CLINICALPeds EOR Exam_Rosh_SmartyPance Flashcards
(160 cards)
1
Q
SmartyPance
what is most common cause of acute bronchiolitis in children?
A
RSV
esp in fall and winter months
2
Q
SmartyPance
how is acute bronchiolitis treated?
A
supportive:
- humidified O2
- antipyretics
- beta agonist
- nebulized racemic epi
- steroids
3
Q
SmartyPance
what is the only treatment demonstrated to improve bronchiolitis?
A
oxygen
4
Q
SmartyPance
what are hospitalization criteria for acute bronchiolitis?
A
If O2 sat <95-96%
if age <3 months
if RR>70
if child has nasal flaring or retractions
if CXR shows atelectasis
5
Q
SmartyPance
what are common s/s of acute bronchiolitis?
A
tachypnea
respiratory distress
wheezing
6
Q
SmartyPance
what is the most common cause of lower respiratory tract infection in children worldwide?
A
Respiratory
Syncytial
Virus
(virtually all children get it by age 3)
7
Q
SmartyPance
what is the leading cause of pneumonia and bronchiolitis?
A
Respiratory
Syncytial
Virus
8
Q
SmartyPance
s/s of RSV?
A
rhinorrhea wheezing/coughing (persists for months) low grade fever nasal flaring/retractions nail bed cyanosis
9
Q
SmartyPance
how is RSV diagnosed?
A
nasal washing, RSV antigen test
CXR can show diffuse infiltrates
(in real life, it’s diagnosed clinically, maybe with nasal swab)
10
Q
SmartyPance
how is RSV treated?
A
supportive measures:
- albuterol via nebulizer
- antipyretics
- humidified O2
- steroids (controversial)
- resolves in 5-7 days
11
Q
SmartyPance
what kids get vaccinations for RSV?
A
kids with lung issues, born premature (<30 weeks), immunocompromised
once per month for five months, start in Nov.
12
Q
(Rosh Review)
what ages of children most often present with retropharyngeal abscesses?
A
< 5 yrs
13
Q
(Rosh Review)
what are the two most common causes of retropharyngeal abscesses?
A
Strep pyogenes
Staph aureus
14
Q
(Rosh Review)
presentation of a child with retropharyngeal abscess?
A
fever odynophagia (painful swallowing) stridor drooling torticollis
15
Q
(Rosh Review)
what specific type of position and imaging is required for diagnosis of retropharyngeal abscess?
A
Xray
on INSPIRATION
with neck EXTENSION
(if xray is positive, get CT of neck with contrast)
16
Q
(Rosh Review)
What is the plan for children with retropharyngeal abscess?
A
hospitalization
otolaryngologist consult
IV abx would likely include ampicillin-sulbactam or clindamycin
17
Q
(Rosh Review)
what is the involuntary compulsive use of obscenities seen in Tourette’s syndrome?
A
coprolalia (a type of tic)
18
Q
(Rosh Review)
three descriptors of candidal diaper dermatitis
A
beefy red plaques
satellite lesions
inguinal folds are involved
19
Q
(Rosh Review)
treatment of choice for candidal diaper dermatitis
A
nystatin ointment
apply 2-3 x/daily, continue until rash has fully resolved for 48 hrs
20
Q
(Rosh Review)
define complex febrile seizures (three factors)
A
multiple szs occur during the same febrile illness,
szs are prolonged (>15 minutes)
szs have a focal component
(not all criteria required to dx complex febrile sz)
21
Q
(Rosh Review)
seizures lasting under 15 minutes are _______
A
…associated with simple febrile seizures
when multiple szs occur w/in same febrile illness, szs are classified as complex
22
Q
(Rosh Review)
what is first-line therapy while baby is in the hospital with bronchiolitis, RSV?
A
supportive care is first line therapy while in hospital, which includes suctioning of nares with saline
23
Q
(Rosh Review)
what is the difference between croup and bacterial tracheitis?
