Boards Flashcards
(145 cards)
1
Q
What are the signs of an uncal (temporal lobe) herniation?
A
- blown unilateral pupil (due to CN III compression)
- contralateral paresis
- usually secondary to trauma
2
Q
What is the optimal starting dose of levothyroxine for congenital hypothyroidism? When should it be started?
A
10-15 micrograms/kg per day; start before 2 weeks of age for best outcomes
3
Q
True or false: Prior BCG vaccine can cause a false positive TB skin test.
A
True-but response usually wanes so this should be
4
Q
True or false: The quantiferon gold test result is affected by prior BCG vaccines.
A
False– prior BCG vaccine does NOT react
5
Q
What is the most common cause of acute ataxia in children?
A
Ingestion (should have altered mental status)
If normal mental status -> consider acute cerebellar ataxia (usu post-viral)
symptoms of acute cerebellar ataxia usually resolve in weeks to months and rarely recur
6
Q
What is the classic presentation for an infant with transposition of the great arteries?
A
Severe cyanosis within the first few hours of life WITHOUT respiratory distress
If you put the baby in a 100% oxygen hood the cyanosis will not correct
Look for low PaO2 on arterial gas
Need to give PGE
7
Q
How do you distinguish PPHN and cyanotic heart disease in the neonate?
A
- hyperoxia test (100% O2 in hood)
- If it fails to correct cyanosis and O2 remains low -> cyanotic heart disease, also low PaO2 on art gas
- If it corrects with O2 -> PPHN
8
Q
What is the most common renal tumor in childhood? What are the presenting signs?
A
=Wilms tumor
-painless abdominal mass, hypertension, and hematuria
9
Q
What diagnosis should be considered in a skeletally immature child with negative xrays with point tenderness pain (ex over lateral ankle)?
A
=fracture of the growth plate (physis, type I salter harris fracture)
-generally heal with 4-6 weeks of immobilization
10
Q
True or false: an optimally treated (ie diet managed) child with PKU will not have any sequelae
A
False
- Risk of longterm neurocognitive effects (attention, EF, processing speed)
- Diet makes risk for micronutrient deficiencies and disrupted bone metabolism -> increased risk of osteopenia and osteoporosis
- Still risk for teratogenesis even with strict maternal adherence during pregnancy
11
Q
You note a bifid uvula on exam. What two commonly associated problems do you need to evaluate for?
A
- Submucous cleft palate (notching of the posterior hard palate, bifid uvula, diastasis of the muscles of the soft palate)
- Middle ear effusions and conductive hearing loss
- hx of recurrent ear infections
- presence of effusion on exam
- speech concerns
12
Q
What is the time to onset of SABAs (ex albuterol)? Duration of action?
A
Onset: 15 minutes
Duration: 4-6 hours
13
Q
What is time of onset of LABAs (ex salmeterol, formoterol)? Duration of action?
A
Onset: 15-30 minutes
Duration: 12 hours
Regular use of LABAs and SABAs can lead to decreased bronchoprotective effect.
14
Q
True or false: ERCP should be performed during a suspected episode of acute pancreatitis secondary to a gallstone
A
False–invasive procedure, risk of worsening the pancreatitis
Try to confirm presence of gallstone (ie MRCP) before intervening and let pancreas cool off a bit
15
Q
Low calcium with a elevated PTH represents ______
A
=pseudohypoparathyroidism
- due to resistance to PTH
- Can have resistance of other endocrine hormones (ex TSH)
- look for Albright’s hereditary osteodystrophy phenotype (if after 5 years, short, fat, brachydactyly)
16
Q
Warm agglutinins (in autoimmune hemolytic anemia) are IgG or IgM based? What are some causes?
A
warm agglutinins=IgG based
-causes: infectious (younger children), antibiotics
17
Q
Cold agglutinins (in autoimmune hemolytic anemia) are IgG or IgM based? What is a type of infection in pediatrics associated with this?
A
cold agglutinins=IgM based
-associated with mycoplasma infections
18
Q
What does a Coombs or DAT test detect?
A
antibodies or complement proteins bound tot he surface of erythrocytes
RBCs are washed of normal plasma proteins, then incubated at 37 degrees (warm) with the Coombs reagent which contains a protein that will bind to the human gamma globulin and complement. If these autoantibodies are present on the surface, it binds and then causes agglutination (clumping) of the RBCs. Follow-up testing is then done to determine the type of autoantibody vs complement that was bound to the RBCs
19
Q
A positive DAT should make you consider ________.
