Pediatric Board Study #1 10/2020 Flashcards

Question

How should murmur of HCM vs AS differ when valsalva? When squatting?

Answer 1

HCM: louder with valsalva, lower with squat Explanation: - In normal circumstances, increase flow through a cardiac lesions causes a louder murmur. Increased venous return is an example. - HCM is the opposite. Murmur is caused by the interaction between Septum and Mitral valve. Since increased venous return “separates” the two from each other, murmur decreases

Answer 2

- Handgrip increases afterload - Forward flowing murmurs (e.g. AS, HCM) decrease with hand grip since it’s a counter force - Backward flowing murmurs (e.g. mitral regurgitation) increase with hand grip

Answer 3

Cervicofacial

Answer 4

- Golden tree: branching chains gram positive bacilli - Head and neck with tree coming from top: cervicofacial presentation like neck massage - dentures hanging on the tree: oral flora - Abe Lincoln with blue light saber cutting down teeth: penicillin

Answer 5

Humidity means more water in the air. Keeps sweat on skin from evaporating. Less cooling. COOL Phys: the process of evaporating liquid sweat provides cooling. It requires energy, energy taken as heat from the body, leading to cooling.

Answer 6

Stroke: CNS sx and 104 (40 c)

Answer 7

Phenotypically similar to each other but Noonan has normal karyotype.

Answer 8

Pulmonary stenosis

Answer 9

Hypopigmentation, atrophy and TELANGIECTASIA

Answer 10

Ointments > creams > lotions > solutions > foams

Answer 11

Low to medium potency | Low for face and intertriginous areas

Answer 12

Picmonic: - ixodes scapularis: ixodia head on tick - Maltese cross in RBC: throwing Maltese crosses - Northeast and Midwest: Jew - Hepatomegaly: liver shield hit by Maltese crosses - hemolytic anemia and thrombocytopenia: broken plates and RBC from stars

Answer 13

Authoritative parenting style TIP: balance the rules a parent sets with encouragement and love. Does NOT mean there is no room for personal choice, but has to be age appropriate.

Answer 14

The ability to first withstand hardship, then adapt to it, followed by recovery from it.

Answer 15

Volume of RBC/the Volume of Blood usually expressed as a percentage

Answer 16

In the third trimester, iron stores from the mother are transferred to the fetus. In addition, the liver becomes more sensitive to hypoxia, producing more EPO. Preterm infants miss this last stage of increased RBC production, hence lower Hematocrit TIP: In the fetus, the liver, NOT the kidney, acts as the producer of EPO in response to hypoxia

Answer 17

Thyroid dysgenesis which is the abnormal development of the thyroid, which is either of 3 things: - incomplete development of thyroid tissue - lack of thyroid tissue - ectopic thyroid tissue that is dysfunctional

Answer 18

- Red indurated plaques, somewhat similiar appearing to cellulitis - No treatment; reduce exposure to cold; resolvs in 3 weeks

Answer 19

Inflammation of the subcutaneous fat (e.g. erythema nodosum)

Answer 20

- Bun/Cr - Complement levels GN is associated with HTN and azotemia

Answer 21

POC Glucose

Answer 22

Polysomnography with multiple sleep latency tests

Answer 23

1) Cardinal feature: Daytime sleepiness - TIP: VERY COMMON SYMPTOM IN GENERAL 2) Hynagogic hallucination: 3) Sleep paralysis 4) Cataplexy

Answer 24

Patient instructed to sleep every 2 hours for 20 minutes In Narcolepsy, sleep latency is short and REM is reached in 2 out of 4 sleep periods

Answer 25

- Septic thrombophlebitis of the internal jugular vein | - Fusobacterium Necrophorum

Answer 26

- Classically, pharyngitis | - However, any head and neck infections, including otic and dental

Answer 27

ALL children that received HSCT require 3 doses of Hib vaccine 6 months AFTER HSCT/completion of immunosuppressive therapy - REGARDLESS of prior vaccine status

Answer 28

- "TWO 6-MONTH-old Pediatric POLIticians DIscussed Rejecting HIs HEP B at 4 MONTHS" - 2/6 months have the same 6 shots - 4 mos has same shots EXCEPT Hep B - P: PCV - Poli: POLIO - DI: DTAP - R: RV - HI: Hib - HEP: Hep B TIP: First 6 months, 6 shots each time.

Answer 29

- Pain in medial aspect of knee - Localized swelling in the medial aspect of knee - Pain with valgus stress

Answer 30

Joint effusion around entire knee

Answer 31

Unconjugated hyperbilirubinemia

Answer 32

Conjugated bilirubin > 1.0 - SIMPLE!

Answer 33

Biliary atresia, a progressive obliterative disease of intra/extra hepatic biliary ducts that leads to liver diseas

Answer 34

Presence of: - Micrognathia - Cleft palate - Glossoptosis (retracted and downward displaced tongue, leads to obstruction)

Answer 35

- Obesity with addn risk factors: - Family hx of Type II DM - High risk ethnicity: Native American, Asians, Pacific Islanders, Hispanics, African americans (TIP: NOT whites/indians/middle east) - PE signs of insulin resistance Styne DM, Arslanian SA, Connor EL, et al. Pediatric obesity-assessment, treatment, and prevention: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;

Answer 36

- Fasting glucose - A1c - Oral glucose tolerance test

Answer 37

YES! Like any other substance, even as culturally acceptable as marijuana, as long as it causes dysfunction in a patient's life, it can be considered a disorder that requires treatment

Answer 38

Dental pain is the most common cause of referred otalgia COOL PHYS: Referred pain comes from misinterpretation of the sensory cortex 2/2 overlapping innervation The auriculotemporal branch of the mandibular division of the trigeminal nerve supplies sensory innervation to parts of the auricle, external auditory canal, and tympanic membrane, as well as the cranial cavity, scalp, orbit, face, nose, nasal cavity, nasal sinuses, mouth, teeth, temporomandibular joints, and parotid glands.

Answer 39

- Splenectomy 2/2 a primary blood disorder - Splenectomy at a young age - Recent splenectomy

Answer 40

Encapsulated bacteria: - SHiNSKiS - Salmonella - Hemophilus Inf - Neisseria Meningitiditis - Staph aureus - Klebsiella - Strep Pneumoniae EXTRA: Pseudamonas, E. Coli, Group B Strep

Answer 41

< 5 yo (high risk for complications)

Answer 42

- Distributing possessions | - Posting about suicidal thoughts via social media

Answer 43

Rickettsia rickettsia

Answer 44

Galactose 1 phosphate uridyltransferase

Answer 45

- Metabolic acidosis - Hypoglycemia - Coagulation disorder - Hyperbilirubinemia - Hepatic injury

Answer 46

- Early localized: erythema migraña - Early disseminated: - Carditis, heart block - CNS, meningitis, facial palsy - Arthritis - Diffuse rash - Late disseminated: large joint arthritis effusion which tends to be out of proportion with pain and inflammatory markers

Answer 47

Ankylosing spondylitis is a subtype of JIA called enthesitis related arthropay (ERA)

Answer 48

Starts with oligoarthritis of hip, knee and ankle Then later axial skeleton Imagine the arthritis creeping up the body to reach the back

Answer 49

he Schober test is used to measure forward flexion of the lumbar spine—with the patient standing straight, a mark is made over the spinous process of the 5th lumbar vertebra; a second mark is then made 10 cm above it. After asking the patient to bend maximally forward, the distance between the 2 points is normally > 15 cm. Measurements ≤ 15 cm are consistent with limited forward flexion.

