May 2021 Flashcards

Question

"What is the characteristic ocular change after prolonged exposure to oxygen among premature neonates? A. Blood vessels in vitreous B. Papillary edema in the optic nerve root C. Corneal ulcers D. Microaneurysm of the retinal arteriole "

Answer 1

C Nelson’s 21st, p. 364: Signs of subacute or chronic toxicity can include headache, vomiting (early signs), anorexia, dry itchy desquamating skin, and seborrheic cutaneous lesions. With chronic hypervitaminosis A, one may observe fissuring at the corners of the mouth, alopecia, and coarsening of the hair, bone abnormalities and swelling, enlargement of the liver and spleen, diplopia, increased intracranial pressure, irritability, stupor, limited motion, dryness of the mucous membranes, and desquamation of teh palms and the soles fo the feet.

Answer 2

C "Narrow superior mediastinum, globular heart and hyperinflated lungs indicate that this is a TGA (egg-on-a-string). Mustard procedure is atrial switch. This is the earlier procedure that used to be definitive for TGA but has been superseded by the arterial switch. Rastelli procedure is to relieve pulmonary obstruction in mga DORV, d-TGA but usually at 2 years old. Fontan procedure connects the IVC to the pulmonary artery but is usually for hypoplastic left heart diseases and is performed after the Glenn procedure. "

Answer 3

B Nelson 21st p2397. Depending on the frequency and severity of hypercyanotic attacks, 1 or more of the following procedures should be instituted in sequence: (1) placement of the infant on the abdomen in the knee-chest position while making certain that the infant’s clothing is not constrictive, (2) administration of oxygen (although increasing inspired oxygen will not reverse cyanosis caused by intracardiac shunting), and (3) injection of morphine subcutaneously in a dose not in excess of 0.2 mg/kg. Calming and holding the infant in a knee-chest position may abort progression of an early spell. Premature attempts to obtain blood samples may cause further agitation and may be counterproductive

Answer 4

A Pentalogy of Fallot is a rare congenital cyanotic heart disease and a variant of tetralogy of Fallot, in which tetralogy of Fallot is associated additionally with an atrial septal defect

Answer 5

D ``` "I - barely audible II - medium intensity III - lud but no thrill IV - loud with thrill V - very loud VI - very loud can be heard even if steth is off the chest " ```

Answer 6

A "Nelsons 21st ed Chapter 160.1 Testing for total hemolytic complement activity (CH50) effectively screens for the most common diseases of the complement system. "

Answer 7

C "[Nelsons ch457, 458] Truncus arteriosus - Pulmonary blood flow may be augmented by or totally dependent on a PDA TGA - The systemic and pulmonary circulations exist as 2 parallel circuits. Survival in the Immediate newborn period is provided by the foramen ovale and the ductus arteriosus, which permit some mixture of oxygenated and deoxygenated blood "

Answer 8

B "Nelsons p2270-2271 (RHD) Mitral Insuff - The 2nd heart sound may be accentuated if pulmonary hypertension is present. A 3rd heart sound is generally prominent. A holosystolic murmur is heard at the apex with radiation to the axilla Mitral stenosis - The principal auscultatory findings are a loud 1st heart sound, an opening snap of the mitral valve, and a long, low-pitched, rumbling mitral diastolic murmur with presystolic accentuation at the apex. Aortic insuff - The typical murmur begins immediately with the 2nd heart sound and continues until late in diastole. The murmur is heard over the upper and midleft sternal border with radiation to the apex and upper right sternal border "

Answer 9

D "Nelsons (Chapter 448.3 Neonatal Circulation): 10-15 hours AAP Article (PDA in Preterm): “In term infants, the PDA normally constricts after birth and becomes functionally closed by 72 hours of age..” Uptodate: constriction of the ductus arteriousus (DA) results in functional hemodynamic closure within 10-15 hours after delivery. Closure begins at the pulmonary end of the DA, proceeds toward the aortic end and is usually completed by two to three weeks of age. (physiologic closure) "

Answer 10

D "Nelson 21st p2524 Table 482.4 12-24hr - Replacement of intracellular iron stores, subjective improvement, decreased irritability, increased appetite, increased serum iron 36-48hr - Initial bone marrow response, erythroid hyperplasia 48-72hr - Reticulocytosis, peaking at 5-7 days (do repeat retic count at this time) 4-30 days - Increase in hemoglobin level, increase in MCV, increase in ferritin (do repeat CBC at this time) 1-3 months - Repletion of stores (Iron supplements continued for at least 8 weeks) "

Answer 11

C Nelsons p. 2536: Less frequently, elliptocytosis results from mutations in protein 4.1 or glycophorin C, proteins of the junctional complex that link spectrin tetramers to the actin cytoskeleton. These defects in horizontal membrane skeleton protein interactions leave the cell susceptible to shearing forces, leading to the charac- teristic elliptical deformation of the cell and potentially membrane fragmentation.

