EOR Flashcards
(477 cards)
1
Q
when does surfactant production surge?
A
after 36 weeks (steadily increases 33-36 weeks)
2
Q
When is surfactant produced?
A
20 weeks
3
Q
what is found on CXR in NRDS?
A
ground glass appearance w/ bronchograms
4
Q
what endocrinopathy is associated w/ SCFE?
A
hypothyroidism
5
Q
does mono cause posterior or anterior cervical lymphadenopathy?
A
posterior cervical lymphadenopathy
6
Q
What risks are associated with gestational DM?
A
hypoglycemia, shoulder dystocia, HCOM, NRDS, congenital anomalies, PCV, jaundice, electrolyte disturbance (hypomag, hypocalcemia), caudal regression syndrome
7
Q
macrolide use in newborns can cause what complication?
A
pyloric stenosis
8
Q
which meds exacerbate hypercalcemia?
A
thiazide diuretics & lithium
9
Q
ADEs of thiazide Diuretics?
A
hyponatremia
hypokalemia
hypomagnesemia
HYPERcalcemia
10
Q
treatment of non-blistering, non-systemic, confined poison ivy rash?
A
clobetasol propionate 0.05% x 14 days (need longer corse bc it is a delayed Hypersensitivity rxn)
11
Q
which heavy metal deficiency is associated with telogen effluvium?
A
zinc
12
Q
Kawasaki Disease Symptoms
A
[CRASH and Burn]
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hand or foot edema
Uncontrolled high fever (burn)
13
Q
preferred monitoring for neonates who delivered breech d/t risk of DDH
A
US @4-6 weeks
14
Q
what is normal BS during first day of life?
A
> 45 mg/dL
15
Q
erythema toxicum neonatum
A
common, non-threatening rash that affects newborns. It usually appears within the first week of life, but can appear as early as the first few hours, and affects 4–70% of newborns
16
Q
most common risk factor for developing pulmonary non-tuberculous mycobacterial disease in children?
A
CF
17
Q
murmur of coarctation of the aorta
A
SYSTOLIC EJECTION MURMUR best heard at LUSB w/ radiation to the L inter-scapular area
18
Q
otitis media & conjunctivitis (otitis-conjunctivitis syndrome) is a sign of what infection & requires which abx?
A
non-typeable HIB
tx w/ amoxi-clav
19
Q
what is the most useful lab test to assess degree of dehydration in children?
A
serum bicarb
20
Q
at what age is bronchiolitis less likely cause of pulmonary symptoms?
A
6+ years old
21
Q
4-2-1 rule for hourly pediatric maintenance fluids
A
<10 kg: 4 ml/kg/hr
10-20kg: 40 ml + 2 ml/kg for every kg > 10 kg
> 20 kg : 60 + 1 ml/kg for every kg > 20 kg
22
Q
pneumonia vs bronchiolitis on auscultation
A
bronchiolitis has diffuse crackles & wheezing
pneumonia has more focal findings
23
Q
treatment for status asthmaticus?
A
SABA + Steroids
24
Q
substances to kill live insect in the ear canal
A
mineral oil, lidocaine 1%, ethanol 95%
25
where is atopic dermatitis located on YOUNG kids?
EXTENSOR SURFACES
** diff than adults & older kids which is usually on flexoral surfaces
26
Irritant Diaper Rash spares what?
genitocrucal folds
27
Candidal rash involve or spare genitocrural folds?
involves genitocrural folds & is commonly isolated to the perineal area
28
Burns in Children
anterior head: 9%
posterior head: 9%
anterior torso: 18%
posterior torso: 18%
anterior leg, each 6.75%
posterior leg, each 6.75%
anterior arm, each 4.5%
posterior arm, each 4.5%
genitalia/perineum 1%
29
common cause of erythema multiforme in children
mycoplasma pneumoniae
30
is nikolsky sign +/- in erythema multiforme ?
NEGATIVE
31
6 Ps of Lichen Planus
purple, polygonal, planar, pruritic, papules or plaques
(autoimmune disease)
will also see wickham strae = fine white lines on the surface of the lesions
tx = corticosteroids
32
SJS/TEN where does it start & spread?
starts w/ acute onset on face/upper trunk, palms/soles and spreads distally & to extremities
33
superficial partial vs deep partial 2nd degree burns
superficial partial is painful to temp, air, touch
deep partial is painful to deep pressure only.
both blister & blanch with pressure
34
which degree burn does NOT blanch w/ pressure?
3rd degree
35
what is CI in initial care of a burn?
ice or ice water - can cause pain & increase depth of the burn
36
drugs causing erythema multiforme
sulfa
oral hypoglycemics
anticonvulsants
Penicillin
NSAIDs
(SOAPS)
MCC is HSV or mycoplasma infx (think post URI in kids)
37
isotretinoin monitoring/screening
SE:
- hyperlipidemia
- hepatotoxicity
- depression
- inflammatory bowel disease
- ankylosing hyperostosis
- teratogenic
Screening (initiation)
- Depression screening
- baseline liver panels
- lipid panels
- pregnancy test
- confirm x2 BC measures
38
MC type of psoriasis in children
plaque
[guttate is common in children but not MC]
39
tx for non-systemic poison ivy
topical triamcinalone x 2-3 weeks
40
first line tx verrucae
salycylic acid or cryotherapy
41
do HPV vaccines target strains that cause verrucae (common wart)?
NO
42
rash on newborn babies that appears like acne in first 2-7 days of life?
erythema toxicum neonatorum
43
Which neonatal dermatologic condition occurring around 3 weeks after birth and caused by a reaction to Malassezia species is characterized by inflammatory pustules on the cheeks without the presence of comedones?
Neonatal cephalic pustulosis
44
teratogenic in the first trimester by increasing risk of congenital cataracts, SNHL & heart Disease
Rubella
45
TX OF SEB DERM IN INFANTS
MINERAL OIL
45
hx of tet spells (cyanosis w/ crying/feeding/pooping) and squatting for relief
tetraology of fallot
45
tetraology of fallot four components
**PROV**e
**P**DA
**R**VH
**O**verriding Aorta
**V**SD
46
recommended supplementation for breast-feeding infants?
vitamin D
## Footnote
400 IUD
47
what is tx for otitis media?