Answer 50

CPS and Health Department

Answer 51

- Sequential | - At the same time

Answer 52

3 + 1/4( # points) = age 1 point for every body part: - nose - mouth - pair of eyes - pair of arms - pair of legs

Answer 53

Sudden death attributed to exertional rhabdomyolysis (a.k.a. “exertional sickling") has been reported among athletes with sickle cell trait

Answer 54

Anytime as long as the lesions are covered

Answer 55

- Epidural hematoma: "Above" the dura. Between the skull and the dura mater - Subdural hematoma: "Below" the dura. Between the dura and the arachnoid mater - Review: - Skull -> Dura -> Arachnoid mater -> pia mater - Veins draining blood from brain parenchyma cross all the layers until reaching the dural sinuses

Answer 56

- Subdural: Crescent shaped. - Exp: location of bleed between dura and arachnoid mater, hence, it can cross suture lines, but not midline - Epidural hematoma: Lenticular shaped - Exp: location is between periosteum and dura; since dura is attached to the sutures, blood can't cross sutures

Answer 57

Child Abuse

Answer 58

Viral infection

Answer 59

Voice abuse

Answer 60

Drug Screen of the meconium as UDS only evaluates drug exposure in the past 5 days.

Answer 61

Random glucose > 200 + Symptoms of hyperglycemia TIP: - A1c, Fasting Glucose > 126, or OGTT > 200 - all x 2 are diagnostic of diabetes

Answer 62

- Celiac disease | - Hypothyroid

Answer 63

140kcal/kg/day

Answer 64

- 0-6 months: 110 kcal/kg/day - 7-12 months: 100 kcal/kg/day - Formula is 20kcal/oz

Answer 65

0-3 months: at least 5 oz/kg/day 3 - 12 months: anywhere between 26 to 32 oz/day - TIP: AKA if feeding 8x/day, anywhere between 3 oz/feed to 4 oz/feed

Answer 66

CT Chest to evaluate for thymoma

Answer 67

- Plasma exchange OR IVIG, both aiming to reduce the burden of autoantibodies

Answer 68

- Antibiotics: Fluoroquinolone, Macrolides and Aminoglycosides - Magnesium - STEROIDS! - cause a transient worsening of symptoms in the first 2 weeks

Answer 69

- Hepatorenal recess - Splenorenal recess - Suprapubic recess - Subxyphoid view to evaluate for pericardial effusion

Answer 70

- Hyperkeratotic scales on the extensor surfaces - Hyperlinear palms - Sparing the flexural surfaces

Answer 71

- Emollient containing alpha hydroxy acid (e.g. ammonia lactate)

Answer 72

Children: - Non severe: Metro vs oral vanc - Sever: Vanc Adult: - Non severe: Vanc - Severe: Vanc +/- metro TLDR: Adult use vanc, vanc, vanc; Children use metro or vanc, but def vanc in severe disease

Answer 73

YES! - Children with lead levels < 5 are more likely to be diagnosed with ADHD and lower IQ's - Pregnant mothers with lead levels < 5 are more likely to have small birthweight children

Answer 74

No breastfeeding since lead can be transmitted through breast milk. PICMONIC: breast with lead pencils

Answer 75

- ALL children < 24 mos of age require RUS for their first febrile UTI because there are high risks for anatomic abnormalities. - VCUG is pursued later if RUS demonstrates any abnormalities to evaluate for VUR

Answer 76

TIP: The move invasive the procedure, the lower amount of bacteria required to diagnose UTI since it is more sterile and less likely to be contaminated - Suprapubic aspiration: ANY bacteria - Urinary catheterization: >50k CFU - Clean catch specimen: > 100k CFU

Answer 77

HCV Ab at 18 months - Exp: Key is chronic infection. If HCV RNA is measured soon after birth and is positive, it may clear eventually, so positive test does NOT mean chronic Hep C. At 18 months, maternal HCV Ab will have cleared from baby's system.

Answer 78

5% only! TIP: Hep C as an adult will likely be chronic, less likely transmit to baby. Opposite to Hep B, which is less likely to be chronic, high likelihood of perinatal transmission.

Answer 79

- Skeletal maturity (Risser Score) - Degree of curvature ("Cobb angle") - Exp: Skeletal maturity matters because patients that have yet to reach full skeletal maturity have more room to grow. It is during the growth phase that scoliosis worsens the most. If skeletal maturity is near, further changes are NOT expected. Degree of curvature predicts symptoms and morbidity.

Answer 80

Kingella Kingae

Answer 81

PCR assay can help diagnose Kingella (and other organisms) that are difficult to culture

Answer 82

- Small Ears, Large nose, Small mouth: Rat - Eye abnormalities/Vision abn (vision loss, amblyopia, refractive errors, strabismus): Binoculars - Pierre Robin Sequence: bird watching - Treacher: "Preacher"

Answer 83

NONE! Peds Hospitalists who had Treacher Collins Syndrome!

Answer 84

- Girls: Breast development → Pubic hair → Peak height velocity → Menarche. - Boys: Testicular enlargement → Pubic hair → Increased penile length → Peak height velocity.

Answer 85

Puberty in girls begins between 8 and 13 years of age and in boys between 9 and 14 years of age. TIP: 8 looks like breasts; 9 looks like testicle/penis

Answer 86

Puberty in girls begins between 8 and 13 years of age and in boys between 9 and 14 years of age. So, for girls it is no puberty (Breast buds) > 13, boys is no puberty (no testicular enlargement) > 14

Answer 87

Anytime within the year prior to menarche TIP: think of the white discharge as the herald for the red discharge (menses)

Answer 88

Unrestricted VSD, that is, a VSD in which the pressure between the right and left ventricle is normalized, leads to increased blood flow from the left side of the heart to the right. This increased volume to the right side leads to pulmonary HTN and resistance. Eventually, right side pressure becomes greater than left such that shunt goes from right to left - blue blood goes to red blood.