A
bacterial tracheitis is croup that worsens despite treatment
high fever develops
airway compromise risk is higher
(this is usually caused by Staph aureus)
24
Q
(Rosh Review)
slippage of femoral head on femoral neck
A
slipped capital femoral epiphysis (SCFE)
25
(Rosh Review)
| presentation of acute slipped capital femoral epiphysis
```
pain in hip, groin, knee
gait abnormalities
decreased ROM
pain dull (chronic) or sharp (acute)
limited flexion of hip
LIMP
```
26
(Rosh Review + SmartyPance)
| what is treatment of slipped capital femoral epiphysis?
casting, surgery (fixation with screw), or both
(SmartyPance: PROPHYLACTIC SCREW FIXATION of the contralateral hip may be considered for patients, as there is a risk of the disease in the contralateral hip later in life - usually for patients < 10 or > 16 years of age)
27
(Rosh Review)
| complications of slipped capital femoral epiphysis
avascular necrosis of femoral head
| osteonecrosis
28
(SmartyPance)
| how is diagnosis of slipped capital femoral epiphysis made?
radiography
AP and frog-leg lateral of right and left hip
- lateral radiograph is the best way to identify a subtle slip
29
(Didactic)
| name three causes of microcephaly
Down's, Fetal Alcohol Syndrome, Zika
30
(SmartyPance)
define Downs Syndrome
what is special about it?
chromosome 21 disorder causing developmental and intellectual delays
MC chromosomal disorder
MC cause of mental retardation
31
(SmartyPance)
| RF for Downs:
advanced maternal age
1: 1500 in women <20 yrs
1: 25 in women >45 yrs
32
(SmartyPance)
| three comorbidities common with Down's
- ALL
- early-onset Alzheimer's
- atlantoaxial instability
33
(SmartyPance)
| Dx for Down's:
PRENATAL:
- first trimester U/S
- amniocentesis
- chorionic villus sampling (CVS)
- quadruple screen
POSTNATAL:
- clinical identification of dysmorphic features
34
(SmartyPance)
| treatment for Down's
prenatal genetic counseling
| supportive management of affected body systems
35
(SmartyPance)
| what is Turner Syndrome?
genetic disorder caused by a missing X chromosome in females
(45X0)
36
(SmartyPance)
| how is Turner Syndrome diagnosed?
physical exam
| pt hx
37
(SmartyPance)
| what is the test of choice for suspected Turner Syndrome?
```
karyotype analysis
(may identify 45X0)
```
38
(SmartyPance)
| what is treatment of Turner Syndrome?
growth hormone therapy
| sex hormone replacement therapy
39
(RoshReview)
| what is the name of the disease caused by the measles virus?
rubeola
40
(SmartyPance)
| How is measles diagnosis made?
clinically:
- hx of fever at least 3 days
- at least one of the 3 C's (cough, coryza, conjunctivitis)
maybe also Koplik's spots
maybe you get labs and find measles IgM antibodies or isolation of measles virus RNA from resp specimens
41
(SmartyPance)
| what is the treatment for measles?
SUPPORTIVE
- anti-inflammatories
ISOLATION
- 1 week after onset of rash
**vaccination is highly effective
42
(RoshReview)
| how does the measles rash spread?
red maculopapular eruption rash begins in forehead, behind ears, on upper neck ------> spreading to torso, extremities
43
(RoshReview)
| what is first line abx treatment for epiglottitis?
CEFTRIAXONE - OR -
cefotaxime plus vancomycin
(this covers H.influenzae and GAS)
44
(RoshReview)
| when are antibiotics administered for epiglottitis patients?
only after pt's airway has been protected through intubation
45
(RoshReview)
| what the finding on lateral neck XR for epiglottitis?
thumbprint sign
46
(RoshReview)
| what is NOW the MC cause of acute epiglottitis in pediatric population?