HIGH DOSE amoxicillin
80-90 mg/kg/day in divided doses BID x 10 days
** need high dose to exceed MIC of s. pneumonae & target non-susceptible strains
48
calcium needs by age
0-6 mo: 210 mg
6-12 mo: 270 mg
1-3 yrs: 500 mg
4-8 yrs: 800 mg
9-18 yrs: 1300 mg
49
when should you start introducing solid foods
4 months
50
when can babies start drinking water?
6 months
51
when should a babies weight double from birth weight?
4 months
52
when should routine POCT lead testing performed?
12-24 months
[CDC recommends 12 months as this is when children are walking by holding on to furniture & pulling to stand]
52
spot hemoglobin screening in babies for anemia is indicated when?
9-12 months
52
age indications for RSV vaccination
up until 19 months then child ages out
53
exclusive breastfeeding vitamin supplemention?
4000 IUD vit D
54
causative agent of impetigo?
S. Aureus
(GAS ~10%)
55
Treatment of Disseminated impetigo?
cephalexin (keflex)
56
exanthem of rubella (german measles)
pink/red non confluent maculopapular rash that starts on face & spreads to trunk & extremities x 3 days
Spreads more rapid than measles (rubeola) & is much darker & more confluent
57
rubeola (measles) sx
3 Cs [cough, coryza, conjunctivitis] + rash
58
only viral exanthem that begins on the trunk
roseola
59
which exanthem can be treated with vitamin A
measles (rubeola)
60
pertusis tx
azithromycin
61
TOC If genital lesions are absent or if the lesions are crusted over and no vesicular fluid can be obtained?
serologic testing for HSV antibodies
62
prevention of Congenital CMV
high-dose oral valacyclovir administered prior to 14 weeks gestation and within 8 weeks of the maternal infection ↓ vertical transmission
63
s/sx congenital CMV
chorioretinitis, periventricular calcifications, SNHL, hepatosplenomegaly, thrombocytopenia rash (petechiae), IUGR
64
congenital toxoplasmosis
diffuse calcifications/periventricular calcifications, hydrocephalus & chorioretinitis
65
varicella vaccination schedule
dose 1: 12-15 mo
dose 2: 4-6 yrs
66
PE will show prominent lymphadenopathy (occipital, cervical, postauricular) and a rash that spreads from face down
Rubella
67
premature birth occurs when?
born before 37 weeks
68
Orajel CI in children under 2
can cause methemoglobinemia 2/2 to benzocaine in thew product - amt of oxygen carried by RBCs is reduced which can lead to death
69
obesity definition
BMI of 30 kg/m^2 or greater OR body weight 20% over the ideal weight
**Children are considered to have obesity when the body mass index (BMI) is > 95th percentile for age and sex.
70
somogyi effect
Nocturnal hypoglycemia followed by rebound hyperglycemia
[sooo much insulin]
71
dawn phenomenon
Normal glucose until rise in serum glucose between 2-8 am
72
tx of DKA
[SIPS]
Saline, Insulin (regular), Potassium repletion, Search for underlying cause
73
determining DKA severity
bicarb levels more important than glucose
levels in determining severity of DKA
74
common cause of HHS
profound dehydration
75
true or false: HHS is not usually associated with severe ketosis or acidosis?
true
76
s/sx of congenital hypothyroidism
- large fontanelles
- hypotonia
- hypothermia
- macroglossia
- hoarse cry
- umbilical hernias
77
genetic disorder assoc. w/ hypothyroidism
Trisomy 21
78
What percentile translates to a definition of short stature?
23rd percentile
79
BMI between 5-85th percentile
healthy weight
80
BMI between 85-95th percentile
overweight
81
BMI > 120% of the 95th percentile or > 35 kg/m2
severe class II obesity
82
painLESS rectal bleeding in a pt < 5 y/o
Meckel Diverticulum
83
indications for sending to ED in depression
- have a plan for suicide
- expressing imminent intent to hurt one’s self
- having access to the planned means to attempt suicide
- the inability to contract for safety
84
murmur of VSD
2/6 mid-frequency holosystolic murmur heard best at the fourth left intercostal space, a diastolic rumble, and a prominent apical impulse displaced laterally
85
egg allergy is a precaution for which vaccine?
influenza
86
plaque
elevated area of skin 2 cm or more
(can be considered a wheal and/or present in urticaria)
87
when to treat a cutaneous wart in children?
when it is painful or discomfort is experienced
[watchful waiting is rec. as many resolve spontaneously w/n 2 years]
88
when are two doses of influenza vaccine are recommended?
children 6 mo - 8 years old
89
s/sx of fetal alcohol syndrome
- short palpebral fissures
- a short nose
- a thin upper lip with a smooth philtrum
90
tx for hereditary spherocytosis?
splenectomy
91
why limit milk to 16 oz / day in newborn children?
risk of iron deficiency anemia
92
adherent white plaques on tongue, palate & inner cheeks that CAN be scraped off (may cause bleeding)
oral thrush (candida albicans)
93
treatment of croup?
nebulized racemic epinephrine
94
Tropia vs Phoria
tropia = strabismus
phoria = latent strabismus which is only evident w/ one eye is covered
95
how long can babies have strabismus?
up to 12 months
96
most appropriate dx test for Acute Rheumatic Fever?
echo
97
ectopic testes vs. undescended testes
undescended: once massaged into the scrotal sac, will remain there as cremasteric muscle relaxes
ectopic: will immediately spring back out of the scrotum
98
RF for pyloric stenosis?
1st born male
## Footnote
** also erythromycin use
99
hypochloremic, hypokalemic metabolic alkalosis
pyloric stenosis
100
reflux in newborn vs. milk protein allergy?
reflux = spitting up after feeds, better with raising the head, will resolve as LES tightens ~3-4 months
mil protein allergy= spitting up, fussy after feeds, loosing weight, blood in stool, possible dermatitis
101
barking cough + inspiratory stridor
croup
[parainfluenza virus; tx w/ dexamethasone & racemic epinephrine]
102
#1 tx for allergic rhinitis
intranasal glucocorticoids
MOA: act on nasopharynx directly to reduce mucosal inflammation
ex. fluticasone, beclomethasone, mometasone
103
pathophysiology of hypertrophic cardiomyopathy
mutations in the genes for sarcomeric proteins
104
1st line tx of otitis media w/ perforation
PO amoxicillin x 10 days
105
s/sx of bronchiolitis
diffuse crackles & scattered expiratory wheezes w/ subcostal retractions & nasal flaring
106
characteristics of herald patch of pityriasis rosea
large salmon-covered herald patch that gradually regresses
as lesion resolves: center clears & margins develop scale
107
neonate presenting with fever should always consider what on ddx?
congenital HSV infection
[dx with PCR of cerebrospinal fluid]
108
Vit D deficiency causes which disorder?
