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AMEDEX MIX > AMEDEX MIX > Flashcards

AMEDEX MIX Flashcards

1
Q

The following are absolute contraindications to ACE inhibitors: • History of angioedema regardless of cause (even if not due to ACE inhibitor) • Pregnancy (due to harm to fetus) • Bilateral renal artery stenosis. Previous __________________ to ACE inhibitors

A

allergic reaction

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2
Q

Relative contraindications are: •
Aortic stenosis •
Hypertrophic cardiomyopathy
A dry cough is a common adverse effect of ACE inhibitors and a main cause of ______________ and abandonment of treatment

A

non-compliance

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3
Q

neither pre- existing cough nor ACE inhibitor-induced _____________is not a contraindication to their use.

A

cough

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4
Q

The clinical history is suggestive of laryngomalacia. Laryngomalacia is
congenital softening of the tissues of the larynx above the vocal cords. This is the most
common cause of —————- in infancy.

A

noisy breathing

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5
Q

Acute asthma makes breathing difficult, and wheeze is audible in
_____________

A

any body position

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6
Q

Asthma is an extremely rare possibility in a ____________ neonate.

A

2-week-old

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7
Q

Croup (laryngotracheobronchitis) is most commonly caused by _____________ virus type 1
infection.

A

para-influenza

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8
Q

It is characterized by a seal barking cough and inspiratory stridor.

A

Croup (laryngotracheobronchitis

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9
Q

Croup affects

mainly children aged 6 month to __ years.

A

3

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10
Q

Acute bronchiolitis is an acute viral
infection of the lower respiratory tract, typically affecting infants (≤24 months) and is
characterized by __________, wheezing, and inspiratory fine

A

respiratory distress

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11
Q

It is primarily caused by respiratory syncytial virus (RSV). Treatment is supportive with oxygen and
___________.

A

hydration

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12
Q

Prognosis is generally excellent; however, some chidlren may develop apnea or
respiratory failure.

A

Acute bronchiolitis

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13
Q

Epiglottitis is a rapidly progressive bacterial infection of the
epiglottis and surrounding tissues that may lead to sudden _____________ and death.

A

respiratory obstruction

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14
Q

Symptoms include severe sore throat, dysphagia, high fever, drooling, and inspiratory stridor.

A

Epiglottitis

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15
Q

Treatment includes airway protection and antibiotics.

A

Epiglottitis

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16
Q

Lipomas are common benign tumors of mature fat cells that can be seen in
any site of the body containing ___________.

A

fatty tissue

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17
Q

They are not premalignant. Although they
frequently occur in the subcutaneous fat tissue, it is not uncommon to see ________in the deeper
layers such as beneath the fascia or within muscles.

A

lipomas

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18
Q

As there is very little fat in the scrotum lipomas almost never occur there, but fat deposition within the ____________ may be seen.

A

spermatic cord

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19
Q

Unlike lipomas, ___________ of the scrotum are common.

A

epidermoid cysts

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20
Q

Lipomas are usually freely
mobile and not attached to the overlying skin; however in areas such as the back of the neck or
the trunk, where the skin has less mobility, they could be less mobile or even ___________.

A

immobile

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21
Q

The
most characteristic physical feature of a lipoma is the lobulated contour, which can reliably
differentiate it from an epidermoid cyst and its
____________________.

A

smooth contour

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22
Q

The clinical picture of headache worse in the morning, and by sneezing,
coughing and bending forward is suggestive of a space-occupying lesion in the brain that can
be either a __________

A

tumor or abscess

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23
Q

Considering the age of the patient, history of heavy smoking and
the cough, this patient has __________cancer with high certainty.

A

lung

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24
Q

Lung cancer is one of the three

primary cancers that tend to metastasize to the _________(21%).

A

brain

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25
Q

The other two are melanomas

40%) and breast cancer (9%

A

metastasize to the brain

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26
Q

With this history and chest X-ray findings, the lesion is most
likely to be a metastatic brain lesion from a __________________.

A

primary lung cancer

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27
Q

Metastatic brain tumors are

the most common form of __________tumors.