Group A Strep
| before vaccination, H. influenzae type b was most common
47
(SmartyPance)
| how do we diagnose epiglottitis?
first, secure the airway, then
CULTURE
48
(RoshReview)
| How do we treat pertussis?
oral macrolide antibiotics:
- erythromycin
- azithromycin, or
- clarithromycin
**everyone in the house gets this treatment too, as prophylaxis!!**
49
(RoshReview)
| How is pertussis definitively diagnosed?
isolating the organism from a nasopharyngeal culture
50
(RoshReview)
| what is the pattern of spread of the rubeola rash?
centrifugal
| begins on head, spreads down face to trunk and extremities
51
(PPP)
| how do we diagnose acne vulgaris? (mild, moderate severe)
mild: comedones, sm amts of papules &/or pustules
moderate: comedones, lgr amts of papules &/or pustules
severe: nodular (>5mm) or cystic acne
52
(PPP 609)
| How do we treat mild acne vulgaris?
MILD: TOPICALLY
- azelaic acid
- salicylic acid
- benzoyl peroxide
- retinoids
- tretinoin
- topical abx like Clindamycin or Erythromycin
53
(PPP 609)
| how do we treat SEVERE acne vulgaris?
severe (refractory nodular acne): oral isotretinoin
54
(PPP 609)
| How do we treat moderate acne vulgaris?
```
moderate:
topically (as with MILD),
add oral abx (i.e. minocycline or doxycycline)
or
spironolactone
```
55
(PPP)
| how do we treat mild acne vulgaris?
mild: topically
- azelaic acid, salicylic acid, benzoyl peroxide, retinoids, tretinoin or topical antibiotics
- topical abx --> i.e. clindamycin or erythromycin
56
(PPP 612)
| how do we diagnose androgenetic alopecia?
clinically
| - dermoscopy maybe...look for miniaturized hair and brown perihlar casts
57
(PPP 612)
| how do we treat androgenetic alopecia?
Topically, orally, or transplant
Topical: minoxidil, needs 4-6 month trial (widens blood vessels, allowing more blood O2 & nutrients to promote anagen/growth phase
Oral: 5-alpha reductase type 2 inhibitor (inhibits the conversion of testosterone to dihydrotestosterone)
Transplant: effective, works if pt has sufficient # of donor plugs
58
(PPP 616)
| How do we diagnose erythema infectiosum?
clinically
| (can also look for parvoviris-specific IgM via serology)
59
(PPP 616)
| How do we treat erythema infectiosum?
supportive
- anti-inflammatories (acetaminophen or NSAIDs)
it's a self-limited disease
60
(PPP 617)
| How do we diagnose HFMD?
clinically
| - you could do a culture for cocksackievirus-specific immunoglobulin A
61
(PPP 617)
| How do we treat HFMD?
supportive
- antipyretics (acetaminophen, ibuprofen)
- hydration
- topical lidocaine
62
(PPP 620)
| how do we diagnose impetigo?
clinically
- can do gram stain and wound culture if you wish
63
(PPP 620)
| How do we treat EXTENSIVE impetigo?
EXTENSIVE: systemic abx like cephalexin or dicloxacillin (a PCN) or macrolides
64
(PPP 620)
| how do we treat COMMUNITY-ACQUIRED MRSA impetigo?
```
COMMUNITY-ACQUIRED MRSA:
- doxycycline
- clindamycin
or
- TMP-SMX
```
65
(PPP 620)
| How do we treat MILD impetigo?
```
MILD:
mupirocin tid x10 days,
or bacitracin,
or retapamulin,
wash with soap & water
```
66
(PPP 635)
| define atopic dermatitis
```
rash, due to
defective skin barrier
susceptible to drying,
leading to pruritus & inflammation
"the itch that rashes"
```
67
(PPP 635)
| what is the atopic dermatitis triad?
eczema + allergic rhinitis + asthma
68
(PPP 635)
| how is atopic dermatitis diagnosed?
clinically
| increased IgE supports dx
69
(PPP 635)
| how is atopic dermatitis treated?