Answer 89

Patient who has < 3 tetanus vaccinations OR unknown who comes in with a human bite needs TIG. THIS IS THE ONLY SCENARIO IN HUMAN BITE THAT REQUIRES TIG

Answer 90

- < 3 tetanus vaccinations or unknown - > 3 tetanus vaccinations, BUT > 5 yo since you are nearing the time of booster which means immunity is waning (booster in general is needed between 4-7 years of age)

Answer 91

- Sepsis - Febrile hemolytic transfusion reaction - Febrile non-hemolytic transfusion reaction - Allergic reaction given hypotension TIP: blood cultures, antibiotics and labs to evaluate for hemolysis

Answer 92

Clonidine is a central alpha 2 agonist, working centrally to decrease the transmission of NE (think of ADHD) as well as decrease the sympathetic outflow peripherally. Hence, central AND peripheral effects - Central: sedation - Peripheral: bradycardia, hypotension (as a result of decreased sympathetic outflow) - Respiratory: apenea, respiratory depression

Answer 93

- If mild, CBT | - If CBT is not sufficient, addition of SSRI is recommended

Answer 94

- Fluoxetine - Sertraline - Fluvoxamine

Answer 95

The obsessions (or intrusive thoughts) for children are more harmful or violent than adults

Answer 96

Localized pain at tibia or fibula ( 50% of the cases) Not associated with activity Responds well to NSAIDS

Answer 97

Adequate caloric intake is the main stay Secondary treatments include Vit D/Calcium, weight bearing exercises

Answer 98

Decreased linear growth compared to normal children

Answer 99

Growth hormone replacement (before puberty) INTERESTING (and sad): Short adult height in patients with end-stage renal disease is also associated with lower self esteem, decreased education, marital status, and decreased income.

Answer 100

IVIG (AND Plasmapheresis). Both have similar efficacy. IVIG is more tolerable. And plasmapheresis is reserved for cases of severe respiratory failure

Answer 101

Triad of Ophthalmoplegia, Areflexia and Ataxia. TIP: the ataxia and ophthalmoplegia are the key differences between GBS and Miller Fisher Variant TIP: any CN OR brainstem involvement, think of Miller Fisher

Answer 102

- Parkland formula: 4ml/kg x weight (in kg) x body surface area affected (%) TIP: think of a park on fire. - First 24 hours

Answer 103

"Rules of 9" Girl diagram

Answer 104

Fluid deficits from burns + fluid maintenance for the day = fluid deficit for the first day Parkland formula + Holliday Segar 4ml/kg x weight (kg) x surface area burned (%) + 100 x weight (kg) = total fluid needs of the first day

Answer 105

Post partum depression is a risk factor for developmental delay

Answer 106

PICMONIC or Mnemonic - Chest up in prone position - Holds hands together at midline; holds rattle - Coos - Social smiles Picmonic: Imagine baby swan; prone; rattle between 2 hands; chin propped up and chest off the ground; smiling big to camera; "2 is coo"

Answer 107

Polyethylene Glycol

Answer 108

Fecal incontinence

Answer 109

Palpable Purpura Abdominal Pain Arthritis Hematuria

Answer 110

Skin (edema/palpable purpura) > Arthritis > GI > Renal TIP: Though renal is the least common organ affected in the classic presentation. It is the one that warrants follow up

Answer 111

- Renal involvement is seen in 30% to 50% of children and presents with varying severity including NO inolvement, microscopic hematuria, macroscopic hematuria, proteinuria, nephrotic syndrome, nephritic syndrome, and rapidly progressive glomerulonephritis No involvement: monthly UA Hematuria or non-nephrotic range proteinuria: weekly UA The rest: Nephrology

Answer 112

Unilateral rhinitis, possible green-yellow discharge | Foul breath odor

Answer 113

Characteristic physical examination findings include edematous, pale, or bluish nasal turbinates; allergic shiners; Dennie lines (folds under the eyes because of edema); and a transverse nasal crease.

Answer 114

The best screening test for Lesch-Nyhan syndrome is a urinary urate-to-creatinine ratio, which will be greater than 2.0 in a child who is younger than 10 years of age WATCHOUT: Hyperuricosuria and hyperuricemia (serum uric acid concentration >8 mg/dL [476 µmol/L]), while often present, are not sensitive or specific enough to confirm the diagnosis.

Answer 115

- Hypoxanthine-guanine phosphoribosyltransferase enzyme activity is reduced leading to excess uric acid that deposits - X Linked - hence, ONLY boys are affected; girls who are carriers are NOT affected

Answer 116

The recommended treatment regimen for uncomplicated N gonorrhoeae infections of the cervix, urethra, and rectum is ceftriaxone 250 mg intramuscularly in a single dose (if unavailable, cefixime 400 mg orally as a single dose) PLUS azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days Reason is because of resistance

Answer 117

- They are the opposite - one is an NSAID the other is a prostaglandin - Prostaglandin OPENS the PDA is needed in ductal dependent pulmonary or systemic flow - Indomethacin closes the PDA

Answer 118

- Patient has CHD that is ductal dependent, likely to pulmonary flow. At birth PDA was open so pulmonary flow was adequate, but as PDA closes, cyanosis occurs in the case of ductal dependent pulmonary flow

Answer 119

- Functionally, the first 24 hours of birth | - Complete closure doesn't occur until 3 weeks

Answer 120

- 6 mos to 2 years, hence the recommendation of RV vaccination from 2-6 mos of age.

Answer 121

Brushing with fluoridated toothpaste should begin with first tooth eruption

Answer 122

< 3 yo: grain of rice size | > 3 yo: pea size

Answer 123

The AAP recommends application of fluoride varnish every 3 to 6 months to both primary and permanent teeth starting at tooth eruption

Answer 124

Coagulopathy (INR > 1.5) and encephalopathy that occurs acutely (< 26 weeks)

Answer 125

If INR > 4, diagnosis can be made without the presence of encephalopathy

Answer 126

- 50%: unknown - Infectious: EBV, Adenovirus, Parvovirus, HSV are most common. - TIP: Hep A, B and C are uncommon causes in children - Toxins: Acetaminophen, phenytoin, valproic acid, isoniazid - Metabolic: Wilsons, galactosemia, tyrosinemia, urea cycle defects, and mitochondrial disorders - Autoimmune: - Ischemic: Budd Chiari Syndrome

Answer 127

Orientation and mobility training is essential to ensure that children with visual impairment are able to navigate their environment safely and effectively

Answer 128

20/400 or worse when best corrected for visual acuityP

Answer 129

These are outlined in the American Foundation for the Blind Expanded Core Curriculum

Answer 130

HYPOGLYCEMIA, early onset sepsis, seizure, metabolic disorder

Answer 131

- Recurrent bacterial infections suggest innate immune system - Recurrent or atypical viral infections suggest adaptive immune system

Answer 132

- X linked: X ninja stars - Oxidative burst defect: bubbles of grandmas stuck with X marks the spot - Skin and lung infections: girl in bikini flying around with a jet pack, with staff popping bubbles - Staph aureus abscesses

