From Becky

Question 1

10-14 days of age

Answer 1

When do newborns return to their birth weight after the in

Question 2

5-10%

Answer 2

How much weight do newborns tend to lose in the first few

Question 3

25-30 grams per day

Answer 3

Beyond the first two weeks of life, infants should gain __

Question 4

• An infant is < 5th percentile for weight
• An infant is < 5th percentile in weight for length, or
• The rate of growth results in the infant crossing more than two major lines on the standard infant growth curve.

Answer 4

What are the three definitions of failure to thrive?

Question 5

Most sources report that organic problems account for < 10% of cases of failure to thrive, while psychosocial problems account for the majority of cases

Answer 5

Are organic or non-organic causes of FTT more common?

Question 6

10-30 minutes at a time

Answer 6

How often do young, breastfeeding infants typically nurse f

Question 7

Five to six wet diapers per day, plus multiple stools per day

Answer 7

How many wet diapers do infant typically make per day?

Question 8

Congenital heart disease/CHF (poor wt gain/FTT?)
Respiratory infection (fever?)
Sepsis (The early signs of sepsis can be subtle and nonspecific, including lack of fever)
Metabolic disorder (+ on newborn screening?)

Answer 8

DDx for respiratory distress and feeding difficulty in an

Question 9

40-60 breaths per minute

Answer 9

Normal respiratory rate in a newborn.

Question 10

Coarctation of the aorta

Answer 10

A discrepancy in the strength of the brachial and femoral

Question 11

Diastolic.

Answer 11

Choose one:Systolic/Diastolic murmurs are always pathologic

Question 12

Tetralogy of Fallot

Answer 12

Most common congenital heart defect.

Question 13

Ventricular septal defect
Mitral regurgitation
Tricuspid regurgitation

Answer 13

Three causes of holosystolic murmurs.

Question 14

Aortic stenosis
Pulmonic stenosis

Answer 14

Two causes of systolic ejection murmurs.

Question 15

HepatomegalyDecreased renal blood flow, RAAS activation, Fluid retention, Systemic venous congestion, and hepatomegaly

Answer 15

What liver finding is a fairly consistent finding in child

Question 16

CHF
Hepatitis
Congenital infections
Inborn errors of metabolism
Anemias
Tumours (less commonly)

Answer 16

DDx of hepatomegaly in infants.

Question 17

Dyspnea with feedingsDiapohresisPoor growthActive precordiumHepatomegaly

Answer 17

What are the classic findings of CHF in an infant within a

Question 18

Innocent murmurMost common between 3-7 years”Musical or vibratory”Heard best as left lower sternal borded

Answer 18

Stills Murmur

Question 19

Still’s Murmur

Answer 19

Innocent murmurMost common between 3-7 yearsMusical or vi

Question 20

While the children are learning their ABCs, you may discover:
A - Atrial septal defect
B- Bicuspid Aortic Valve

Answer 20

What congenital heart defects are more likely to be detect

Question 21

ASD

Answer 21

Heart sound: Widely split, fixed S2

Question 22

Ventricular septal defect

Answer 22

Heart sound:Holosystolic murmur beginning with S1 with a

Question 23

Aortic stenosis

Answer 23

Heart Sound:Systolic ejection murmur, radiating to the ne

Question 24

Pulmonic stenosis

Answer 24

Heart sound:Systolic ejection murmur, radiating to the lu

Question 25

Associated with patent ductus arteriosus

Answer 25

Continuous machine-like murmur and bounding pulses (from

Question 26

PROVe
Pulmonary infundibular stenosis (RV outflow tract obstruction)RVHOverriding aortaVentricular septal defect (VSD)

Answer 26

Four main components of Tetrology of Fallot.

Question 27

Tetrology of FallotTransposition of the Great ArteriesTruncus arteriosusTricuspid AtresiaTotal Anomalous pulmonary venous return

Answer 27

5 Ts of cyanotic heart defects

Question 28

VSDSevere aortic stenosisCoarctation of the aortaLarge patent ductus arteriosus

Answer 28

Heart defects that present with a murmur and signs of CHF

Question 29

Cardiomegaly
Increased pulmonary vascular markings
Pulmonary edema

Answer 29

Hallmark chest x-ray findings of a large left-to-right shu

Question 30

The typical ECG findings for an infant with a large VSD are prominent biventricular forces (high voltage QRS complexes in leads V1 and V2), suggesting both LV volume overload and RV pressure overload.

Answer 30

Typical VSD ECG findings.

Question 31

There is elevated pulmonary vascular resistance in a newborn.
When the systemic and pulmonary vascular resistances (PVR) are nearly equal, there is no reason for blood to shunt through the VSD.
The murmur of a VSD will not appear until the PVR drops, usually at a few days to weeks of age. This is why, typically, VSD murmurs are not heard in the nursery.

Answer 31

Why are VSD murmurs not heard in newborns (ie. why may the

Question 32

“FED”
Furosemide(counteract retention caused by activation of RAAS)
Elanapril (reduce afterload, such that SVR is low to promte fwd flow of blood from left ventricle as opposed to through the VSD to the pulmonary vasculature).
Digoxin (mechanism not clear, as contractility is not an issue)
Increased caloric intake (for the FTT)

Answer 32

Treatment for newborn with CHF.

Question 33

Pulmonary vascular obstructive disease; outcome ofunrepaired VSD.
The pulmonary vasculature constricts in response to exposure to high pressure and high flow. With chronic exposure to these conditions the pulmonary vasculature will develop permanent changes and loses the ability to relax. This causes the pulmonary vascular resistance to exceed the systemic resistance, and shunting through the VSD will shift from left-to-right to right-to-left. The patient will then develop cyanosis, progressing to polycythemia, heart failure, and death.

Answer 33

Eisenmenger syndrome

Question 34

Hyperdynamic precordium with a holosystolic murmur

Answer 34

A 5-week-old infant is brought to the pediatrician for fai

Question 35

RA > foramen ovale > LA > LV > systemic circulation
Foramen ovale connects RA to LA, bypassing RV and lungs

Answer 35

You have accepted a part-time tutoring job for first-year m

Question 36

Hepatitis B vaccine.

Answer 36

Which vaccine is given within the first 12 hours of life?

Question 37

~4-5 months

Answer 37

When does birth weight double (for an average infant)?

Question 38

Formula fed infants tend to gain weight faster than do breastfed infants because they ingest more calories.

Answer 38

Select one:Formula/Breastfed infants tend to gain weight fa

Question 39

Maternal HTNDM (some are LGA)LupusMaternal malnutrition

Answer 39

Name four maternal conditions during pregnancy that can ca

Question 40

High Metabolic RateCHFCongenital heart defectsMalabsorptionCeliacLow IntakeMalnutritionFormula allergyChronic diarrhea or vomiting (?severe GERD, bowel obst.)Neglect
OtherDevelopmental delay with poor suck and swallow

Answer 40

Name at least three conditions that can result in FTT.

Question 41

Method (bottle, breast; ask further details on sufficient breast milk, both breasts, formula prepackaged or prepared, etc.)EffortTime it takes to eatDiaphoresisSpits up after feeding?

Answer 41

What are 4 key questions to ask with regard to feeds?

Question 42

20 cal/oz
667 cal/L

Answer 42

Calorie content of breast milk (which formula matches).

Question 43

A formula that is made for infants that have protein or fat malabsorption; protein is fragmented and thus easier to digest.

Answer 43

What is Pregestimil used for.

Question 44

Breast milk contains less vitamin D than most commercial formulas.

Answer 44

Select one:Breast milk/formula contains more vitamin D.

Question 45

100-110 cal/kg/24 hours

Answer 45

To maintain adequate growth, healthy full-term infants typ

Question 46

CBC (?anemia, infection?)Urinalysis (?Renal tubular acidosis, hematuria, UTI, etc.)BUN/Cr (?renal failure)

Answer 46

If pt is present

Question 47

≥ 60 mg/dL

Answer 47

Sweat chloride ____is most consistent with cystic fibrosi

Question 48

Autosomal recessive(For an infant to have the disease, EITHER both parents must be heterozygote carriers of the mutant allele OR one parent is homozygous and one parent is heterozygous)
For parents who are both heterozygous, each child of this couple will have a 25% chance of having CF, a 25% chance of being unaffected, and a 50% chance of being a carrier like the parents. For a homozygous and heterozygous couple, each child will have a 50% chance of being affected and a 50% chance of being heterozygous.

Answer 48

Inheritance pattern of CF.