A

brain

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28
Q

Of all brain tumors, more than a half are ______________.

A

metastatic

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29
Q

In patients with systemic malignancies, ____________metastases occur in 10- 30% of adults and 6-10% of
children.

A

brain

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30
Q

With the high probability of an underlying lung cancer in this patient, this
tumor is more likely to be _________________

A

metastatic than primary.

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31
Q

The clinical picture and the age of the child is mostly consistent with oppositional defiant disorder (ODD) as the diagnosis. ODD is a disruptive behavior disorder in children and teenagers characterized by patterns of unruly and argumentative behavior and ________toward authority figures.

A

attitudes

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32
Q

This pattern is often considered by parents simply as stubbornness, emotionalism and strong will.

A

oppositional defiant disorder

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33
Q

ODD manifests with a constant extremely negative, defiant and hostile behavior leading to disruption of the social, school, and home life for at least ___________

A

6 months

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34
Q

Children with ODD often direct their anger and resentment toward their parent, teachers, and other authority figures; however, they can have such problems with their _________as well

A

peers

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35
Q

They are often uncooperative, vindictive, and easily annoyed.

A

ODD

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36
Q

They usually defy the rules, have anger outburst, blame others for their mistakes, seek revenge, and disturb others on purpose.

A

ODD

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37
Q

Since the child is unlikely to understand that he has a problem, seeking treatment is often from the parents’ side

A

ODD

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38
Q

A careful history is essential because many other childhood conditions may have some shared features with ____

A

ODD

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39
Q

It is important to differentiate whether the abnormal in the behavioral pattern is due to ODD or simply a response to a _____situation.

A

temporary

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40
Q

The international Classification of Diseases 10th Revision (ICD-10) classifies ODD as a mild form of ________disorder

A

conduct

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41
Q

It has been estimated that up to 60% of patients with ODD will develop _________disorder

A

conduct

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42
Q

Treatment is necessary at earlier stages to prevent it from developing into a more serious conduct disorder (most important), mental health disorder, or criminal behavior.

A

ODD

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43
Q

Treatment entails a combination of behavioral therapy, family therapy and at occasions, medications.

A

ODD

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44
Q

In more than 50% of patients with ADHD, _____is also part of the clinical picture

A

ODD

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45
Q

There is strong evidence suggesting that ODD and ____overlap and many medications that are used to treat _________may also be efficacious in treatment of ODD too.

A

ADHD

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46
Q

A few studies have reported the positive effects of psychostimulants or atomoxetine in the treatment of ODD associated with ______

A

ADHD

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47
Q

Patients with ODD and conduct disorder with severe aggression may well respond to risperidone, with or without ___________

A

psychostimulants

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48
Q

Mood regulators, alpha2 agonists, and antidepressants may also have a as second-line role in treatment of ___________and its comorbidities

A

ODD

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49
Q

Of the options, risperidone, is the only option that can be used if pharmacotherapy is considered.

A

ODD

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50
Q

Mood stabilizers such as sodium valproate (option B) or olanzapine (option A), and antidepressants such as SSRIs (option C) are second-line options.

A

ODD

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51
Q

There is no evidence supporting carbamazepine (option E) as a pharmacological treatment for __________

A

ODD

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52
Q

___________ is congenital softening of the tissues of the larynx above the vocal cords

A

Laryngomalacia

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53
Q

This is the most common cause of noisy breathing in infancy.

A

Laryngomalacia

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54
Q

In _________, the laryngeal structure is malformed and floppy, causing the tissues to fall over the airway opening and partially block it.

A

Laryngomalacia

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55
Q

symptoms are usually present at birth, and can become more obvious within the first few weeks of life.

A

Laryngomalacia

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56
Q

Symptoms of laryngomalacia include: Noisy breathing - an audible wheeze when a baby ________.

