Child and Adolescent Medicine

Question 1

Caput Succedaneum vs Cephalohematoma vs Subgaleal Hemorrhage

Answer 1

Caput Succedaneum - swelling of the scalp caused by pressure on the head, crosses suture lines.(edema)

Cephalohematoma - bleeding between the skull and periosteum, does not cross suture lines.(hematoma)

Subgaleal Hemorrhage - bleeding beneath the scalp, can results from extensive blood loss, crosses suture lines.

Question 2

Genu Varum is normal until age —-

Answer 2

2 (bow legs)

Question 3

Genu Valgum is normal until age —

Answer 3

8 (knock knee)

Question 4

Internal rotation of the leg between the knee and the ankle(Tibial torsion) is normal until…

Answer 4

18 months

Question 5

Difference in bilirubin levels with physiologic jaundice vs pathologic jaundice

Answer 5

Pathologic appears within 24hrs, lasts >1 week, fast rise >5 mg/dl/day & bili > 15 mg/dl w/direct bili >2mg/dl

*physiologic rises w/in 24hrs, peaks 3-5 days and lasts about 1 week

Question 6

CXR in transient tachypnea of the newborn vs RDS in infant

Answer 6

TTN: streaky perihilar opacities w/fluid in fissures
RDS: ground glass

Question 7

When should you refer for cryptochidism?

Answer 7

1 yoa

Question 8

Breastfeeding decreases the risks of…

Answer 8

DM, obesity, allergies. Also facilitates bounding & improves immune system

Question 9

What babies need vitamin D supplementation? How much and for how long?

Answer 9

0-12 months; 400 IU Vit D daily or formula fortified with vita D

Question 10

When should formula fed babies be transitioned to cows milk?

Answer 10

1 yoa

Question 11

When should you introduce iron rich foods into babies diet?

Answer 11

6 months of age

Question 12

Between what age is whole milk best?

Answer 12

1-2 years then introduce low fat milk

Question 13

Describe the growth curb and hx of kid with Familial Short Stature.

Answer 13

born at normal weight and length but adjust to a lower percentile within the first 2 years of life then follow along that curve. parents are short. skeletal maturation and timing of puberty are WNL.

Question 14

Describe the growth curb and hx of kid with Constitutional Growth Delay

Answer 14

“late bloomer” in family history. Growth pattern simular to familial short stature - follows along curve but linear curve continues beyond typical age for reaching full height. SKELETAL MATURATION & PUBERTY ARE DELAYED

Question 15

Describe the growth curb and hx of kid with GH Deficiency

Answer 15

decrease in growth velocity, delays in skeletal maturation

Question 16

Rule of 3s for colic

Answer 16

3 hours a day, 3 days a week, 3 weeks or more

Question 17

When should colic resolve?

Answer 17

4 months of age

Question 18

What should you screen for in an infant with colic?

Answer 18

child abuse! - kids are at increased risk!

Question 19

Tx of colic?

Answer 19

parent education & PPI if suspect GERD

Question 20

how often do newborns poop?

Answer 20

after every feed but this decreases around 2-3 months

Question 21

how many wet diapers should a newborn have a day?

Answer 21

6-8 per day

Question 22

Nocturnal enuresis is abnormal after…

Answer 22

7 yoa

Question 23

Up to what age is Esotropia(cross eye’d) normal?

Answer 23

5-6 months

Question 24

When does teething begin?

Answer 24

3-12 months - encourage use of cup at 1 yoa

Question 25

Kids have to ride in the back seat till age

Answer 25

13

Question 26

When can a child use a lap/shoulder seatbelt?

Answer 26

4'9'' which is usually on or after 8 yoa

Question 27

Common bugs for pneumonia in newborns

Answer 27

GBS, Gram neg enteric bacteria, CMV, listeria

Question 28

Common bugs for pneumonia in infants

Answer 28

chlamydia, RSV, S pneumoniae, S.Aureus

Question 29

Common bugs for pneumonia in Toddlers

Answer 29

viruses, S.pneumoniae, H flu

Question 30

Common bugs for pneumonia in children 4-14 yoa

Answer 30

mycoplasma, pneumococcus, chlamydia

Question 31

Fever unknown origin in newborns less than what age require the kitchen sink?

Answer 31

<30 days (technically less than 21 days)- after that its basically tailored to what u think is the cause starting with UA and progressing from there.

Question 32

tx of kawasaki disease, echo?

Answer 32

High dose ASA + IVIG for acute phase then low dose ASA x6-8 weeks or untill coronary aneurysm resolves ECHO: at time of dx, again at 2-4 weeks & 6-8 week or untill aneurysm resolves

Question 33

Most common food allergy in infancy

Answer 33

cows milk! - more common in families with atopy. Symptoms resolve with avoidance by 3 week. Avoid soy protein as they often have allergy to this too. Will outgrow allergy usually by 2-3 yoa

Question 34

When will most kids outgrow cows milk allergy?

Answer 34

2-3 yoa

Question 35

Kids with cows milk allergy should also avoid..

Answer 35

soy protein ! they are usually allergic to this too

Question 36

At what angle do you need to refer to ortho for scoliosis

Answer 36

>20

Question 37

Still's Disease

Answer 37

JIA that is systemic: Arthritis(waxs & wanes), fever, rash, hepatosplenomegly & leukocytosis

Question 38

Precocious Puberty age in M & F?

Answer 38

M: 9, F: 8

Question 39

Delayed puberty age in M & F?

Answer 39

M: 14, F: 13

Question 40

When do you need to do an ultrasound for a kid with a urinary tract infection?

Answer 40

If there are less than two years of age or they are getting recurrent urinary tract infections. Would get a VCUG if abnormal or recurrent UTIs

Question 41

CENTOR criteria for GAS

Answer 41

1 point for each: fever, absence of cough, swollen/tender anterior cervical nodes, tonsillar swelling and/or exudate, age 3 through 14 Score: Less than one no testing is needed, between two and three points rapid testing. 4+ points no testing as needed just treat

Question 42

For how long would it be appropriate to watch asymptomatic lymphadenopathy in children?

Answer 42

Up to four weeks then consider work up with ultrasound if under the age of 14 or CT if over the age of 14. If persistent needs FNA

Question 43

Treatment of bronchiolitis versus croup

Answer 43

Croup steroids(>2 yoa), bronchiolitis is supportive only.

Question 44

Stages of pertussis and duration

Answer 44

Catarrhal stage - most contagious lasting 1 to 2 weeks with URI symptoms Proximal stage-whoops and posttussive emesis lasting 2 to 6 weeks but can last up to 10 weeks Convalescent stage – 2-3 weeks 

Question 45

What antibiotic is used for prophylaxis of those you’ve come in contact with someone with pertussis?

Answer 45

Azithromycin

Question 46

Drug of choice for pneumonia in a kid less than five years old and a kid older than five ?

Answer 46

Less than five use amoxicillin, older than five uses azithromycin