Question 49

Trypsinogen test (IRT - Immunoreactive trypsionogen)
Note: Infants without CF may also have elevated IRT levels, however, so confirmatory testing is done either by performing a genotype for the most common CF mutations or by repeating the IRT.

Answer 49

Screening test for CF.

Question 50

This infant is likely not consuming adequate calories to grow. The mother or primary caregiver may neglect proper feeding of the infant because of preoccupation with the demands or care of others, her own emotional problems, substance abuse, lack of knowledge about proper feeding, or lack of understanding of the infant’s needs. It is also important to assess the mother for post-partum depression. Standardized screening tools, such as the Edinburgh, are used routinely in pediatric office settings for this purpose.

If it was CHF,child would have signs such as:tiring with feeds, sweating, or tachypnea, tachycardia, or hepatomegaly.

Answer 50

A 4-week-old infant presents to clinic for a well child che

Question 51

Inadequate caloric intake is correct because it is the most common cause of FTT.
Furthermore, we have reason to believe that this particular infant is not receiving adequate calories. Breastfed infants should eat every two to three hours until 3 months of age, whereas this infant eats every four hours and shares the milk supply with her twin. Twins can thrive on exclusive breastfeeding, but it requires that the mother consume extra fluids and calories and ensure that both twins receive adequate calories.

Answer 51

An 8-week-old infant is brought to the clinic for a health m

Question 52

Sweat chloride testThe patient’s loose stool is concerning for malabsorption. This occurs in patients with cystic fibrosis due to their impaired pancreatic exocrine function. Given the stool history in the face of failure to thrive, a sweat chloride test would be indicated at this time. Cystic fibrosis should still be suspected in the child who has a normal newborn screen. States differ in the type of test offered to screen for cystic fibrosis, and although great strides have been made in newborn detection, methods are not 100% sensitive.

Answer 52

A 6-week-old is brought into clinic by his mother for poor

Question 53

B. The mutation in CFTR gene results in defective salt balance. CF is caused by mutations in a single large gene on chromosome 7 that encodes the cystic fibrosis transmembrane conductance regulator (CFTR) protein. Clinical disease requires disease-causing mutations in both copies of the CFTR gene.

Answer 53

A 6-month-old infant is referred to the pulmonology clinic

Question 54

D. CF causes exocrine pancreatic insufficiency and ultimately results in fat malabsorption. This causes frequent loose stools in infancy and progresses to foul-smelling and greasy stools in childhood.

Answer 54

A two-week-old infant presents to the clinic to follow-up o

Question 55

Vitamin K injection, Hepatitis B vaccine and erythromycin ophthalmic ointment.

Answer 55

What 3 things do babies recieve after birth?

Question 56

​Hypotonia (most consistent finding in infants with Down syndrome)Upslanting palpebral fissuresFlattened midfaceEpicanthal foldsRedundant skin on back of neck (nuchal skin)Small ears (usually less than 34 mm at maximum dimension in a term infant
Additional common physical findings are small brachycephalic head, Brushfield spots, small shaped mouth, single transverse palmar crease, short fifth finger with clinodactyly, and wide spacing and a deep plantar groove between the first and second toes.

Answer 56

Name 6 common features od

Question 57

Lymphocyte karyotype

Answer 57

What is the standard lab dx for Down Syndrome?

Question 58

No.

Answer 58

Is consanguinity a risk factor for Down Syndrome?

Question 59

Hypothyroidism

Answer 59

Select one:Down Syndrome is associated with hypo/hyperthyro

Question 60

Amniocentesis and chromosome analysis of amniotic fluid cells
and
Chorionic villus sampling (CVS) and chromosome analysis of CVS tissue

Answer 60

What are the prenatal diagnostic tests for Down Syndrome?

Question 61

Fragile X syndrome

Answer 61

What is themost common familial cause of intellectual dis

Question 62

Respiratory rate:23–39 breaths/minute
Oxygen saturation:> 95%
Heart rate:120–180 beats/minute (mean 150)
Blood pressure:90% at 100/65 mmHg, 50% at 85/50 mmHg

Answer 62

Normal vitals for a 2-month-old.

Question 63

The etiology of infant colic is unknown.
The crying typically starts after 2 weeks of age, peaks at 6 weeks, and gradually lessens by age 3 or 4 months.
The infant eats normally and has normal growth.
The crying can create feelings of rejection, frustration, and anxiety in caregivers.

Answer 63

Timeline of infant colic (eg. onset, peak, resolution)

Question 64

Cardiac:Congenital heart disease (eg. Tet spell), arrhythmia (brady 2^ to congenital heart block or long QT syndrome)Resp: RSV infection, pertussis, LRI (pneumonia)GI: GERD, swallowing abrnomalitiy, tracheoesophageal fistulaCNS:Reflexive breath holding, increased ICPSystemic: Sepsis, inborn errors of metabolism, toxins, CO

Answer 64

Approach to apnea in infants (by system)

Question 65

The most common respiratory cause of apnea is respiratory syncytial virus (RSV) infection.
Premature infants and infants younger than 2 months are at highest risk for apnea with RSV.

Answer 65

Most common respiratory cause of apnea?

Question 66

Brief, resolved unexplained event (dx of exclusion).
Defined as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now-resolved episode that includes one or more of the following: * cyanosis or pallor * absent, decreased, or irregular breathing * marked change in tone (hyper- or hypotonia) * altered level of responsiveness.

Answer 66

What is a BRUE?

Question 67

Age 6 months to 6 years

Answer 67

At what age to breath-holding spells occur?

Question 68

Congenital Dermal Melanocytoses
Flat birthmarks that can sometimes be confused with bruising; more common in babies with darker skin pigmentation, but still seen in infants with lighter complexions

Answer 68

More appropriate name for Mongolian Spots?

Question 69

A score below 8 means the infant is severely impaired and in coma.

Answer 69

An Infant Glasgow Coma Scale below what indicates that the

Question 70

• Fractures or injuries that are inconsistent with reported mechanism of injury and/or the developmental stage or abilities of the child.
• Multiple fractures or injuries at different stages of healing
• Fracture of the femur or tibia in a non-walking child. Note that “Toddler’s fracture” is a common injury, typically to the tibia, in young walking children. Toddler’s fracture is not a sign of abuse.
• Posterior rib fractures, which are frequently associated with shaken baby syndrome due to squeezing of the thorax by the perpetrator’s hands during shaking.
• Skull fracture in an infantis also very suspicious for abuse. In these cases, it is very important to discern if the mechanism of injury reported by the parent or caretaker is consistent with the injury seen. Involvement of a pediatric radiologist skilled in interpreting these films can be critical.

Answer 70

Name 5skeletal survey findings that raise suspicion for a

Question 71

MRI is less sensitive for an early bleed than CT;head CT is highly sensitive for an intracranial bleed, such as a subdural hematoma

Answer 71

Which is more sensitive for an early bleed: CT or MRI?

Question 72

Vasovagal syncopeHypoglycemiaDehydrationSeizureHeat stroke

Answer 72

Name 5 causes of syncope.

Question 73

Syncope is defined as a transient, usually brief, loss of consciousness and postural tone that results from inadequate cerebral perfusion.
Syncope is typically self-limited with unconsciousness for less than 1 minute, followed by gradual return of cerebral perfusion and awakening.

Answer 73

Define syncope.

Question 74

-Duration of sx-Time of the day-Last meal-Wt changes-Activities leading up to the event-Drugs/meds-Associated sx:

• Palpitations, CP, headache, SOB, N/V, diaphoresis, visual changes, hearing changes

Answer 74

What are the critical qs to ask in a hx for syncope?

Question 75

ECG

Answer 75

What must you order in a patient with syncope?

Question 76

WPWLong-QT syndrome

Answer 76

Name two

Question 77

Hypertrophic cardiomyopathy (HCM)

Answer 77

The most common cause of sudden cardiac death.

Question 78

EchocardiogramECG is not appropriate as 10% of folks with HCM have normal findings.

Answer 78

Which test is required to rule out HCM?

Question 79

Left ventricular hypertrophy and/or ST/T wave changes indicative of repolarization abnormalities.

Answer 79

ECG findings associated with HCM.

Question 80

MSKPrecordial catch syndromeis the most common cause of chest pain in adolescents and is thought to be a form of musculoskeletal pain of unknown etiology. It is a benign condition characterized by sudden, sporadic onset of sharp pain, usually along the left sternal border, which is often exacerbated with deep inspiration. These pains are brief, lasting seconds to a few minutes, and resolve spontaneously. The pain can often be “broken” with a forced deep inspiration. It is often not associated with exercise.