Rickets
109
ASD murmur
Mid-systolic pulmonary flow or ejection murmur w/ fixed split second heart sound
110
topical acne tx that is CI in pregnancy
- Tazarotene (retin A) [category x]
- Clindamycin
- Azelaic acid
- BPO
111
rule of 2's is for what dx?
Meckel Diverticulum
2 year old
2 feet from ileocecal valve
2 inches long
2% population
2 epithelial types (gastric, pancreatic)
112
polyehylene glycol is what medication?
miralax (stool softner)
113
gold standard in dx of children w/ lead poisoning
venous blood lead level
114
acyclovir indications for varicella tx?
- unvax adults & child 12+ y/o
- pregnant
- immunocompromised
114
blood lead level requiring chelation therapy
>/= 45 mcg/dL
114
four H's of Scurvy [vit C aka ascorbic acid deficiency]
1. hemmorhage (petechiae, gingival bleeding)
2. hyperkeratosis (rough skin, loose teeth)
3. hypochondriasis( emotional changes)
4. hematologic abnormalities (easy bruising)
114
only d/o that causes increased MCHC?
hereditary spherocytosis
115
2 cell lines down on cbc + abnormal sx (bone pain, unspecified limp, bruising) ... you should think?
Non-Solid Malignancy (Leukemia, Lymphoma)
116
tx Kawasaki disease?
IVIG+Aspirin
117
mcc of anemia btwn 6-9 weeks
physiologic = 2/2 decreased erythropoiesis d/t increased tissue oxygenation
btwn 6-9 wks hg goes from 14 --> 11 g/dL
118
blanching rash that starts in the groin & axillae, spreads to trunk/extremities & spares palms/soles
Scarlett Fever
119
retropharyngeal abscess vs peritonsillar abscess?
**Retropharyngeal Abscess**: forms between prevertebral fascia & constrictor muscles --> sx include fever, sore throat, **NUCHAL RIGIDITY**, muffled voice, stridor
**Peritonsillar Abscess**: sx include unilateral tonsillar swelling, fever, hot potato voice w/ uvular deviation
120
fever, hypotension, desquamation & mucosal hyperemia?
TSS complication of nasal packing
121
protective factor in otitis media
breastfeeding
122
tx of acute tympanic rupture?
PO Amoxicillin or amoxi-clav if otitis-conjunctivitis syndrome
123
risk associated w/ PO erythromycin for pt < 2 weeks old
development of pyloric stenosis
124
tx of uncomplicated mastoiditis
IV abx & myringotomy (middle ear drainage)
125
tachypnea in the newborn
> 70 RR
126
croup vs. bacterial tracheitis
croups is non-toxic appearing w/ barking cough
bacterial trachiectasis has barking cough + toxic appearing
127
MCC of bacterial tracheitis
staph aureus
128
CAP tx based on age
< 6 mo old = inpatient
mild & > 6 mo old = amoxicillin
> 5 y/o = consider azithro or doxy to cover for mycoplasma or chlamydia pneumonae
129
what sweat chloride value indicates CF?
>/= 60 mEq
130
common asthma trigger in warm environments
dust mites
*educate pt on washing sheets & blankets weekly in hot water
131
meds that exacerbate asthma sx
NSAIDs
ASA
non-selective BB
ACEi
132
medication that decreases hospitalizations in pt born prematurely
palivizumab
** monoclonal antibody against RSV glycoprotein
133
best test for bronchiectasis
CT scan of the lungs
134
common finding in CF HEENT exam?
nasal polyps
135
MCC of bacterial tracheitis
staph aureus
136
what medication is increased in the step up approach to Asthma?
increasing the strength of the steroid in the ICS-LABA medication
137
what is a Cardiorespiratory monitor?
mini EKG (not full 5 lead) & RR (but not super accurate)
does NOT give you pulse ox
138
asthma vs reactive airway disease?
typically 2-3 y/o is cut off for pursuing diagnosis of asthma
** tx is relatively the same
139
URI vs bronchiolitis?
in bronchiolitis respiratory exam will improve/exam will change with secretions and coughing
URI: less symptoms in the chest
140
how many calories = 1 lb
500
141
pt with anorexia who is acidotic on acid-base analysis?
most likely abusing laxatives and pooping bicarb
142
when is MCHAT screening performed?
16-30 months
143
In infants is severity of retinal hemorrhages assoc. with liklihood of abuse?
yes
144
when is D5NS not indicated for pediatric maintenance fluids?
children presenting in the ED w/ history of eating disorder
** will push kid into refeeding syndrome 2/2 to insulin surge which decreases lites (K, phos, mag)
145
in patients < 25 what warning should be given before initiating SSRIs?
black box warning for increased risk of suicide ideation & behavior
146
increased LDH
increased homocysteine
INCREASED methylmalonic acid
Neuro Symptoms
B12 deficiency (pernicious anemia)
147
no neuro symptoms
Increased homocysteine
NORMAL methylmalonic acid
folate deficiency
148
what happens to haptoglobin levels in hemolytic anemia?
DECREASED
** binds all the free Hgb released from the RBC destruction
149
EPISODIC hemolytic anemia assoc. W sulfa drugs, fava beans, infections
G6PD
(-) coombs tests, (+) bite cells & heinz bodies
150
coombs positive
think: MAHA
151
Only anemia where all three cell lines are decreased (WBC, RBC, PLT) - pancytopenia
aplastic anemia
** ddx should include non-solid malignancies
152
causes of prolonged PTT
Intrinsic pathway
Heparin, DIC, vWD, Hemophilia A&B, antiphospholipid syndrome
153
causes of prolonged PT
Warfarin therapy, vitamin K defiency, DIC
154
hemophilia A
factor 8 Deficinecy
155
hemophilia B
factor IX deficiency
[Christmas Disease]
156
patho of factor V leiden
Protein C stops fx of factor V to decrease clot formation; in this d/o there is a mutation in factor V so that it does not respond to inhibition from factor C = increase clotting
s/sx: DVT, PE, miscarriages etc.