Answer 133

Flow cytometry to access oxidative burst, achieved through testing of the Dihydroxy-rhodamine 123 reduction

Answer 134

Hamartoma is a tumor made up of the cells normally found in the anatomic site where it is found. It is also always benign. Teratoma is a tumor made up of cells that differentiate toward somatic cells (typical of adult or embryonic development) NOT normally found in the anatomic site where is is found. Can be malignant

Answer 135

Tan, hairless plaque with a velvety texture that was present at birth. COOL PHYS: A nevus sebaceus is a hamartoma, composed of sebaceous and apocrine glands and epidermal elements, that is present in 0.3% of newborns. It will grow in puberty because androgens will have affect on the sebaceous glands as is the case in other parts of the body

Answer 136

TIP: Hyperglycemia and the absence of DKA labs BG > 600 + OSM>320 + absence of DKA (pH >7.3, Bicarb > 15, little to no ketones)

Answer 137

Insulin rate is lower: 0.05 u/kg/hour (instead of 0.1 u/kg/hour)

Answer 138

VACCINATED close quarters! TIP: 2 dose mumps vaccination only confers 88% immunity

Answer 139

- Ruling out other dangerous causes of acute ataxia - Normal MRI - Normal Lumbar puncture

Answer 140

"Acute cerebellitis" is more severe and associated with encephelopathy

Answer 141

2-5 years old

Answer 142

Typhoidal salmonella: resource limited countries, fever and constitutional sx predominate some abdominal pain due to bacteremia TYPHOID FEVER occurs in resource limited places Nontyphoidal salmonella: US, gastroenteritis predominant presentation

Answer 143

- slow speech that emphasizes al the syllables, almost like slurred speech - Ataxia, hence cerebellar

Answer 144

Jervell Lange Nielson Syndrome

Answer 145

Carbohydrate metabolism disorder Explanation: Sugars or carbohydrates have the ability to reduce other substances e.g. cupric ions to cuprous ions. The presence of the reducing substances in the urine implies carbohydrates in the urine. The presence of carbohydrates in the urine implies excess carbohydrates. This implies carbohydrate metabolism disorder TIP: so fatty chain oxidation disorders do NOT have reducing substances in the urine

Answer 146

Rash comes AFTER the fever (when defervescence occurs) - Starts in the trunk and spreads to the face, neck and extremities; lesions are distinct, discrete and can be papular

Answer 147

6-15 months (TIP: same as febrile seizures)

Answer 148

Development of diabetes Hypertension Cardiomegaly TIP: become the opposite of an athlete, someone with heart disease, HTN and diabetes

Answer 149

Nearly 100%

Answer 150

Osteochondritis and periostitis

Answer 151

- Overlapping fingers - Dysplastic nails - Rocker bottom feet

Answer 152

Most die within 1 year Median survival is 2 weeks Cause of death usually due to renal anomalies or heart defects

Answer 153

No, even death

Answer 154

Penicillin + Beta Lactamase Inhibitor

Answer 155

Triad: Torticollis, Fever and Odynophagia

Answer 156

Supravalvular aortic stenosis

Answer 157

Strong expressive language skills, socially engaged, polite and very endearing "Elfin appearance"

Answer 158

VSD TIP: Remember that alcohol ablation is used to treat HOCM. So, alcohol during fetal period is a natural "ablater" of the septum

Answer 159

- At birth: HBIG and HBV vaccine - Then HBV at 1, 2, 6 months TIP: DO NOT COUNT HBV at birth as one of his vaccines.

Answer 160

No, because seroconversion rate is low in infants < 2kg. So, no HBV at birth. But at 1 month of age, regardless of weight, seroconversion rate is similar to term infants

Answer 161

Acyclovir AND STEROIDS

Answer 162

TIP: presentation is the sequelae of cranial nerve 7 and 8 involvement - Vesicular rash around and in the ear canal (oropharynx, soft palate and 2/3 of tongue) - Facial nerve palsy - Tinnitus, vertigo, hearing loss, ataxia

Answer 163

Ramsey Hunt - King tut hunter shooting an arrow - Shooting arrow into a giant ear - Missing and hitting the bell located on the ear lobe - Standing on a cliff (CN 7) - Handcuffed to the ground (CN 8)

Answer 164

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections) COOL PHYS: Autoimmune anti streptococcal antibodies cross the BBB and cross react with tissue and affect caudate, putamen and pre-frontal cortex

Answer 165

Danazol increases the level of C1 esterase inhibitor

Answer 166

Increases it in Strep Pneumoniae

Answer 167

PRSS1 gene TIP: Think press the pancreas Cool phys: Gene mutation leads to defective trypsinogen that prematurely converts to trypsin while still in the pancreas and causes inflammation

Answer 168

As long as the graft is there, immunosuppresive therapy will be required TIP: LIFELONG

Answer 169

The deceased donor has longer cold ischemia time. So reperfusion injury is more common

Answer 170

Abdominal U/S

Answer 171

Corrected visual acuity worse than 20/40

Answer 172

Although AAI has been reported in up to 27% of individuals with DS, only 1% to 2% experience symptoms. Best evidence indicates that identification of AAI on cervical spine radiographs in asymptomatic DS patients does not predict future injury in those who participate in unrestricted sports activity. AAP does not recommend screening cervical spine radiographs in these athletes if they are asymptomatic and have normal neurologic examination findings. Interesting: Special Olympics requires radiographs

Answer 173

Tramadol and Codeine are NOT recommended given variable metabolism and concern for undertreatment of pain. Morphine is preferred In 2012, the World Health Organization published the Guidelines on the Pharmacologic Treatment of Persisting Pain in Children with Medical Illnesses

Answer 174

Cerebral hypoxia

Answer 175

Serology (IgM/IgG) of BOTH the CSF and blood TIP: Though called WNV, it is common all over the US

Answer 176

Most US states, with the highest numbers seen in California, North Dakota, South Dakota, Oklahoma, Colorado, and Nebraska

Answer 177

Viral symptoms such as conjunctivitis, cough, coryza make the likelihood of Group A Strep pharyngitis less likely.

Answer 178

Simply, how is hypercarbia accompanied by hypoxia in hypopnea? - Decreased air intake leads to decrease O2 in alveoli - Decreased ventilation leads to alveolar collapse, which leads to intrapulmonary shunting (pulm blood flow through collapsed alveoli) - As CO2 increases in the alveoli, O2 decreases, as consistent with the ideal gas law that PV= nRT. P is total pressure exerted by the sum of the partial pressure of each molecule. In order for P remains the same, if partial pressure of CO2 increases in hypercapnia, then partial pressure of O2 must decrease.