Answer 12

D Nelsons 21st p. 2596 Factor VIII concentrate is indicated as treatment and as prophylaxis Mild Factor VIII deficiency may be treated with desmopressin, but is ineffective in moderate to severe Factor VIII.

Answer 13

A "PT is not prolonged with deficiencies of factors VIII, IX, XI, and XII. Bleeding time evaluates platelet function. Most procoagulants and anticoagulants are produced in the liver except Factors III, IV, and VIII. "

Answer 14

C "Nelsons 21st pg.2613 “The role of splenectomy in ITP should be reserved for 2 circumstances: 1. Older child (>or equal to 4yo) with severe ITP that lasted for more than 1 year (chronic ITP) and whose symptoms are not easily controlled with therapy; 2. When life-threatening hemorrhage (ICH) complicates acute ITP, if the platelet count cannot be corrected rapidly with transfusion of platelets and administration of IVIg and corticosteroids "

Answer 15

A Nelsons 21st ed p.10555 Bone tumor should be suspected in a patient who presents with deep bone pain, often causing nighttime awakening, and has a palpable mass with radiographs that demonstrate a lesion. The lesion may be mixed lytic and blastic in appearance, but new bone formation is usually visible. The classic radiographic appearance of osteosarcoma is the sunburst pattern

Answer 16

A Nelsons p. 2723: The typical patient develops an acute nephritic syndrome 1-2 wk after an antecedent streptococcal pharyngitis or 3-6 wk after a streptococcal pyoderma.

Answer 17

A Nelsons 21st p2723: Severity of kidney involvement varies from asymptomatic microscopic hematuria with normal renal function to gross hematuria with acute renal failure. Depending on the severity of renal involvement the patient can develop varying degrees of Edema, Hypertension and oliguria.

Answer 18

D "PSGN- low c3 BUT NOT PERSISTENT, normal c4 Alport syndrome and IgA nephropathy→ normal complement Fundamentals p.1417. MPGN is also characterized by persistent hypocomplementemia (low serum C3) and the presence of anti-complement C3 nephritic factor (C3NeF) which clearly distinguish it from PSAGN. "

Answer 19

C "Isolated glomerular diseases with recurrent gross hematuria include: IgA nephropathy, Alport Syndrome, Thin Basement Membrane Disease, and PSGN. ---> PSGN is not recurrent though Membranous nephropathy presents as nephrotic syndrome, more common in adults than in children. Goodpasture disease presents with pulmonary hemorrhage, acute glomerulonephritis (so may also present with hematuria), nephritic urinary sediments with cellular casts, proteinuria and hypertension. PSGN is the classic example of acute nephritic syndrome characterized by the sudden onset of gross hematuria, edema, hypertension, and renal dysfunction. Pero keyword dito gross vs microscopic, so not PSGN not MN, end stage na din GPD so more on nephrotic na din. "

Answer 20

D "Nelson’s page 2836: “ Children with urolithiasis usually have gross or microscopic hematuria.” But specifically for pre-school children according to AAP, “Gross or microscopic hematuria is found in 33% to 90% of children who have urolithiasis and occurs equally across age groups. Urinary tract infection frequently is the presenting sign of urolithiasis in preschool-age children.” ``` Nelsons p2600 (Urinary Lithiasis) Children with urolithiasis usually have gross or microscopic hematuria. If the calculus causes obstruction, then severe flank pain (renal colic) or abdominal pain occurs. The calculus typically causes obstruction at areas of narrowing of the urinary tract—the ureteropelvic junction, where the ureter crosses the iliac vessels, and the ureterovesical junction. ``` ``` Fundamentals p1442 (Urolothiasis) “As a rule, UTI is the presentation in most children but pain is more common among adolescents " ```

Answer 21

C "Pedia Nephro book ``` Proteinuria is detected by dipstick testing 3 or 4+. Quantitative evaluation gives figures ranging from less than 1g to more than 10g/day. The nephrotic range proteinuria is defined as (careful sa units) >50mg/kg/day or >40mg/m2/hr or >30mg/dL " ```

Answer 22

C "Nelson 21st p2757. The idiopathic nephrotic syndrome is more common in males than females and most commonly appears between the ages of 2 and 6 years. However it has been reported as early as 6 mo of age and throughout adulthood. MCNS is present in 85-90% of patients <6 years of age Important features of minimal change idiopathic nephrotic syndrome are the absence of hypertension and gross hematuria. The urinalysis reveals 3+ or 4+ proteinuria, and microscopic hematuria is present in 20% of children. A spot urine protein:creatinine ratio should be >2.0. The serum creatinine value is usually normal. The serum albumin level is <2.5g/dl, and serum cholestrol and triglyceride levels are elevated. Serum complement levels are normal. A renal biopsy is not usually performed if the patient fits the standard clinical picture of MCNS "

Answer 23

B Di ko na alam kung saan nila to pinulot.Not in fundamentals, di ko rin mahanap sa nelsons. Found this in a parenting/family website. “The cross-cradle hold, works well for nursing premies, newborns, and babies that have trouble getting latched on.”

