pediatric Flashcards
(59 cards)
Q: What is the initial step in management when child abuse is suspected with signs like multiple bruises at different healing stages?
A: ensure child safety
In any case where child abuse is suspected (e.g., multiple bruises in different stages of healing), the immediate and first priority is to ensure the child’s safety. This comes before investigations (e.g., skeletal survey) or social interventions. If the child is in imminent danger, they may need to be removed from the abusive environment urgently.
Q: What vaccine poses a potential allergic risk in a child with egg allergy?
A: Influenza vaccine
At what age can a baby get into a sitting position with help and roll from prone to supine?
A: 4 months
By 6 months, babies usually sit without support and roll both ways (prone to supine and vice versa).
A 4-year-old with an abdominal mass growing obliquely across the midline — what is the most likely diagnosis?
A: Neuroblastoma
Explanation:
Neuroblastoma is a common adrenal or sympathetic chain tumor in young children (typically <5 years) and is known for:
Being a firm, irregular abdominal mass.
Crossing the midline, often growing obliquely.
Possible systemic signs (e.g., opsoclonus-myoclonus, catecholamine secretion).
A child with sore throat, enlarged non-exudative tonsils, and watery nasal discharge — best treatment?
A: Chlorpheniramine
A child has persistent cough and post-tussive vomiting, with delayed immunization — which vaccine could prevent this?
DTaP
How to prevent varicella in an unvaccinated child after exposure to a sibling with chickenpox?
Varicella vaccine (within 5 days)
NOTE:
📆 Routine Varicella Vaccine Schedule:
1st dose: at 15 months (or 12–15 months range)
2nd dose: at 4–6 years (pre-school or school-entry booster)
SO :
Post-Exposure Varicella Management Based on Age & Risk
Age ≥12 months & Unvaccinated: Give varicella vaccine within 3–5 days
Age <12 months & Immunocompetent: Observe only (vaccine not indicated)
Immunocompromised or High-Risk (any age): Give VZIG within 10 days
All Exposed Cases: Apply airborne + contact precautions until lesions crust.
What is the next step for a 1-month-old neonate exposed to varicella from a sibling with no maternal peripartum infection?
Contact precautions
extra :
Indications for VZIG in Pediatric Cases:
Neonates with maternal varicella: If mother develops varicella ≤5 days before or ≤2 days after delivery.
Hospitalized preterm infants <28 weeks or ≤1 kg: Regardless of maternal immunity.
Hospitalized preterm infants ≥28 weeks: If mother lacks evidence of VZV immunity.
Immunocompromised children: With no evidence of VZV immunity.
Bone marrow transplant recipients: Without prior post-transplant varicella infection or immunization.
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What is the best initial management for a 7-year-old with bedwetting and psychosocial distress?
Bed alarm
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Pediatric Enuresis Overview:
Definition: Child is developmentally ≥5 years with repeated involuntary voiding.
Types:
- Primary: Never had bladder control.
- Secondary: Regression after ≥6 months of dryness.
- Monosymptomatic: Nighttime bedwetting only.
- Nonmonosymptomatic: Includes daytime symptoms (urgency, frequency, incontinence).
Initial Evaluation:
- Urinalysis: Rule out infection or diabetes.
- Assess for constipation: Common contributor.
- Voiding diary: Helps evaluate bladder patterns.
- Screen for OSA: If snoring, restless sleep, or daytime fatigue.
- Counseling & motivational therapy: Encourage progress, avoid punishment.
- Behavioral changes: Limit fluids before bed, scheduled voiding, reward systems.
First-Line Interventions:
- Bedwetting alarm: Most effective long-term solution.
- Desmopressin (DDAVP): Consider in children ≥7 years for short-term use (e.g., sleepovers, camps).
A 13-year-old girl with primary amenorrhea, short stature, low-set hairline, thick neck skin fold, and high-arched palate. Likely diagnosis?
**Turner syndrome **
What is the best nutritional advice for a 2-month-old infant born at 27 weeks to promote weight gain?
Adding artificial formula
Indications for Premature Infant Formulas:
Very preterm infants: Typically < 32 weeks gestation (e.g., 27-week neonate).
Low birth weight: < 1500 g or very low birth weight < 1000 g.
Insufficient breast milk: Inability to tolerate, access, or produce enough breast milk.
Catch-up growth needs: Increased nutritional demands in early neonatal care.
13-year-old boy at 5th percentile height, parents at 50th percentile. What is the next step?
A: Bone age
(to assess for constitutional growth delay vs pathologic cause)
Q: What is the likely age of a child who can ride a tricycle, say their name, dress with help (except buttoning), and speak in sentences?
A: 3 years
Q: Which finding in a 3-month-old with burns most suggests abuse?
Child can’t roll at this age
7-year-old stares into space for seconds then resumes activity. Dx?