1 - topical corticosteroids, first line. Also, antihistamines for itching. Wet dressings. (treat secondary infections w/ abx)
2 - topical calcineurin inhibitors (alternatives to steroids): tacrolimus, pimecrolimus
3 - systemic: phototherapy, cyclosporine, azathioprine, mycophenolate mofetil, methotrexate, dupilumab
70
(PPP 632)
| how do we diagnose contact dermatitis?
clinically
- can do PATCH TESTING to id potential allergens
- histology not needed, but will show spongiosis (intercellular edema in epidermis)
71
(PPP 632)
| how do we treat contact dermatitis?
AVOIDANCE - id and avoidance of irrititnts
CORTICOSTEROIDS: topical corticosteroids, first line trtmt
- severe rxn? add oral corticosteroids
CALCINEURIN INHIBITORS: topical calcineurin inhibitors - tacrolimus or pimecrolimus
72
(SmartyPance)
| Burns Rule of 9's for kids
head 18%
back 18%
chest 18%
each leg 14%
each arm 9%
73
(SmartyPance)
| what is the Palmer method for estimating burns for children?
patient's palm = 1%
74
(SmartyPance)
| Staples of treatment for pediatric burns
monitor ABCs
fluid replacement
1% silver sulfadiazine
MILD:
soap & water
drain & debride bullae
cover w/ silver sulfadiazine
MODERATE/SEVERE:
cover w/ dry dressing
admit
75
(SmartyPance)
| what labs do we get for pediatric burns?
```
ABG
CBC
CMP
CK
U/A
carboxyhemoglobin
```
76
(SmartyPance)
| how is fluid replacement managed for pediatric burns?
kids with >10% total BSA GET FLUIDS
LR 3mL x wt (kg) x %BSA
"half given in 1st 8 hrs, then 16 hrs"
77
(SmartyPance)
| what are drug eruptions?
adverse cutaneous rxn in response to admin of a drug, usually w/in past 6 weeks
78
(SmartyPance)
| what are the most common adverse drug reactions?
skin reactions
79
(SmartyPance)
| what drugs are common offenders for drug eruption?
```
penicillin (amoxicillin, ampicillin)
TMP-SMX (bactrim)
allopurinol
NSAIDs
CCBs
sulfonamides
anticonvulsants
```
80
(SmartyPance)
| how do we diagnose perioral dermatitis?
clinically
| - a biopsy may help
81
(SmartyPance)
| how do we treat perioral dermatitis?
```
topical metronidazole (AVOID STEROIDS)
mild, first line, topical alone:
- pimecrolimus 0.1%
- erythromycin solution q12 hrs
- metronidazole 0.75% gel q12 hr
- Clindamycin lotion q12 hours
```
moderate:
- topical + oral abx
- Oral ABX: Doxycycline if necessary - no gels, solutions, or lotions on eye
82
(SmartyPance)
| what is erythemia multiforme?
TYPE IV HYPERSENSITIVITY RXN
affecting skin and mucous membranes
an acute, self-limited, sometimes recurring skin condition that affects extremities and mucosa
83
(SmartyPance)
| how may erythema multiforme manifest itself in the eyes?
target iris lesions, dull "violet" red
84
(SmartyPance)
| what characterizes the rash of erythema multiforme?
blanching
| lack of itchiness
85
(SmartyPance)
| how do we diagnose erythema multiforme?
clinical hx
| phys exam
86
(SmartyPance)
| how do we treat erythema multiforme?
remove the offending agent
IV fluids if needed
magic mouthwash
systemic steroids if it's severe
87
(SmartyPance)
| erythema multiforme is divided into major and minor forms. describe.
Major: widespread skin lesions, affects 2+ mucosal sites
Minor: limited region of skin affected, 1 type of mucosa affected (usually oral)
88
(SmartyPance)
| how does a lice infestation manifest itself?
pruritic scalp, body, or groin
small white specs on hair shaft
89
(SmartyPance)
| how do we treat lice?
launder potential fomites in water >131 F
permitherin topical drug of choice
- capitis? permitherin shampoo x 10 minutes
- pubis? permitherin lotion x 8 hrs
90
(SmartyPance)
| what is lichen planus?
papulosquamous inflammatory dermatosis
of unknown etiology,
probably autoimmune in origin
91
(SmartyPance)
| how do you know it's lichen planus?
