

Question 222

does a double bubble sign present with epigastric mass

Answer 222

no. double bubble is duodenal atresia and epigastric mass usually pyloric stenosis

Question 223

Yersinia enterocolitica is primarily acquired through

Answer 223

the consumption of contaminated food, most commonly raw pork. Other documented vehicles of transmission that have been implicated in outbreaks include unpasteurized milk products, unfiltered water, and food contaminated with pet feces. After a typical incubation period of 4–6 days,

Question 224

Yersiniosis causes

Answer 224

inflammatory diarrhea, nausea, low-grade fever, and, in some cases, RLQ tenderness that may mimic appendicitis (pseudoappendicitis).

Question 225

Reye syndrome is caused by

Answer 225

hepatic mitochondrial injury that can develop in children 3–5 days after aspirin treatment of a febrile viral illness (most commonly with VZV or influenza B).

Question 226

Reye syndrome initially presents as

Answer 226

hepatic encephalopathy that manifests with profuse vomiting (due to ↑ ICP) and lethargy, which progresses to delirium, seizures, and coma. Other typical findings include hepatomegaly, elevated AST and ALT (3 times the normal levels), hyperammonemia, hypoglycemia, metabolic acidosis, and a prolonged INR.

Question 227

what is the most important step in suspected epiglottitis

Answer 227

securing the airway, as this can get worse quickly. diagnostic measures such as x ray are important later on

Question 228

what is the treatment for mild croup (no intercostal retractions, mild stridor)

Answer 228

cool mist and dexamethasone inhalation

Question 229

what is the presentation of pertusis

Answer 229

Paroxysmal coughing spells followed by deep, noisy (“whooping”) breaths are very typical of infection with Bordetella pertussis.

Question 230

treatment of choice for pertussis

what is the post exposure prophylaxis and guidelines

Answer 230

Macrolides (e.g., azithromycin, erythromycin, clarithromycin) They are also given as postexposure prophylaxis to all close contacts of infected individuals, regardless of immunization status.

Question 231

are macrolide given to babies? what are the risks

when are they given to babies

Answer 231

Macrolides, in general, are not used in infants < 1 month of age because of their adverse gastrointestinal effects; erythromycin, in particular, is associated with an increased risk of infantile hypertrophic pyloric stenosis. However, the potential benefit of avoiding infantile pertussis with azithromycin therapy specifically outweighs the potential harm.

Question 232

when should adults be vaccinated for pertusis

Answer 232

Regarding vaccination, adults < 65 years of age who have contact with infants should be vaccinated with Tdap to boost potentially waning immunity and prevent potential infection in the infant. Tdap administration is thus important in both the father (unknown immune status) and mother (last booster > 10 years ago).

Question 233

pertusis infection puts patients at risk of what

Answer 233

due to the coughing and increases in intraabdominal and thoracic pressure can cause epistaxis, abdominal hernias, pheumothorax
also at risk for bilateral conjunctival hemorrhage and petechia i

Question 234

Croup is considered moderate-to-severe if

Answer 234

the patient has dyspnea and tachycardia at rest, severe stridor with significant retraction, and agitation,

Question 235

moderate-to-severe croup requires what treatment

Answer 235

nebulizer racemic epinephrine

Question 236

peritonsillar abscess requires what treatment

Answer 236

I and D and IV antibiotics such as ampicillin and sulbactam

Question 237

what is the prophylactic treatment for RSV and when is it given and what is its purpose?

Answer 237

palivizumab
given to infants at risk or with brochohlitis and bronchopulmonary dysplasia and premature
this provides passive immunity

Question 238

what is bronchopulmonary dysplasia

Answer 238

A chronic lung disease primarily found in premature infants exposed to prolonged mechanical ventilation and oxygen therapy (causing barotrauma, oxygen toxicity, and inflammation) for neonatal respiratory distress syndrome.

Question 239

what is the most common cause of postinfluenza pneumonia

Answer 239

strep pneumonae

this will be a more mild pneumonia than staph and will present without cavitary lung lesions

Question 240

what is the treatment of post influenza pneumonia

Answer 240

treated empirically with antibiotics (e.g., levofloxacin) until confirmatory data (e.g., cultures) are available.