A
Autoimmune hemolytic anemia (esp warm)
20
Q
Name the toxidrome with the following symptoms:
- hyperpyrexia
- hypertension
- tachycardia
- dry mucus membranes
- flushed skin
- mydriasis
- decreased bowel sounds
- confusion
A
=anti-cholinergic
21
Q
What are some classes of medications associated with anti-cholinergic properties?
A
- antihistamines
- TCA anti-depressants
- OTC cold and sleep aids
- atropine
- scopolamine
- contaminated street drugs
* Jimson weed
22
Q
Define metatarsus adductus. What is the most common cause?
A
=congenital foot deformity characteristized by medial deviation (adduction) of the forefoot relative to the hindfoot.
-in mild or moderate cases you can correct it with stretching
Most commonly caused by intrauterine molding
23
Q
How is metatarsus adductus treated?
A
- usually stretching by parents, usually within 4-6 months
- serial casting is used for patients with more severe or rigid deformities that cannot be passively abducted to midline
24
Q
True or false: skin prick testing is superior to serum based RAST testing.
A
=FALSE
-use of serum-specific IgE testing is comparable
25
True or false: a positive skin prick test tells you the child is allergic to the item in question.
=FALSE
-it only tells you the child is sensitized. The presence of symptoms on exposure to the item in question in the setting of a positive skin prick indicates an allergy
26
Define femoral anteversion. Describes its common features.
=femoral neck is rotated anterior compared to the axis of the knee and the femur.
- medially facing patella
- intoeing
- increased internal hip rotation when prone
- "egg beater" running gait
27
What is the natural history of femoral anteversion? When is orthopedic referral indicated?
Most spontaneously improved with time by skeletal maturity, usually by age 7 years
Refer to orthopedics when anteversion persists beyond age 11 years or is unilateral
28
What is the most common complication of an aspirated foreign body?
=pulmonary infection (especially when presentation is delayed)
29
What is the most common long-term manifestation of congenital toxoplasmosis infection? Congenital CMV?
toxoplasmosis =visual loss (secondary to chorioretinitis)
| CMV=hearing loss
30
True or false: ANA can be positive in up to 1/3 of the healthy population and may occur in family members of patients with autoimmune disease.
=True
- it is not associated with autoimmune disease in setting of a normal examination
- it is not predictive of developing autoimmune disease in the future.
31
True or false: The ANA can only be positive in the setting of rheumatologic autoimmune conditions.
False
-infections (TB, osteomyelitis, lyme disease, viral infections) and other conditions (DM, psoriasis, ITP, autoimmune hepatitis, MS, type I DM, lymphoma, leukemia) can cause elevated ANA
32
True or false: kids with PE tube otorrhea can be treated with only topical antibiotics.
False--oral or topical antibiotics--same pathogens that are responsible for AOM cause PE tube otorrhea
-Oral antibiotics indicated for
33
A history of an indwelling cathether put you at risk for a UTI due to what organism?
enterococcus
- suspect when UA negative for nitrites
- Need ampicillin + 3rd generation cephalosporin or gentamicin
34
True or false: fever is an absolute contra-indication for sports participation
true
35
Define transient erythroblastopenia of childhood. Who gets it?
- Transient aplasia of RBCs that leads to a normocytic/macrocytic anemia and low reticulocyte count (b/c of hypoproliferation)
- usually seen in children 1-4 years old after viral infection
- Tends to present with typical signs of anemia
- Usually self resolves, but will need to follow CBC, retic count weekly until it resolves
- Usually not associated with abnormalities in other cell lines
- Differential diagnosis Diamond-Blackfan anemia (look for congenital anomalies, more severe anemia, onset
36
Do all children with corneal abrasions need ophthalmology follow-up?
No; usually small abrasions heal in 48-72 hrs
- If persistent symptoms after 3 days -> refer
- If child wears contact lenses or a large abrasion -> immediately refer
37
A child has persistent moderate-severe atopic dermatitis despite optimal management. What should you do?
Refer for testing for food allergies
38
A flank mass, hematuria, and thrombyoctyopenia in a newborn suggest _____.
renal vein thrombosis
39
What is the treatment of choice for chlamydia pneumonia in a neonate?