```
the 5 P's:
purple
papule
polygonal
pruritis
planer
```
92
(SmartyPance)
| how do we treat lichen planus?
topical steroids
93
(SmartyPance)
| how do scabies present themselves on patients?
S-shaped or linear burrows on skin
often on web spaces of hands, wrists, waist
severe itching, worse at night
94
(SmartyPance)
| how do we treat scabies?
> 2 months old?
topical permethrin 5%
apply to entire body and wash after 8-14 hrs, repeat in 1 week
95
(SmartyPance)
| how do we treat scabies for kids <2 mo old?
sulfur 5%-10% ointment
96
(SmartyPance)
| how do we treat scabies if there is extensive involvement or immunocompromised indivudual?
oral ivermectin
97
(SmartyPance)
| does treatment of scabies bring instant relief?
no, pruritus may persist for 2-4 weeks after treatment
98
(SmartyPance)
| what is Stevens-Johnson syndrome?
rare
serious hypersensitivity complex
affects skin and mucous membranes
reaction to meds or infection
MC caused by anticonvulsants and sulfa drugs
99
(SmartyPance)
| how much of the body does Stevens-Johnson cover?
3-10% OF THE BODY
100
(SmartyPance)
| how do we diagnose Stevens-Johnson?
skin biopsy show necrotic epithelium
| ddx includes erythema multiforme, viral exanthems, drug rash
101
(SmartyPance)
| how do we treat Stevens-Johnson?
stop all offending medications
early admit to burn unit
manage fluids/electrolytes/nutrition, airway, eye care
102
(SmartyPance)
| how do we diagnose tinea?
scrape and KOH prep
(dermatophytes = long branching fungal hyphae with septations
candidiasis = budding yeast, pseudohyphae
tinea versicolor = short hyphae and clusters of spores ("spaghetti and meatballs")
103
(SmartyPance)
| how do we treat tinea capitis?
Oral griseofulvin (Drug of Choice): 20–25 mg/kg/24 h (max 1 g/24 h) once daily or divided b.i.d. of microsize griseofulvin for 6–8 weeks.
In addition, topical therapy of 2.5% selenium sulfide or ketoconazole shampoo twice weekly suppresses viable spores. Laboratory monitoring is not needed.
Systemic therapy warranted to penetrate the hair shaft
104
(SmartyPance)
| how do we treat tinea corporis?
Topical azole antifungals (1% clotrimazole, 2% ketoconazole)
or
1% terbinafine cream applied twice daily for 2–4 weeks.
105
(SmartyPance)
| what is toxic epidermal necrolysis?
A rare, life-threatening skin condition that is usually caused by a reaction to drugs
TOXIC EPIDERMAL NECROLYSIS IS >30% OF THE BODY
(very similar to Steven-Johnson)
106
(SmartyPance)
| what is the difference between toxic epidermal necrolysis and Steven-Johnson syndrome?
The difference is the AGE of the individuals (in toxic epidermal necrolysis older patients vs. SJS younger patient)
and
percentage of the body affected (in TEN > 30% of body surface area affected vs. SJS < 10% of body surface area affected)
107
(SmartyPance)
| how do we diagnose toxic epidermal necrolysis?
biopsy
| necrotic epithelium
108
(SmartyPance)
| how do we treat toxic epidermal necrolysis?
admit to burn unit with supportive care;
consult ophthalmology if eyes affected;
cyclosporine
and
possibly plasma exchange for severe cases
109
(RoshReview)
| MC hereditary bleeding disorder
von Willebrand disease (VWD)
110
(RoshReview)
| What is von Willebrand Disease?
type 1 is qualitative or quantitative defect in von Willebrand factor, a protein necessary for platelet adhesion function
111
(RoshReview)
| What is a key sign of von Willebrand Disease (VWD)?