Answer 24

D Vitamin A therapy is indicated for all patients with measles. Vitamin A should be administered once daily for 2 days at doses of 200,000 IU for children 12 months of age or older; 100,000 IU for infants 6 months through 11 months of age; and 50,000 IU for infants younger than 6 months of age. (Nelson 21st Chapter 273: Measles)

Answer 25

C "https://www.ncbi.nlm.nih.gov/books/NBK539790/ “The breast milk can be divided into the bluish-grey foremilk, present at the beginning of a feed which contains less fat, and the creamy white hindmilk secreted towards the end of a feed that is rich in fat. Breast milk can differ depending on maternal health and diet, environmental exposure, gestational age, and the infant's age.[5] The breast milk generally consists of 87% water, 3 to 5% fats, 6.9 to 7.2% lactose, 0.8 to 0.9% proteins, vitamins, minerals, and bioactive substances.[6][4][5] It can yield up to 60 to 75 kcal per 100 ml.” → Lactose (~7%) > Fats (~4%) > Proteins (~1%), so B is false https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/ “Human milk protein concentration is not affected by maternal diet, but increases with maternal body weight for height, and decreases in mothers producing higher amounts of milk” → so A is false “Fat is the most highly variable macronutrient of milk. Hindmilk, defined as the last milk of a feed, may contain two to three times the concentration of milk fat found in foremilk, defined as the initial milk of a feed” → supports C “A study of milk from 71 mothers over a 24-hour period found that the milk fat content was significantly lower in night and morning feedings compared to afternoon or evening feedings” → D is false Fat content shows significant changes during the night(9); this may, however, be related to changes in frequency of feeding rather than circadian rhythms brought about at a cellular level.(10) In short, researchers are just beginning to discover the many new implications of day/night variation in breast milk.- https://www.llli.org/breast-milks-circadian-rhythms-2/ → D is false "

Answer 26

C C. Age. Infants have higher water requirements due to larger BSA compared to older children and adults. Inverse relation means as the option goes up, the water requirements go down or vice versa. Increased RR and high body temperature (fever) increase water requirements because of higher insensible losses. A high specific gravity can suggest dehydration, meaning, it needs a higher water requirement

Answer 27

B [Nesons] The RDA is an estimate of the daily average nutrient intake that meets the nutritional needs of more than 97% of the individuals in a population, and it can be used as a guideline for individuals to avoid deficiencies

Answer 28

D "A. It promotes high levels of estrogen, promoting a contraceptive effect. - False! Estrogen levels are LOW when breastfeeding, while prolactin levels are HIGH. B. The best galactagogue is regular pumping of milk. - False! The best galactagogue is per-demand suckling. C. Mothers on anti-TB drugs should not breastfeed. - False! They can breastfeed after 2 weeks of TB treatment Nelson 21st ed. Chapter 113.5: “Nursing at first for least 5 min at each breast is reasonable, allows a baby to obtain most of the available breast contents, and provides effective stimulation for increasing the milk supply.”"

Answer 29

D "Cephalexin: “̌Limited information indicates that maternal cephalexin produces low levels in milk that are usually not expected to cause adverse effects in breastfed infants.” Mefenamic acid: “Milk samples taken 2 hours after the first dose of each day found average mefenamic acid milk levels of 170 mcg/L (range 30 to 660 mcg/L), although these levels might be inaccurate because the concentration measured in blank milk samples in this study was 200 mcg/L and potentially active metabolites were not measured.” Cefuroxime: “Limited information indicates that cefuroxime produces low levels in milk that are not expected to cause severe adverse effects in breastfed infants.” Cotrimoxazole: “In 20 mothers in the immediate postpartum period given oral trimethoprim, peak milk levels occurred 3 hours after the dose. In 14 of these women who received a daily dosage of 320 mg, the peak milk level averaged 2.4 mg/L and the trough averaged 1 mg/L. In 6 other women who received a daily dosage of 480 mg, the peak milk level averaged 4 mg/L and the trough averaged 1.5 mg/L. The authors calculated that a breastfed infant would receive a daily dosage of 0.75 mg with a maternal dosage of 320 mg daily and 1.7 mg with a maternal dosage of 480 mg.” "

Answer 30

A "Nelsons 21st ed Chapter 129 In contrast to the rapid progression of pneumonia caused by pyogenic organisms, an indolent course may be seen in nonbacterial infection. The onset can be preceded by upper respiratory tract symptoms or conjunctivitis. The infant may demonstrate a nonproductive cough, and the degree of respiratory compromise is variable. Fever is usually absent or low grade, and radiographic examination of the chest shows focal or diffuse interstitial pneumonitis or hyperinflation. Infection is generally caused by C. trachomatis, CMV, Ureaplasma urealyticum, or one of the respiratory viruses. Rhinovirus has been reported to cause severe respiratory compromise in infants, particularly those who are preterm. Although Pneumocystis (carinii) jiroveci was implicated in the past, its etiologic role is now in doubt, except in newborns infected with HIV "