** PT & PTT are normal bc not affected
157
HUSS
hemolysis
uremia (inc. BUN & Cr)
shitting (GI sx)
school aged
158
s/sx of protein C&S defiency in newborns
purpura fulminans in newborns - red purpuric lesions at pressure points, progresses to painful black eschars
159
delayed bleedng or swelling in weight-bearing joints (hemarthrosis) should make you think of what disorder?
hemophilia (A or B)
**will have prolonged PTT, normal PT
** PTT will correct with mixing studies
160
inheritance of VW disease
autosomal dominant
[MC inherited bleeding disorder]
161
anemia, thrombocytopenia w/ 20% blasts on bone marro aspiration
ALL
162
Child + LAD + bone pain + bleeding + fever +
>20% blasts
ALL
163
(+) smudge cells
CLL
middle age + asymptomatic + fatigue + LAD + splenomegaly
164
+ myeloblasts on bone marrow biopsy & (+) auer robs
AML
165
philadelphia chromosome (translocation of 9&22)
CML
** must be treated with a tyrosine kinase inhibitor (imatinib)
166
- painLESS lymphadenopathy or pain w/ alcohol ingestion
- mediastinal mass
- b symptoms
- (+) reed sternberg cells
hodgkin lymphoma
167
treatment considerations in pediatric patients with hodgkins lymphoma
Pretreatment: benzodiazepines to help w/ N/V
Postreatment: 5-HT3 can be helpful in first 24 hours following tx
168
type of NHL associated with EBV
Burkitt Lymphoma
169
anemia assoc. w/ carbamazepine
aplastic anemia
170
anemia assoc with parovirus B19 in sickle cell patients
aplastic anemia
171
tx for severe aplastic anemia
allogenic hematopoeitic stem cell transplant
172
bone marrow biopsy w/ increased myeloblasts but < 20%
myelodysplasia --> can progress to AML
173
myeloid cell lines
RBC
PLT
Granulocytes: eosinophils, basophils, neutrophils
174
lymphoid cell lines
B lymphs --> plasma cells
T lymphs
NK cells
175
AML vs CML
AML involves myeloblasts
CML invovles granulocytes (neutrophils)
176
ALL
anemic, lumpy (hepatosplenomegaly), limping
177
what is needed in treatment of ALL
prophylaxis the CNS w/ methotrexate
ALL can remain dormant in CNS and pt will present with relapse of leukemia w/ meningitis
178
APL
a form of AML
179
absolute lymphocytosis [WBC 5,000+ ]
CLL
180
fever of unknown origin ddx should include what 3 subcategories of dz?
infectious, malignant, rheumatologic
181
what happens to BP and venous return in asthma attacks?
wide pulse pressure (low diastolic) 2/2 to low venous return from increased ITP & expansion that impedes flow in the IVC
182
paraphimosis
EMERGENCY
retracted foreskin that can't be returned to normal position
(think post foley catheter placement for surger)
183
phimosis
inability to retract foreskin over the glans
184
when is phimosis considered normal?
children < 5 y/o
(typically resolves by 5 y/o)
185
auricular hematoma
accumulation of blood in the subperichondrial space, usually secondary to blunt trauma
186
s/sx of auricular hematoma
edematous, fluctuant, & ecchymotic pinna with loss of normal cartilaginous landmakrs
187
etiology of auricular hematoma
spontaneous in babies, perichondritis, bleeding diathesis
188
MC. innocent murmur
pulmonary flow murmur
[2/2 small size of the branched pulmonary arteries d/t the lung receiving only
15% of CO during fetal development]
189
tx of acute cystitis
2nd or 3rd gen cephalosporin
cefuroxime, cefdinir
190
wilms tumor
firm, nontender abdominal mass that does NOT cross the midline
191
MC kidney malignancy in teens 15-19 y/o
RCC
192
HTN, hematuria & periorbital edema
nephritic syndrome
193
severity of accessory muscle use
subcostal --> intercostal --> tracheal tugging --> nasal flaring
194
Jaundice Progression
starts on face and spreads down
195
What happens to K+ with renal hypoperfusion?
HYPOkalemia
196
diagnosis criteria of constipation
2 of the following:
infrequent bowel movements (<2/week)
Straining
hard stools
feelings of incomplete evacuation
use of digital maneuvers
sensation of anorectal obstruction/blockage w/ 25% of BMs
Above must be fulfilled for last 3 months w/ symptoms onset 6 months prior to discharge
197
sx of dehydration in children
pee/pressure
anterior fontanelle
refill (cap)
crying
HR
skin elasticity
dryness (membranes)
198
sterile pyuria is a indication of what disease?
kawasaki dz
199
gold standard test for GERD
24 hour ambulatory pH monitoring
200
GERD sx < 2x/week
antacids, H2 antagonists
201
GERD sx > 2x/week
PPI
202
protrusion through the internal inguinal ring & possibly into the scrotum
indirect inguinal hernia
d/t patent process vaginalis
203
protrusion through the external inguinal ring
direct inguinal hernia
204
severe abdominal PAIN in pt with anorexia
Superior mesenteric artery (SMA) syndrome
[weight loss-induced atrophy of the mesenteric fat pad, causing compression of the third part of the duodenum -> small bowel obstruction]
205
vomiting + abdominal pain + bloody stool (currant jelly stool)
intussusception
206
pathologic jaundice
present in 1st day of life
207
physiologic jaundice
typically presents first 3-5 days of life and lasts ~ 1 week
208
Kernicterus
cerebral dysfunction and encephalopathy due to bilirubin deposition in brain tissue
s/sx= seizures,
lethargy, irritability, hearing loss, mental developmental delays
associated with bilirubin levels 20 mg/dL+
208
dubin-johnson syndrome
hereditary conjugated (direct) hyperbili
dubin + direct + dark liver
** typically presents in adolsecents
209
(+) dirct coombs test in baby
Rh incompatibility
ABO incompatibility
209
patho of crigler-najjar syndrome
absence of UGT enzyme = unable to conjugate bili = increased indirect bili = jaundice
** this often does not respond to phenobarbitl stimulation
210
Gilbert Syndrome
hereditary unconjugated hyperbili w/ transient episodes of jaundice during periods of stress, fasting, alcohol, illness
211
B3 deficiency
dermatitis (photosensitive), diarrhea, dementia
212
best test to confirm dx of lactose intolerance?
hydrogen breath test
213
test to r/o IBD?
fecal calprotectin
214
(+) serum tissue transglutimase antibody
celiac dz
215
tx of intussusception?
air or contrast enema
(pressure will straighten out the intestine)
216
abdominal distention & postive squirt sign
Hirschsprung Disease
217
string sign on UGI series?
pyloric stenosis
218
vomiting first day of life should make you think?
duodenal atresia
219
colic age group and tme duration
occurs in children < 3 mo
resolves typically by 9 weeks
220
otherwise healthy infant who is < 3 months of age who cries for ≥ 3 hours per day ≥ 3 days per week without a clear explanation,
colic
221
when and what are the first teeth to erupt?
central incisors @ 5-8 months
222
when should all teeth be in?