Answer 80

What is the most common cause of chest pain in an adolesce

Question 81

EBV serologies
The patient’s symptoms are suggestive of infectious mononucleosis. These include complaints of low-grade fever and malaise and findings of cervical lymphadenopathy and pharyngeal exudate. If testing is positive, the patient should be restricted from strenuous activity or contact sports during his illness due to the risk of splenic rupture

Answer 81

John is a 17-year-old presenting today for a pre-participat

Question 82

Prolonged QT syndrome can cause syncopal episodes in late childhood or adolescence. QT intervals are elongated on ECG and lead to arrhythmias, like ventricular fibrillation. This condition is often associated with other abnormalities, including severe congenital sensorineural deafness.

Answer 82

A 17-year-old girl presents for a sports pre-participation

Question 83

ECG and referral to cardiology.
Referral to cardiology is the absolute next best step! The combination of syncope with exertion and a family history of a young death is concerning for something like hypertrophic cardiomyopathy. Don’t be fooled about heat stroke. That is a positive family history for sudden death in a young person. This patient must be evaluated by cardiology, even if you don’t hear a cardiac murmur!

Answer 83

A 16-year-old boy presents to your office requesting cleara

Question 84

Give fluids and recheck her vital signs

Answer 84

A 16-year-old previously healthy girl comes to the Pediatri

Question 85

Reassurance
Based on the history, and assuming your physical exam is unremarkable, this sounds most suggestive of precordial catch syndrome, the most common cause of chest pain in an adolescent. No further workup is needed.

Answer 85

Claire is a 16-year-old girl who presents for birth control

Question 86

Penicillin(Amoxicillin is generally used to treat Group A Strep in young children since it is more palatable)

Answer 86

The treatment of choice for Group A Strep pharyngitis

Question 87

Macule

Answer 87

Flat, circumscribed discoloration < 1 cm.

Question 88

Flat, circumscribed discoloration < 1 cm (> 1 cm is a patch)

Answer 88

Macule

Question 89

Group A Streptococcus infection

Answer 89

Scarlet fever is caused by what

Question 90

“Warm CREAM”Fever for at least 5 days+Conjunctivitis (non-purluent)RashErythema & swellingof the palms/solesAdenoapthy (cervical, often unilateral)Mucous membranes - dry and red; “strawberry tongue”

Answer 90

Name 6 signs/sx of Kawasaki disease (a vasculitis).

Question 91

A rash that typically starts on the ankles/wrists and progresses centrally; also may not have a rash.

Answer 91

Rocky Mountain spotted fever (RMSF) is associated with wha

Question 92

Measles

Answer 92

What is associated with the following:After a prodrome of

Question 93

Erythema Infectiosum(Viral infection (parvovirus B19))

Answer 93

What is associated with the following:

Question 94

Group A strep pharyngitisKawasaki diseaseToxic Shock Syndrome

This finding can also be seen in infectious mononucleosis, but it is usually in the presence of a concomitant streptococcal pharyngitis.

Answer 94

Name 3 conditions have been associated with a finding of a

Question 95

ASAHigh-dose initially (four doses)Low dose followingdefervescenceDiscontinued 6-8 weeks later if no coronary artery changes seen
IVIG (Intravenous immune globulin)Asingle dose of 2g/kg over 10-12 hrs

Answer 95

Treatment for Kawasaki Disease

Question 96

This presentation is consistent with infection by cocksackie A, an enterovirus. This is commonly known as hand, foot, and mouth disease (HFMD).
Following an incubation period of three to five days, patients have fever, tender vesicles on their hands and feet, and oral ulcers. Sometimes the rash also occurs on the buttocks and the genitals. The infection resolves spontaneously within three days, and is spread from person to person via saliva, fluid from the vesicles, stool, or nasal discharge.

Answer 96

A 5-year-old girl, previously healthy, presents with an ery

Question 97

he constellation of symptoms described suggests Kawasaki disease. The other two classic signs not mentioned are erythematous tongue (“strawberry tongue”), and erythema/edema of the extremities.

Answer 97

A 2-year-old girl presents to the urgent care clinic with a

Question 98

Kawasaki disease (KD)

Answer 98

A 3-year-old boy presents with fever to 103 F for the past

Question 99

Rapid strep test with back-up culture if negative.

Answer 99

A 5-year-old boy comes to the clinic with a chief complaint

Question 100

Echocardiogram to look for coronary artery aneurysm

Answer 100

A 3-year old girl comes to the clinic with a chief complain

Question 101

Viral bronchiolitisAsthmaForeign body aspirationGERD

Answer 101

Name 4 causes of wheezing in infants and toddlers.

Question 102

2-5 years old

Answer 102

In which age is croup moust common?

Question 103

infiltration of inflammatory cells into the airway mucosa, mucus hypersecretion, and mucosal edema, accompanied by bronchoconstriction.

Answer 103

Asthma is characterized by …

Question 104

400U of Vitamin D daily soon after birth; up to 12 months of age

Answer 104

Babies who are exclusively or partially breastfed should r

Question 105

• Young infants cannot digest cow’s milk as completely or easily as they digest breast milk or formula.
• Cow’s milk contains high concentrations of protein and minerals, which can stress a newborn’s immature kidneys.
• Cow’s milk lacks iron, vitamin C, and other nutrients that infants need.
• Cow’s milk can irritate the lining of the stomach and intestine, leading to blood loss in the stool.
• Cow’s milk does not contain the optimal types of fat for growing infants.

Answer 105

3 reasons why cows milk is inappropriate to feed a baby l

Question 106

Infants born at >37 weeks gestational age require 100 to 120 kcal/kg/day. Average daily weight gain for term infants is 20 to 30 grams.

Answer 106

Infants born at >37 weeks gestational age require _____ kc

Question 107

Present at birth, disappears by age 4 months.

Used to detect peripheral problems such as congenital MSK abnormalities, or neural plexus injuries.

Answer 107

When does the Moro reflex disappear?What is it used to de

Question 108

Seborrheic dermatitis

Answer 108

Name this rash:

Question 109

This reflex must disappear before the infant can begin grasping objects voluntarily.
This reflex persists until 2-3 months of age.

Answer 109

When does palmar grasp disappear?

Question 110

Infant dorsiflexes the big toe and fans the other toes when examiner strokes the lateral aspect of the foot’s plantar surface.This reflex is normal in children up to 2 years of age.

Answer 110

Babinski Response

Question 111

Babies are developmentally ready to begin spoon feeding solid foods between 4 and 6 months of age.

Answer 111

When are babies ready for solid foods?

Question 112

DTaP-IPV-Hib vaccineDiphtheria, tetanus, pertussis, polio, haemophilus influenzae type b
Pneumococcal conjugate (Pneu-C-13)
Rotavirus (Rot-5) vaccine

Answer 112

Vaccine(s) given at 2, 4, 6, and 18 months?

Question 113

Double by 5 months, triple by 12 months(In addition, most children will reach double their birth length by age 4 years)

Answer 113

By what ages should an infant double and triple his or her

Question 114

CataractsGlaucomaRetinoblastomaChorioretinitis

Answer 114

Absence of a symmetric red reflex or the presence of leuko

Question 115

12 months

Answer 115

At what age would you expect a well-developed pincer grasp

Question 116

Neuroblastoma

Answer 116

______is a likely diagnosis in an infant younger than a y

Question 117

Wilms’ tumor (nephroblastoma)

Answer 117

This is a likely diagnosis in a child with an asymptomatic

Question 118

Urine or serum VMA/HVA measures metabolites of catecholamines, which are elevated in neuroblastoma.

Answer 118

Whattest is highly specific for neuroblastoma and can be

Question 119

Reassure the parents that the boy’s development appears normal.

Answer 119

A 36-month-old presents for a well child visit. The parents

Question 120

At 18 months, a child should be able to walk backward, and 50-90% of children can run at this stage.
An 18-month-old should be able to scribble, build a tower of 2 cubes, have 3-6 words in her or his vocabulary, and be able to help in the house and remove garments.

Answer 120

Sammy is a healthy male child brought into your office by h

Question 121

Wilms’ tumor is commonly associated with Beckwith-Wiedemann syndrome, a genetic overgrowth syndrome. Other features that may be seen in children with this syndrome include omphalocele, hemihypertrophy, hypoglycemia, large for gestational age, and other dysmorphic features.