=erythromycin
40
What are the 4 most common causes of rectal bleeding in a child
- anal fissure
- milk protein colitis
- NEC
- swallowed blood
41
What is the definition of neutropenia in an infant 2 months to 1 year old? What is considered severe neutropenia?
Neutropenia =2 months -1 year: ANC
42
True or false: severe congenital neutropenia is NOT associated with an increased risk for malignant tumors.
FALSE
43
True or false: boys with hemophilia A should avoid intramuscular injections, activities with high risk for blows to the head, aspirin or NSAIDs.
True
44
True or false: you can proceed with circumcision of a male infant born to a mother who is a known carrier of factor VIII deficiency.
False--delay until diagnosis is confirmed--child at 50% risk of having the disorder and may have clinically significant bleeding.
45
What is the recommended management for a black widow spider bite?
1. Cleaning the wound
2. Analgesics
3. Up to date tetanus shot
46
Who should receive anti-venom for a black widow spider bite?
-young children with a confirmed bite and symptoms of moderate to severe envenomation
47
Define meningococcemia. What is the associated organism?
=disseminated meningococci in the bloodstream due to Neisseria meningitides infection
-can present with: 1) meningitis 2) meningitis+bacteremia, 3) bacteremia without meningitis
48
What is the strongest risk factor associated with mortality due to meningococcemia?
-young age
49
What is the treatment of choice once N. meninigitidis diagnosis is confirmed
High dose IV penicillin G for 5-7 days
50
How long can dysfunctional uterine bleeding due to anovulatory cycles last?
2 years post-menarche
| After 2 years after menarche, need to investigate for other causes (ex PCOS)
51
Name 3 complications of a basilar skull fracture.
Basilar skull fracture=fracture in 1 of the 5 bones that make up the skull
Complications:
1. CSF leak (usually resolved within a week with no tx, increased risk 5% for meningitis but abx do NOT prevent this)
2. Hearing loss
3. Cranial nerve dysfunction
52
Is the weakness/paralysis in infantile botulism ascending or descending?
descending
53
How is a diagnosis of infantile botulism made?
identification of the botulinum toxin in stool specimen
54
What is the treatment of infantile botulism?
1. supportive care
| 2. human botulism immune globulin given early in the disease can be beneficial
55
What is Osgood-Schlatter disease?
=irritation of the tibial tubercle apophysis
-repetitive quadriceps muscle contraction through the patellar tendon at its insertion provides traction and tension on the skeletally immature tibial tubercle resulting in microavulsions
56
What is an aphophysis?
=Minor growth plate or secondary center of ossification that are located where tendons attach to bone
57
What is the treatment for Osgood-Schlatter disease?
1. Support care--patellar strap, rest, quadriceps stretching, ice and NSAIDs
2. activity as tolerated , most can continue to participate in sports
58
Infants that develop progressive weakness, plateau of motor skills, visual dysfunction, exaggerated startle response, think of ________.
- Tay Sachs
- cherry red spots (often at time of dx no hepatosplenomegaly vs infantile Gaucher or Niemann Pick
- hexosaminidase deficiency
- No enzyme replacement available currently
59
Stridor in a burn patient indicates _________.
Upper airway edema, need for immediate intubation
60
An elevated DHEA-S is specific for _______, it is elevated in __________.
adrenal disease; adrenal tumors
61
The presence of body odor, pubic hair, signs of virilization in a female should make you think about ________ secretion from the ______.
androgen secretion from the adrenal gland
62
True or false: soy formulas are an appropriate alternative choice for preterm infants
False
| They contain phytates that bind calcium and phosphorous -> increased risk of osteopenia
63
What is the first line treatment for ITP associated with moderate to severe bleeding?
1. IVIG or short course of steroids
Most cases go into remission spontaneously, about 15-20% develop chronic ITP
splenectomy reserved for chronic, severe ITP
64
What are the diagnostic criteria for Tourette syndrome?
Presence of motor and vocal tics for more than 1 year
65
What are the laboratory values associated with neonatal hyperinsulism?
1. Hypoglycemia
2. No reducing substances or ketones
3. Normal insulin level (but this is inappropriate for degree of hypoglycemia)
66
What are the first steps in managing a suspected poisonous snake bite?