2.5 y/o
223
when do secondary teeth begin to grow?
6=7 y/o
224
what cardiovascualr d/o is assoc w/ turner syndrome?
coarctation of aorta (30%)
225
labs assoc with turner syndrome
Low Estrogen
high FSH & LH
226
rocker bottom feet are associated with which genetic d/o?
trisomy 18 (Edward syndrome)
227
short stature, webbing of the neck, low hairline, and widely spaced nipples, Sheild chest
Turner syndrome (45 XO)
228
which congenital heart defet is associated with down syndrome
VSD
229
simple febrile seizure
number of seizures: 1
duration: < 15 mins
type: generalized
230
complex febrile seizures
number of seizures: >1 in 24 hours
duration: >15 mins
type: focal or generalized
231
empiric abx coverage for meningitis in pt < 1 mo
cetoximin + amp OR gentamicin + amp
232
CI to ceftriaxone
hyperbili in infants
233
growth during growth spurt?
limbs grow before truck
234
MC benign primary brai tumor of childhood?
grade I astrocytoma
235
brain tumor sx by location
cerebellum: weakness, tremor, ataxia
visual pathway: visual loss nystagmus, proptosis
spinal cord: pain, weakness, gait disturbance
236
MC malignant brain tumor of childhood?
medulloblastoma
237
enterobius vermicularis
pin worm
238
- recurrent upper tract bacterial infections
- renal scarring
- hyperntension
vesicoureteral reflux complications
239
treatment of vesicouretral reflux
< 2 m = TMP-SMX, nitrofuratonin
> 2 m = cephalexin, ampicillin, amoxicillin
240
241
CXR finding in aspiration?
unilateral hyperinfaltion, mediastinal shift, atelectasis
242
black box warnings of gentamicin
neurotoxicity, ototoxicity, nephrotoxicity, neuromuscular blockade
243
atypical pneumonia
MCC is mycoplasma pneumoanie
typically less severe symptoms --> less toxic appearing (low grade, temp, URI sx)
244
1st line uncomplicated cystitis
cephalosporins (cefixime)
245
inital tx of encoporesis?
colonic dissimpaction & longterm oral laxative therapy
246
mcc of intestinal obstruction btw 6-36 mo of age?
intussusception
247
Ortolani Maneuver
abduction & elevation to feel for reducibilyt --> audible click/clunk
| this can temporarily reduce the dislocation
248
barlow Maneuver
gentle adduction w/o downward presure to feel for dislocatability
249
how long is pt in hip spica splint for DDH
6-15 months
250
MC site of osteosarcoma
90% occur in **metaphysis of long bones **
**distal femur** > promimal tibia & proximal humerus
251
when do you start screening BP in kids?
3 y/o
252
Osteogensis Imperfecta
autosomal dominant d/o 2/2 to mutations in collagen
multiple fx, HL, blue sclera, increased laxity of joints
## Footnote
** can treat with bisphosphonates or surgery
253
joint pain or antalgic gait in child who was recently sick
transient synovitis
254
Tx threshold for ASD
> 3-5 mm requires frequent f/u
symptomatic mgmt = diuretics, ACEi, digoxin
surgery = 1 cm + symptoms
255
Continuous machine-like murmur loudest @ pulmonic area (LUSB - 2nd intercostal space)
PDA
256
coarctation of the aorta
SYSTOLIC EJECTION MURMUR best heard at LUSB w/ radiation to the L interscapular area
257
Late systolic ejection murmur/continuous murmur radiating to the left back, left
scapula or chest, heard in the aortic area
coarctation of the aorta
258
gold standard test for coarctation of aorta
angiography
259
young child w/ HTN
r/o coarctation of the aorta
260
Harsh systolic murmur @ left mid to upper sternal border
Tetralogy of Fallot
261
boot shaped heart
Tetralogy of Fallot
262
annual screening needed in pt with Tetralogy of Fallot
QRS width
263
two congenital HD that require PGE prophylaxis
Coarctation of aorta & tetralogy of fallot
264
Medium pitched harsh mid-systolic crescendo-decrescendo murmur heard @ LSB
murmur of HCOM
265
does valsava/standing increase or decrease murmur of HCOM
## Footnote
decreased venous return
Increase
266
does squatting, supine or leg raise increase/decrease HCOM murmur?
decrease
## Footnote
increase venous return
267
murmur w/ a loud S4 gallop and apical lift
HCOM
268
1st line tx of HCOM
beta blockers
269
HCOM precuations
AVOID dehydration, extreme exertion, exercise
Caution w/ digoxin, nitrates, diuretics
## Footnote
(Digoxin ↑ contractility, nitrates & diuretics ↓ LV volume)
270
MC congenital HD
VSD
271
High-pitched harsh holosystolic murmur best heard @ LLSB w/ palpable thrill
## Footnote
thrill increased in small abnormality
VSD
272
when should a VSD close by?
12 months
273
MCC of pediatric syncope
vasovagal or idiopathic
274
syncope Red Flags
syncope during exercise
multiple recurrence w/n short time
older age
heart murmur
injury during syncope
Fhx of sudden unexpected death
275
does direct or indirect bili cross the bbb
indirect --> leading to kernicterus
276
HR in infants ages 0-3 mo
100-204 bpm (when awake)
277
when do peds HR reach adult values of 60-100
8 y/o
278
fifth percentile of BP
70 mmhg + 2x age in years
279
diastolic murmurs
MS.PRARTs Died
280
MR vs. MVP murmur
MR = pansystolic
MVP = mid systolic click
281
radiographic finding in tetralogy of fallot?
Boot shaped heart
282
radiographic findings in coarctation of aorta?
aortic 3 sign & posterior rib notching
283
tx of coarctation of the aorta?
balloon angioplasty or open surgical repair
284
aortic diseases that cause BP to be lower in LE than UE
coarctation of aorta
Aortic dissection
supravalvular aortic stenosis
285
coarctation assoc with ANTERIOR or POSTERIOR rib notching?
posterior
| not anterior bc intercostal arteries do not run along grooves in the ate
286
when should a PDA close?
before 3 days of life --> if extends beyond 3 days of life, is considered pathological
287
murmur + respiratory distress, bounding pulses, wide pulse pressure, abdominal distention, and prominent left ventricular impulse.