bleeding time is increased
| PTT is normal or may be increased
112
(RoshReview)
| What is testicular torsion?
twisting of spermatic cord, most commonly due to an anatomical defect, can result in ischemia of testicle
abnormal anchoring of testicle w/in tunica vaginalis, which allows it to move freely in scrotum (bell clapper deformity)
113
(RoshReview)
| key s/s of testicular torsion
absence of cremaster reflex (most sensitive PE finding)
others:
- negative Prehn's sign (lifting of testicle will not relieve pain)
- sudden severe pain, swelling, n/v, TTP
- blue dot sign = tender nodule 2-3 mm in diameter on upper pole of testicle
114
(RoshReview)
| how do we diagnose testicular torsion?
ultrasound
and
radionuclide study (gold standard)
115
(SmartyPance)
| how do we treat testicular torsion?
surgical emergency
| repair both testes w/in 4-6 hrs
116
(SmartyPance)
| how do we diagnose acute ottis media?
```
1 - bulging of TM
2 - other signs of acute inflammation
- marked erythema
- fever
- pain
- middle ear effusion
3 - loss of landmarks
4 - limited mobility of TM with pneumotoscopy (key finding)
```
117
(SmartyPance)
| how do we treat acute otitis media?
1st line: amox
2nd line: augmentin (amox + clavulanic acid)
*if PCN allergy, use azithromcin, erythromycin, TMP-SMX
<2 y/o, treat 10 days
>2 y/o, treat 5-7 days
118
(SmartyPance)
| MC cause of acute pharyngotonsilitis?
viral
| adenovirus most common virus
119
(SmartyPance)
| how do we treat acute pharyngotonsilitis caused by GAS
1st line: PCN
*use azithromycin if PCN-allergic
(GAS pharyngotonsilitis complication --> rheumatic fever, post-strep glomerulonephritis)
120
(SmartyPance)
| how do we treat viral pharyngotonsilitis?
suportive
121
(SmartyPance)
| how do we treat mono acute pharyngotonsilitis?
symptomatic
avoid sports for 3 weeks from symptom onset (4 weeks for strenuous contact sports)
*amox or ampicillin may cause a rash
122
(SmartyPance)
| how do we treat fungal acute pharyngotonsilitis?
clotrimazole
miconazole
nystatin
123
(SmartyPance)
| how do we treat gonrrhea pharyngitis (acute pharyngotonsilitis)?
preferred regimen:
intramuscular ceftriaxone (250 mg)
azithromycin as second agent
124
(SmartyPance)
| how do we diagnose viral conjunctivitis?
```
acute onset
unilateral or bilateral erythema of conjunctiva
copious watery discharge
tender preauricular lymphadenopathy
scant mucoid discharge
```
(MC cause = adenovirus, highly contagious)
125
(SmartyPance)
| how do we treat viral conjunctivitis?
eye lavage w/ normal saline bid 7-14 days
antihistamine drops
warm to cool compresses
126
(SmartyPance)
| how do we diagnose bacterial conjunctivitis?
purulent (yellow) discharge from both eyes, but may be unilateral
glued shut eyes
crusting
worse in morning
127
(SmartyPance)
| what are two most common pathogens causing acute mucopurulent bac conjunctivitis?
S. pneumo
| S. aureus
128
(SmartyPance)
| how do we treat bac conjunctivitis?
1 - gentamicin/tobramycin aminoglycoside
2 - erythromycin ointment (chlamydia eyes for newborns)
3 - trimethoprm and polymyxin B for corneal or conjunctiva involvement
4 - ciprofloxacin
contact users need to treat for pseudomonas and get FQ's (cipro)
129
(SmartyPance)
| what is the most common site for anterior epistaxis?
Kesselbach's Plexus (epistaxis is usually anterior)
130
(SmartyPance)
| what is the treatment of epsistaxis?
most are ANTERIOR (Kiesselbach's Plexus) and stop with direct pressure, leaning forward
otherwise - anterior nasal packing w/ CEPHALOSPORIN - or - petroleum jelly inside nostril bid 4-5 days
131
(SmartyPance)
| what is treatment of less common posterior epistaxis?