Answer 31

B Formula: FiO2= 20% + (4 X oxygen liter flow)

Answer 32

A "Nelson 21st p1901 Stool frequency is extremely variable in normal infants and can vary from none to 7 per day. Breastfed infants can have frequent small, loose stools early (transition stools), and then after 2-3 wk can have very infrequent soft stools. Some nursing infants might not pass any stool for 1-2 wk and then have a normal soft bowel movement. The color of stool has little significance except for the presence of blood or absence of bilirubin products (white-gray rather than yellow-brown)"

Answer 33

B "Room temp (<25C) - 4 hours Room temp(>25C)- 1 hour Refrigerator (4C)- 8 days Freezer compartment of a 1-door ref- 2 weeks Freezer compartment of a 2-door ref- 3 months Deep freezer with constant temp (-20C)- 6 months "

Answer 34

C "D can be used as step 1 controller + reliever drug for adolescents based on 2020 GINA, but not for 6-11yo For 6-11yo, SABA PRN pa rin treatment of choice for step 1 Terbutaline is a SABA→ yes ang answer ko rin dito is Terbutaline, given that the question asked specifically for intermittent "

Answer 35

B "(Nelson 21st Chapter 572: Hormones of the Hypothalamus and Pituitary) ...Five cell types in the anterior pituitary produce 6 peptide hormones (growth hormone, prolactin, thyroid-stimulating hormone, adrenocorticotropic hormone, luteinizing hormone, follicle-stimulating hormone)... ...The primary physiologic role for Prolactin is the initiation and maintenance of lactation. It prepares the breasts for lactation and stimulates milk production postpartum. During pregnancy, prolactin stimulates the development of the milk-secretory apparatus, but lactation does not occur because of the high levels of estrogen and progesterone. After delivery, the estrogen and progesterone levels drop and physiologic stimuli such as suckling and nipple stimulation signal prolactin release and initiate lactation. ...Oxytocin stimulates uterine contractions at the time of labor and deliv- ery in response to distention of the reproductive tract and stimulates smooth muscle contraction in the breast during suckling, which results in milk letdown. Studies suggest that oxytocin also plays a role in orgasm, social recognition, pair bonding, anxiety, trust, love, and maternal behavior. Most recently, through the interaction with its G-protein-coupled receptor in pancreatic and adipose tissue, oxytocin appears to play a significant role in appetite regulation and obesity by inducing anorexia. "

Answer 36

C "Nelson 21st; page 2320: - If the pneumothorax is recurrent, secondary or under tension, or there is more than a small collapse (other term for big/massive? haha), chest tube drainage may be necessary. - so CTT - In case of recurrent pneumothorax, a sclerosing procedure may be indicated to induce the formation of strong adhesions between the lung and the chest wall with the introduction of talc, doxy, iodopovidone into the pleural space (chemical pleurodesis). - MASSIVE naman ang sa question, not RECURRENT "

Answer 37

C " Nelson 21st p363. The most characteristic and specific signs of vitamin A deficiency are eye lesions, but these may manifest rather late in the progression of vitamin A deficiency, develop insidiously, and rarely occur before age 2 yr. An earlier symptom of vitamin A deficiency is delayed dark adaptation, as a result of reduced resynthesis of rhodopsin; this may progress to night blindness."

Answer 38

A "A. Frankel line: dense zone of provisional calcification found in scurvy. Vit C def B. Caput quadratum-Rounded prominence of the frontal and parietal bones in an infant's cranial vault from untreated Vit D deficiency. C. Pot belly-Bowed legs, a waddling gait, pot belly, and disturbed growth in children affected by Rickets. D. Harrisons groove- Formation of Harrison sulcus (or groove) at the lower margin of the thorax caused by the muscular pull of the diaphragmatic attachments to the lower ribs found in Vit D def. "

Answer 39

(NOTA) Vitamin D deficiency

Answer 40

B ``` "Disappearance of primitive reflexes 3mos: Fencing 4mos: Gallant 4-6mos: Rooting, placing 6mos: Moro, grasp 12-18mos: Babinski Never: Parachute " ```

Answer 41

A ``` "Nelsons 21st p.132 Table 22.1 Sits with support - not explicitly stated Monosyllabic babble - 6 mos Scribbles - 13 mos Bangs 2 blocks - 8 mos " ```

Answer 42

C "Nelsons p75: 36 MONTHS Motor: Rides tricycle; stands momentarily on 1 foot Adaptive: Makes tower of 10 cubes; imitates construction of “bridge” of 3 cubes; copies circle; imitates cross Language: Knows age and sex; counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables; most of speech intelligible to strangers Social: Plays simple games (in “parallel” with other children); helps in dressing (unbuttons clothing and puts on shoes); washes hands "