1. Remove any constricting clothing
2. Cleanse the wound
3. Immobilize the extremity in a splint in a position of comfort. If possible keep above the level of the heart
Avoid giving Benadryl as sedation properties may cloud clinical assessment
Traditional techniques including a tourniquet are not recommended
67
What are the clinical features associated with Shwachman-Diamond syndrome?
1. growth failure
2. pancreatic insufficiency -> steatorrhea, fat soluble vitamin deficiencies
3. bone marrow dysfunction (cytopenias on CBC)
4. Skeletal abnormalities
5. recurrent infections (ex purulent AOM due to neutropenia)
can see fatty infiltration of pancreas on U/S
Increased risk for leukemia
68
What is the treatment of choice for otitis externa?
Topical fluroquinolones
Most common bugs: pseudomonas and s. aureus
69
An infant is born vaginally to a mother who has vaginal legions consistent with HSV? What piece of information due you need to know to determine management?
1. Prior history of HSV genital lesions
- If no (ie primary outbreak) -> high risk of infection to the infant, start acyclovir and obtain cultures (skin, eye, rectum, mouth, nose) at 24-36 hrs
- If yes (recurrent outbreak) -> low risk of transmission to neonate, observe off acyclovir, obtain cultures at 24-36 hrs (more likely to represent true infection at that time instead of surface exposure if obtained earlier)
70
True or false: C-section in a mother with a history of HSV exposure with less than 4 hours of rupture of membranes protects the infant from HSV exposure.
-True
71
Recurrent hypoglycemia with intercurrent illness (ex viral gastro, bronchiolitis) in the absence of metabolic acidosis or other electrolyte imbalance is suggestive of _______.
=carnitine deficiency
- can also have symptoms with fasting
- Labs: hypoglycemia, normal bicarb, mildly elevated AST/ALT, mildly elevated ammonia
-some kids can have hepatomegaly
72
Toe walking can be a normal finding until age _____ years.
4 years
73
What is the antibiotic of choice for treatment or prophylaxis in infants with pertusiss (or exposed to it).
azithromycin
74
True or false: early child care (daycare) exposure reduces the risk of development of asthma
True
| Also having multiple siblings in the house -> increased respiratory infections -> decreased risk for atopy
75
What symptoms suggest a presentation of neonatal listeria infection?
1. Maternal symptoms--fever +GI symptoms (nausea, vomiting) shortly before delivery
2. Preterm labor
3. meconium stained fluid
4. sepsis
5. rash (erythematous with small pale nodules)
Ampicillin will provide coverage against Listeria
76
A capillary blood gas is considered a good equivalent for an arterial blood gas for which of the following parameters: pH, PCO2, PaO2, bicarb, base excess?
In what clinical situation is a CBG not as good as an ABG?
CBG is usually substitute to look at pH, PCO2, bicarb, and base excess compared with ABG
CBG will not be as accurate as an ABG when there is hypotension.
CBG also not good at looking at PaO2
77
What is the timeframe for contagiousness for measles? What is the best form of protection for exposed unimmunized children?
Measles is infectious from 3-5 days before onset of rash until 4 days after development of rash
IM immune globulin within 6 days of exposure is indicated for unvaccinated exposed children or immunocompreomised children
78
What diagnosis should be considered in infants with severe eczema, bleeding and recurrent infections? What is the associated laboratory finding?
Wiscott-Aldrich; low serum IgM and thrombocytopenia
79
How can you distinguish a myopathy from a neuropathy?
Myopathy=hx of proximal muscle weakness, muscle pain
exam with proximal muscle weakness, normal sensation, normal reflexes
Neuropathy= hx of parasthesia + weakness (back pain if a nerve root)
exam with weakness +sensory loss (root/nerve dermatomal pattern) +hyporeflexia
80
How should a person with a history of allergy to radiocontrast media be managed?
Give oral antihistamines and corticosteroids prior to another study with radiocontrast
81
What is the recommended treatment for urethritis in males?
=ceftriaxone + azithromycin (or doxycycline x 7 days)
-if CTX + azithro only need 1 time doses for both
82
What is the recommended treatment for hyperthyroidism?
Methimazole + beta blocker (propranolol)
=avoid PTU because of concerns for hepatotoxicity
83
Limb hypoplasia, microcephaly, ID, eye abnormalities, and cutaneous scarring are findings of this congenital infection?