Answer 121

A 5-month-old male is brought to the urgent care clinic wi

Question 122

Non-amplification of the n-myc gene is a favorable prognostic factor

Answer 122

An asymptomatic, healthy 9-month-old is found to have a pa

Question 123

Influenza, Hep B, IPV

Influenza, Hep B, IPV is correct. The patient needs a third Hep B, a third IPV, and a yearly flu shot starting at 6 months of age.

Answer 123

A 9-month old comes to the clinic for a well-child visit. T

Question 124

Small round blue cells with dense nuclei forming small rosettes
In addition to neuroblastoma, other tumors associated with small blue cells include Ewing’s sarcoma and medulloblastoma, both of which tumors are seen in children.

Answer 124

A 10-month-old asymptomatic infant presents with a RUQ mas

Question 125

Age for copying a circle: 3
Age for copying a cross: 4

Answer 125

Developmental Milestones:Age for copying a circle?Age for

Question 126

Lubrication (to protect the skin)
Topical anti-inflammatories in short bursts
Treat associated skin infections agressively

Answer 126

The basic (3) tenets of the treatment of eczema are:

Question 127

Intoeing in toddlers is usually caused by tibial torsion, while intoeing in pre-school/school-aged children is usually caused by femoral anteversion.

Answer 127

Intoeing in toddlers is usually caused by ____, while intoe

Question 128

Misalignment of the eyes;amblyopia, or poor visual development if not managed.

Amblyopia​:Impaired or dim vision without obvious defect or change in the eye

Answer 128

Strabismus

Question 129

Stop the bottle & gradually introduce new foods and slowly decrease his old favorites.

This choice is correct, because gradually introducing new foods and slowly decreasing his old foods will likely ease the transition to healthier diet choices and encourage long-term adjustment.

Answer 129

A 3-year-old boy is brought to the clinic by his parents fo

Question 130

C. Age-appropriate development

Answer 130

A 2-year-old girl is brought to the clinic by her mother fo

Question 131

A. This choice is correct. A a normally developing 4-year-old should be able to hop on 1 foot, copy a cross, pour/cut/mash their own food, and brush teeth.

Answer 131

A 4-year-old boy is brought to the clinic by his mother for

Question 132

D. This choice is correct. Given the patient’s age and preference for pasta and milk, the most likely cause of anemia is iron deficiency. Treatment would include oral iron supplementation and increased dietary iron intake.

Answer 132

A 5-year-old girl is brought by her mother to the clinic for

Question 133

ODD/CD is the psychiatric condition with the highest comorbidity rates with ADHD.

Answer 133

What pychiatric condition has the highest comorbidity rate

Question 134

Appetite suppression
Insomnia
Decrease in growth velocity

Answer 134

Name the three primary side effects of stimulant ADHD medi

Question 135

High birth weightObese parentLower SESPrader-Willi syndrome

Answer 135

Name 4 risk factors for childhood obesity.

Question 136

The most likely diagnosis is primary hypertension because the only physical findings are hypertension and obesity. Given the mild hypertension and the patient’s age, symptoms are unlikely to be present. Other etiologies should be ruled out, but review of systems and physical examination do not currently suggest other etiologies.

Answer 136

An 8-year-old obese male with no past medical history is fo

Question 137

Catecholamine excess (pheochromocytoma or neuroblastoma) should be suspected in a child who is hypertensive and has episodes of sudden sweating, flushing, or feels that his heart is racing. This patient is exhibiting these signs and a urine catecholamine testing would be appropriate in this case.

Answer 137

A 7-year-old male presents to the clinic with complaints of

Question 138

Both steroids and CNS stimulants can cause an increase in blood pressure, especially when used in combination. Steroids increase blood pressure by mimicking endogenous cortisol and the sympathetic fight or flight response. Stimulants mimic norepinephrine, stimulating alpha and beta adrenergic receptors, causing an overall increase in blood pressure.

Answer 138

An 8-year-old female presents to your clinic for follow-up

Question 139

Alcohol, ingested toxinsEpilepsy, encephalitis, endocrine, electrolytesInfection (meningitis/sepsis)Overdose, opiates, oxygen deprivedUremia (renal failure)Trauma, temperatureInsulinPsychosisStroke, shock, space occupying lesions

Answer 139

Causes of AMS (AEIOU TIPS)

Question 140

Children younger than 6 are more likely to have a bacterial than a viral infection.

Answer 140

Children younger than 6 are more likely to have a bacteria

Question 141

acute glomerulonephritis (A), congestive heart failure (B), hepatic failure (C), and nephrotic syndrome (D).

Answer 141

Differential Diagnosis for Fatigue, Periorbital Edema, and

Question 142

Periorbital edema is often the first sign of hypoalbuminemia, which may be caused by glomerulonephritis

Answer 142

Periorbital edema is often the first sign of ________.

Question 143

An overloaded left ventricle

Answer 143

An S4 gallop indicates what?

Question 144

1. Proteinuria2. Hypobilirubinemia3. Edema4. Hyperlipidemia

Answer 144

Four major characteristics used to help dx nephrotic syndr

Question 145

Minimal change disease is the most common cause of primary nephrotic syndrome in children, accounting for 90 percent of cases under the age of 10.

The characteristic histologic finding in minimal change disease is diffuse effacement of the epithelial cell foot processes on electron microscopy but otherwise completely normal findings.

Answer 145

_________ is the most common cause of primary nephrotic s

Question 146

Post-streptococcal Glomerulonephretis(PSGN)

Answer 146

What is the most common cause of acute glomerulonephritis

Question 147

Glomerulonephritis classically presents with a combination of gross hematuria (usually tea or cola colored), hypertension, edema, and sometimes with acute kidney injury.

Answer 147

________

Question 148

When glomerulonephritis is suspected, it is important to ask about recent throat and skin infections.

Answer 148

When glomerulonephritis is suspected, it is important to a

Question 149

Hematuria (gross)EdemaAKIHTN

Answer 149

Gnephritis: HEAD

Question 150

Post-strep glomerulonephritis

Answer 150

The following suggest which disease?Elevated antistreptoly

Question 151

Corticosteroids
Na+ restriction to a level of 1500-2000mg daily

Combined use of furosemide and 25% albumin is recommended only for those children with symptomatic edema (particularly to relieve dyspnea and edema if these symptoms are causing discomfort).

Answer 151

Treatment for primary nephrotic syndrome.

Question 152

Spontaneous peritonitis

Answer 152

Most common cx of nephrotic syndrome.

Question 153

D. Low C3 complement
C3 is decreased in PSGN. This value will return to normal six to eight weeks after presentation of PSGN symptoms. Although this patient was treated appropriately for his strep throat, treatment does not prevent PSGN. However, timely and appropriate treatment of strep throat will prevent development of rheumatic fever.
C3 plays a role in bacterial killing. A low C3 > less bacterial killing > more prone to infection.

Answer 153

An 8-year-old boy presents with tea-colored urine, hyperten

Question 154

A. Normal glomeruli
This choice is correct because it describes the histology seen in minimal change disease. Histologically, minimal change disease is characterized by normal glomeruli on light microscopy. Minimal change disease is the most likely diagnosis of nephrotic syndrome between the ages of 1 and 10 years old, accounting for 85% or more of cases.

Answer 154

A 6-year-old boy comes to the clinic with a chief complaint

Question 155

C. Nephrotic syndrome
The constellation of history and physical exam findings, with a recent viral infection and subsequent edema, suggests nephrotic syndrome. Minimal change disease is the most common form of nephrosis in pediatrics. Changes in the podocytes of the glomerular apparatus allow significant proteinuria (> 3.5 g/day or >2.0 mg/mg on pr/cr ratio), which leads to hypoalbuminemia and eventually interstitial edema and ascites. This would explain the patient’s periorbital swelling, increasing abdominal girth (ascites), and weight gain (pure fluid overload).

Answer 155

Katie is a 5-year-old girl with three-day history of swelli

Question 156

E. Acute post-infectious glomerulonephritis
Acute glomerulonephritis would explain all aspects of Brian’s presentation. The disease may present with gross hematuria (which most patients describe as tea-colored or cola-colored), periorbital swelling and ascites due to hypoalbuminemia, and hypertension due to intravascular fluid overload. Additionally, acute glomerulonephritis frequently follows a URI.

Answer 156

Brian, a 5-year-old boy with swelling around both his eyes a

Question 157

Urinalysis
Choice B is correct. Because of the high suspicion of nephrotic syndrome, urinanalysis would be the next step in diagnosis. This patient has symptoms of periorbital edema, lethargy, and pedal edema (she quickly outgrew her shoes). This test can be done in an outpatient setting and is not invasive (you do not have to stick her with a needle!).

