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Flashcards in Boards Deck (145):
1

What are the signs of an uncal (temporal lobe) herniation?

1. blown unilateral pupil (due to CN III compression)
2. contralateral paresis
- usually secondary to trauma

2

What is the optimal starting dose of levothyroxine for congenital hypothyroidism? When should it be started?

10-15 micrograms/kg per day; start before 2 weeks of age for best outcomes

3

True or false: Prior BCG vaccine can cause a false positive TB skin test.

True-but response usually wanes so this should be

4

True or false: The quantiferon gold test result is affected by prior BCG vaccines.

False-- prior BCG vaccine does NOT react

5

What is the most common cause of acute ataxia in children?

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

What is the classic presentation for an infant with transposition of the great arteries?

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

How do you distinguish PPHN and cyanotic heart disease in the neonate?

-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

What is the most common renal tumor in childhood? What are the presenting signs?

=Wilms tumor

-painless abdominal mass, hypertension, and hematuria

9

What diagnosis should be considered in a skeletally immature child with negative xrays with point tenderness pain (ex over lateral ankle)?

=fracture of the growth plate (physis, type I salter harris fracture)
-generally heal with 4-6 weeks of immobilization

10

True or false: an optimally treated (ie diet managed) child with PKU will not have any sequelae

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

You note a bifid uvula on exam. What two commonly associated problems do you need to evaluate for?

1. Submucous cleft palate (notching of the posterior hard palate, bifid uvula, diastasis of the muscles of the soft palate)
2. Middle ear effusions and conductive hearing loss
-hx of recurrent ear infections
-presence of effusion on exam
-speech concerns

12

What is the time to onset of SABAs (ex albuterol)? Duration of action?

Onset: 15 minutes
Duration: 4-6 hours

13

What is time of onset of LABAs (ex salmeterol, formoterol)? Duration of action?

Onset: 15-30 minutes
Duration: 12 hours

Regular use of LABAs and SABAs can lead to decreased bronchoprotective effect.

14

True or false: ERCP should be performed during a suspected episode of acute pancreatitis secondary to a gallstone

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

Low calcium with a elevated PTH represents ______

=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

Warm agglutinins (in autoimmune hemolytic anemia) are IgG or IgM based? What are some causes?

warm agglutinins=IgG based
-causes: infectious (younger children), antibiotics

17

Cold agglutinins (in autoimmune hemolytic anemia) are IgG or IgM based? What is a type of infection in pediatrics associated with this?

cold agglutinins=IgM based
-associated with mycoplasma infections

18

What does a Coombs or DAT test detect?

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

A positive DAT should make you consider ________.

Autoimmune hemolytic anemia (esp warm)

20

Name the toxidrome with the following symptoms:

-hyperpyrexia
-hypertension
-tachycardia
-dry mucus membranes
-flushed skin
-mydriasis
-decreased bowel sounds
-confusion

=anti-cholinergic

21

What are some classes of medications associated with anti-cholinergic properties?

1. antihistamines
2. TCA anti-depressants
3. OTC cold and sleep aids
4. atropine
5. scopolamine
6. contaminated street drugs
* Jimson weed

22

Define metatarsus adductus. What is the most common cause?

=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

How is metatarsus adductus treated?

-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

True or false: skin prick testing is superior to serum based RAST testing.

=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