Case Files 1

Question 1

Five things in apgar score

Answer 1

HR, Respiratory effort, muscle tone, reflex irritability (catheter in nose), and color

Question 2

How does a child with a diaphragmatic hernia often present

Answer 2

Immediate respiratory distress, scaphoid abdomen, cyanosis, and heart sounds displaced to right side of chest

Question 3

What does choanal atresia result in

Answer 3

Respiratory distress when a child stops crying: intubate until surgery can be completed

Question 4

GDM when mothers fasting glucose above

Answer 4

95

Question 5

What cause HCM from GDM

Answer 5

Glycogen deposition in myocardium

Question 6

Why RDS from GDM

Answer 6

Inulin appears to interfere with cortisols ability to induce surfactant production

Question 7

When do give IV glucose to IDM

Answer 7

When blood glucose less than 40 with any symptom of hypoglycemia
hypocalcemia also seen

Question 8

Two labs for neonatal jaundice

Answer 8

Bilirubin and hematocrit

Question 9

What kind of bilirubin is toxic to brain

Answer 9

Unconjugated (deposition into brain causes kernicterus)

Question 10

What does end-tidal CO2 concentration (ETCO) measure

Answer 10

Non-invasive measure of bilirubin association

Tracutaneous bilirubinometer can also be used

Question 11

4 findings suggestive of non-physiologic jaundice in newborn

Answer 11

1. First 24-36 hours
2. Rise > 5 in 24 hours
3. Bili greater than 12 in healthy newborn
4. Jaundice lasts > 2 weeks

Question 12

Jaundice in 2nd to 3rd week of life likely

Answer 12

Breast milk jaundice

Question 13

How does maternal phenobarbital reduce neonatal jaundice

Answer 13

Induces gluconuryl transferase

Question 14

Defect in Crigler-Najjar

Answer 14

Severe uridine-diphosphate glucuronyslatransferase def (all newborns somewhat def)

Question 15

Three features typical of GBS pneumonia

Answer 15

Rapid symptom onset, low WBC with left shift, and CXR show infiltrates

Question 16

Majority of early onset neonatal sepsis occurs when

Answer 16

Within first 24 hours (def is within 6 days)

Question 17

What is crucial for patients with suspected sepsis

Answer 17

Blood culture

Question 18

MCC of neonatal sepsis from birth to 3 months

Answer 18

GBS

Question 19

When do screen pregnant women for GBS

Answer 19

35-37 weeks

Question 20

How does late onset GBS most commonly manifest

Answer 20

Bacteremia without a focus

Question 21

Neonatal sepsis Ab tx for early vs late

Answer 21

Early: Pen and amino glycoside (gent)
Late: Vanc and 3rd gen ceph

Question 22

Late onset neonatal infection (7-90 days) usually caused by

Answer 22

Environment (coag neg staph, E. coli)

Question 23

Microphallus size

Answer 23

less than 2cm for neonate (

Question 24

3 goals for intersex born baby

Answer 24

1. Learn etiology
2. Assign gender
3. Intervene with surgical or other treatment

Question 25

MCC of male pseudohermaphroditism

Answer 25

Androgen insensitivity syndrome

Question 26

Hyper pigmentation of labial scrotal folds seen in

Answer 26

CAH

Question 27

What is used for karyotype analysis in neonates

Answer 27

Activated lymphocytes

Question 28

Whats elevated in the MC CAH? what helps

Answer 28

17-hydroxyprogesterone | Administration of hydrocortisone helps

Question 29

Gonad + ovaries on US

Answer 29

True hermaphroditism

Question 30

Androgen insensitivity syndrome

Answer 30

Blind vagina in girl with amenorrhea and no pubic hair

Question 31

Infants born with intrauterine HSV infection suspected to have

Answer 31

Skin vesicles, chorioretinitis, microcephaly

Question 32

Blueberry muffin rash with what

Answer 32

Congenital rubella infection | Also some CMV

Question 33

Neonatal HSV CNS manifestations seen when

Answer 33

2-3 weeks of life

Question 34

Congenital toxo triad

Answer 34

Hydrocephalus, intracranial calcifications, and chorioretinis

Question 35

CMV vs toxo calcifications in baby

Answer 35

toxo: basal ganglia CMV: periventricular w/ blue petechia on baby

Question 36

Rubella in baby

Answer 36

Blueberry muffin, cataracts, normal CT

Question 37

Tracheal esophageal malformation seen when ~4-12 month old has recurrent aspiration pneumonia

Answer 37

H type TEF

Question 38

VACTERL

Answer 38

``` Vertebral anomaly Anal imperforation Cardiac Tif Renal Limb ```

Question 39

CHARGE

Answer 39

``` Coloboma of eye Heart defects Atresia of nasal/esophagus Retardation Genital Ear ```

Question 40

Why hypocalcemic crisis in DiGeroge

Answer 40

Parathyroid hypoplasia

Question 41

What causes transient tachypnea of the newborn

Answer 41

Slow absorption of fetal lung fluid with resultant tachypnea, treated with supportive care *More commonly seen with C sections*