Answer 43

D "Nelsons 21st p. 1021: “Gender identity develops early in life and is typically fixed by 2-3 yr of age.” P. 145 “By age 3, children have self-identified their sex and are actively seeking understanding of the meaning of gender identification.” "

Answer 44

B Nelsons 21st p 954 Jaundice usually becomes apparent in a cephalocaudal progression, starting on the face and progressing to the abdomen and then the feet, as serum levels increase. Dermal pressure may reveal the anatomic progression of jaundice (face, approximately 5 mg/dL; mid-abdomen, 15 mg/dL; soles, 20 mg/dL),

Answer 45

A Nelsons 21st Chap 367: Chronic diarrhea is defined as stool volume of more than 10 g/kg/day in toddlers/infants and greater than 200 g/day in older children that lasts for 4 wk or more. Persistent diarrhea began acutely but lasts longer than 14 days. In practice, this usually means having loose or watery stools more than 3 times a day. Awakening at night to pass stool is often a sign of an organic cause of diarrhea. The epidemiology has 2 distinct patterns. In developing countries, chronic diarrhea is, in many cases, the result of an intestinal infection that persists longer than expected. This syndrome is often defined as protracted (persistent) diarrhea , but there is no clear distinction between protracted (persistent) and chronic diarrhea.

Answer 46

A "A pleural effusion is a collection of fluid in the pleural space. Fluid gathers in the lowest part of the chest, according to the patient's position. If the patient is upright when the X-ray is taken, then fluid will surround the lung base forming a 'meniscus' – a concave line obscuring the costophrenic angle and part or all of the hemidiaphragm. "

Answer 47

A or B "Nelson p. 1566. The hallmark of TBI is a positive TST or IGRA result. Acid fast bacilli is a hallmark of mycobacterium. Hallmark of primary tuberculosis is relatively large size of the regional lymphadenitis. [TBIC] IGRAs are diagnostic tools for latent tuberculosis infection. P89. "

Answer 48

A Nelson 21st p3231. The most common sequelae from meningitis include hearing loss, cognitive impairment, recurrent seizures, delay in acquisition of language, visual impairment and behavioral problems. Sensorineural hearing loss is the most common sequela of bacterial meningitis and is usually present at the time of initial presentation.

Answer 49

A The first clue to amaurosis in an infant may be nystagmus or strabismus, with the vision deficit itself passing undetected for some time. (p. 3348, Nelsons 21st ed)

Answer 50

D The most effective preventive strategy for NEC is the use of human milk. It is well documented that newborns exclusively breastfed have a reduced risk of NEC… Despite concerns about increased risk for NEC with early and aggressive feeding regimens in VLBW infants, a safe protocol remains unknown. While extensive data and meta-analyses would support the use of probiotics to prevent NEC, there is no clear consensus on the safest, most effective formulation, timing of administration, or length of therapy. Other preventive strategies using prebiotics and synbiotics have also been studied, with variable outcomes. Inhibitors of gastric acid secretion (H2-receptor blockers, PPIs) or prolonged empirical antibiotics in the early neonatal period have been associated with increased risk of ENC and should be avoided. (Nelson 21st Chapter 123 p.953)

Answer 51

C Nelson 21st Ch 122.10 p. 946, predictors of poor prognosis: associated major anomaly, symptoms before 24 hours of age, severe pulmonary hypoplasia, herniation to the contralateral lung, need for ECMO.

Answer 52

D Nelson 21st Ch 113 p869. Persistently small fontanels suggest microcephaly, craniosynostosis, congenital hypothyroidism, or wormian bones.

Answer 53

C "Pathologic jaundice - Appears in first 24-26HOL - Serum bilirubin rises at a rate faster than 5mg/dl/24hr - Serum bilirubin i >12mg/dl in a term infant and 10-14mg/dl in a preterm infant - Jaundice persists past 10-14 DOL - Direct bilirubin >2mg/dl at any time "

Answer 54

B Nelson 21st p3170. For children who have a diagnosis of CP, a team of physicians, including neurodevelopmental pediatricians, pediatric neurologists, and physical medicine and rehabilitation specialists, as well as occupational and physical therapists, speech pathologists, social workers, educators, and developmental psychologists, is important to reduce abnormalities of movement and tone and to optimize normal psychomotor development (MULTIDISCIPLINARY APPROACH)

Answer 55

A Double effect: The doctrine of double effect states that a harmful effect of treatment, even resulting in death, is permissible if it is not intended and occurs as a side effect of a beneficial action.