A

inhales

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57
Q

It is often worse when the baby is agitated, feeding, crying or sleeping on his back High pitched sound Difficulty feeding (in severe cases) •

A

laryngomalacia

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58
Q

Poor weight gain (in severe cases) • Choking while feeding (in severe cases) (Option A)

A

laryngomalacia

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59
Q

___________ makes breathing difficult, and wheeze is audible in any position.

A

Acute asthma

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60
Q

__________is an extremely rare possibility in a 2-week-old neonate.

A

Asthma

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61
Q

Croup (laryngotracheobronchitis) is most commonly caused by _____________________infection.

A

para-influenza virus type 1

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62
Q

Croup is characterized by a distinctive seal barking cough and _______________

A

inspiratory stridor

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63
Q

Croup affects mainly children aged ________________

A

6 month to 3 years.

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64
Q

Acute bronchiolitis is an acute viral infection of the lower respiratory tract, typically affecting infants younger than 12 months of age, and is characterized by respiratory distress, __________.

A

wheezing

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65
Q

It is primarily caused by respiratory syncytial virus (RSV).

A

Acute bronchiolitis

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66
Q

Treatment is supportive with oxygen and hydration

A

Acute bronchiolitis

67
Q

Prognosis is generally excellent; however, some children may develop apnea or respiratory failure.

A

Acute bronchiolitis

68
Q

Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden _______________ and death

A

respiratory obstruction

69
Q

Symptoms include severe sore throat, dysphagia, high fever, drooling, and inspiratory stridor.

A

Epiglottitis

70
Q

Treatment includes airway protection and antibiotics

A

Epiglottitis

71
Q

While expiratory stridor indicates an obstruction in the lower trachea, inspiratory stridor suggests obstruction above the ____________.

A

glottis

72
Q

______________ discharge in female children should always be taken seriously and investigated promptly

A

Blood-stained vaginal

73
Q

One exception is vaginal bleeding in the first week of birth in female neonates that is caused by withdrawal from maternal ________upon birth.

A

estrogen

74
Q

Causes of vaginal bleeding in children include the following: • Vaginal foreign body • Severe vulvovaginitis • Trauma (including straddle injury and sexual abuse) • Excoriation associated with threadworms Onset of first menstruation Hematuria • ________prolapse (an inflamed “doughnut” of tissue is visible at the urethral meatus Of the above

A

Urethral

75
Q

_____________ is the most common cause of bloody vaginal discharge.

A

a vaginal foreign body

76
Q

The foreign body is often toilet t papers. Foreign body in the vagina causes offensive purulent vaginal discharge that _________frequently despite successful initial management with antibiotic unless the foreign body is removed.

A

recurs

77
Q

It can also cause vaginal bleeding. Children with suspected vaginal foreign body should be rereferred to pediatrics specialist for ______________________.

A

removal of the foreign body

78
Q

Monilial (candida) vulvovaginitis is almost never seen in prepubertal girls except as an association with ______________

A

nappy rash

79
Q

Atrophic vulvovaginitis is a less common condition in prepubertal girls and if present should raise suspicion against _____________.

A

lichen sclerosus

80
Q

Even in case of atrophic vaginitis, itching and _______________ would be the expected presentation

A

mucoid discharge

81
Q

Infection with chlamydia, gonorrhea and trichomonas can cause offensive bloody vaginal discharge. These infections in children are highly suggestive of _________________

A

sexual abuse

82
Q

For every child with vaginal discharge associated with unusual features such as persistent and significant discharge or __________in the discharge, sexual abuse should be considered as a possibility and approached appropriately.

A

blood

83
Q

Although sexual abuse should also be considered and thought of in such situation, the most likely cause of such presentation remains a vaginal foreign body, unless investigations establish the presence of chlamydia, gonorrhea or ___________, in which case sexual abuse is almost always the cause.

A

trichomonas

84
Q

Infection with threadworm may vulvovaginitis, in which case, ___________is the most prominent symptom

A

itching

85
Q

The earliest sign of Perthes disease is an intermittent limp, especially after exertion, with mild or intermittent pain in the anterior part of the ________.

A

thigh

86
Q

____________ is the most common cause of a limp in the 4-to 10-year-old age group.

A

Perthes disease

87
Q

The classic presentation of Perthes disease has been described as a ‘_________________.