=varicella acquired in 1st or early second trimester
| -very low risk but more likely to occur with primary varicella infection vs shingles
84
What are the most common causes of an abdominal mass in the newborn period?
1. Multicystic dysplastic kidney
| 2. Ureteropelvic obstruction
85
What is the most common cause of hydronephrosis in the newborn period? How does it present?
=ureteropelvic obstruction
-usually unilateral
- presents as prenatally detected hydronephrosis or a palpable abdominal mass
- Will likely need VCUG to determine degree of reflux to other kidney
86
A male newborn has severe bilateral hydronephrosis. What is your next step in management?
1. Urgent referral for VCUG to determine posterior urethral valves
87
What is a multi-cystic dysplastic kidney?
=A congenital renal malformation where the kidney consists of multiple non-communicating cysts and a small amount of renal parenchyma
- Unilateral lesion, bilateral not compatible with survival
- High risk of VUR -> start prophylactic amox
- Small risk of malignant transformation -> frequent ultrasounds
- Usually involutes by 6 year of age
88
When PGE1 is used to maintain ductal patency, what it will help increase _____ blood flow via ____ to _____ ductal shunting.
systemic blood flow via right to left shunting
89
What is the normal actions of parathyroid hormone?
Important for calcium homeostasis
Low calcium -> increased production of PTH
PTH acts to increase circulating calcium levels by:
1) increased absorption of calcium through the GI tract (via Vitamin D activity)
2) increased bone resorption
3) direct effects on kidneys to increase calcium retention/decrease renal excretion
90
Rifampin can be used of chemoprophylaxis for what two types of bacterial meningitis?
1. Neisseria meningitidis
| 2. Haemophilus B (typable--ie vaccine preventable)
91
A newborn has been in contact with a suspected tuberculosis. What are the next steps?
- Separate the infant from that person until they have had proper TB evaluation and started treatment AND the infant is on exposure treatment
- once treated, the household contact will need to wear a mask when around the baby
- Exposed infants need INH and repeat TB skin test in 3-4 months
- If mother has TB at time of delivery, infant need work up for congenital TB (CXR and LP)
92
Bilateral hydroureteral nephrosis, undescended testicles, and absent abdominal wall musculature is characteristic of _________.
prune belly syndrome
93
What is the treatment for transient erythroblastopenia of childhood?
=nothing
-PRBC transfusion IF hemodynamic instability, severe exercise intolerance, or altered mental status
94
What is the average length of time between thelerarche and menarche? What is the range?
Typically 2 years; can range from 2.5 to 5 years.
95
What is the antibiotic of choice for a dog-bite? What is an alternative if there is an allergy?
=augmentin
| alternative is clindamycin (provides strep and anaerobe coverage) + TMP/SMX (covers Pasturella)
96
Neural tube defects, abdominal wall defects (gastroschisis, omphalocele), and TE fistulas are associated with ______ AFP level. Trisomy 21 and 18 are associated with a ________ AFP level.
Increased; decreased
97
When does the AAP recommend dental care to begin?
1st tooth eruption or by 1 year of age.
98
What is the normal concentration for hemoglobin in post-puberty adolescent males? Females?
Males: 14-18
Females: 12-15
99
True or false: a nasal septal hematoma is an indication for immediate ENT referral.
True
| -may present as a blueish bulge
100
What is the recommended supply of water for mixing formula?
Boiled tap water
101
Name 3 classes of drugs + 2 immunosuppressant medications that are associated with renal toxicity
1. Antibiotics (ex gentamicin, vancomycin)
2. NSAIDs
3. chemotherapeutic drugs
4. cyclosporine
5. tacrolimus
102
Causes of nasal ______ include CF, asthma, chronic allergic rhinitis, primary ciliary dyskinesia, and chronic bacterial sinusitis
polyps
103
How is a diagnosis of Staph Scalded Skin Syndrome confirmed?
- Usually clinical diagnosis
- dx confirmed classically with skin biopsy (splitting of skin layers) and cultures (of skin lesions)
- blood cultures usually negative
104
What is the imaging test of choice to diagnose nephrolithiasis?
-non-contrast CT
105
What is the second most common cause of pancreatic insufficiency in childhood (after CF)?
=Schwachmann-Diamond syndrome
106
Who should get ROP screening? When is it recommended to start?
Who should get it:
-BW 30 weeks if there are other risk factors
When should it start?