Answer 157

A 7-year-old girl is brought to her pediatrician because of

Question 158

Kidsshould be saying a minimum of six words at 18 months of age

Answer 158

At 18 mo. of age, kids should be saying ___ words.

Question 159

True

Answer 159

T/FOTC antihistamine/decongestants should not be given to

Question 160

Streptococcus pneumoniaeHaemophilus influenzae,nontypeable

Answer 160

Whatare the most prevalent pathogen causes of AOM?

Question 161

High doseamoxicillin (80 to 90 mg/kg/day) is the appropriate first-line treatment.

Answer 161

Treatment of choice for acute otitis media?

Question 162

High dose amoxicillin/clavulanate

Answer 162

Treatment for children with concurrent otitis media and pu

Question 163

OME(Otitis media with effusion)

Answer 163

The ear findings of anamber, non- or poorly mobile, opaqu

Question 164

Rhinovirus causes the common cold and is the most reasonable diagnosis. Rhinovirus is a very common cause of congestion and other cold-like symptoms. She presents with slightly elevated temperature, slight tachypnea, and inflamed turbinates and oral mucosa. Her symptoms all correlate with the common cold.

Answer 164

An 18-month-old girl presents to the clinic with nasal cong

Question 165

Amoxicillin/clavulanateThis choice is correct because of the severe symptoms our patient is exhibiting with a high temperature greater than 39 C. Amoxicillin/clavulanate is the treatment of choice for patients with moderate to severe otalgia or high fever, and is used for additional beta-lactamase coverage forHaemophilus influenzaeandMoraxella catarrhalis, and when failure with amoxicillin is suspected.

(High-dose amoxicillin is the most common first-line treatment for acute otitis media due to its general effectiveness against susceptible and partially resistantS. pneumo, in addition to being low cost and having a high safety profile. However, this antibiotic was recently administered, raising concerns for a resistant organism.)

Answer 165

A 14-month-old female presents to clinic with fever to 39.2

Question 166

Haemophilus influenzaeH. influenzaeis a frequent cause of AOM (15-52% of cases). Although the child has been vaccinated againstH. influenzaetype B, this does not cover the unencapsulated strains ofH. influenzaethat cause AOM

Answer 166

An 18-month-old girl is brought to her pediatrician by her

Question 167

Otitis media with effusion
The earlier diagnosis of acute otitis media together with current findings of bilateral yellow and poorly mobile tympanic membranes on physical exam make this the most likely diagnosis.

Answer 167

An 18-month-old presents with yellow and poorly mobile tymp

Question 168

Maxillary sinusitis
The maxillary and ethmoid sinuses are large enough to harbor infection in infancy. The sphenoid sinuses do not become large enough until the third to fifth year of life, and the frontal sinuses are rarely large enough until the sixth to tenth year of life. Sinusitis is characterized by the findings in the question stem, and is often preceded by a URI. Pus draining from the middle meatus is suggestive of either maxillary, frontal, or anterior ethmoid sinusitis.

Answer 168

An 8-year-old girl comes to the clinic with two weeks of na

Question 169

CroupSubglottic diseaseForeign body

Answer 169

DDx (3) for barking cough.

Question 170

Lower-resp infection

Answer 170

Most likely cause of wet/productive cough?

Question 171

AsthmaSinusitisAllergic/vasomotor rhinitis (postnasal drip)

Answer 171

Name 3 possible etiologies that lead to a cough that is wo

Question 172

Symptoms of recurrent airway obstruction by history and exam
Demonstration that airway obstruction is at least partially reversible
Exclusion of other causes of obstruction

Answer 172

Diagnosis of asthma requires these three things.

Question 173

National guidelines recommendspirometry in children > age 5 to demonstrate that airway obstruction is present and at least partially reversible.
In younger children who cannot cooperate with spirometry, response to a trial of bronchodilator treatment is often used in diagnosis.

Answer 173

What do you use for asthma dx in children > 5?

Question 174

Start treatment with a low-dose inhaled corticosteroid twice a day to keep the inflammation under control and albuterol as needed to relax the airways/
All patients with persistent asthma should receive daily prophylaxis with anti-inflammatory therapy such as inhaled corticosteroids. These medications are intended to prevent asthma exacerbations, thereby reducing the need for systemic steroids.
The steroid medications most commonly prescribed include beclomethasone, fluticasone, and budesonide.

Answer 174

Therapy for persistent asthma

Question 175

AsthmaCystic FibrosisObstructive lung disease (e.g., asthma and cystic fibrosis) is characterized by a reduction in air flow and trapping of air inside the thorax behind tight, plugged airways, which lowers the FEV1.

Answer 175

Name two obstructive lung diseases.

Question 176

A. Chest x-ray and tuberculin skin test
A. Signs and sx of primary pulmonary tuberculosis are few to none. Toddlers may present with nonproductive cough, mild dyspnea, wheezing, and/or failure to thrive (defined as weight < 5th percentile or drop in two percentile curves for weight). In children, TB can present without systemic complaints (fever, night sweats, and anorexia), severe cough, and sputum production. Regarding diagnostic tests, the TST is a practical tool for diagnosing TB infections. All children with chronic cough (more than four weeks) should be evaluated with a chest x-ray, as other pathology—such as lung abscess or malignancy—can also be detected on CXR.

Answer 176

A 4-year-old boy who recently emigrated from eastern Europe

Question 177

B. This answer choice is correct. Low-dose inhaled corticosteroid daily is correct because this patient has mild persistent asthma. His symptoms occur 3–6 days/week and 3–4 nights/month.
D. This answer choice is incorrect. High-dose inhaled corticosteroids, LABA, and oral corticosteroids would be indicated in a patient with severe persistent asthma (symptoms occur continuously throughout the day and every night).

Answer 177

An 11-year old boy presents to the clinic with wheezing. Mo

Question 178

D. This answer choice is correct. Asthma frequently presents with cough that worsens at night. The cough is usually a dry cough and may be associated with wheezing. It is also often associated with other atopic conditions such as atopic dermatitis and food allergies.

Answer 178

A 4-year-old patient presents with several months of cough.

Question 179

C. This answer choice is correct. Persistent cough and wheezing that affect the patient every other day (3–4 days with symptoms/week) are consistent with mild persistent asthma, which is appropriately treated with short-acting beta agonist PRN and low dose inhaled corticosteroid. The swelling under the eyes (allergic “shiners”) and skin rash are other signs of atopy, as mentioned above.

Answer 179

A 9-year-old boy presents to your clinic with discoloration

Question 180

C. This answer choice is correct. Alveolar consolidation in the right lower lobe would be suggestive of a pneumonia. The prolonged fever, productive cough, fatigue and focal findings on examination are all suggestive of pneumonia.

Answer 180

A previously healthy 10-year-old boy comes to the clinic wi

Question 181

Hyperinflation in one lung field would be consistent with a foreign body aspiration.

Answer 181

Hyperinflation in one lung field would be consistent with

Question 182

Viral gastroenteritis typically presents with both vomiting and diarrhea; bacterial gastroenteritis classically presents with bloody or profuse diarrhea.

Answer 182

4 DDx for kid with vom & diarrhea.

Question 183

B. Mild to moderate (3-9%)

Answer 183

What degree of dehydration would include the following:His

Question 184

Begin oral rehydration with a commercially prepared solution while monitoring Caleb in the pediatric clinic.
Oral rehydration therapy (ORT) is accepted as the standard of care and first-line treatment in the management of acute gastroenteritis in mild to moderate dehydration

Answer 184

Dr. Whitman agrees with you that Caleb is mildly to moderat

Question 185

The recommended fluid replacement volume for mild-moderate dehydration is 50-100 mL/kg, to be replaced over 2-4 hours.

Answer 185

What is the recommended fluid replacement volume for mild-

Question 186

Due at 2 months of age

Answer 186

When is the first rotavirus vaccine given?

Question 187

GERD (regurg/spitting up may be difficult to distinguish from vom); FTTMilk protein allergy(may present with vom imm after eating; more typically a rash or loose stools; does not typically cause dehydration)Viral Gastroenteritis(large watrey stools are more of the hallmark)Malrotation +/- volvulus(Bilious emesis is common with intestinal volvulus)Inborn error of metabolismPyloric stenosis(projectile, non-bilious vomiting is a hallmark)Intussusception(bikious emesis, currant jelly of stool)CNS diseaseUTI(In infants, symptoms of UTI are non-specific and may include fever, poor feeding and vomiting, leading to dehydration if not identified and treated)

Answer 187

Name the DDx (9)for recurrent emesis.