Answer 56

B "Fundy p.50 It talks about adolescent assent and consent--that adolescents have the right to know the diagnosis and know what will happen to them. But at the end of the day, parents still provide the informed consent. So if there was a choice na: have parents talk to the child to get the assent etc etc, I would’ve chosen that. Otherwise, I feel like the answer is still B. A yung sinagot ko dito. For Assent since adol nasiya. "

Answer 57

C "Nelson 21st P48 Differences in religious beliefs or ethic-based cultural norms may lead to conflict between patients, families, and medical caregivers over the approach to medical care. Pediatricians need to remain sensitive to and maintain an attitude of respect for these differences, yet recognize that an independent obligation exists to provide effective medical treatment to the child. An adult with decision-making capacity is recognized as having the right to refuse treatment on religious or cultural grounds, but children who have not yet developed this capacity are considered a vulnerable population who has a right to treatment. In situations that threaten the life of the child or that may result in substantial harm, legal intervention should be sought if reasonable efforts toward collaborative decision-making are ineffective. If a child’s life is imminently threatened, medical intervention is ethically justified despite parental objections."

Answer 58

B "Nelson 21st p49 The more widely held opinion is that children may be exposed to a limited degree of risk with IRB approval, parental permission, and assent if the child is capable. The federal regulations allow healthy children to participate in minimal-risk research regardless of the potential benefit to the child"

Answer 59

B Nelsons 21st ed Chapter on Meningococcemia (summary: Ceftri over Penicillin) if you read the chapter after this paragraph, there’s a table preferring Ceftriaxone over other meds. However, if NEONATE, the answer is CEFOTAXIME. Since the question does not specify that it’s a neonate, best answer is Ceftriaxone.

Answer 60

B Nelson 21st P1488 prophylaxis. “unvaccinated children < 48 months old who are in close contact with an index case of invasive Hib infection are at increased risk for invasive infection”

Answer 61

B Nelsons 21st p. 1505: The mainstay of diagnosis of typhoid fever is a positive result of culture from the blood of another anatomic site. Results of blood cultures are positive in 40-60% of the patients seen early in the course of the disease, and serial blood cultures may be required to identify Salmonella bacteremia. Stool and urine culture results may become positive after the 1st week.

Answer 62

C C. Foreign body aspiration

Answer 63

A Nelson 21st ed. ““Ciprofloxacin (20-30 mg/kg/24 hr divided into 2 doses) is the drug of choice recommended by WHO for all patients with bloody diarrhea, regardless of age.”

Answer 64

Neonatal tetanus

Answer 65

D "Nelson 21st p47 The doctrine of double effect (DDE) holds that an action with both good and bad effects is morally justifiable if the good effect is the only one intended, and the bad effect is foreseen and accepted, but not desired."

Answer 66

D "Acute appendicitis is believed to be a time-sensitive condition, thus, any delay in diagnosis or treatment may lead to an increased risk of perforation and its attendant morbidity. (Nelson 21st Chapter 370 p. 2053) A major area of focus and challenge in the management of AP is the group of patients with delayed presentation (>48 hr of symptoms). In most busy centers, because AP often has an insidious onset of generalized malaise, as many as 40-50% of patients have delayed presentation. This cohort of patients has a high incidence of Perforated Appendicitis (PA) at presentation (40-59%) and a 56% greater length of stay than those presenting within <24 hr of the onset of symptoms. The risk for development of post-op complications (SSI, intraabdoinal abscess, small bowel obstruction) approaches 20-30% for children with PA vs an appro. 3% risk of complications in patients with simple AP. (Nelson 21st Chapter 370 p. 2054) "

Answer 67

C "Nelson 21st p325 Intact cow’s milk protein–based formulas in the United States contain a protein concentration varying from 1.8-3 g/100 kcal (or 1.4-1.8 g/dL), considerably higher than in mature breast milk (1.2-1.3 g/100 kcal;0.9-1.0 g/dL). This increased concentration is designed to meet the needs of the youngest infants, but leads to excess protein intake for older infants. In contrast, breast milk content varies over time to match protein needs at various ages"

Answer 68

D "Nelson 21st p1937 Positioning measures are particularly important for infants, who cannot control their positions independently. Seated position worsens infant reflux and should be avoided in infants with GERD. PPIs (omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole) provide the most potent antireflux effect by blocking the hydrogen–potassium adenosine triphosphatase channels of the final common pathway in gastric acid secretion. PPIs are superior to H2RAs in the treatment of severe and erosive esophagitis. Prokinetic agents..The available controlled trials have not demonstrated much efficacy for GERD. The long-term regular use of antacids cannot be recommended because of side effects of diarrhea (magnesium antacids) and constipation (aluminum antacids) and rare reports of more serious side effects of chronic use"

Answer 69

B Overweight is defined as 85th-95th percentile BMI.

Answer 70

A Weight for height is the basis of diagnosing acute malnutrition, height/length for age is an index of chronic malnutrition. Weight for age is the most commonly used index of nutritional status

Answer 71

Mid parental height

Answer 72

A Nelson 21st Ch 532.1 The presence of a cutaneous hemangioma increases the likelihood of other visceral hemangiomas. Since no history of aspiration and kid is too old to present with tracheomalacia at this point AND no signs of infection, best answer would be A.