Answer 179

75%! It is the rule, not the exception - Anxiety, depression, speech/language disorder, autism spectrum disorder, learning disability, oppositional defiant disorder, and tic disorders

Answer 180

Stimulant meds such as amphetamine/methylphenidate and Atomoxetine TIP: NE reuptake inhibitor, hence more NE, vasoconstrictor

Answer 181

All children with developmental delay, multiple congenital anomalies or intellectual disability of unknown etiology

Answer 182

4 p deletion: Sail boat - picmonic for "P": pearl - sailing toward an island with pearls and clams Facies: wolve with a "greek helmet", small ears with large holes (like african tribes) - Greek helmet nose - Ear pits Antibody deficiencies (69%) - Zangief tied to the mast by kidneys and ureters cardiac defects (50%) - Wolf with spear pierces piercing heart/brain urinary tract anomalies (30%) - central nervous system malformations (80%) -

Answer 183

- Born 30 weeks or less - Born less than 1500 gm COOL PHYS: abnormal growth of the retinal blood vessels sometimes INTO the vitreous and causing retinal detachment. Hence laser for photocoagulation to stop vessel growth

Answer 184

Mittelschmerz occurs from ovulation, hence 1-2 weeks BEFORE menses and should ONLY last 1 day the most Primary dysmenorrhea occurs right before menses and into menses

Answer 185

- O2 sat < 90% x 1 - DUH | - 90-95% OR greater than 3% difference between right foot and right hand x 3

Answer 186

- Jerk nystagmus involves a slow phase followed by fast phase. - Pendular nystagmus is a slow sinusoidal oscillation

Answer 187

Spasmus nutans is a childhood condition characterized by a clinical triad of dysconjugate pendular nystagmus, torticollis, and head bobbing (this is the "spasms")

Answer 188

Congenital nystagmus present at birth, but usually diagnosed at 3 mos of age Spasmus nutans diagnosed between 6 mos to 1 year of age They are both on the differential for infants with nystagmus

Answer 189

- SG < 1.020 - tubular dysfunction - epithelial casts - tubular dysfunction - FeNA> 2% - tubular dysfunction - Na > 20

Answer 190

- Thicken feeds and avoid overfeeding | - If persistent, can trial hydrolyzed formula or have mother eliminate dairy from her diet (if breastfeeding)

Answer 191

TIP: flexion of the fingers occurs through these 2 tendons Test flexor digitorum profundus: hold the middle phalanx of the suspected injured finger to prevent PIP from flexing; ask patient to flex so to test flexion of the DIP Test flexor digitorum superficialis: Stabalize the 2 fingers flanking the suspected injured finger, ask patient to flex the injured finger to test flexion of the PIP and MCP

Answer 192

Tendon tear as noted by digitorum profundus and flexor digitorum superficialis on exam

Answer 193

A Still murmur is a classic innocent murmur typically described as a low-pitched, musical, 2/6 systolic murmur heard best at the lower left sternal border that changes with position and is not heard during the Valsalva maneuver.

Answer 194

- Married - Joined the military and are active - Judge granted

Answer 195

Assent is an interactive and ongoing process between a child and a clinician wherein developmentally relevant information is disclosed about a particular intervention. During the assent process, the child is engaged and his or her input is sought. The goal of assent is to protect children’s rights by allowing them to voice their preferences when it is appropriate to do so. TIP: Assent is like consent, but developmentally appropriate for the age.

Answer 196

"5,4,3,2,1" Rule 5 days of fever 4/5 symptoms: - B/l conjunctivitis, non-purulent - Oral findings: red tongue, chapped lips - Lymphadenopathy > 1.5cm - Hands/Feet: Desquamating rash, edema - Diffuse rash described as maculopapular or erythoderma 3 supplementary labs: Leukocytosis, Anemia, Thrombocytosis, AST/ALT, hypoalbuminemia, leukouria 2 inflammatory markers: CRP/ESR 1 ECHO finding

Answer 197

High dose ASA (100mg/kg) | IVIG 2gm/kg

Answer 198

Ecythema Grangenosum Painless, necrotic, ulcerative cutaneous lesion with a gray-black eschar with surrounding redness.

Answer 199

- Put the baby to bed when awake, but drowsy - Nightly, wait progressively longer times prior to checking up on infant (extend by 10 minutes/night) - When checking on child, limit to 1-2 minutes and soothe by patting, NOT carrying

Answer 200

Winshield wiper fluid Household solvents (TIP: solvents are substances that dissolve other things) Perfumes Cooking fuels

Answer 201

It competitively inhibits alcohol dehydrogenase Alcohol dehydrogenase metabolizes methanol into formaldehyde, which later metabolizes into FORMIC acid. This is the toxic metabolite

Answer 202

Rapid decompensation first 24-72 hours of birth Neonatal period. Hence, Urea cycle defect should be on the diff/diag in a neonate who decompensates

Answer 203

- Hyperammonemia - Progressive respiratory alkalosis due to the above - NAGMA - Normal glucose COOL PHYS: Urea cycle is the cycle by which proteins are broken down. Nitrogen is broken down to urea that is excreted in the urine. Build up of nitrogen leads to accumulation in the form of ammonia, hence hyperammonemia implies a protein metabolism defect, hence urea cycle disorder

Answer 204

X linked TIP: this is the ONLY urea cycle disorder that is NOT recessive. ALL are recessive.

Answer 205

Urine Orotic acid and plasma amino acids Urine orotic acid, if high, indicates OTC Plasma amino acids demonstrate which AA are not being metabolized appropriately

Answer 206

Yes, 3 months of Pyrimethamine, Sulfadiazine and Folinic acid

Answer 207

Yes, no need to be immunocompromised

Answer 208

Whenever patient becomes immunocompromised. For example, new diagnosis of leukemia. Reason: Acute toxoplasmosis is due to reactivation of previous infection instead of new primary infection

Answer 209

American Indian

Answer 210

American Academy of Pediatrics (AAP) approved updated recommendations for the use of quadrivalent (serogroups A, C, W-135, and Y) meningococcal conjugate vaccines in adolescents and in people at persistently high risk of meningococcal disease (e.g. asplenia, complement deficiency)

Answer 211

11-12, then booster at age 16 (right before college!)

Answer 212

Repeat episodes of pulmonary infiltrates associated wtih anemia and hemoptysis PHYS: milk allergy possibly

Answer 213

Spinal Muscular Atrophy "Muscular atrophy" occurs because of "spinal" cause, that is, neurodegeneration of the anterior horn cells. Hence, presentation is ALL lower motor neuron: areflexia, hypotonia, flaccid paralysis, fasciculations

Answer 214

SMA 1: diagnosed < 6 mos, never sits SMA 2: diagnosed between 6-18 months, sits, but never walks SMA 3: Diagnosed > 18 mos, walks, but falls

Answer 215

In the process of normal sex differentiation, the gonads and internal and external structures begin as bipotential. The sex determining region (SRY) and other genes on the Y chromosome are responsible for gonadal differentiation into a testis. TIP: srY is located on the Y chromosome In the presence of SRY gene, testicular Leydig cells secrete testosterone and Sertoli cells secrete anti-Müllerian hormone (AMH). The testosterone stabilizes the Wolffian ducts, which become the epididymis, vas deferens, seminal vesicles, and ejaculatory ducts. Anti-Müllerian hormone causes the Müllerian structures to regress. The Müllerian structures are the uterus, fallopian tubes, cervix, and upper vagina. Testosterone is converted to the more potent androgen, DHT, by 5α-reductase. Dihydrotestosterone is responsible for virilizing the external genitalia, causing growth of the phallus, fusion of the labioscrotal folds, and migration of the urethra to its normal position in the penis.