Question 188

Pyloric Stenosis

Answer 188

What disease has the following hallmarks?An escalating patt

Question 189

Pyloric stenosis
The “olive” is the hypertrophic pyloric muscle.

Answer 189

This finding is associated with what disease:A palpable o

Question 190

Intussusception

Answer 190

This finding is associated with what disease:Bilious emesi

Question 191

Malrotation ± volvulus

Answer 191

This finding is associated with what disease:Bilious emesis

Question 192

Pyloric U/S
Upper GI contrast study IF U/S is unavailable; will demonstrate the “string sign”
Electrolytes (typically hyopchloremic, hypokalemic, alkalotic)

Answer 192

What is the diagnostic work-up for pyloric stenosis?

Question 193

Upper GI contrast study

Answer 193

Diagnostic modality of choice to diagnose malrotation wit

Question 194

Surgery!

Answer 194

Treatment for pyloric stenosis.

Question 195

Nooooo
Keep it to N/S boluses

Answer 195

Should a bolus contain dextrose or a significant amount of

Question 196

1. Replace the fluid deficit.3x (max) rpt boluses of NS 10-20mL/kg with reassess after each2. Provide maintenance fluids.4-2-1For the first 10 kg, 4mL/kg/hour;second 10 kg, 2mL/kg/hour;For any additional kg, 1mL/kg/hour3. Replace any ongoing fluid losses.Vom/Diarrhea/NG output/etc.

Answer 196

Name the three basic steps of fluid management.

Question 197

D. No immediate intervention is necessary
This patient most likely has viral gastroenteritis. No immediate intervention is needed as the patient is still tolerating some PO and has a normal physical exam. He should be advised to continue oral hydration and to return if symptoms worsen and the patient can no longer tolerate oral hydration.

Answer 197

A 25-month-old male presents to the ED with a 2-day history

Question 198

Intravenous lactated Ringer’s solution of 20mL/kg boluses until baseline clinical status is achieved, then either oral hydration or IV fluid hydration if not tolerating PO.

Answer 198

Rashid is a 5-week-old infant who presents to clinic with 4

Question 199

B. GERD with esophagitis

Choice B is correct because regurgitation/spitting up may be difficult to distinguish from true vomiting. Infants who reflux with overfeeding may sometimes have forceful vomiting. Severe esophagitis may result in blood-streaked emesis. Pain from reflux or esophagitis may lead to feeding aversion when gastroesophageal reflux is severe.

Note: this is a more chronic px, so not something like intussusception

Answer 199

A 6-month-old infant comes to clinic because of several we

Question 200

Pyloric stenosis
Choice E is correct because the history of frequent vomiting, poor weight gain, and the finding of an abdominal mass are consistent with pyloric stenosis. Children with pyloric stenosis often present between 3-5 weeks of age.

Answer 200

You are seeing a 1-month-old infant who is < 3rd percentile

Question 201

C. The patient is moderately dehydrated and should be managed of 50-100ml/kg over 2-4 hours.

This is correct. It is appropriate to trial a bolus of oral rehydration solution in the mild-moderately dehydrated patient. The recommended treatment is 50-100ml/kg of oral rehydration administered over 2-4 hours in small aliquots. Oral rehydration would not be appropriate if the child was severely dehydrated.

Answer 201

A 15-month-old boy presents to the ED in January with a 3-da

Question 202

Tension Headache

Answer 202

This type of headache typically:is most often episodicgener

Question 203

Migraine Headaches

Answer 203

This type of headache ismore severe than tension headaches

Question 204

A “classic” migraine headache is one that is accompanied by an “aura,” which can include visual symptoms (bright spots in the visual field), speech changes or sensory abnormalities (such as paresthesias).
A “common” migraine headache-also referred to as migraine without an aura-is the most frequent type of migrainous headache seen in children; it is typically unilateral, frontal or temporal in location, but may involve any part of the head.

Answer 204

Is a classic or common migraine accompanied by an aura

Question 205

Elevated BP
Bradycardia
Irregular respirations

Answer 205

What is Cushings triad in the context of elevated ICP?

Question 206

A term used to describe lack of coordination of muscle movements.
Ataxia is a non-specific neurologic sign which can result from dysfunction in various parts of the nervous system that coordinate movement, such as the cerebellum, the inner ear, and the dorsal columns.

Answer 206

Ataxia

Question 207

Post-infectious cerebellitis(Acute cerebellar ataxia)

Answer 207

Most common cause of acute ataxia in children.

Question 208

Hydrocephalus

Answer 208

Ataxia associated with _____generally is insidious in ons

Question 209

A psychiatric disorder known as conversion reaction can manifest as a hysterical involuntary disturbance in gait (patient truly believes something is wrong, but no physical pathology exists) known as astasia abasia.
Unlike true ataxia, this gait is wildly erratic and involves lurching of the body which requires extraordinary balance.
The child is generally able to sit without difficulty, but when put in a standing position, immediately begins to sway at the waist.

Answer 209

Astasia abasia

Question 210

Intracranial mass

Answer 210

The presence of worsening headaches, especially those occu

Question 211

Cerebellar hemispheric lesions cause ipsilateral limb abnormalities, nystagmus, tremor/dysmetria and tend to spare speech

Answer 211

Cerebellar hemispheric lesions cause (?ipsilateral or contr

Question 212

MRI
Computed tomography (CT) is not good in visualizing the posterior fossa quite as well. In cases when intracranial hemorrhage is suspected or needs to be ruled out, a head CT may be valuable as the first test since it is often easier and faster to obtain than an MRI in some centers, and unlike MRI rarely requires sedation of the child.

Answer 212

What imaging modality is best for examining the posterior

Question 213

Trial of prophylactic medication for migraine headaches
This child is presenting with signs of both typical and atypical migraines and could be started on a trial of prophylactic medication. Tricyclic antidepressants (TCAs) are often used in children for migraine prophylaxis, which is the most likely diagnosis in a child with this constellation of symptoms.

Answer 213

A 7-year-old male presents with a five-year history of int

Question 214

E. Magnetic resonance imaging
MRI is more expensive and less readily available than CT imaging. It also frequently requires sedation in pediatric patients. However, it provides the best detail of the posterior fossa, which is the most common location of pediatric brain tumors.

Answer 214

A 7-year-old male with a past medical history of headaches p

Question 215

Post-infectious cerebellitis is correct.
This typically presents in a younger child with ataxia, nystagmus, vomiting and sometimes dysarthria. It is believed to be an autoimmune response leading to demyelination of the cerebellum occurring several weeks after a viral infection such as varicella or coxsackie virus.

Answer 215

A 3-year-old female presents to the ED with sudden onset dif

Question 216

Tension-type headaches are often bilateral and involve the forehead, temporal areas, or back of the head. Tenderness of the posterior muscles of the neck may also be present. They should be responsive to NSAIDs. Stress can give rise to a tension headache, and this is consistent with this patient developing headaches after school.

Answer 216

A 12-year-old female presents to her pediatrician complainin

Question 217

All can lead to SGA

Toxoplasmosis”Others”Examples: Hepatitis B, Human parvovirus, Syphilis and ZikaRubellaCytomegalovirusHerpes simplex type 2

Answer 217

What are the TORCH infections?

Question 218

Prolonged Rupture of Membranes (PROM)
Prematurity
Intrapartum fever
Previous delievery of infant who developed GBS disease

Answer 218

Name the risk factors for early onset GBS disease.(Group B

Question 219

Appearance (skin color)Pulse (heart rate)Grimace (reflex irritability)Activity (muscle tone)RespirationA newborn receives a score of 0, 1, or 2 for each component, with the final Apgar score ranging from 0 to 10.

Answer 219

APGAR

Question 220

Born at > 37 weeks’ gestation

Answer 220

Term means …

Question 221

Poor delivery of nutrition to the fetus (example maternal smoking) often results in asymmetric IUGR.

Answer 221

Poor delivery of nutrition to the fetus (example maternal s

Question 222

Hypoglycemia
Hypothermia
Polycythemia

Answer 222

Name three risks for SGA newborns.

Question 223

The mother was on an anticonvulsant for her seizures. Taking anticonvulsants during pregnancy may lead to cardiac defects, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, IUGR, and microcephaly. Mental retardation may be seen. A rare neonatal side effect is methemoglobinuria.

