CLIPP Cases

Question 1

Things to ask in well child visit

Answer 1

Interval hx, development, growth, diet and social history

Question 2

Calories an infant requires a day? pre term? very low birth?

Answer 2

100-120 for full term
130 for pre-term
150 for very low birth weight

Question 3

Baby weight course

Answer 3

Lose some in first week, expected to gain back birth weight by 2 weeks

Question 4

What is the moro reflex

Answer 4

Abrupt change in infants head causes symmetric abduction and extension of arms followed by abduction and sometimes cry

Question 5

Solid foods start when

Answer 5

Cereal at 4 months (rice)

Question 6

Two month vaccines

Answer 6

DTaP 
RotaV
Hib 
IPV 
PCV13

Question 7

When should an infants birth weight double and triple?

Answer 7

Double by 5 months, triple by 12 months

Question 8

4 things absence of red reflex could be

Answer 8

Cataracts
Glaucoma
Retinoblastoma
Chorioretinitis

Question 9

6 month milestones

Answer 9

Rolls over and sits up
Reaches for items and looks at drops items
Turns towards voices and babbles
Feeds self and demonstrates stranger recognition

Question 10

1 year milestones

Answer 10

Stands alone
Neat pincer grasp
Says mama and dada and a few other words
Points to things and can hand things

Question 11

Mass in baby for constipation

Answer 11

likely LUQ

Question 12

What is the HHEADS interview

Answer 12

For young adults about all the fun/bad stuff (more comfortable questions go first)

Question 13

3 big things seen in mono

Answer 13

fatigue, pharyngitis, and lymphadenopathy

Question 14

What depression feature is more common in adolescents that adults

Answer 14

Early morning waking

Question 15

Progression in severe anorexia

Answer 15

Bradycardia, electrolyte imbalances, arrhythmias, circulatory collapse, death

Question 16

Girls vs Boys starting puberty

Answer 16

Girls b/w 8-13 years of age

Boys b/w 10-15

Question 17

VWD tx

Answer 17

Desmopression (releases factor 8)

Question 18

75% of newborn bilirubin comes from

Answer 18

Breakdown of hemoglobin

Question 19

Manifestations of kernicterus

Answer 19

lose the suck reflex
become lethargic
develop hyperirritability and seizures, and
ultimately die

Question 20

Physiologic jaundice of newborn def

Answer 20

total bilirubin level ≤ 15 mg/dL (≤ 257 μmol/L) in full-term infants who are otherwise healthy and have no other demonstrable cause for elevated bilirubin.

Question 21

deficient or completely absent UDPGT causes

Answer 21

Crigler-Najjar syndrome

Question 22

Normal breast fed baby timing

Answer 22

typically nurses 8–12 times in 24 hours

Question 23

Day 3 and 6 after birth pee patterns

Answer 23

Day 3: The baby should be voiding 3-4 times a day.

Day 6: Baby should be voiding at least 6–8 times a day.

Question 24

Day 3 and 6 poo patterns

Answer 24

Day 3: Meconium should no longer appear in the stool and bowel movements should begin to appear yellow.

Day 6 or 7: Most newborns have 3–4 stools per day, although many infants pass stool with every feeding.

Question 25

A healthy-appearing infant who develops jaundice, dark urine, and acholic (pale) stools between 3 and 6 weeks of age may have

Answer 25

Biliary atresia | Tx is surgery

Question 26

What should solely breast fed infants start on after 6 months

Answer 26

Iron and fluoride (if water levels are low)

Question 27

Where does jaundice start on a baby

Answer 27

Face and moves down to trunk

Question 28

When do you worry about hemolysis as a cause for jaundice in newborn

Answer 28

If jaundice started in the first 24 hours

Question 29

Test for CAH

Answer 29

17-OH progesterone level

Question 30

Galactosemia in baby can cause

Answer 30

Direct hyperbilirubinemia, vomiting, and lethargy, can lead to death

Question 31

When would you stop breast feeding for a few days in breast milk jaundice? How long can breast milk jaundice persist?

Answer 31

16-25 mg/dL | Can last up to 12 weeks

Question 32

Physiologic jaundice timeline

Answer 32

peaks at 3–4 days of life and generally resolves within a day or two

Question 33

Things to remember to ask two week old mom

Answer 33

Preg history, hep B status and hearing screen, feeding history, and developmental milestones

Question 34

How much vit D should breast fed babies get

Answer 34

400 IU

Question 35

Lethargy def in children

Answer 35

poor or absent eye movements or as the failure of a child to recognize parents or to interact with persons or objects in the environment.