Question 241

if someone presents with tonsillitis and the rapid test is negative what is the next step

Answer 241

throat culture

Question 242

what is the presentation of bronchopulmonary dysplasia

Answer 242

persistent tachypnea, labored breathing (intercostal and subcostal retractions), FiO2 > 30% to maintain peripheral saturation > 90%, and diffuse granular densities with basal atelectasis on x-ray. Later in the disease course, interspersed cystic areas and diffuse hyperinflation of the lung can develop

Question 243

The first step in management of neonatal respiratory distress syndrome is

Answer 243

nasal CPAP to provide positive end-expiratory pressure. PEEP helps prevent alveolar collapse by providing pressure at the end of expiration when alveoli are most prone to collapse. After initiation of CPAP, an ABG should be obtained to assess the effectiveness of this ventilatory method.

Question 244

immature neonatal lungs without sufficient surfactant production causes

Answer 244

an increased surface tension in the alveolar sacs that results in alveolar collapse, atelectasis, and ventilation-perfusion mismatch.

Question 245

If FiO2 > 0.4 or pH < 7.25, after PEEP therapy in neonatal distress syndrome then BLANK is warranted.

Answer 245

intubation and surfactant therapy

Question 246

why aren’t surfactant therapy and incubation first line therapy for neonatal distress sydnrome

Answer 246

because they have serious complications such as bronchopulomonary dysplasia

Question 247

what is more specific tuberculin skin test or interferon gamma test

Answer 247

gamma test.

Question 248

what is the next step in management if a patient has a positive interferon gamma release assay, came from India and has negative chest x ray

Answer 248

isoniazid treatment for 9 months

Question 249

where is the inflammation characteristic of croup

Answer 249

the subglottal airway

Question 250

juvenile angiofibroma presents and diagnosed how

Answer 250

as nosebleeds with a pink mass in the nostril. diagnosed with biospy

Question 251

what is the most common predisposing factor for bacterial sinusitis

Answer 251

viral URI

Question 252

how does a viral URI predispose to bacterial sinusitis

Answer 252

A viral URTI may cause ostial obstruction and dysfunction of the mucociliary apparatus, leading to the development of sinusitis.

Question 253

what is the presentation of bacterial sinusitis secondary viral URI

Answer 253

initially clear drainage and mild that prolong and do not improve over the course of 2 weeks, progress to purulent nasal discharge along with facial pain, which indicate secondary bacterial infection.

Question 254

First-line treatment for uncomplicated acute bacterial rhinosinusitis consists of

Answer 254

amoxicillin-clavulanate.

Question 255

what is the most common adverse effect of treatment with inhaled corticosteroids.

Answer 255

Oropharyngeal candidiasis (thrush) is the

Question 256

how to avoid oropharyngeal candidiasis with inhaled glucocorticoid treatment

Answer 256

It can be prevented by gargling with water after use of the inhaler and/or by adding a spacer to metered dose inhalers.

Question 257

what is the diagnostic test of choice for osteomyelitis and why

Answer 257

bone biopsy. has a high sensitivity and can guide the antibiotic applications

Question 258

what should precede the first dose of antibiotics for osteomyelitis

Answer 258

bone biopsy. unless acutely ill. broad spec can be given while blood cultures are pending

Question 259

what is the treatment for a septic joint

Answer 259

prompt synovial drainage via arthrocentesis and antibiotic coverage.

Question 260

what are the interventions for Legg-calves Perthes disease

Answer 260

mild with no femoral deformity is conservative consisting of limited weight bearing and physical therapy. if there is femoral head deformity then brace and casts.

Question 261

what is the treatment for slipped cap femoral epiphysis

Answer 261

femoral head pinning

Question 262

what is the underlying cause of Legg calves perthes

Answer 262

femoral head avascular necrosis

Question 263

what is the treatment for developmental dysplasia of the hip

Answer 263

harness

Question 264

what age group is typically affected by Legg-calve-perthes

Answer 264

is most common in children between 4–10 years of age

Question 265

what age group and body type is typically affected by SCFE

Answer 265

it occurs most often in obese children between 10–16 years of age.

Question 266

Distal humerus fractures can cause what

Answer 266

Distal humerus fractures, including supracondylar fractures, can lead to arterial compromise either by entrapping or directly injuring the brachial artery.

Question 267

The genu varum deformity (bow legs) is

Answer 267

normal in children ≤ 2 years and typically corrects as the infant learns to walk and bear more weight on the lower extremities

Question 268

Seronegative polyarticular JIA is characterized by

Answer 268

the involvement of ≥ 5 joints within 6 months of disease onset. Typical manifestations include symmetrical arthritis of the interphalangeal joints, as well as involvement of the cervical spine and the temporomandibular joint. Chronic anterior uveitis is another common finding.