Answer 216

Testosterone is converted to the more potent androgen, DHT, by 5α-reductase. Dihydrotestosterone is responsible for virilizing the external genitalia, causing growth of the phallus, fusion of the labioscrotal folds, and migration of the urethra to its normal position in the penis

Answer 217

Palpable gonads

Answer 218

First 2 minutes of CPR - AKA the first round of CPR. If no IV, then move to IO.

Answer 219

IO " In a large meta-analysis, the IO route achieved more frequent successful access and improved time to achieving access as compared to peripheral and central venous techniques in patients requiring emergent vascular access in the emergency department."

Answer 220

> 3.5 cm liver edge below the right costal margin | > 2cm in children

Answer 221

Anteroposterior view of the pelvis and a “frog leg” lateral view of the hip.

Answer 222

Crutches and non-weight bearing, referral to Ortho. The key is to maintain the femoral head in the acetabulum. In order to do so, non-weight bearing to keep from persistent strain

Answer 223

Advance directives, also known as "living wills", outline patient's wishes for medical treatment in event of lost decision-making capacity. This does include end of life care, but is not limited to that.

Answer 224

2 months! Super early!

Answer 225

30% is sufficient. More than that yields no added benefit. TIP: protection from BOTH ticks and mosquitoes! Didn't know that!

Answer 226

The updated definition and stages of hypertension are: - normal BP (< 90th percentile) - elevated BP (≥ 90th percentile to < 95th percentile); - stage 1 hypertension (≥ 95th percentile to <95th percentile + 12 mm Hg) - stage 2 hypertension (≥ 95th percentile + 12 mm Hg).

Answer 227

Condoms + another method of contraception to prevent BOTH pregnancy and STI's

Answer 228

> 32 ounces of milk COOL PHYS: - Low BA of iron - The induction of an exudative enteropathy with associated mucosal injury and persistent enteric blood loss not associated with gross bleeding

Answer 229

The RDW is a measure of the variability of red blood cell volume. As the production of hemoglobin becomes more unreliable when iron levels fall, the variability of red blood cell sizes increases, as represented by an increased RDW. The TIBC is a measure of the blood’s capacity to bind iron with transferrin. As the iron concentration falls, the capacity to bind iron increases, and thus the TIBC increases. RDW - red cell distribution width

Answer 230

NSAID! TIP: few rheumatologic diseases can be treated with NSAIDS alone

Answer 231

"4 + 5 + 6 ~ 16" Rule < 16 years old - "Juvenile" 4 Joints = oligo 5 joints = poly > 6 weeks of persistent sx

Answer 232

MTX TIP: Just like RA! Used to be called JRA.

Answer 233

Phimosis is the inability to retract the foreskin Paraphimosis is the opposite, that is, after retraction, you can't reduce the foreskin - Paraphimosis is an EMERGENCY due to ischemia

Answer 234

90% by age 3 | 99% by adolescence

Answer 235

DSD presents in 2 ways: 1) Ambiguous genitalia - neither fully male in appearance nor fully female in appearance 2) Discordant genotype/phenotype sex: - Ex: XY prenatally, but undervirilized genitalia at birth (micropenis) - Ex: XX prenatally, but virilized genitalia (clitoromegaly)

Answer 236

A group of congenital conditions in which the development of chromosome, gonad or anatomic sex (external genitalia) is atypical. And any combination of the three.

Answer 237

Categorize by the chromosomes: - 46 XX DSD - females with virilization - 46 XY DSD - males with undervirilization - DSD with sex chromosome abnormalities - e.g. Klinefelter in which XXY w/ undervirilization

Answer 238

Behavioral inhibition

Answer 239

Mitochondrial Encephalomyopathy Lactic Acidosis with Stroke-like symptoms

Answer 240

Organs highly dependent on aerobic metabolism: - Heart - Muscles - Nervous system

Answer 241

"Maternal inheritance" which means the disorder is transmitted from the mother. This is the case since ALL mitochondrial DNA comes from mothers.

Answer 242

A woman can transmit a variable amount of mutated mtDNA to each of her offspring, thus yielding significant clinical variability among her children, the “bottleneck effect.” In addition, tissue distribution can vary among organ systems, a concept known as “heteroplasmy.” Because of heteroplasmy, a mtDNA pathogenic variant may not be detectable in leukocytes, thus warranting molecular genetic testing of mtDNA in other tissues, such as cultured skin fibroblasts or skeletal muscle for diagnosis.

Answer 243

- Copper transport defect: Copper monkey riding a copper roller coaster ride - Kinky, twisted hair - Corkscrew looking hair - Neurologic/Connective tissue/Bone manifestations are the most commonly affected organs - Neurologic manifestations include seizures - Connective tissue defects include saggy skin and abnormal blood vessels - Bone manifestations include: osteopenia, long bone fractures - X linked - Death by 3 years of age Copper monkey with kinky hair in a transporter, bowling with a clear ball with brain inside, aiming at skeleton bones (instead of bowling pins) and X marks the spot for all the bones

Answer 244

Depends if they are fully vaccinated. If < 2 vaccines, then administer MMR vaccine within 72 hours TIP: HIGHLY contagious, that is, 90% of exposed patients will contract measles

Answer 245

The first dose of MMR is recommended at 12 to 15 months of age, and the second dose is recommended between 4 to 6 years of age.

Answer 246

- Breast development will show a stippled areola with 1- to 2-mm breast bud - Movements of the arms may be characterized as jerky but not irregular - They may exhibit periodic breathing. However, they should not have periods of apnea (cessation of breathing for 20 seconds) - Their ear cartilage should be soft with instant recoil

Answer 247

- Obesity - Vitamin D deficiency - Allergies

Answer 248

Cutaneous anthrax TIP: Pulmonary anthrax has a mortality rate as high as 90%. But this only occurs if bacillus anthracis is aerosolized, something that occurs in bioterrorism

Answer 249

- Neonates with severe pulmonary stenosis should urgently undergo balloon valvuloplasty, and therefore be transferred as soon as possible to a center that performs such procedures regularly. With severe pulmonary stenosis, the right ventricle can ultimately fail because of the increased work needed for pulmonary blood flow in the context of a high pressure gradient. - If O2 sat is abnormal, prostaglandin infusion to keep PDA open

Answer 250

ADEK given abnormal biliary flow

Answer 251

ADEK given abnormal biliary flow

Answer 252

The level of sedation is characterized by patient's ability to respond, the effect of the medication on the respiratory/circulatory system/airway. E.g. - Moderate sedation: purposeful response to verbal commands with or without gentle stimulation, maintenance of cardiovascular function, spontaneous ventilation, and no required intervention for airway maintenance - Deep sedation: INTUBATED; interventions may be required to maintain the airway and ventilation, cardiovascular function is usually maintained, and purposeful response will occur after repeated stimulation.

