COMQUEST Wrongs 1

Question 1

how long should you wait for an undescended testicle to descend before referring to surgery?

Answer 1

4 months

Question 2

when do testis stop descending (babies)?

Answer 2

9 months

Question 3

what are the physical exam findings for a varicocele

Answer 3

scrotal “fullness”, non-tender mass described as a “bag of worms” over upper portion of the testes

Question 4

when does chlamydia conjunctivitis and pneumonia present in an infant after birth?

Answer 4

conjunctivitis: 10 days after birth pneumonia: 3-6 weeks of age

Question 5

when does group b strep infection present in an infant after birth?

Answer 5

within 48 hours-1 week of birth

Question 6

When does herpes infection present in an infant after birth?

Answer 6

mom with primary infection: sepsis and pna within 1st week mom with secondary/ recurrent infection: localized skin, eye, and mucous membrane infection

Question 7

what does listeria infection look like in a new born?

Answer 7

sepsis or meningitis

Question 8

when does gonorrhea conjunctivitis present in a newborn?

Answer 8

purulent eye discharge 3 days after birth

Question 9

what are signs of increased intracranial pressure?

Answer 9

headache, nausea, vomiting

Question 10

most common pediatric brain tumor?

Answer 10

Infratentorial, medulloblastoma

Question 11

a new born who is a few hours old develops tachypnea, nasal flaring, grunting, retractions, and maybe cyanosis. Born via c section or intense vag delivery. What is the diagnosis?

Answer 11

transient tachypnea of the newborn. etiology= inability of the infant to absorb fetal lung fluid. CXR may show perihilar streaking and “starburst” pattern. usually resolves within 72 hours

Question 12

when should breast feeding begin and what supplementation for baby may be appropriate?

Answer 12

immediately after birth; vitamin D supplementation at onset of breast feeding and iron supplementation at 4 months if baby is not getting iron rich foods

Question 13

what is Type 1 Renal Tubular Acidosis?

Answer 13

failure of H+ excretion and K+ reabsorption by the collecting cells in the distal nephrons

Question 14

what are the symptoms of Type 1 Renal Tubular Acidosis?

Answer 14

growth failure, hypokalemia, non-anion metabolic acidosis, and elevated urine pH above 5.5 (basic)

Question 15

what is Slipped Capital Femoral Epiphysis?

Answer 15

the ball at the head of the femur slips off the neck of the bone in a backwards direction

Question 16

treatment for slipped capital femoral epiphysis?

Answer 16

internal fixation of the affected hip

Question 17

Signs and sx of slipped capital femoral epiphysis?

Answer 17

unilateral hip pain in obese adolescent, with limp, and pain referred to knee.

Question 18

physical exam findings of slipped capital femoral epiphysis?

Answer 18

reduced internal rotation, abduction, and flexion and a knee-axilla sign (hip flexion results in thigh rotation into external rotation.

Question 19

When does malaria develop after travel to endemic area?

Answer 19

a few weeks after travel

Question 20

describe the sx of malaria?

Answer 20

high recurrent fever, GI complaints, and travel to an endemic area

Question 21

describe the fever associated with malaria

Answer 21

paroxysms of shaking chills that last about 1-2 hours followed by a high fever, profuse sweating, and then return to normal temperature. these episodes recur every 2-3 days.

Question 22

what features are present in a seizure but not in a breath hold spell?

Answer 22

incontinence, post-ictal state, and no inciting event

Question 23

what is mild acne, and what is the treatment?

Answer 23

mild acne= comedones with few papulopustules. Tx=benzoyl peroxide or topical retinoids

Question 24

what is nodulocystic acne and what is the treatment?

Answer 24

painful nodules >5mm in diameter and scarring. Tx=intralesional steroid injection and isotretinoin. systemic abx.

Question 25

name some treaments for moderate-severe acne:

Answer 25

oral abx, spironolactone or hormone therapy for girls

Question 26

signs of hodgkin lymphoma

Answer 26

painless cervical adenopathy, fever, weight loss, night sweats, reed sternberg cells

Question 27

signs and sx of pyloric stenosis?

Answer 27

projectile, non-bilious vomiting at 3-5 weeks of age, may or not be RUQ mass

Question 28

how to diagnose pyloric stenosis if there is no presence of RUQ mass?

Answer 28

ultrasound

Question 29

what is the next step in management of a newborn who has a lump, tuft of hair, or birthmark in the lumbar spine?

Answer 29

ultrasound of the lower spine (to see if it is a meningomyelocele, spina bifida occulta)

Question 30

little girl presents with dribbling after peeing and is found to have a membrane partially covering the introitus between the labia minora. what is this and how do you treat it?

Answer 30

it is a labial adhesion. treat with estrogen cream.

Question 31

woman of childbearing age presents with fever, joint pain, and rash. what is this and how do you test for it?

Answer 31

SLE and using serum antinuclear antibodies, anti-smith, and anti-double stranded DNA

Question 32

What are the presenting signs of acute lymphoblastic leukemia in a child?

Answer 32

anemia (pallor), thrombocytopenia (easy bruising/bleeding), neutropenia (fever)

Question 33

what is the most common type of childhood leukemia?

Answer 33

acute lymphoblastic leukemia (ALL)

Question 34

What is often the presentation of ALL in a child?

Answer 34

sepsis

Question 35

What is the first step to management of a child with ALL + sepsis?

Answer 35

blood culture and immediate administration of broad spectrum abx

Question 36

Signs and sx of diabetes insipidus in infant?

Answer 36

* previously a vigorously-feeding infant who starts feeding poorly and has irritability and failure to thrive * peeing a lot * hypernatremic * dilute urine * dehydrated (sunken fontanelles) * within first week of life is usually nephrogenic DI

Question 37

signs and sx of DI in older chld?

Answer 37

* polyuria * polydypsia * hypernatremia * dilute urine * dehydration * do whole DI workup

Question 38

Pt presents with recent/ongoing URI with fever, pain with eye movement, and proptosis. What happened?

Answer 38

rupture of ethmoid sinus into the posterior eye space (orbital cellulitis).

Question 39

Thrombocytopenia and eczema in a male infant who then develops life-treatening infections by encapsulated organisms is which disease?

Answer 39

Wiscott-Aldrich syndrome

Question 40

Female child with precocious puberty, hx of fractures, and cafe'-au-lait spots is suggestive of what syndrome?

Answer 40

McCune-Albright syndrome

Question 41

Which endocrinologic condition is often present in McCune-Albright syndorme?

Answer 41

hyperthyroidism

Question 42

Name some characteristic findings in a baby born to a mother with gestational diabetes mellitus (8):

Answer 42

* **macrosomia** * metabolic derangements (**hypoglycemia, hypocalcemia, hypomagnesemia**) * **hyperbilirubinemia (polycythemia)** * cardiomyopathy (**cardiac ventricular outflow obstruction**) * **caudal regression syndrome** (poor or absent lower extremity growth (hypertrophy of LEs), anencephaly, spina bifida * **Small left colon syndrome**