Question 42

What is required to link neonate to ECMO

Answer 42

Cannulation of the carotid artery and jugular vein

Question 43

CXR of transient tachypnea of newborn

Answer 43

Perihilar streaking and fluid in the fissures

Question 44

2 causes of tachypnea of infant born to diabetic mother

Answer 44

Polycythemia and hypoglycemia

Question 45

What is aphakia

Answer 45

Absence of the lens

Question 46

Misalignment of the visual axes

Answer 46

Strabismus | *Ambylopia is decrease of loss of vision caused by underuse of one eye*

Question 47

Galactosemia can cause

Answer 47

congenital cataracts (also think about other metabolism errors)

Question 48

Low birthweight, PDA, and congenital cataracts likely

Answer 48

Congenial rubella

Question 49

Excessive tear production in newborn that later becomes mucupurulent likely

Answer 49

Congenital nasolacrimal duct obstruction

Question 50

Abnormal red light reflex next step

Answer 50

Consult optho

Question 51

What can clinician observe during exam to help figure out cause of FTT

Answer 51

Feeding -may give clues to maternal-child interaction bonding issues or to physical problems

Question 52

Calcifications of CMV vs Toxo

Answer 52

CMV: periventricular pattern Toxo: Scattered throughout cortex

Question 53

When do young children often become picky eaters

Answer 53

Between 18-30 months of age, which can cause their growth rates to plateau

Question 54

Most common cause of FTT in US

Answer 54

Psychosocial or non-organic

Question 55

3 appropriate first steps for FTT

Answer 55

1. Cheap screening tests 2. Dietary counseling 3. Observation of weight changes

Question 56

What can be found in unpasteurized goats milk

Answer 56

Brucellosis

Question 57

What is an ovovegetarian

Answer 57

Diets devoid of animal products but includes eggs

Question 58

Infants receiving goat's milk as primary nutrition should get what

Answer 58

Folate and vitamin B12, also iron

Question 59

What vitamin is low in breast milk

Answer 59

Vitamin K

Question 60

What def causes fontanelle fullness

Answer 60

Vitamin A

Question 61

What vitamin def causes hemolytic anemia

Answer 61

Vit E

Question 62

Galactosemia features

Answer 62

jaundice, hepatosplenomeglay, vomiting, hypoglycemia, failure to thrive, MR, inc risk of E. coli sepsis

Question 63

What is phosphate dependent rickets due to

Answer 63

Renal phosphate wasting | *Low serum PO4 with normal PTH*

Question 64

Stage 1 vs 2 vs 3 calcipenic rickets

Answer 64

1. Hypocalcemia 2. Normal Ca but low PO4 and inc Alk pos due it inc PTH 3. Low Ca b/c PTH compensation reached its limits

Question 65

Symptoms of severe hypocalcemia

Answer 65

Seizures, tetany, poor feeding, vomiting, apnea spells, arrhythmias

Question 66

Genu valgum vs varum

Answer 66

valgum - knock kneus | vacuum - bowed legs

Question 67

Best sites to examine to look for rickets

Answer 67

Distal ulna and metaphases of the knees

Question 68

Why are premies at risk for rickets

Answer 68

80% of placental Ca and PO4 occur b/w 32-36 weeks

Question 69

Vitamin D levels in kids? Tx for def

Answer 69

> 20 normal | 15-20 insuff

Question 70

Labs in Vit D def rickets

Answer 70

Low Ca and PO4, elevated alk pos and PTH

Question 71

Prominence of chostochondral junctions seen in

Answer 71

Rickets

Question 72

Vit D in healthy kids

Answer 72

400 for up to one year | 600 for healthy kids after birth

Question 73

MCC of non-nutritional rickets

Answer 73

Primary hypophosphatemia (x linked dominant) - proximal tubule kidney defect

Question 74

Sickle cell crisis prophylaxis drug

Answer 74

Hydroxyurea

Question 75

Most common cause of sickle cell aplastic crisis

Answer 75

Parvo B19 infection

Question 76

Why is sickle cell crisis + fever emergency

Answer 76

Functional asplenia predisposes patients to crisis with encapsulated bacteria

Question 77

Test to prevent strokes in SCD kids

Answer 77

Annual transcranial doppler US until pt is 16

Question 78

When should SCD kids get CBCs

Answer 78

Baseline and periodic with relic count starting at 2 months of age

Question 79

Top two causes of pneumonia in first 2 days of life? tx?

Answer 79

enterobacter and GBS | * tx Amp and gent

Question 80

Bug to think in infant with staccato cough and tachypnea and conjunctivitis? lab? tx?

Answer 80

Chlamydia, may see eosinophilia | Erythromycin

Question 81

Most prevalent viral pneumonia in the first few days of life

Answer 81

HSV

Question 82

Peds kids 5 and up with LRTI typically have

Answer 82

Mycoplasma

Question 83

cough and increased respiratory effort in an afebrile infant with eye discharge consistent with

Answer 83

Chlamydia | *transmission typically vaginal delivery*

Question 84

Fever, cough, and bilateral lymphadenopathy in young guy likely

Answer 84

Childhood TB

Question 85

most likely pneumo for neonates? toddlers? adolescents?

Answer 85

Neonates: GBS Toddlers: RSV Adolescents: Mycoplasma