Answer 73

D Systemic antibiotics are indicated for documented urinary or cutaneous infections and for suspected bacteremia (Staphy- lococcus aureus or Pseudomonas aeruginosa) because infection is the leading cause of death. Prophylactic systemic antibiotics are not necessary. Although corticosteroids are sometimes advocated in early, severe cases of SJS, no prospective double-blind studies evaluating their efficacy have been reported. Most authorities discourage their use because of reports of increased morbidity and mortality (sepsis) with their administration, although definitive trials in children are lacking. IV immunoglobulin (IVIG; 1.5-2.0 g/kg/day × 3 days) should be considered in early disease. Total dose greater than 2 g/kg has shown improved but not statistically significant outcomes in children compared to adults. Other immunosuppressive treatment regimens have not dem- onstrated clear benefit or repeated success in multiple controlled studies. (Nelson 21st Chapter 673.2, p. 3483)

Answer 74

C Oxacillin, since Staphylococcus aureus has high penicillin resistance.

Answer 75

B "Nelsons 21st p3116 Lorazepam is often used in the acute treatment of neonatal seizures; it is distrubuted to the brain very quickly and exerts its anticonvulsant effects for less than 5 minutes. Diazepam has also been used, and midazolam is often started as a continuous infusion for refractory cases of neonatal seizures. "

Answer 76

B MDR-TB involves HR. Polydrug TB involves Pyrazinamide and Ethambutol resistance.

Answer 77

D Nelson 21 Ch 242 p. 1576. Tuberculin sensitivity develops within 3 weeks to 3 months.

Answer 78

C "The mother who has current TB disease but has undergone treatment for 2 weeks or more is presumed to be no longer contagious at the time of delivery. However, the possibility of congenital TB should be ruled out. If the newborn is well (absence of any s/sx suggestive of TB), do not give BCG first. Instead, give IPT for 3 months. After 3 months, perform TST. If TST is negative, stop IPT and give BCG. If TST is positive and baby remains well, continue IPT for another 3 months. After 6 months of IPT and baby remains well, give BCG.If TST is not available and the newborn is well, the newborn should receive 6 months of IPT followed by BCG immunization. (TBIC 4th edition 2016, p. 178: Management of a Newborn whose mother has TB Disease) "

Answer 79

C Nelson 21st. “In general, paralysis is more likely to develop in male children and female adults. Mortality and the degree of disability are greater after the age of puberty. Pregnancy is associated with an increased risk for paralytic disease. Tonsillectomy and intramuscular injections may enhance the risk for acquisition of bulbar and localized disease, respectively. Increased physical activity, exercise, and fatigue during the early phase of illness have been cited as factors leading to a higher risk for paralytic disease.”

Answer 80

C Nelsons pg 1722. Diagnosis of congenital CMV requires revcovery of replicating virus or viral Nucleic acids in the first 2-3weeks of life sources include Urine Saliva and blood.... Sensitivity of blood spots is low, preferred screening is Saliva but requires confirmation preferably with urine assay

Answer 81

C The qualifier for this question stem is the (+) spatula test, which clinches tetanus and the other diseases less likely. The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a soft-tipped instrument and observing the effect.

Answer 82

C Nelsons 21st p. 2219: Pharmacologic agents have largely proven ineffective in the management of bronchiolitis. Cochrane reviews have failed to demonstrate any impact on clinical outcomes with use of albuterol or corticosteroids in bronchiolitis; neither are currently recommended for management. Response to bronchodilators is unlikely and unpredictable in children younger than 1 yr, and there is no validated method of assessing response in the clinical setting. The use of inhaled or oral steroids in very young children with wheezing has not been shown to prevent the progression of childhood wheezing or development of asthma. There is debate over the use of HTS in children with bronchiolitis, although most studies and meta-analyses fail to demonstrate any benefit. Racemic epinephrine has not been found to improve length of stay or clinical outcomes among inpatients with bronchiolitis, although there is some evidence to suggest that it may reduce risk of hospitalization when used in the outpatient setting.

Answer 83

D "Nelson 21st Chap 86 Brain death is determined by clinical assessment. Although ancillary tests such as electroencephalography (EEG) and cerebral blood flow (CBF) studies are sometimes used to assist in making the diagnosis, repeated clinical examination is the standard for diagnosis. Contributing factors must be corrected in order to diagnose brain death: Core body temp >35; systolic BP in acceptable range; sedatives excluded; metabolic intoxication excluded; neuromuscular blockade excluded PE: flaccid tone, unresponsive to pain, pupils fixed dilated; corneal, cough, gag reflexes absent; oculovestibular reflexes absent; spontaneous respiration absent Ancillary testing is required (1) when any components of the examination or apnea testing cannot be completed; (2) if there is uncertainty about the results of the neurologic examination; or (3) if a medication effect may be present."