- Born at 27 weeks or less, at 31 weeks CGA
- Born at 28-30 weeks, at 4 weeks old
107
What is the predominant bacteria in the mouths of children that is implicated in developing caries?
=streptococcus mutans
| -Mom's colonization is biggest risk factor because this is the source for the infant
108
What is the treatment of choice for iron deficiency anemia? Treat how long? When do you recheck the CBC?
- Ferrous sulfate drops
- Treat for total of 3 months
- Recheck CBC and retic in 1 month into treatment to see how child is responding, if yes then continue for 2 more months
109
In a patient with primary amenorrhea you obtain FSH, LH, and a prolactin level. The FSH is elevated. What should you conclude about this individual's physiology?
Elevated FSH in setting of primary amenorrhea suggests ovarian insufficiency/failure => think about Turner syndrome
110
What is the imaging test of choice for blunt abdominal trauma?
CT WITH contrast
-IV and oral contrast are recommended in setting of trauma to help determine organ perfusion, the presence of free intraperitoneal fluid, and bowel integrity.
111
True or false: routine EKG is not indicated before starting a stimulant medication for ADHD
- True
- But need to ask about symptoms (palpitations, syncope) AND family hx (SCD, known cardiac disease) prior to starting meds
- If anything suspicious, get EKG and consider sending to cardiology
112
Give a differential diagnosis for a petechial/purpuric rash
1. Meningococcemia
2. Strep pneumonia
3. RMSF
4. Enterovirus
5. Group A strep
6. Other viral infections
7. Malignancy
113
Name 4 different bugs that could cause periorbital cellulitis. When do you consider them?
1. staph aureus (esp if bug bite)
2. group A strep -bug bite, skin trauma
3. haemophilus --rhinosinusitis
4. strep pneumo-rhinosinusitis
114
You are seeing a child in clinic for ED follow-up after they were treated for anaphylaxis to a bee sting. What is the recommended next steps?
1. serum tryptase level 1-2 weeks after episode
- this screens for underlying mastocytosis, if elevated need to see an immunologist for further work -up
2. Allergy testing (start with RAST or serum IgE testing), skin testing if negative
3. consider immunotherapy (reduces risk of anaphylaxis to subsequent bee stings.
4. Epi-pen and epi-pen teaching
115
What is the risk of recurrent anaphylaxis with subsequent insect stings?
-20-60% per episode
116
A 38 week pregnant woman needs GBS prophylaxis. She is allergic to penicillin--gets a rash. The OB calls you. What would you recommend?
1. Ancef
| 2. Vancomycin--if hx of severe anaphylaxis
117
What is the initial recommended treatment for acute rheumatic fever?
1. Antibiotics (PCN)
2. Steroids
3. +/- supportive meds (ex Lasix) if
118
Define anisometropia
=different refractive power of the eyes
119
What is a Sprengel anomaly? What syndrome should you look for? What complication do you need to look for?
Sprengel anomaly=upward displacement of the scapula
Klippel Feil syndrome=short neck 2/2 cervical vertebral segmentation defects, limited neck ROM, low posterior hairline
-make sure to look for hearing loss
120
What is the duration of action for glargine? Should this be held as part of sick day management?
- glargine is 24 hour insulin coverage
- withholding may result in severe DKA
- better to check for ketones in urine, short acting insulin PRN and frequent glucose checks, encourage drinking
121
Side effects of this commonly used systemic medications include: weight gain, hypertension, striae, cataracts, hirsutism, avascular necrosis, increased risk of infections , and linear growth failure.
=corticosteroids
122
What is the treatment of choice for tinea versicolor?
1. topical selenium sulfide
| 2. topical ketoconazole
123
You suspect a trauma patient in the ED has a flail chest. What should you do next?
1. prepare to intubate and mechanically ventilate (flail chest will lead to impaired ventilation
2. provide analgesia
124
Define equinovarus foot deformity. What is another name for it? How does it differ from metatarsus adductus?
equinovarus foot deformity=talipes equinovarus=club foot
-entire foot is internally rotated (vs metatarsus adductus only the forefoot is medially deviated)
125
What are the symptoms of splenic sequestration in a patient with sickle cell disease? What is the treatment of choice?
=weakness/lethargy, pallor, splenomegaly, dyspnea +/- shock, abdominal pain or distension
-lab findings; HgB
126
A boy presents with hematuria. What specific questions do you need to ask about family history? What condition are you considering?