(posterior bleed, less frequent, Woodruff Plexus)
| posterior balloon packing
high risk for complications
132
(SmartyPance)
| what must we do for recurrent epistaxis?
r/o HTN or hypercoagulable disorder
133
(SmartyPance)
| what is duodenal atresia?
congenital failure of the duodenal lumen to recanalize during fetal development
(often seen in infants with Down syndrome and is associated with a number of congenital anomalies including biliary atresia, as well as cardiac and renal malformations)
134
(SmartyPance)
| how is duodenal atresia treated?
Nasogastric or orogastric tube placement is the first step in management prior to surgical intervention
135
(SmartyPance)
A 7 year-old boy wets the bed nearly every night. Which of the following is the best pharmaceutical agent to use in treating this patient?
Desmopressin,
| while not curative, will relieve symptoms
136
(SmartyPance)
| what is the most appropriate study for diagnosing Hirschsprung disease?
RECTAL BIOPSY
rectal biopsy showing the absence of ganglion cells in both the submucosal and muscular layers of the involved bowel is the most appropriate diagnostic study for Hirschsprung disease
137
(SmartyPance)
A 6 year-old boy is brought to the pediatric clinic by his mother for an evaluation of his asthma. He coughs about 3 days out of the week with at least 2-3 nights of coughing. What would be the most appropriate treatment for this patient?
low dose inhaled corticosteroid
| Low dose inhaled corticosteroids are the preferred treatment for mild persistent asthma
138
(SmartyPance)
| What is the pathophysiologic mechanism of hyaline membrane disease?
surfactant deficiency
(Hyaline membrane disease (Resp distress syndrome) results from alveoli collapse due to lack of adequate lung surfactant and immature lungs)
139
(SmartyPance)
| what is the treatment for Kawaski's Disease?
ASA and IVIG
(Patients with Kawasaki's disease present with fever, bilateral conjunctival injection, pharyngeal erythema, edema of the hands and feet, rash, and LAD. Tx of choice is high-dose aspirin and IV immunoglobulin)
140
(SmartyPance)
| what is the sign of duodenal atresia on xray?
double-bubble sign
(Duodenal atresia presents within the first day of life with bilious vomiting without abdominal distention . A double-bubble sign is noted on abdominal xray film. Treatment of choice is a duodenoduodenostomy.)
141
(SmartyPance)
| what is homocystinuria?
Homocystinuria is a disorder of amino acid metabolism
142
(SmartyPance)
| how is homocystinuria treated?
Vit B6
| is best treated with high doses of Vitamin B6
143
(SmartyPance)
An 18 month old presents with abdominal pain and bloody diarrhea. On physical examination a sausage shaped mass is noted in the upper mid-abdomen. What is most likely the diagnosis?
INTUSSUSCEPTION
Intussusception, telescoping of proximal bowel into distal bowel, is most common in children younger than age 2, who present with abdominal pain and bloody "currant" jelly" stool. On physical examination a sausage-shaped mass is noted in the mid abdomen.
144
(SmartyPance)
| A 12 month-old child with tetralogy of Fallot is most likely to have which clinical features?
CYANOSIS
(The main characteristic of tetralogy of Fallot is cyanosis. Hypercyanotic spells or "tet spells" are paroxysmal episodes in which the cyanosis acutely worsens. Crying, feeding, or defecating can bring on these episodes.)
145
(my general question)
| what is atopy?
"Atopy refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis (eczema). Atopy is typically associated with heightened immune responses to common allergens, especially inhaled allergens and food allergens."
(AAAAI)
146
(SmartyPance)
| A 2 month-old infant has been diagnosed with pneumonia due to Chlamydia trachomatis. What is the treatment of choice?
erythromycin
| Erythromycin or sulfisoxazole is the treatment of choice for an infant with Chlamydial pneumonia.