A

painless limp’

88
Q

The child may present with limited range of motion of the affected extremity. The most common symptom is persistent pain

A

Perthes disease

89
Q

Hip pain may develop and is a result of necrosis of the involved bone

A

Perthes disease

90
Q

This pain may be referred to the medial aspect of the ipsilateral knee or to the lateral thigh.

A

Perthes disease

91
Q

The quadriceps muscles and adjacent thigh soft tissues may atrophy, and the hip may develop adduction flexion contracture.

A

Perthes disease

92
Q

The patient may have an antalgic gait with limited hip motion, or a Trendelenburg gate (abductor lurch).

A

Perthes disease

93
Q

Pain may be present with passive range of motion and limited hip movement, especially internal rotation and abduction.

A

Perthes disease

94
Q

Laboratory studies including a full blood count, ESR and CRP are usually normal and are often ordered to exclude other possible causes of hip pain and limp such as septic arthritis, transient synovitis, or juvenile rheumatoid arthritis

A

Perthes disease

95
Q

In most cases X-rays are normal early in the course of the disease but are used serially to assess the progression of the disease

A

Perthes disease

96
Q

Stage 1 - Cessation of femoral epiphyseal growth • Stage 2 - Subchondral fracture Stage 3 - Resorption Stage 4 - Reossification Stage 5 - Healed or residual stage

A

Perthes disease

97
Q

A bone scan can be used to evaluate the site for avascular necrosis (AVN). Early radiographic findings in acute phase can be a nonspecific effusion of the joint evident by slight widening of the joint space.

A

Perthes disease

98
Q

Other early findings may include decreased bone density around the joint and a bulging joint capsule. The acute phase often lasts 1-2 weeks. Decreasing bone density in and around the joint is noted after a few weeks.

A

Perthes disease

99
Q

Once Perthes disease is suspected, the child should be urgently referred to orthopedic specialist for management and treatment

A

Perthes disease

100
Q

In the meanwhile, limited movement and reducing the weight from the hip joint should be encouraged to prevent or minimize further damage of the femoral head.

A

Perthes disease

101
Q

For this purpose, crutches are prescribed and encouraged to use.

A

Perthes disease

102
Q

Treatment goals in ___________ are: • Eliminating hip irritability • Restoring and maintaining good range of motion in the hip Preventing femoral epiphyseal collapse

A

Perthes disease

103
Q

Having a spherical femoral head when the hip heals Initial therapy includes protecting the hip joint and making it non-weightbearing

A

Perthes disease

104
Q

This can be achieved by maintaining the femur abducted and internally rotated to keep it held well inside the rounded portion of the acetabulum.

A

Perthes disease

105
Q

Most cases are treated conservatively using splinting (e.g. Scottish Rite brace).

A

Perthes disease

106
Q

At occasions surgery (osteotomy) may be considered. Surgery does not speed femoral head healing, rather it results in a more spherical oreossification of the femoral head.

A

Perthes disease

107
Q

Limb shortening is a potential complication of surgical treatment.

A

Perthes disease

108
Q

Although Perthes disease is associated with hip pain and decreased range of motion, the two most severely affected movements are __________________, not external rotation.

A

abduction and internal rotation

109
Q

Perthes disease is mostly diagnosed clinically. The imaging modality of choice to help with diagnosis and also assessment of the disease progression is _________, not ultrasound.

A

X-ray

110
Q

Osteotomy can be a treatment option depending on the child’s age and the disease severity:more conservative strategies such as bracing are applied as the treatment option of choice where feasible.

A

Perthes disease

111
Q

____________ is not an inflammatory condition; therefore, inflammatory markers such as WBC, ESR and CRP are usually negative

A

Perthes disease

112
Q

Positivity of such markers points toward an alternative diagnosis such as septic arthritis, rheumatoid arthritis, synovitis, etc.

A

Perthes disease

113
Q

Recurrent urinary tract infections (more than 2 times during childhood) can result in renal scarring, hypertension, and _____________________________.