Family hx of renal disease or hearing loss
| -Think about Alports=can present initially with hematuria and proteinuria and renal failure develop later
127
A patient with a history of recurrent fractures has a low calcium AND a low phosphorous on a screening BMP. What is the most common cause of a low calcium and low phosphorous?
=prolonged Vitamin D deficiency
128
You suspect that a patient has Lyme disease? What is the test of choice to confirm the diagnosis (in the absence of a pathognomic rash)?
1. enzyme immunosorbant assay (EIA)
| 2. Positive or equivocal test results should be followed Western blot for proteins from Burelia burgdorferi
129
What are the most common causes of upper GI bleeding?
1. Swallowed blood
2. Esophagitis
3. Gastritis/Peptic Ulcer disease
4. Mallory-Weiss tear
5. Rupture esophageal varice
6. Vasculitis
7. Tumor
8. Vascular malformation
130
A patient presents with coffee ground emesis. She is hemodynamically stable. What is the initial procedure of choice in addition to obtaining labs?
1. NG lavage
2. Looks at the type of contents to determine activity and severity of bleeding
If what you get on NG lavage is coffee ground, that tells you it's a slow bleed, you should be able to clear this with saline lavage
If bright red blood -> active bleed, needs urgent endoscopy
131
What is the pathological defect that leads to the clinical symptoms of ITP?
=immune-mediated destruction of platelets => thrombocytopenia
- A bone marrow of these patients reveals increased megakaryocytes as a compensatory mechanism
- Bone marrow aspirate not routinely indicated unless persistent symptoms or other cytopenias
132
True or false: a history of an egg allergy is a contra-indication to giving the MMR vaccine
=False
133
What is a condition that can have a similar clinical presentation to Guillan-Barre syndrome?
=tick born paralysis
| -symptoms usually come on much faster, GBS is associated with elevated CSF protein
134
What are the symptoms to counsel parents of a child with Down Syndrome to watch out for atlanto-axial instability?
-atlanto-axial instability results in cervical spinal cord compression
- symptoms: gait changes, clumsiness, neck pain, head tilt
- exam signs: spasticity, weakness, hyperreflexia
135
What is a positive Trendelburg test?
=when the patient stands on the affected leg, the opposite hip drops
-indicates weakness of gluteals and hip adductor muscles
136
What is the treatment of choice for a SCFE?
=surgical pinning
| -place child on bed rest and refer to ortho
137
A weak urinary stream in a newborn male is a classic symptom for ________.
- posterior urethral valves
| - high risk for VUR, also can have type IV RTA
138
What are the red flags for immunodeficiency?
1. 4 or more new infections in 1 year
2. 2 or more serious sinus infections in 1 year
3. 2 or more months of antibiotics with no effect
4. 2 or more episodes of pneumonia within a year
5. growth failure
6. Need for IV antibiotics to clear an infection
7. family history of primary immune diseases
139
How can you evaluate functioning of the humoral immune system with laboratory testing?
=B cell functions
1. serum immunoglobulin levels
2. serum immunoglobulin titers in response to vaccines
140
Recurrent sinus infections and recurrent otitis media with effusion may be a sign of ________.
=allergic rhinitis
- esp if seasonality to infections
- could refer to allergist for evaluation
141
Acute appearance of jaundice, abdominal pain and a right upper quadrant mass are characteristic of ________.
A choledochal cyst
142
Who needs SBE prophylaxis for dental procedures?
1. Cardiac transplant with valvoplasty
2. Prosthetic valve or repaired with prostethic material
3. Unrepaired cyanotic CHD
4. Repaired CHD with residual shunt or use of prosthetic material
143
What is the most common solid tumor in infancy? In childhood?
Infancy=Neuroblastoma ( arise anywhere the sympathetic nervous system is located, 50% arise from adrenal gland and present as abdominal mass +/- systemic symptoms fever, pallor)
Early childhood=Wilm's tumor (peak age 3-4 years)
144
What is the treatment of choice for a warm auto-immune hemolytic anemia?
1. corticosteroids
| 2. packed PRBCs
145
What exposure should you worry about in a survivor of a house fire with no external burns and neurologic symptoms?
Carbon monoxide poisoning
Give 100% oxygen by non-rebreather