Answer 223

A 33-year-old G1P0 female with a history of medically contr

Question 224

Heroin is the correct choice. Maternal opiate use during pregnancy places the newborn at risk for neonatal abstinence syndrome. Affected newborns may exhibit CNS findings (irritability, hyperactivity, hypertonicity, incessant high-pitched cry, tremors, seizures), GI symptoms (vomiting, diarrhea, weight loss, poor feeding, incessant hunger, excessive salivation), and respiratory findings (including nasal stuffiness, sneezing, and yawning).

Answer 224

A 19-year-old female in her 38th week of pregnancy goes int

Question 225

Alcohol Exposure
This choice is correct. Fetal alcohol syndrome has very characteristic facial features, including a smooth philtrum, thinning of the upper lip, and small palpebral fissures.

Answer 225

A 19-year-old G1P0 female presents in labor to the ED at 38

Question 226

Functional abdominal pain is the most common cause of abdominal pain in school-age children. Functional — or chronic recurrent — abdominal pain is usually nonspecific and is not life-threatening.

Functional abdominal pain is defined as pain that is “without demonstrable evidence of a pathologic condition such as an anatomic, metabolic, infectious, inflammatory, or neoplastic disorder.”

Answer 226

What is the most common cause of abdominal pain in school-

Question 227

Celiac Disease

Answer 227

The classic presentation of _____in children occurs betwe

Question 228

IgA tissue transglutaminase antibodies (TTG) is a sensitive and specific test, buta small bowel biopsy showing villous atrophy is the gold standard.

Answer 228

Testing for celiac

Question 229

Calprotectin is a protein released by neutrophils
Elevated fecal calprotectin reflects neutrophilic intestinal inflammation and may be useful in distinguishing IBD from non-inflammatory causes of chronic diarrhea.

Answer 229

What is fecal calprotectin?

Question 230

Inflammatory bowel disease (IBD)

Answer 230

Abnormal labs such as guaiac-positive stool, anemia, high

Question 231

Induce remission: Corticosteroids (can also use enteral nutrition, anti-TNF therapy)
Immunomodulators for maintenance (thiopurines, methotrexate); anti-TNF therapy is approved for moderate to severe CD

Answer 231

What are children with Crohns disease often trialed on to

Question 232

The single greatest risk factor for the development of IBD is having a first-degree relative who has the disease.

Answer 232

The single greatest risk factor for the development of IBD

Question 233

Gluten-free diet
Celiac disease can present with chronic abdominal pain, vomiting, abdominal distention, and diarrhea. Growth failure can result from malabsorption or anorexia. Anemia may also result from occult GI bleeding, although frank blood in the stool is rare. The IgA tissue transglutaminase antibody titer is a very sensitive and specific test for this disease.

Answer 233

A 2-year-old female is brought to the ED by her mother beca

Question 234

Functional abdominal pain
Functional abdominal pain would be the most likely diagnosis in this setting at this time. History in this setting is not suggestive of any other diagnosis directly causing his abdominal pain, except a change in his social setting. For better understanding of the nature of this child’s pain, it would be best to talk to him alone, without his mother present, to determine if he is having trouble adjusting to school and to assess whether he has a stable home environment. His pain is chronic, with no other symptoms (diarrhea, bloody stools, growth failure), making a functional pain most likely.

Answer 234

An 11-year-old male comes to the clinic with a chief compla

Question 235

Crohn’s disease is most consistent with this presentation, as it affects GI tract from mouth to anus, leading to abdominal pain, diarrhea (can be bloody), vomiting, or weight loss. Extraintestinal symptoms include skin rashes, arthritis, and fatigue. Fever, fistula, and perianal complications are also common. Slowed weight and height velocity may be observed.

Answer 235

An 8-year-old girl is brought to clinic because of intermitt

Question 236

Colonoscopy
Colonoscopy is the best answer. This patient likely has IBD (Crohn’s disease or ulcerative colitis [UC]). He has crampy abdominal pain and intermittently bloody diarrhea (that wakes him up at night), perianal disease, and erythema nodosum. He also has microcytic anemia, likely from chronic blood loss. Colonoscopy with biopsies will allow you to diagnose Crohn’s disease (or UC) prior to treating it. The diagnosis begins with a colonoscopy to obtain tissue biopsies as well as blood tests.

Answer 236

A 12-year-old boy comes to your clinic with a chief complain

Question 237

Oral griseofulvin
Topical antifungals are not usually successful in treating tinea capitis, because the infected hair follicles are deep within the scalp. Systemic griseofulvin is the first choice for treatment of tinea capitis.

Answer 237

A 3-year-old male presents to clinic with an annular, well-c

Question 238

Treatment consists of emollients and topical corticosteroids.
Atopic dermatitis most often presents with dry, itchy skin in addition to erythema or lichenification in skin flexures.

Answer 238

A 3-year-old child is found to have a dry, pruritic rash on

Question 239

Decreased number of active melanocytes and decreased number and size of melanosomes.
Pityriasis alba,common in children 3 to 16 years of age, presents as hypopigmented macules. They most often occur on the face, neck, trunk, and extremities. They have irregular borders, can vary in size, and may have a slight scale. Lesions may become more noticeable after sun exposure because of tanning of the surrounding skin. The etiology of this disorder is unknown, but ultrastructural examination of epidermal cells reveal decreased number of active melanocytes as well as decreased number and size of melanosomes.

Answer 239

A 10-year-old boy presents to his pediatrician with a histo

Question 240

Plaque

Answer 240

Broad, elevated lesion (or confluence of papules) > 1 cm

Question 241

Petechiae

Answer 241

Tiny, red or purple macules caused by capillary hemorrhage

Question 242

Acute Urticaria (Hives)
Treated with OTC antihistamines (loratidine or cetirizine; both are less sedating than Benadryl [diphenhydramine])

Answer 242

A rash that comes and goes.OFten caused by histamine relea

Question 243

• Baby oil and a small brush to remove the scales
• Frequent (i.e., daily) shampooing with a gentle baby shampoo, or—for more persistent cases—use of a prescription shampoo containing ketoconazole, an anti-fungal agent, or pyrithione zinc.
• A low-potency topical steroid cream (e.g., hydrocortisone). In older children and adults, ketoconazole cream may be used.

Answer 243

Treatment for seborrheic dermatitis

Question 244

Delayed type IV
Onset is usually within 24-72 hours of contact
Treatment: avoid nickel, apply emollient (eg. Vaseline)

Answer 244

Chronic nickel contact dermatitis is which type of hyperse

Question 245

Acute contact dermatitis

Answer 245

Unlike chronic reactions, acute _____ tends to have vesicl

Question 246

The most common bacteria cultured from superficial skin infections are Staphylococcus aureus and Streptococcus pyogenes (Group A Strep).

Treatment:
- Mild localized impetigo can be treated effectively with topical antibiotics such as mupirocin

Answer 246

Most common bacterial cause of impetigo and treatment.

Question 247

Currently, the first-line treatment is 1% permethrin lotion

While not perfect at removing nits, any treatment should involve combing the wet hair with a fine-toothed comb.

Answer 247

Treatment for pediculosis capitis (head lice)

Question 248

Treatment is with two applications of permethrin 5% cream, one week apart, for all affected household members.

Answer 248

Treatment for scabies.

Question 249

Ringworm of the body (tinea corporis)

Answer 249

Theclassic lesionof ______is an annular, well-circumscri

Question 250

Irritant Dermatitis

Answer 250

Most common cause of diaper rash.

Question 251

Diaper candidiasis (vs. irritant dermatitis, which tends to spare the intertriginous creases)

Treated withnystatinantifungal.

Answer 251

This form of diaper rash DOES NOT spare the skin folds.

Question 252

Mild:OTC benzoyl peroxide or retinoids (for comedonal acne)
Moderate: Mild treatment + topical abx (like clindamycin or erythromycin; active against P. acnes)
Severe:Refer to derm; will likely prescribe isotretinoin (Accutane)

Answer 252

Treatment for mild, mod, and severe acne.

Question 253

Roseola

Answer 253

A viral exanthem that classically follows 3-5 days of a feb

Question 254

Papular urticaria

Answer 254

Common pediatric condition.Lesions are papular and 3 mm to

Question 255

Streptococcal infection

Answer 255

Most commonly associated with the rash of scarlet fever, w

Question 256

Erythema multiforme

Answer 256

An acute hypersensitivity syndromeAssociated with a symmetr

Question 257

Erythema infectiosum (Fifth disease)

Answer 257

Rash starts on the face with a slapped-cheek appearance f

Question 258

D. Infection with Bordetella pertussis in the paroxysmal stage
D. The paroxysmal stage of pertussis lasts four to six weeks and is characterized by repetitive, forceful coughing episodes, followed by massive inspiratory effort. This massive inspiratory effort is what results in the characteristic “whoop”-sounding cough. This is consistent with the patient’s presentation and duration of illness. The forceful coughing fits in pertussis can even lead to conjunctival hemorrhages and pneumothoraces from the increased intrathoracic and intracranial pressures from Valsalva. The antimicrobial agents of choice for treatment of pertussis are azithromycin, clarithromycin, and erythromycin. Antibiotics given in the paroxysmal phase will reduce communicability but will not alter the clinical course.