A

end-stage renal disease

114
Q

The underlying etiology is vesicoureteral reflux (VUR) -retrograde passage of urine from the bladder into the upper urinary tract

A

Recurrent urinary tract infections

115
Q

Dimercaptosuccinic acid scintigraphy (DMSA) scan is the gold standard for diagnosis of _____________ and assessment of renal functions

A

kidney scarring

116
Q

_________is indicated in the following conditions: • Clinical suspicion of renal injury • Reduced renal function Suspicion of VUR • Suspicion of obstructive uropathy on ultrasound in older toilet-trained children

A

DMSA

117
Q

For this child with recurrent episodes of UTI, a DMSA should be considered as the most diagnostic modality for assessment of renal function and possible _________________

A

renal scaring

118
Q

Biopsy provides clues to histopathological abnormalities in kidney associated with certain type of renal diseases such as _______________but not the overall kidney function

A

glomerulonephritis

119
Q

Moreover, it is unnecessarily invasive.

A

Biopsy provides clues to histopathological abnormalities in kidney

120
Q

Ultrasound is capable of assessing the presence of fluid collections, bladder volume and the size, shape and location of _________________.

A

kidneys

121
Q

it gives no clue regarding kidney function or scarring

A

Ultrasound

122
Q

Ultrasound is indicated for assessment of children with UTI in the following situations: Concurrent bacteremia Atypical UTI organisms: i.e., Staphylococcus aureus, Pseudomonas UTI <3 years old • Non/inadequate response to 48hrs of IV antibiotics • Abdominal mass • Abnormal voiding Recurrent UTI • First febrile UTI and no prompt follow up assured • Renal impairment Significant ______________________

A

electrolyte derangement

123
Q

Elevated levels of urea and creatinine indicated renal impairment but gives no clue for each indivudual kideny or at times kidneys in general because urea and creatinine may be normal in early stages of ___________________________.

A

pre-renal or post-renal renal failure

124
Q

normal values do not exclude the presence of abnormalities in only one kidney as the other kidney can _______________.

A

compensate

125
Q

Many patients may have normal ranges in the presence of severe damage to one kidney while the other is functional and __________________.

A

compensating

126
Q

Abdominal CT scan will visualize the kidneys, adrenal glands and adjacent structure but is not capable of assessment of ____________.

A

renal function

127
Q

Intermittent abdominal pain in children is a frequent reason of seeking medical attention by concerned parents. The causes of intermittent abdominal pain are diverse, ranging from benign conditions such as functional abdominal pain to grave diseases such as childhood _________________.

A

malignancies

128
Q

______________________obstruction is by far the most common cause of pediatric hydronephrosis, occurring in 1 per 1000-2000 newborns.

A

ureteropelvic junction (UPJ) UPJ

129
Q

Widespread use of antenatal ultrasonography and the advent of modern imaging techniques have resulted in earlier and more common diagnosis of the condition.

A

ureteropelvic junction (UPJ) UPJ

130
Q

In older children, periodic abdominal pain with vomiting is a common symptom. These symptoms are probably caused by intermittent kinking of the _____________________

A

ureteropelvic junction (UPJ) UPJ

131
Q

If obstruction does not resolve, severe hydronephrosis and pelvic distention can follow, presenting with flank pain or even tenderness.

A

ureteropelvic junction (UPJ) UPJ

132
Q

Wilms tumor is the most common intra-abdominal malignant tumor of childhood that often presents with a smooth firm abdominal mass that usually _________________

A

do not cross the midline

133
Q

Abdominal pain, either constant and vague or intermittent, is another finding.

A

Wilms tumor

134
Q

____________is the most common extracranial malignant tumor of childhood.

A

Neuroblastoma

135
Q

The initial presentation is most commonly within the first 2 years of life. The tumor is intraabdominal in two-thirds of cases.

A

Neuroblastoma

136
Q

The tumor is intraabdominal in two-thirds of cases

A

Neuroblastoma

137
Q

two-thirds originating from adrenal glands. It can also present with a palpable abdominal mass that is non-tender.