PDA
| (machine like murmur)
288
Tx of a PDA
indomethacin
289
holosystolic murmur loudest at the apex (2/2 to MR) + S3 or S4
HCOM
290
digoxin MOA
positive inotrope which makes LV pump harder
| worsens sx of HCOM
291
isosorbide dinitrate
vasoldilator --> decrease peripheral resistance
## Footnote
increased LV outle obstruction in HCOM
292
unilateral cervical lymphadenopathy
kawasaki disease
293
cyanosis worse w/ crying & feeding
Tetraology of Fallot
294
A harsh, medium- to high-pitched pansystolic murmur is heard best at the left sternal border in the third and fourth intercostal spaces with radiation over the entire precordium.
VSD
295
frequent respiratory infections and slow weight gain in addition to dyspnea, diaphoresis, and fatigue as early as 1–6 months of age.
VSD
296
Sequelae of VSD
irreversible pulmonary HTN
297
valsalva affect on venous return
decreased = decreased preload = increased murmur of HCOM
298
cervical venous hum
innocent murmur during > 1 y/o
continuous murmur heard best over L or R USB, infraclavicular area or supraclavicular area
accentuated w/ head extension while seated
lessens with supine position
299
most serious complication of kawasaki dz
coronary artery abnormalities
300
rare complication of KD?
macrophage activation syndrome
301
consequence of ASD
right atrial hypertrophy
302
maneuvers that increased VSD?
handgrip, squatting
## Footnote
2/2 to increased PVR
303
Amyl Nitrate
decreases afterload
304
characteristics of innocent murmurs
vibratory or musical
grade 2 intensity
short systolic duration (not holosystolic of diastolic)
crescendo-decrescendo w/o radiation
standing decreases intensity
305
inutero infx associated with PDA
rubella
306
rash of kawasaki dz
polymorphous rash
307
MC pathogen of infective endocarditis
Staph Aureus
308
MCC of pediatric aortic stenosis
bicuspid aortic valve
309
murmur of VSD
harsh holosystolic murmur is auscultated at the mid-left sternal border, and a thrill is palpated at the third left intercostal space
310
OCP recommended for PMDD
Drospirenone
## Footnote
progesterone-only OCP
311
first line tx for complex partial seizures
## Footnote
(focal onset impaired awareness seizure)
levetiracetam
312
common tx in generalized seizures
lamotrigiene & valproic acid
313
rash that starts behind the ears (on face) & spreads to trunk
## Footnote
commonly appears 2-4 days after fever & spares palms/soles
measles (rubeola)
314
definitive dx of measles
anti-measles IgM
## Footnote
detected 3 days after onset of rash
anti-measles IgM detected until 14 days after rash appears
315
otitis media w/ effusion presentation
retracted tympanic membrane w/ DECREASED motility on insufflation
316
can you use topical therapy in tinea capitus
no --> inadequate penetration
## Footnote
tx w/ oral antifungals [terbinafine, griseofluvin x6-8 weeks]
griseofluvin = 1st line
317
ADE of repeated oxymetazoline use
rhinitis medicamentosa
318
tx of anterior vs posterior epistaxis
anterior: pressure, Afrin, silver nitrate cuatery
posterior: packing & consult ENT
319
s/sx primary congenital hypothyroidism
slow growth, hypotonia, umbilical hernia, macroglossia, large fontanelle, dry skin, hypothermia, jaundice, intellectual disability
| ** not usually present at birth
320
dx of congenital hypothyroidism
heel sticxk measurement of free T4 & TSH in every newborn
321
emergent mgmt of epiglottitis
bag mask ventillation
## Footnote
after emergent mgmt --> humidified oxygen + ceftriaxone/vancomycin
322
thumb print sign on lateral xray
epiglottitis
323
simple febrile seizure tx
acetominophen
324
HL screening in children of average risk
4,5,6,8 and 10 years
## Footnote
inc. risk --> 24 & 30 months (e.g. those with NICU stay, ototoxic drug exposure - gent)
325
tx of severe otitis externa w/ edema & occlusion
wick placement & topical otic solution w/ abx + glucocorticoids
326
RF necrotizing otitis externa
DM, immunocompromised
327
common skeletal abnormality seen in Marfan Syndrome
scoliosis
## Footnote
** also assoc. with AA & dissection
328
RF for cleft palate
cigarette smoking
Alchol consumption
Folate deficiency
## Footnote
** majority cleft palates are unilateral
329
gingivostomatitis
HSV1 infx w/ prodrome of fever, irritability, HA or tingling/burning sensation
presents with ulcerations of gingiva or mucous membranes --> perioral vesicular lesions
330
Herpangia
etiology: coxsackie virus
painful, posterior pharyngeal lesions that DO NOT bleed
eryhtematous-based macules --> papules --> vesicules --> central ulcers w/ erythemous halo
331
LT mgmt of SVT
radiofreuqency catheter ablation
332
typical presentation of osteosarcoma
pain + soft tissue mass
333
weakest part of pediatric bone
diaphysis (growth plate)
334
most effects med for MDD in children & adolescences
fluoxetine
## Footnote
also an SSRI w/ longer half-life, best for when kids miss doses
335
when does kawasaki dz require labratory testing?
incomplete KD --> pt w/ fever of unknown origin & absence of 4+ classic findings
- leukocytosis (neut dominant)
- anemia
- ESR/CRP elevation
- liver transaminases
- thrombocytosis
- sterile pyuria
336
pediculosis capitus tx
## Footnote
presents with scalp purityus & excoriations in multiple fam members
topical permethrin
337
how does eye move in a cover-uncover test w/ strabismus
will move in direction opposite of which it is deviated (corrects itself)
## Footnote
ex. eye that moves outward to fixate demonstrates esotropia)
338
at what age is new onset esotropia suspicious for CNS disease?
> 5 y/o
339
worsening cyanosis w/ poor feeding & tachypnea is sx of what d/o?