Question 269

Systemic juvenile idiopathic arthritis is characterized by

Answer 269

arthritis involving at least 1 joint and the occurrence of systemic symptoms. Joint involvement is most often polyarthritic (may also be oligoarthritic) and commonly affects the knees, ankles, and wrists. Systemic symptoms include intermittent fever and a transient, salmon-pink rash, which often occurs simultaneously to fever spikes. Spleno- or hepatomegaly, generalized lymphadenopathy, and serositis (e.g., pleuritis) can also occur.

Question 270

Oligoarticular juvenile idiopathic arthritis (JIA) is

Answer 270

the most common type of arthritis seen in children and adolescents. Girls between 2–4 years old are most affected. Oligoarticular JIA presents with asymmetrical arthritis of ≤ 4 large, weight-bearing joints (e.g., knees, ankles) within 6 months of disease onset. The affected joints are often stiff in the morning or after longer periods of inactivity (e.g., sitting), with mobility improving with activity throughout the day. Chronic anterior uveitis is another common symptom and may present with recurring episodes of ocular pain, redness, and photosensitivity. Most patients also have an elevated ESR and increased antinuclear antibody levels but negative rheumatoid factor.

Question 271

Langerhans cell histiocytosis (LCH) is

Answer 271

a rare disorder that most commonly affects children 5–10 years of age. It presents as single or multiple osteolytic lesions that cause bone pain and swelling. The skull is the most commonly affected bone in children (as in this patient), but LCH can also involve the liver, spleen, and other organ systems.

Question 272

what is Osgood Schlatter disease, who does it affect and how does it present

Answer 272

Traction apophysitis of the tibial tubercle which typically affects adolescent athletes. Overuse (e.g., sports that involve running and jumping) leads to the patellar tendon exerting excessive strain on the tibial tuberosity, which is not yet fully ossified in adolescents and is thus susceptible to detachment.x-ray shows a separated, sclerotic bone fragment cranial of the tibial tuberosity

Question 273

first treatment measure in Osgood-Schlatter disease should always be

what are other treatments

Answer 273

a combination of rest, ice, and oral anti-inflammatory medication, like ketorolac. If this combination is not effective, cast immobilization can be attempted. Surgical excision of the fragmented tibial tubercle (and any other ossicles found in the area of the tendon) is reserved for refractory cases.

Question 274

what is indicated in achondroplasia

Answer 274

neuroimaging to assess the size of the foramen magnum

Question 275

presentation of achondroplasia

Answer 275

Decreased muscle strength is common in infants with achondroplasia, and in combination with increased deep tendon reflexes, raises suspicion for complications such as brain stem compression and spinal stenosis. Narrowing of the foramen magnum commonly occurs in achondroplasia due to increased growth of the head compared to the torso, which can cause compression of the cervical medulla and lead to subsequent muscular hypotonia/quadriparesis, apnea/hypopnea, and sudden infant death. Neuroimaging is thus indicated at the time of diagnosis to assess the size of the foramen magnum,

Question 276

Defective type V collagen is the cause of

Answer 276

Ehlers-Danlos syndrome type II (classic EDS),

Question 277

Ehlers-Danlos syndrome type II (classic EDS), which is characterized by

Answer 277

weakness of connective tissue that predominantly affects the joints and skin. clinical features include joint hypermobility and subluxation (e.g., patella, temporomandibular, shoulder), skin hyperextensibility and fragility, and skeletal abnormalities (e.g., scoliosis). The fragile skin shows a tendency to bruise and break easily, leading to potentially severe lacerations from minor trauma. Cardiovascular features are seen less commonly in classic EDS, but may include heart valve defects and aneurysms/dissections of large arteries.

Question 278

Defective type III collagen is the cause of

Answer 278

vascular Ehlers-Danlos syndrome

Question 279

vascular Ehlers-Danlos syndrome, which presents primarily with

Answer 279

cardiovascular manifestations. These include heart valve defects (especially mitral valve prolapse), aneurysms or dissections of large arteries (e.g., aortic, iliac), and berry aneurysms of cerebral arteries. Features of other types of EDS may occur (e.g., skin is fragile, but not extensible), but are rare and are typically much less pronounced. In spite of the fact that cardiovascular symptoms seldom manifest before young adulthood, the severity of this patient’s symptoms cannot be explained by a defect in type III collagen.