A: Absence seizure
Explanation:
Absence seizures are brief episodes of impaired consciousness, often with staring, that resolve suddenly. They’re common in school-aged children and typically last a few seconds with no postictal confusion.
Q: How many tetanus doses complete the vaccination in a 6-year-old?
5 doses
Explanation: The primary DTaP (which includes tetanus) vaccination series includes 5 doses at ages: 2 months, 4 months, 6 months, 15–18 months, and 4–6 years.
What is the appropriate initial management for a child with severe dehydration and signs of hypovolemic shock?
0.9% Normal Saline 20 mL/kg bolus
Initial Management:
Severe dehydration/shock: 0.9% NS 20 mL/kg bolus IV over 15–30 min → repeat as needed until perfusion improves
Moderate dehydration (no shock): ORT if tolerated OR 0.9% NS 10–20 mL/kg IV bolus if vomiting
Mild dehydration: ORT 50 mL/kg over 4 hours
Q: What is the most appropriate next step in management for a 9-month-old with cough, fever, O2 sat of 93%, mild intercostal retractions, wheezing, and normal chest x-ray?
A: oxygenation and maintain hydration
Bronchiolitis
Signs: 1- to 3-day prodromal URI symptoms
PE: tachypnea, retractions, polyphonic wheezing, rales
Diagnosis is made by: history and physical exam
Most commonly caused by: respiratory syncytial virus (RSV)
Tx: supportive care (oxygen, fluids, nutrition, nasal suctioning), HFNC
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What is the most appropriate initial next step in a 2-year-old with sudden-onset shortness of breath, wheeze, suprasternal retractions, and SpO₂ of 92%?
Chest x-ray
Child presents with drooling and refusal to eat, suspected epiglottitis. What is the next best step?
A: Intubation
What is the next step in a child with a button battery lodged in the esophagus?
A: Endoscopic removal
Pathophysiology: Button batteries cause injury via hydroxide ion generation at the negative pole upon tissue contact; burns may develop within 2 hours.
Risk of Injury: Highest in the esophagus, with possible extension to the trachea or aorta.
Diagnostic Imaging: X-ray (AP and lateral views) is the first-line tool.
- AP view: Look for “double rim” or “halo” sign, characteristic of button batteries.
- Lateral view: May reveal a step-off due to different pole thicknesses.
Management Based on Location:
1. Esophagus: Requires emergency endoscopic removal within 2 hours. Do not delay for further imaging if diagnosis is suspected.
2. Stomach:
- If asymptomatic: Elective endoscopic removal may be considered.
- If symptomatic: Emergency endoscopic removal is indicated.
3. Beyond the Stomach (Bowel):
- If asymptomatic: Conservative management with close monitoring.
- If symptomatic or no progression on serial imaging: Emergency intervention needed.
- Signs of bowel obstruction or perforation also warrant urgent action.
Monitoring and Follow-up:
- Serial X-rays every 3–4 days to confirm passage through the GI tract.
- Inspect stool for battery passage.
- Surgical consult if battery fails to progress or if the patient becomes symptomatic.
Q: What is the next step in a child with choking and effective cough (still coughing)?
in MCQs, best one was: abdominal thrust
age-based choking management
Infants (< 1 year):
- If severe airway obstruction (unable to cough or breathe): perform 5 back blows followed by 5 chest thrusts
- Do not perform abdominal thrusts (risk of injury)
Children ≥ 1 year:
- If severe airway obstruction (ineffective cough, cannot speak or breathe): perform abdominal thrusts (Heimlich maneuver)
- Do not perform back blows (risk of pushing object deeper)
Effective cough at any age:
- Do not intervene with back blows or abdominal thrusts
- Encourage the child to continue coughing
- Monitor for signs of deterioration
❗true answer **A: Encourage coughing and monitor **
KEY in management :
❗Do not perform back blows or abdominal thrusts: These maneuvers can convert a partial obstruction into a complete one by dislodging the object into a more dangerous position.
Encourage effective coughing: Allow the child to continue coughing spontaneously, as this is the safest and most effective way to expel the foreign body.
Close monitoring is essential: Observe for any signs of clinical deterioration, such as:
- Ineffective cough
- Increased respiratory distress
- Cyanosis
- Decreased level of consciousness
Escalate care if needed: If the child shows signs of complete obstruction, initiate appropriate life-saving maneuvers based on age and guideline recommendations.
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Q: 3-year-old rocking head forward/backward with eyes closed & round object on X-ray — what to do?
**A: Upper endoscopy **
The double-rim (halo) sign on the AP X-ray confirms a button battery. for emergency removal
The object is centered over the vertebral column, which suggests the posterior structure — the esophagus.
2-year-old with cyanotic spells, squatting, systolic murmur, XR show — most likely cause?
Tetralogy of Fallot
Mnemonic: PROVe:
Pulmonic stenosis, Right ventricular hypertrophy, Overriding aorta, VSD