147
(SmartyPance)
A 3 week-old male infant presents with recurrent regurgitation after feeding that has progressed to projectile vomiting in the last few days. The mother states that the child appears hungry all of the time. She denies any diarrhea in the child. What clinical findings is most likely?
OLIVE-SIZED MASS IN THE RIGHT UPPER ABDOMEN
(An olive-sized mass may be palpated in the right upper abdomen in pyloric stenosis and if found, is pathognomonic for pyloric stenosis.)
148
(SmartyPance)
| how do we measure spinal curvature for scoliosis?
CALCULATION OF THE COBB ANGLE
("The scoliotic curve is measured by the Cobb method using AP and lateral x-ray films of the entire length of the spine.")
149
(SmartyPance)
"A 2-year-old presents with sudden onset of cough and stridor. On examination the child is afebrile and appears well with a respiratory rate of 42 per minute. What is the next best step in the evaluation and treatment of this patient?"
INDIRECT LARYNGOSCOPY
| "Laryngoscopy is indicated not only for diagnosis, but also removal of the foreign body."
150
(SmartyPance)
| what diagnostic evaluation tool is used for suspected orbital cellulitis?
ORBITAL AND SINUS CT SCAN
("This is the typical presentation of orbital cellulitis. A CT scan of the orbit and sinuses is indicated to check for the presence of a subperiosteal abscess and underlying sinusitis, which is often the cause of orbital cellulitis.")
151
(SmartyPance)
| what is often the cause of orbital cellulitis?
SUBPERIOSTEAL ABSCESS AND UNDERLYING SINUSITIS
("This is the typical presentation of orbital cellulitis. A CT scan of the orbit and sinuses is indicated to check for the presence of a subperiosteal abscess and underlying sinusitis, which is often the cause of orbital cellulitis.")
152
(SmartyPance)
4-year-old presents with a history of having failed two courses of antibiotic therapy for acute otitis media. Initially she was on high-dose amoxicillin for 10 days followed by amoxicillin-clavulanate (Augmentin). Mother has been compliant with administering the medication. What is the next most appropriate intervention?
TYMPANOCENTESIS
("This child has unresponsive acute otitis media having failed two courses of appropriate antibiotic therapy. Tympanocentesis is indicated to identify the causative organism and appropriate antibioticselection.")
153
(SmartyPance)
Small grayish vesicles and punched-out ulcers in the posterior pharynx in a child with pharyngitis is representative of which organism?
COXSACKIEVIRUS
| Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx.
154
(SmartyPance)
"An afebrile 2 year-old female presents with a three-day history of foul smelling, blood-tinged, mucoid drainage from the left nostril. What is the most likely diagnosis in this patient?"
NASAL FOREIGN BODY
("Nasal foreign body typically presents in children under 3 years of age. The symptoms include mucopurulent drainage, epistaxis, foul odor and nasal obstruction.")
155
(SmartyPance)
| what is the Somogyi effect?
nocturnal hypoglycemia, "which stimulates counter-regulatory hormone release resulting in rebound hyperglycemia"
may present with nightmares and night sweats
156
(SmartyPance)
| "What scabicide has been associated with neurotoxicity in infants and young children?"
LINDANE (KWELL)
(Lindane (Kwell) is concentrated in the CNS and toxicity from systemic absorption in infants has been reported.)
(why is this in the SmartyPance exam??)
157
(SmartyPance)
| Which of the following therapies is recommended for a 13 month-old child with sickle cell disease?
"FOLIC ACID AND PENICILLIN V"
("Patients with sickle cell disease should receive prophylactic penicillin V starting at 2 months of age and folic acid starting at 1 year of age. Ferrous sulfate is not globally recommended for patients with sickle cell disease.")
158
(RoshReview)
| tet spells
Tetralogy of Fallot
159
(RoshReview)
| boot-shaped heart
Tetralogy of Fallot
160
(Rosh Review)
| name the four components of Tetralogy of Fallot
1 - R ventricular outflow tract obstruction
2 - RVH
3 - VSD
4 - overriding aorta