A

Neuroblastoma

138
Q

While these masses are commonly benign, there are other possibilities that should be taken into account

A

Childhood cervical masses

139
Q

____________________ in children are divided in the following broad categories: 1. Congenital 2. Inflammatory/infective 3. Neoplastic

A

Cervical masses

140
Q

majority of childhood neck lumps seen in general practice occur as a result of an inflammatory/infective process, other possibilities such as persistent congenital abnormalities and red flag of neoplastic diseases always must be considered

A

Childhood cervical masses

141
Q

Cervical masses in the neonatal period and early infancy are often ___________

A

congenital

142
Q

Examples are thyroglossal duct cyst, teratomas, sternocleidomastoid tumors of infancy and vascular or lymphatic malformations

A

infancy are often congenital

143
Q

Of note, vascular and lymphatic malformations typically grow with the growth of the child. _______________ is most common in infancy and early childhood, with 40-55% of young children found to have palpable cervical lymph nodes.

A

Reactive lymphadenopathy

144
Q

Of note, vascular and lymphatic malformations typically grow with the growth of the child. _______________ is most common in infancy and early childhood, with 40-55% of young children found to have palpable cervical lymph nodes.

A

Reactive lymphadenopathy

145
Q

Rapidly developed masses are typically inflammatory, including reactive lymphadenopathy, lymphadenitis, or secondary infection of underlying __________________ masses.

A

congenital or neoplastic

146
Q

Inflammatory pathology typically resolves within four weeks

A

Rapidly developed masses

147
Q

Cervical masses that persist past _______weeks require further evaluation.

A

six

148
Q

Rapidly growing masses should be immediately referred if there is a concern that they have the potential to affect the airway or have features suggestive of ___________formation.

A

abscess

149
Q

Masses that grow at a slower rate, for months to years, are suggestive of ________________or a slowly enlarging congenital malformation.

A

benign neoplasms

150
Q

In terms of associated symptoms, a viral prodrome, fevers, and cervical tenderness are associated features suggestive of ________________________

A

reactive lymphadenopathy

151
Q

On physical examination, location, size, consistency, and tenderness give important _________.

A

clues

152
Q

Location-wise, ___________masses are more likely congenital and are typically thyroglossal duct cysts or dermoid cysts

A

midline

153
Q

Thyroglossal duct cysts will elevate with tongue protrusion or swallowing, while dermoid cysts are tethered to the ______________.

A

overlying skin

154
Q

__________masses are potentially malignant and need further evaluation

A

Thyroid

155
Q

Lymphadenopathy commonly arises as a lateral lump in the anterior or posterior triangle, and may present an inflammatory or _________process

A

neoplastic

156
Q

Lymphadenopathy in the posterior triangle has a higher risk of malignancy, while supraclavicular lymphadenopathy is considered a ____________.

A

red flag

157
Q

Other masses of the lateral neck include lymphatic and vascular malformations and ________________

A

branchial cleft cysts

158
Q

Reactive lymphadenitis is characterized by a local collection of small, tender, ______________

A

mobile lumps

159
Q

The possibility of suppurative lymphadenitis should be considered if there is palpable warmth, fluctuation, induration, or severe ______________.

A

tenderness

160
Q

If the mass is firm, irregular, or immobile, ____________should be thought with high suspicion

A

malignancy

161
Q

In terms of size, a palpable cervical lymph node less than 1 cm in size can be considered normal in children, while increasing size is associated with a significantly increased risk of _____________

A

malignancy

162
Q

______________ greater than 1 cm in size that persist for longer than six weeks or despite antibiotic therapy should be evaluated with medical imaging and a possible tissue biopsy e.g., FNAC

A

Lymph nodes

163
Q

The following features are red flags for a neck lump in children, the presence of which warrants a more aggressive approach: • Weight loss • Sustained fever • Night sweats Generalized lymphadenopathy Signs and symptoms of pancytopenia • Mass persisting> 6 weeks • Lymph node> 3 cm • Thyroid mass • Supraclavicular mass Hard, ______________mass Fixed mass

A

irregular

AMEDEX MIX (1 decks)

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