Answer 84

C Case of familial short stature. Growth hormone is not always indicated for it? I’m not sure though. → This is a case of Familial short stature because the bone age is equivalent with chronologic age. Constitutional growth delay kasi BA is less than CA. The recombinant hGH is indicated for Constitutional growth delay (Nelsons 21st ed Chapter 573). For FSS, I think the recommendation is still to track the growth trend for another year, but the best answer is, FSS has no organic problems.

Answer 85

A "Nelsons: Klinefelter XXY phenotypically male, Hypogonadism and infertility the greater the aneuploidy the greater the mental impairment develop gynecomastia. They have taller stature. Add. NCBI: Decrease upper/lower segment ratio "

Answer 86

A "Patient is exhibiting signs and symptoms of CAH in crisis Nelson 21st p1973 Chap 594 CAH: 21-Hydroxylase deficiency Because both cortisol and aldosterone require 21-hydroxylation for their synthesis, both hormones are deficient in the most severe, salt-wasting form of the disease...Symptoms include weight loss, anorexia, vomiting, dehydration, weakness, hypotension, hypoglycemia, hyponatremia, and hyperkalemia. These problems typically first develop in affected infants at approximately 10-14 days of age Nelson 21st p1976 CAH: 11B hydroxylase deficiency The adjacent CYP11B2 gene encoding alderone synthase is generally unaffected in this disorder, so patients are able to synthesize aldosterone normally...Thus it is unusual for patients to manifest signs of adrenal insufficiency such as hypotension, hypoglycemia, hyponatremia, and hyperkalemia. CAH: 3b-hydroxysteroid dehydrogenase deficiency Because cortisol and aldosterone are not synthesized in patients with the classic form of the disease, infants are prone to salt-wasting crises. Because androstenedione and testosterone are not synthesized, males are incompletely virilized. Because DHEA levels are elevated and this hormone is a weak androgen, females are mildly virilized, with slight to moderate clitoral enlargement. Postnatally, continued excessive DHEA secretion can cause precocious adrenarche. Nelson 21st p2977 CAH: 17-hydroxylase deficiency Patients with 17-hydroxylase deficiency cannot synthesize cortisol, but their ability to synthesize corticosterone is intact. Because corticosterone is an active glucocorticoid, patients do not develop adrenal insufficiency. Best, most specific answer is B "

Answer 87

A "Urine Culture Interpretation – Suprapubic aspiration Growth of urinary pathogen in any number (except 2-3 x 1000 CFU of coagulase-negative staphylococci) Catheterization Febrile infants or children usually having 50,000 CFU of a single urinary pathogen, but infection may be present with counts >1000 CFU Midstream clean-void Symptomatic patients usually having 10,000 CFU of a single urinary pathogen Midstream clean-void Asymptomatic patients having at least two specimens on different days with 10,000 of same pathogen. *Routine reculturing of urine after 2 days of antibiotics generally not necessary."

Answer 88

C "Grade I: VUR into nondilated ureter Grade II: VUR into upper collecting system without dilatation Grade III: VUR into dilated ureter and/or blunting of calyceal fornices Grade IV: VUR into grossly dilated ureter Grade V: Massive VUR with significant ureteral dilataion and tortuosity and loss of papillary impression "

Answer 89

C "Preseptal cellulitis - no proptosis, normal ocular movements, normal pupil function Orbital cellulitis - proptosis, limitation of eye movement, edema of the conjunctiva, inflammation and swelling of the eyelids with potentially decreased visual acuity "

Answer 90

B "Nelson p3415 Chap 657 Otitis Externa Edema of the ear canal, erythema, and thick, clumpy otorrhea are prominent signs of the acute disease. The cerumen usually is white and soft in consistency, as opposed to its usual yellow color and firmer consistency. The canal often is so tender and swollen that the entire ear canal and TM cannot be adequately visualized, and complete otoscopic examination may be delayed until the acute swelling subsides."

Answer 91

Place under running water for 15 minutes

Answer 92

A """Nelson 21st p2524 Table 482.4 12-24hr - Replacement of intracellular iron stores, subjective improvement, decreased irritability, increased appetite, increased serum iron 36-48hr - Initial bone marrow response, erythroid hyperplasia 48-72hr - Reticulocytosis, peaking at 5-7 days (do repeat retic count at this time) 4-30 days - Increase in hemoglobin level, increase in MCV, increase in ferritin (do repeat CBC at this time) 1-3 months - Repletion of stores (Iron supplements continued for at least 8 weeks) """

Answer 93

D Nelsons 21st ed ITP chapter on Outcome: In 70-80% of children who present with acute ITP, spontaneous resolution occurs within 6 mos. Verbatim: therapy does not affect the natural history of the illness. Only 20% of children go on to suffer chronic ITP.

Answer 94

B BMR St 2. BMR Stage 1 is the protean/ nonspecific symptoms. BMR Stage 2 is as described above. BMR Stage 3 is coma/death. No such thing as BMR Stage 4.

May 2021 Flashcards

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