Answer 258

A 12-year-old boy presents to the ED with complaints of an

Question 259

This patient displays the characteristics of foreign body aspiration including unilateral wheeze and air trapping in one lung-indicating unilateral airway obstruction. The right main bronchus is more commonly obstructed due to anatomy (it is wider and more vertical than the left). The most commonly aspirated foods are hot dogs, nuts, hard candy, grapes, and popcorn. Foreign body aspiration also commonly presents in children younger than four.

Answer 259

A 12-month-old previously healthy girl presents with cough a

Question 260

A. Asymmetric breath sounds and wheezing

This infant is in respiratory distress from foreign body aspiration, consistent with the history of acute onset of distress and asymmetric breath sounds. Common foreign bodies include peanuts, popcorn, grapes, hard candy and hot dogs. Respiratory distress from foreign body aspiration is usually accompanied by asymmetric breath sounds and wheezes on auscultation.

Answer 260

A 10-month-old infant is brought to the Peds ED by her pare

Question 261

Croup or laryngotracheobronchitis is due to a viral infection (Parainfluenza type 1). It is most common in the winter, and often occurs in children age 2 to 5 years. Croup can lead to non-specific URI symptoms with some degree of airway obstruction. A barky or seal-like cough and inspiratory stridor (which should be differentiated from expiratory wheezes) is common in croup.

Answer 261

A 3-year-old girl is brought into the clinic by her mother b

Question 262

Given the patient’s age, foreign body aspiration should always be included in the differential diagnosis for acute onset wheezing. The lung findings of asymmetric breath sounds and wheezing support this diagnosis. Foreign body in the airway can be confirmed by bilateral decubitus or inspiratory/expiratory chest films, characterized by decreased deflation on the affected side. If complete obstruction, x-ray will generally reveal atelectasis (whiting out) and signs of volume loss (mediastinal shift towards affected side to compensate for loss of volume).

Answer 262

A previously healthy 11-month-old infant with 5-day history

Question 263

Epiglottitis;has historically almost always been due to infection with Haemophilus influenzae type b (Hib).

Answer 263

This diagnosis should be considered in a child or adult of a

Question 264

RSV

Answer 264

Most common cause of bronchiolitis.

Question 265

C. Congenital hypothyroidism
Congenital hypothyroidism may not be clinically evident until 6 weeks of age due to circulating maternal thyroid hormone transmitted from the placenta. Signs and symptoms of congenital hypothyroidism include feeding problems, large fontanelles, hypotonia, large tongue, coarse cry, and umbilical hernia. Congenital hypothyroidism should be identified on routine neonatal screening.

Answer 265

A two-month-old infant is brought by her mother to clinic fo

Question 266

Consult with pediatric endocrinologist and start treatment with 10 to 15 mcg/kg/day of crushed levothyroxine in liquid, and follow up labs in 2 weeks
This choice is correct. The American Academy of Pediatrics recommends this treatment regimen for infants 0-6 months of age. Dosing is typically calculated based on age and weight. Consultation with a pediatric endocrinologist on initiation and maintenance of therapy is recommended.

Answer 266

The following are routinely administered or tested in the f

Question 267

Congenital hypothyroidism may present with poor feeding, constipation, jaundice (longer and more persistent than physiologic jaundice of newborn), mottled skin, large fontanelles, hypotonia, hypothermia and an umbilical hernia. Later findings include a hoarse cry, macroglossia, and myxedematous facies. Patients usually remain asymptomatic until after 6 weeks of age, as maternal thyroid hormones may still circulate in younger infants. Patients with primary hypothyroidism will have high TSH and low T4 levels. The most common cause of primary hypothyroidism is aplasia or hypoplasia of the thyroid gland, and - less commonly - inborn errors of metabolism. Secondary or tertiary hypothyroidism (HPA dysfunction) will have both low or inappropriately normal TSH and low T4, and are relatively rare causes of hypothyroidism in infants.

Answer 267

A 6-week-old infant is brought by her parents to the clinic

Question 268

Thyroid function studies

Answer 268

A 6-week-old infant is brought to the emergency room by his

Question 269

B. Absent deep tendon reflexes
This infant likely has infant botulism which usually presents in the first year of life with hypotonia, lethargy, constipation, weak cry and can eventually lead to respiratory failure. These infants will have absent DTRs.

Answer 269

A 5-month-old is brought by her parents to the clinic becaus

Question 270

C. Elevated urine orotic acid
C. Elevated urine orotic acid is diagnostic of OTC deficiency. This is the most common urea cycle disorder and is an x-linked condition. This diagnosis is most likely based on the enlarged liver, mental status changes, and hyperammonemia.

Answer 270

A 3-day-old infant is evaluated in the nursery for poor feed

Question 271

D. Phenylalanine hydroxylase
D. This infant likely has phenylketonuria (PKU), an autosomal recessive disorder of amino acid metabolism caused by a deficiency in the enzyme phenylalanine hydroxylase. Affected infants are normally detected by newborn screening, but can present with vomiting, hypotonia, musty odor, developmental delay, and decreased pigmentation of the hair and eyes. The best developmental outcomes occur if a phenylalanine-restricted diet is initiated in infancy.

Answer 271

A mother brings her 20-day-old male infant to your clinic f

Question 272

The patient likely has a ruptured right-sided ectopic pregnancy, as indicated by the positive pregnancy test, hemodynamic instability, and peritonitis. Hemorrhage into the peritoneum may irritate the peritoneum and cause referred pain to the right shoulder. Cervical motion tenderness may also be found. Patients may experience nausea, vomiting, and fever.

Answer 272

A 16-year-old obese Caucasian female with a history of irreg

Question 273

Choice A is correct because pancreatitis commonly causes continuous abdominal pain that can localize to the right and left upper quadrants (“band-like pain”) as well as radiating to the back. Nausea and vomiting are nearly always present. Lipase is the most sensitive and specific lab test to diagnose pancreatitis. The patient’s history of alcohol use may increase her risk of pancreatitis, though viral etiologies are also very common.

Answer 273

A 16-year-old female presents with acute onset of diffuse

Question 274

A pregnancy test is the best first step in management. Pregnancy is one of the indications for inpatient management of PID, so this is very important information when determining whether to admit the patient from the ED or to provide outpatient treatment. In addition, given the patient’s uncertainty around the timing of her LMP, this could be a presentation of an early ectopic pregnancy if her pregnancy test is positive, making this test important in directing further workup. While cervical cultures and empiric antibiotics are obviously a must when you suspect PID, pregnancy test is the first step, and the best answer.

Answer 274

A 16-year old female presents to the ED with abdominal pain.

Question 275

Appendicitis is the most common condition in children requiring immediate surgical intervention, but often presents differently than in adults (especially in infants). Aspects of their atypical presentation can include lack of migration of pain to the RLQ, negative Rovsing’s sign, and involuntary guarding and fever without perforation. In school-age children who can articulate the pain, they often describe pain with movement or coughing. Also, rebound tenderness was found to be neither sensitive nor specific in the pediatric population, while in the adult population it is one of the most accurate PE findings (86%). This patient is of the older pediatric population, and so will commonly present with a more typical appendicitis. Her sudden onset of intense pain at the umbilicus with vomiting, anorexia, and tenderness at McBurney’s point are all classic findings. The more atypical signs include diffuse pain centered below the umbilicus, and rebound tenderness that might point to a perforation. Another atypical aspect of her exam is her adnexal pain during the pelvic exam, which could be due to the degree of inflammation and the positioning of her appendix. The key take-away point is to have a high index of suspicion for appendicitis for pediatric patients with abdominal pain given their atypical presentation.

Answer 275

Luanne is a 15-year-old female who presents with three hours

Question 276

C. This choice is correct. This patient has signs and symptoms of PID. Cervical discharge should be tested for gonorrhea and chlamydia and sent for culture. As she is a homeless patient, she is at high risk for failure to complete her antibiotic course. Given the deleterious sequelae of incompletely treated PID, she should be hospitalized in order to ensure a full course of treatment.

Answer 276

A 16-year-old homeless female presents with low-grade fever