Answer 253

The American Diabetes Association recommends that insulin should be initiated at diagnosis for youth with type 2 diabetes if the blood glucose is greater than or equal to 250 mg/dL (13.9 mmol/L) or hemoglobin A1c is greater than or equal to 8.5%

Answer 254

- 2-4 year olds do not have a concept of rules and ownership - early school age: understand wrong though they have difficulty fighting the impulse to steal - school age children: around 8 develop a conscience and aware of rules/expectations

Answer 255

Simple cysts result from mature ovarian follicles that did not ovulate and failed to involute.

Answer 256

- Simple cysts come from mature follicles that fail to ovulate and fail to involute thereafter. Luteal cysts come from follicles that ovulate, but fail to involute. - Can only be distinguished by US. Luteal cysts has "echoes"

Answer 257

Shock should be suspected with tachycardia and poor perfusion even without hypotension, as it is often a late finding.

Answer 258

- Adults: 30ml/kg within the first 3 hours | - Children: 20ml/kg boluses, repeat up to 60ml/kg

Answer 259

2 years old TIP: 2 year old > term infant > preterm infant GFR (full renal embriogenesis occurs at 35 weeks, so a 32 weeker hasn't even fully developed his kidneys). Hence, GFR is lower at younger gestation. And lower at birth.

Answer 260

Children and adolescents are at higher risk than adults for hypercalcemia during immobilization because of the high bone turnover state normally seen in these age groups.

Answer 261

Although pediatric SOT candidates may have a decreased immune response to vaccines compared with healthy children, they are more likely to develop vaccine-induced immunity than SOT recipients receiving post-transplant immunosuppressive agents.

Answer 262

In children aged 6 through 18 years at high risk of pneumococcal disease who have not received any doses of PCV13 or PPSV23, administration of 1 dose of PCV13 followed by 1 dose of PPSV23 at least 8 weeks later and a second dose of PPSV23 5 years after the first is recommended. TIP: PCV 13 ALWAYS comes before PPSV23

Answer 263

Oatmeal since rice cereal carries the risk of Arsenic poisoning

Answer 264

Extensively hydrolyzed formula or thicken feeds with oatmeal PHYS: reduced transit time

Answer 265

Testosterone replacement

Answer 266

In individuals with active or recent history of a major psychiatric disorder, including depression, anxiety, psychosis, or schizophrenia, because use of the drug can lead to psychoses and other psychiatric symptoms.

Answer 267

It should not be used in individuals with glucose-6-phosphate dehydrogenase deficiency because it can cause hemolytic anemia.

Answer 268

Breast feeding mothers and renal dysfunction

Answer 269

Atovaquone-proguanil Doxycycline Mefloquine TIP: Like chloroQUINE, they have similar endings except Atovaquone

Answer 270

Up to 50% Hence, recommendation of yearly CXR until 16

Answer 271

5: 2,4,6 mos, 15-18 mos, then 4-6 yo Then Tdap at 11-12 yo

Answer 272

Any of the 3: 1) > 10 days of symptoms 2) Worsening of symptoms after an initial improvement of symptoms 3) 3 days of severe symptoms at the onset of illness

Answer 273

Posterior urethral valve is a condition caused by obstructing membranous folds in the posterior urethra

Answer 274

PUV: Bilateral hydroureteronephrosis UVJ: Unilateral hydroureteronephrosis UPJ: Unilateral hydronephrosis with normal ureter dilation

Answer 275

> 5 minutes of seizure activity

Answer 276

Ativan: 0.1mg/kg IV (max: 4mg) Midazolam: 0.2 mg/kg IM (max: 10mg) Diazepam: 10mg rectal or 0.1mg/kg IV (max: 10mg)

Answer 277

Proximal small bowel: iron, Vit D and Folate | Distal small bowel (ileum): B12, bile salt absorption

Answer 278

- Rabies immunoglobulin and rabies vaccine on day 0 | - Rabies vaccine on day 3, 7, 14

Answer 279

Ascending paralysis

Answer 280

Foxes, bats, skunks, racoons and wood chucks

Answer 281

Graves disease

Answer 282

Graves: Thyrotropin Ab (that is, Ab to the TSH receptor) | Hashimoto's: Anti TPO Ab

Answer 283

HCG is similar to TSH, hence, can bind to the TSH receptor and cause hyperthyroidism E.g. molar pregnancy.

Answer 284

Inhaled corticosteroids have no adverse effect on long-term growth in children. However, poorly controlled asthma can affect growth, as can many other factors.

Answer 285

Gold standard: Head lice infestation is diagnosed by finding live lice on the scalp or eggs attached to hairs that likely are viable (darker in color and located ≤ 1 cm from the scalp)