Question 36

Head size in congenital hypothyroidism

Answer 36

Large

Question 37

Most common cause of congenital hypothyroidism? PE findings?

Answer 37

``` Some kind of dysgenesis Findings: Feeding problems Decreased activity Constipation Prolonged jaundice Skin mottling Umbilical hernia ```

Question 38

Why do most ped docs do amox instead of pen for strep throat

Answer 38

It tastes betters

Question 39

4 Big kawasaki criteria

Answer 39

Fever > 5 days Nonpurulent conjunctivitis (may have cleared prior to presentation) Rash Swelling and erythema of extremities *Thrombophilia on labs and sterile pyuria on UA*

Question 40

"sandpaper like rash" in what

Answer 40

Scarlett fever

Question 41

Strawberry tongue with what 3 diseases

Answer 41

Streptococcal pharyngitis Kawasaki disease Toxic shock syndrome

Question 42

Two kawasaki drugs

Answer 42

Aspirin and IVIG

Question 43

Infection workup in kid

Answer 43

CBC w/ diff and blood culture

Question 44

Bacterial meningitis Ab regimen

Answer 44

3rd gen cef and vanc

Question 45

Only thing elevated in CSF for viral meniningitis

Answer 45

WBC, all others normal

Question 46

Complex febrile seizure features

Answer 46

> 15 min, focal, more than one in 24 hours,

Question 47

Febrile seizures and blanching rash likely what disease?

Answer 47

HHV6 or roseola

Question 48

What children with a fever need to be seen immediately

Answer 48

Infants less than 6-8 weeks

Question 49

4 peds emergencies to worry about needing to reverse immediately

Answer 49

(1) Hypoxemia (2) Shock (septic, hypovolemic, cardiac) (3) Hypoglycemia (4) Poisoning

Question 50

First and most subtle sign of inadequate perfusion

Answer 50

tachycardia

Question 51

Why is hypotension a late sign of shock in kids

Answer 51

They compensate so well

Question 52

Meningitis exposure ppx

Answer 52

Cipro in adults | Rifampin for children

Question 53

Meningitis complications

Answer 53

Hearing loss Neurologic disability Digit or limb amputations Skin scarring

Question 54

Near SIDS is also called

Answer 54

ALTE

Question 55

Most common respiratory cause of apnea

Answer 55

RSV

Question 56

Normal neuro findings in a 2 month old

Answer 56

Can fix and follow easily with their eyes; Exhibit a meaningful smile in response to voices; Have a strong suck; and Are beginning to coo

Question 57

What to do with suspected child physical abuse

Answer 57

Skeletal survey

Question 58

Fractures highly suspicious of shaken baby

Answer 58

Posterior rib fractures

Question 59

Infants with Zellweger syndrome are usually

Answer 59

generally hypotonic and poorly responsive.

Question 60

Most consistent finding in Down's? Other findings

Answer 60

Hypotonia (most consistent finding in infants with Down syndrome) Upslanting palpebral fissures Small ears (usually less than 34 mm at maximum dimension in a term infant) Flattened midface Epicanthal folds Redundant skin on back of neck (nuchal skin)

Question 61

Standard lab diagnosis for Down's

Answer 61

Lymphocyte karyotype

Question 62

Infants born with Down's have an increased risk of

Answer 62

Hypothyroidism

Question 63

Cause of fragile X

Answer 63

inheritance of an abnormal number of CGG repeats in the FMR1 gene

Question 64

Turner syndrome PE findings

Answer 64

``` Webbed neck Low ear placement Edema of the hands and feet Hyperconvex nails, and "Shield" chest, with widely spaced nipples ```

Question 65

Atopic triad

Answer 65

asthma, eczema, and allergies

Question 66

Infant Seborrheic dermatitis tx

Answer 66

Oil to remove scale, frequent shampoo, mild topical steroids

Question 67

Factors known to worsen acne lesions

Answer 67

Make-up (unless noncomedogenic) Mechanical factors such as manipulation) Occlusion, as occurs with some sports gear Overzealous cleaning

Question 68

Doxy AE

Answer 68

photosensitivity, dental staining in children under age 9, teratogenicity, esophagitis, and pseudotumor cerebri

Question 69

Best OTC wart tx

Answer 69

Over-the-counter salicylic acid

Question 70

3 main causes of diaper rash

Answer 70

1. Irritant dermatitis (most common) 2. Diaper candidiasis 3. Bacterial infection (GAS)

Question 71

Nutritional cause of diaper rash

Answer 71

Zinc def