Question 280

spondylolisthesis is

Answer 280

chronic lumbar pain that worsens upon exertion and reclining, a positive step-off sign, a bilaterally positive straight leg raise test, and a waddling gait. Spondylolisthesis is common in all ages. This patient’s history of swimming and weight lifting, both of which involve repetitive hyperextension and rotation of the lumbosacral spine, put him at risk

Question 281

treatment for spondylolisthesis is

Answer 281

conservative management with physical therapy

Question 282

is imaging required for the diagnosis of radial head subluxation

Answer 282

no

Question 283

what is the common presentation of osteogenesis imperfecta

Answer 283

Hearing impairment is a common clinical manifestation of OI, and results from fracture, dislocation, or abnormal formation of the ossicles. also blue sclerae (due to choroidal veins appearing through the overlying thin sclerae), easy bruisability, and brittle, opalescent teeth.

Question 284

what is recommended for secondary prophylaxis of recurrent acute rheumatic fever in patients with manifestations of carditis but no permanent valvular damage.

Answer 284

Intramuscular benzathine penicillin every 4 weeks for 10 years (or until 21 years of age, whichever is longer)

Question 285

5 minor criteria of the modified Duke criteria for the diagnosis of infective endocarditis.

Answer 285

These include a predisposing heart condition (ventricular septal defect), fever ≥ 38°C (100.4°F), vascular phenomenon (splinter hemorrhages and Janeway lesions, i.e., purplish lesions on her palms and soles), immunologic phenomenon (glomerulonephritis and Roth spots, i.e, retinal hemorrhages), and a positive blood culture for atypical microorganisms consistent with IE.

Question 286

what is the best initial test for infective endocarditis

Answer 286

blood cultures

Question 287

when does rib notching occur in coarctation

Answer 287

not until the age of 5

Question 288

when does the anterior fontanelle close

Answer 288

around 18 months

Question 289

when does a ventricular septal defect usually become symptomatic and why

Answer 289

after the first few weeks of life

in utero the pulmonary vascular resistance is high and thus equals the systemic vascular resistance.

Question 290

epstein anomaly is what

Answer 290

maternal lithium exposure displacement of a tricuspid valve leaflet that results in atrialization of the right ventricle, tricuspid regurgitation, and right atrial enlargementto right atrial enlargement, elongation of the tricuspid valve leaflets, and tricuspid regurgitation,

Question 291

what are the most common heart defects in downs syndrome

Answer 291

Atrioventricular septal defects (AVSD; also referred to as endocardial cushion defects)

Question 292

can you treat a VSD with prostaglandin E

Answer 292

no. this worsens the left to right shunt and causes heart failure

Question 293

what is the treatment for small VSDs

Answer 293

outpatient followup as most of them close spontaneously

Question 294

what is a common cause of a murmur that goes away when the patient flexes their neck

Answer 294

venous hum. which is caused by turbulence in the internal jugular vein

Question 295

what is tricuspid valve atresia

Answer 295

this is where is a muscular septum between the right atria and the right ventricle. t

Question 296

what is the presentation of tricuspid valve atresia

Answer 296

left ventricle hypertrophy, right ventricle hypoplasia, left axis deviation

Question 297

tetralogy of fallot presents how

Answer 297

most common cyanotic heart defect tet spells of cyanosis. increased cyanosis with valsalva

Question 298

what are the causes of tetralogy of fallot

Answer 298

usually sporadic, but associated with Downs and DiGeorge

Question 299

what triggers tet spells and why

Answer 299

crying, feeding, defecation
it activate the the sympathetic nervous system, which triggers spastic contractions of the hypertrophic infundibular musculature (at the transition from the right ventricle to the pulmonary artery).

Question 300

what do kids with tetralogy usually do

Answer 300

they squat because that increases the vascular resistance and reverses thee shunting

Question 301

what are VSDs associated with

Answer 301

polycythemia from eisenmengers syndrome (right to left shunting).

Question 302

Cyanosis shortly after birth that does not improve with supplemental oxygen, and a chest x-ray with the classic egg-on-a-string appearance (i.e., an enlarged heart with narrowed mediastinum due to an overlapping aorta and pulmonary trunk) are suggestive of

Answer 302

a diagnosis of transposition of the great arteries.

Question 303

what is the cause of a diagnosis of transposition of the great arteries.

Answer 303

maternal diabetes

Question 304

what is critical for survival in a a diagnosis of transposition of the great arteries.