PDA
340
common trigger for constipation in young children?
change in diet e.g. introduction of cows milk
341
initial therapy for enuresis
education & motivational therapies
342
primary nocturnal enuresis
occurs after age 5 w/o ever achieving bladder control
## Footnote
2/2 is when pt has achieved bladder control and now has enuresis after age 5
343
MCC of CHL in children
otitis media
344
sits w/o assistance
9 months
345
pulls to stand w/o assistance
12 months
346
narrowed angle between the SMA & aorta --> duodenal compression
SMA syndrome in anorexia nervosa
## Footnote
occurs 2/2 to loss of mesenteric fat
dx with abdominal Xray or upper GI series
347
flue vaccine schedule in young children
6 months--> requires 2 doses 1 month apart
348
CI to rotavirus vaccine
hx of intussusception
349
T/F psychosis can manifest in some children w/ MDD as delusions or hallucinations?
True
350
protective factors against RSV
prenatal vit D supplementation & breastfeeding
351
when should you suspect vesicoureteral reflux?
recurrent UTIS
352
Indications for voiding cytourethrogram?
children not toilet trained, recurrent utis, abnl kidney US, s/sx of CKD
OR
**
fever > 102.2 & known urinary pathogen other than E.Coli**
## Footnote
abx prophylaxis w/ TMP-SMX or nitrofuratonin
353
med assoc with oral candidiasis
inhaled glucocorticoids
## Footnote
tx: nystatin suspension 100,000 units to each cheeck 4x/day
354
PE finding assoc with neonatal ARDS
expiratory grunting
355
Ages & Stages Questionarrie
reference for gross motor, fine motor, communication, problem-solving & personal socail domains
administered by 9,18, 30 months of age
356
diet recommendations for CF
high fat
high energy
fat soluable vitamins (ADEK)
357
358
(+) fitzpatrick sign
dermatofibroma
## Footnote
dimpling of skin w/ lateral pressure
359
elevated anti-thyroglobulin
hashimoto thyroiditis
360
diaper dermatitis tx
zinc oxide & nystatin
361
type of psoriasis common after strep infx
guttate psoriasis
362
tx of pityriasis rosea
reassurance
363
assoc. hx of atopy + dry/scaling skin on extensor surfaces
ichthyosis vlugaris
## Footnote
described kinda like lichen planus, 1st line tx is moisturizer
364
sx of complete airway obstruction
inability to speak
365
which reflex persists through life?
parachute
366
TOC for suspected partial KD (mucocutaneous lymph node syndrome)
echo
367
"DK no A"
pt is presenting in DKA w/o meeting w/o ph of 7.3 or HCO3 < 16
368
does throwing up make you more acidotic in DKA?
yes
## Footnote
this is why kids on insulin drips for DKA should be NPO
369
is Type 1 or 2 more aggressive in pediatric patients?
type 2 is more aggressive in pediatric pt
370
tx of measles pneumonia
Ribavirin
371
petechiae on soft palate (forscheimer's spots)
Rubella
372
congenital rubella syndrome
fetal death
delivery
congenital defects
373
complications of congenital HSV
2/2 bacterial infx, pneumonia, encephalitis, reyes syndrome
374
difference btw KD and SF tongue findings
KD = red strawberry tngue
SF = white strawberry tongue
375
Punctate erythema beginning on trunk
spreading to extremities, becoming confluent
“sandpaper” feel to the rash.
flushed face with perioral pallor
rash fading in 4 - 5 days and followed by desquamation
scarlett fever
376
questionnaire offered at 6 months
ages & stages
377
2 month milestones
* 1. turns head 180
* 1. traks objects
* 1. vocalizes in play (coo)
* 1. smiles, knows parents
378
4 mo milestones
* 1. clutches rattle/rolls
* 1. hands together
* 1. laughs
* 1. enjoys looking around
379
6 month milestones
* sits up
* raking grasp
* vocal imitates
* responds to name
380
9- 11 months
* stands/cruises
* sits w/o support
* pincer grasp
* understands" no"
* feeds self
* waves
381
12-14 months
* walks with one hand
* builds two blocks
* uses one word with meaning
* hugs stuffed animals
382
15-17 months
* stoops & recovers
* builds 2-3 blocks
* 4-5 words
* uses spoon
383
18 months
* runs
* scribbles, 3 block tower
* 7-10 words, body parts
* copies parents in task
384
24 months
* throws ball
* 6-7 block tower
* two words combined
* turns book pages
385
3 years
* rides tricycle
* alternates feet upstairs
* copies a cricle
* uses min 250 words, 3 word sentences
* group play
* shares toys
* knows age & gender
386
4 years
* skips
* copies a square
* knows colors, songs, ask questions
* plays cooperative
387
5 years
* walks backwards
* grabs pencil
* prints letters
* prints first name
* abides by rules
388
vanderbilt scale
for ADHD in kids 6-19 y/o
389
Ages & stages questionairre
for cognitive/motor screening in children 4-60 months old
390
when do majority of the primitive reflexes dissipate?
4-6 months
391
which primitive reflex persists through life
parachute
392
Tanner Staging 1
M = no pubic hair, bone age < 12 y/o
F = no pubic hair, no breasts
393
Tanner stage 2
M = minimal pubic hair/voice changes, bone age < 12
F = minimal pubic hair, breast puds, bone age < 11
394
Tanner Stage 3 (pubescent)
M= pubic hair over penis, voice changes, bone age 13-14
F = pubic hair on mons, enlargement of breasts, axillary hair, bone age 12-13
395
Tanner Stage IV
M= adult pubic hair, axillary hair, bone age 13-14
F = adult pubic hair, areola enlargement, bone age 12-13
396
Tanner Stage V
M= as adult, bone age 14-16
F = adult, bone age 13-14
397
T/F in females pubic hair before breasts?
FALSE !!!
398
when does birth weight triple
12 months
399
when does birth length double
4 years
400
what level of bili is neurotoxic & causes kernicterus?
25 mg/dL
401
tx of pyloric stenosis
NG placemore for decompression, hydration, surgical pyloromyotomy
402
bilious vomiting
duodenal atresia
403
gold standard dx test for hirschsprung disease
rectal biopsy
404
abdominal pain, palpable sausage mass, currant jelly stools
intussusception
## Footnote
tx w/ hydrostatic or pneumatic enema (1st line)
405
MC involved site in intussusception?
ileocecal valve
406
bronchiolitis
clinical syndrome in kids < 2 y/o 2/2 to RSV infx.