Answer 304

VSD

Question 305

what valvular disorders are associated with marfans

Answer 305

aortic regurgitation and mitral valve prolapse

Question 306

what are the clinical findings for Marfan syndrome heart valve defects

Answer 306

water hammer pulse (aortic regurgitation) 
click murmur  (mitral valve prolapse)

Question 307

what is the treatment for SVT caused by WPW

Answer 307

procainamide

Question 308

what medications are contraindicated in WPW (AVRT)

Answer 308

AV nodal blocking agents such as beta blockers, CCB

these will cause the aberrant pathway to become the necessary pathway as there will be less resistance.

Question 309

what medications are the medications for AVNRT

Answer 309

adenosine, beta blockers, CCB

these will slow the reentry through the circuit. And there is no accessory pathway to worry about.

Question 310

what is the presentation of hypertrophic cardiomyopathy

Answer 310

systolic ejection murmur caused by the left ventricular outflow track obstruction. rapid squatting softens the murmur while valsalva increases –interventricular petal hypertrophy

Question 311

what is the cause of death in someone with HCM

Answer 311

arrhythmias

Question 312

A systolic ejection murmur that increases with valsalva maneuver and standing and decreases with hand grip, squatting, or lying down leads to a diagnosis of what

Answer 312

HCM

Question 313

what is the treatment of choice for long QT syndrome

Answer 313

beta blockers such as propanolol

Question 314

what is the treatment of choice for refractory long QT syndrome

Answer 314

implantable defibrillator

Question 315

what is the presentation of hereditary angioedema

Answer 315

autosomal dominant c1 inihbitor deficiency.
triggers are stress and trauma. results in swelling, erythema without urticaria or pruritus and primarily effects the mucosa of the GI and upper respiratory tract.
episodes are usually self-limiting and resolve within 2–4 days

Question 316

what is a known risk factor for UTI and why

Answer 316

Constipation is known to be a risk factor for lower UTIs. Prolonged fecal retention leads to bladder dysfunction and urinary stasis, which in turn promotes bacterial overgrowth.

Question 317

what is the preferred method for getting a urine sample on a child that is not potty trained

Answer 317

transurethral catheterization

Question 318

why is a renal and bladder ultrasound preformed after a child has a confirmed UTI

Answer 318

to look for anatomical defects and for abscesses

Question 319

what are the features of posterior urethral valves.

Answer 319

This patient presents with urosepsis, a palpable bladder (midline lower abdominal mass), and a history of oligohydramnios, all of which are features of urinary tract obstruction

Question 320

Can VUR cause hydronephrosis

Answer 320

yes

Question 321

what is a complication of vesicoureter reflux

Answer 321

renal scarring

Question 322

what stone is radioopaque on X ray what shape are the crystals and what test is used to test for it

Answer 322

Hexagon-shaped crystals on urinalysis indicate cystine stones caused by cystinuria. Cystine stones are only poorly radiopaque and often do not appear on x-ray; they are visible on CT, however. Regardless, the positive urine cyanide nitroprusside test confirms the diagnosis.

Question 323

what are the histological findings for minimal change disease

Answer 323

there is usually nothing which is why it is called minimal change

Question 324

what is the cause of post strep glomerulonephritis

Answer 324

Poststreptococcal glomerulonephritis is caused by the deposition of immune complexes composed of IgG and C3 complement that contain the streptococcal antigen within the glomerular basement membrane.

Question 325

what is the course of post strep glomerulonephritis

Answer 325

Recovery of kidney function usually occurs within 6–8 weeks. While 90% of pediatric cases recover completely, approximately 50% of adult patients retain persistently reduced renal function.

Question 326

recurrent episodes of gross hematuria that is always associated with pharyngitis and with glomerulonephritis glomerular origin of the blood (RBCs with dysmorphic features and RBC casts) suggests what

Answer 326

This combination suggests Berger disease.

Question 327

what are the features of membraneous neprhopathy

Answer 327

Subepithelial deposits of IgG and complement along the glomerular basement membrane (spike and dome appearance) is the classic finding in membranous nephropathy.

Question 328

what is a risk factor for membraneous nephropathy

Answer 328

hepatits B infection

Question 329

Renal papillary necrosis is

what are the common renal findings q

Answer 329

a potentially devastating complication of severe pyelonephritis, which is caused by ascending bacterial infections of the bladder with organisms such as Escherichia coli and other enteric flora. The most common urinalysis findings include hematuria, proteinuria, and pyuria, as seen in this patient.

Question 330

what is the diagnosis of hypokalemic, hyperchloremic metabolic acidosis with a high urine pH

Answer 330

type 1 renal tubular acidosis decreased activity of the H+/K+ ATPase antiporter on the apical surface of intercalated cell, which reabsorbs K+ and secretes H+ into the lumen of the tubule.