407
sudden onset LRT sx that do not respond to mgmt of other respiratory conditions
foreign body aspiration
408
idiopathic avascular necrosis of the hip
Legg Calve Perthes
409
Growth Plate Fx
S: straight across (I)
A: above (II)
L: lower (III)
T: through (IV)
ER: eraser - crushed growth plate (V)
410
what type of salter harris fx is most common?
II (above)
411
if question stem indicates abuse
correct answer is typically contact CPS
412
bronchitis vs. bronchiolitis
bronchitis: older children, trachea & large airway infx & mucus presenting w/ persistent productive cough
bronchiolitis: 2 y/o, small airway infx. w/ wheeze, tachypnea, RD
413
tx of RDS
Antenatal therapy → steroids (24 hours before delivery)
Ventilation → CPAP, intubate (continuous positive pressure w/ NO)
Surfactant → endotracheal administration
## Footnote
O2 + intubation + CPAP + surfactant
Antenatal glucocorticoids given to mature lungs if premature delivery is suspected (between 24-36 weeks)
414
benefits of tx scarlet fever
prevents RF
** does NOT prevent APSGN**
415
tx of lime disease if < 8 y/o
amoxicillin
416
mcc meningitis
strep pneumo
## Footnote
[tx w/ ceftriaxone & vanco]
417
stoccato cough
chlamydia pneumonia
418
bad prognostic factor in JIA
RH factor
419
best first test in KD
echo + ekg
420
pt w/ scd c/o point tenderness on femur, fever and malaise
osteomyelitis (Mc bug is salmonella)
421
pt w/ scd w/ decreased hct and decreased retics
aplastic crisis
422
howell jolley body
sx of autosplenectomy
423
mcc of sepsis in scd pt
strep pneumo
424
tx of stroke in scd
exchange transfusion
425
Tx of HUSS
periotoneal dialysis
## Footnote
DO NOT give plt
426
when does plantar grasp extinguish?
12 mo
427
when does palmar grasp extinguish?
6 mo
428
when does babinski extinguish?
12-24 mo
429
empiric tx for neonatal meningitis
amp + gent
## Footnote
covers for GBS & E.coli
430
Blueberry Muffin Rash
rubella
431
vaccines at birth
hep B
432
vaccines 2-6 mo
babies Run Play HIDe
Hep B
RV
PCV13
Hib
IPV
Dtap
## Footnote
[no hep B at 4 months]
433
12 mo vaccines
1st MMR, Varicella, Hep A
## Footnote
[2nd dose @ 4-6 years]
434
4-6 year vaccines
2nd MMR, Varicella
435
11-12 y/o vaccines
HPV
Tdap
MCV
436
16 y/o vaccines
MCV
## Footnote
MCV before you're free (to drive)
437
nasal polyps in young kid with chronic cough, SOB, hemoptysis?
CF
438
Tx of non-severe bronchiolitis
Supportive care
439
cough + fever
think pneumonia
440
most reliable predictors of pneumonia in pediatric patients
hypoxia & increased work of breathing
441
bronchial breathe sounds
sign of obstruction --> think pneumonia
442
MC etiology of afebrile pneumonia in children 1-4 mo
chlamydia trich. (staccato cough)
443
development of nonproductive cough after recent abx use should make you think?
possible progression of URI to pneumonia
444
first step after seeing microscopic hematuria on UA?
check how UA was obtained --> cath can lead to some blood
445
2-14 y/o boy w/ facial edema up to 3 weeks after strep
Cola-colored urine
(+) anti-streptolysin (ASO) titers
Low serum complement (C3)
post strep GN
446
MCC of GN in pediatric pt
IGA
## Footnote
occurs after 24-48 hr URI or GI infx.
447
systemic form of IgA nephropathy. It's characterized by a purpuric skin rash, arthritis, and abdominal pain.
HSP
448
when does rooting reflex dissipate?
2-3 months
449
What are the five levels of alertness in infants?
Quiet sleep
active sleep
awake/drowsy
alert
crying.
450
MCC of bacterial meningitis for ages 3-10 y/o vs. >/= 10
3-10: strep pneumo
>10: N. meningitidis
451
hyperventilation effect on absence seizures?
leads to hypercapnia and respiratory alkolsis - increase in ph decreases neuronal excitability --> absence seizure trigger
## Footnote
Studies have shown that absence seizures are highly sensitive to changes in arterial CO2 levels
452
effects of feeding on wt gain in infants
breastfed = gain wt more rapidly in beginning
formula fed = gain weight slower in first 3-4 mo
453
when does baby roll back to front?
6 months
453
is there an age cut off for rear facing car seat recommendations?
NO - use until pt exceeds height/wt restrictions for safe use
454
labs of secondary hypogonadism
Low T or E
N FSH/LH
455
labs of primary hypogonadism
Low T or E
HIGH FSH/LH
456
flu vaccine recs for child with MILD egg allergy
2x dose of inactivated vaccine
** no assoc with severe rxn in pt with history of egg allergy
## Footnote
inactivated = shot
live/activated = mist
** both CI in children with severe egg allergy
457
URI x 10+ days w/o resolution of sx
amoxi-clav for bacterial sinusitis
458
Synovial fluid white blood cell count is typically elevated in the inflammatory range of 20,000 to 60,000 cells/µL
lyme arthritis
## Footnote
not as high as in septic arthritis
459
headache and fever for 3 days and erythematous PETECHIAL rash on her wrists and ankles
RMSF
## Footnote
give doxycycline
** common in NC, oklahoma, arkansas, MS
460
tx of CAH
hydrocortisone, fludrocortisone, sodium chloride
461
inspiratory stridor indicates?
d/o occuring ABOVE the vocal cords
## Footnote
think laryngomalacia
462
can children < 3 y/o get strep throat?
No - not considered pathologic because not enough tissue to infect/apart of normal flora
## Footnote
+/- data on giving amox for RF prevention
463
normal APGAR score
7+
464
chorioamnionitis
- maternal fever (100.4)
- significant maternal tachy (> 120)
- fetal tachycardia (> 160-180)
- IL-6 is possible marker for chorioamnionitis
- tx with ampicillin & gentamicin (careful w/ gentamicin bc of SNHL in pregnancy)
465
tx of TM performation
contaminated TM perf = ofloxacin drops
TM perf in setting of otitis media = PO abx
466
best initial evaluation of child abuse in ED in pt presenting with lethargy?
CT Brain
## Footnote
pt showing sx of AMS
467
murmur that is louder supine?
still (inocent) murmur