Answer 286

``` No lice White eggs (empty eggs) > 1 cm away from scalp ``` COOL: Eggs are attached to hairs (within 4 mm of the scalp). Viable eggs are pigmented to match the color of surrounding hair. In contrast, empty eggs (ie, those that have hatched) appear white. Eggs are incubated by the host’s body heat and hatch in 8 to 9 days (range, 7-12 days). Based on this information and the knowledge that scalp hair grows approximately 2.5 mm/wk, eggs located more than 1 cm from the scalp likely have hatched.

Answer 287

1% Permethrin on day 1 then day 10

Answer 288

Electronic-cigarette use is associated with an increased risk of cigarette smoking. Meta-analysis has confirmed that e-cigarette use is associated with an increased risk of cigarette smoking. The use of tobacco and nicotine-containing products is also associated with an increased risk of using drugs like marijuana

Answer 289

These are neuropraxic injuries to the upper trunk of the brachial plexus due to traction or compression commonly occurring in football players Unilateral numbness or weakness may also develop

Answer 290

Significant pain with active neck motion or midline tenderness over the cervical spine should prompt further evaluation, and bilateral upper extremity or any lower extremity involvement must be considered a cervical spine injury until proven otherwise

Answer 291

Augmentin Clinda + TMP-SMX Cinda + 3rd generation cephalosporin

Answer 292

Neuroblastoma or adrenal hemorrhage

Answer 293

Because neuroblastoma is a tumor of the sympathetic nervous system, the catecholamine metabolites VMA and HVA are detectable in the urine of approximately 90% of patients with neuroblastoma

Answer 294

< 18 mos, 90% of breath holding spells occur - On average, they can occur between 6 mos and 4 years of age

Answer 295

Breath holding spells are characterized by strong emotional event prior to episode and color change (pallid or cyanotic)

Answer 296

Aneuploidy is the presence of an abnormal number of chromosomes in a cell, for example a human cell having 45 or 47 chromosomes instead of the usual 46

Answer 297

First of all, this is fetal cells detected in maternal serum. Main purpose is SCREENING for aneuploidies (abnormal NUMBER of chromosomes). (Even though it has HIGH sens/specificity) Means 2 things: 1) NOT diagnostic, so any abnormal findings need confirmation - amniocentesis or chorionic villus sampling 2) Does NOT eval for microdeletions, microduplications, translocations or gene mutations

Answer 298

- HCG - AFP - Inhibin A - Estriol

Answer 299

The chromosomal makeup of the placenta is typically identical to that of the fetus; however, sometimes a mutation is confined to the placenta and the fetus has a normal karyotype. Placental-fetal discordance can occur in 1% to 2% of cases and is known as confined placental mosaicism. Other reasons for placental-fetal discordance in cfDNA include a vanishing twin, chromosomal anomalies in the mother, or chromosomal anomalies resulting from a maternal malignancy. Therefore, an abnormal cfDNA result always warrants confirmation with a diagnostic test such as a fetal karyotype or prenatal microarray, especially before considering termination of a pregnancy.

Answer 300

Topical antifungals including nystatin, clotrimazole, or miconazole

Answer 301

Sodium, as evident from the osmolarity formula, has the maximal osmolar contribution and is important to maintain the ECF volume. Low serum sodium (hyponatremia) mostly equates to hypo-osmolality and indicates relative excess of water as compared to sodium in the ECF. To balance the osmoles, water moves from ECF to ICF in hyponatremic conditions

Answer 302

Children who have experienced an allergic reaction of any severity to eggs should still receive the influenza vaccine

Answer 303

< 5 yo (or < 20kg): 0.1 mg/kg >5 yo (or >20kg): 2mg TIP: dosing is typically HIGHER than that of adults because children don't have opioid tolerance. The higher the tolerance, the easier to precipitate withdrawal or reversal with naloxone. If unresponsive to first dose, repeat with SAME dose TIP: - A patient with HIGH tolerance to opioids needs a lot of opioids to maintain. In this case, a small decrease in the amount of opioids he/she is consuming can easily lead to withdrawal. Hence, small doses of naloxone can trigger withdrawal - On the other hand, an opioid naive patient who has overdosed has no tolerance. Hence, small amounts are need to cause toxicity. Hence, to reverse opioid toxicity, one needs to completely remove all the opioids attached to the mu receptor, hence higher doses of naloxone.

Answer 304

A needle is inserted perpendicular to the skin above the second intercostal space in the midclavicular line. After a gush of air is heard, the needle is retracted and the angiocatheter can be left in place and secured. This procedure relieves the high pressure in the intrapleural space, but it does not resolve the pneumothorax, so a chest tube will be required. TIP: 3-4 inch long catheter

Answer 305

TIP: Dyskinetic CP is CP with extrapyramidal manifestations or ABN MOVEMENT manifestations. Think of ADE of antipsychotics i.e. bradykinesia, dystonia Extrapyramidal or dyskinetic type, typically affecting the arms more than the legs with various abnormal movements (instead of tone) such as bradykinesia, choreoathetosis, hemiballismus, or dystonia

Answer 306

Although there are a variety of causes for dyskinetic CP, the 2 most common are neonatal and include hypoxic-ischemic encephalopathy and kernicterus

Answer 307

It occurs after loss of adipose tissue anterior to the duodenum. Normally, adipose tissue separates the SMA from the third portion of the duodenum; however, when the loss of this tissue occurs, the SMA compresses the duodenum, creating a partial or complete small bowel obstruction.

Answer 308

Cyclic vomiting (episodic vomiting with periods of wellness in between) can be associated with malrotation and intermittent midgut volvulus, abdominal migraine, cyclic vomiting syndrome, drug use (marijuana), SMA syndrome, and eating disorders.

Answer 309

Upper GI series

Answer 310

Duodenal atresia - dilated stomach and duodenum because they are 2 discontinuous loops; the disconnected duodenum fills up from its own contents

Answer 311

Small intestine

Answer 312

Appropriate postexposure tetanus prophylaxis depends on 2 factors: if the child has received at least 3 doses of tetanus toxoid (typically from a primary series of vaccinations) and if the wound is considered to be clean or dirty If dirty: need DTaP/Td/Tdap IF > 5years since last one If clean: need DTaP/Td/Tdap IF > 10 years since last one

Answer 313

Children younger than 7 years who require a tetanus vaccine under this management algorithm should receive the DTaP vaccine, children 7 to 10 years old should receive Td, and children 11 years and older should receive Tdap. TIP: - DTaP for < 7 years - Td for 7 to 10 years - Tdap for > 11 years Pattern: DTaP -> Td -> Tdap

Answer 314

Only 2% of individuals with a penicillin allergy are expected to react to cephalosporins, and less than 1% will react to carbapenems

Answer 315

Downward dislocation of the eye lens is typical in Homocystinuria rather than the upward dislocation seen in Marfan syndrome.

Answer 316

Electrocardiogram showing deep Q waves in the inferior leads (II, III, AVF) should be evaluated for an anomalous left coronary artery from the pulmonary artery (ALCAPA)

Answer 317

When the left coronary artery arises from the pulmonary artery and not the aorta, it leads to an ALCAPA. he natural history of pulmonary vascular resistance is that it begins to drop in the first few months after birth. As the pulmonary vascular resistance begins to drop, and consequently, the pulmonary artery pressure begins to drop, the perfusion pressure of this coronary artery also drops, resulting in myocardial ischemia and necrosis.

Answer 318

BOTH have pustules ET: red base, appears 24-48hours after birth TNPM: pustules without erythematous base, resolves within 24-48 hours; base is hyperpigmented

Answer 319

Specific maternal infections (untreated active tuberculosis, HIV in developed countries, human T-cell lymphotropic virus type I or II, untreated brucellosis, and ebola virus)

Answer 320

While the minimum age of assent varies, children as young as 7 years have developed limited logical thought processes and have the capacity for reasoned decision-making.

Answer 321

It will not affect the CSF cell counts or identification of the organism by molecular methods and is unlikely to obscure the diagnosis. Will affect the culture

Answer 322

Hirschsprung disease is caused by failed migration of ganglion cells to the rectosigmoid region of the colon

Answer 323

Barium enema will show a narrow region (the affected region) and the proximal dilated bowel loops

Answer 324

Medical clearance for return to contact sports requires: - full symptom resolution at rest - full symptom resolution when in academic setting - full symptom resolution with physical activity

Answer 325

Neuroblastoma: Young children with isolated Horner syndrome should undergo careful examination for cervical and abdominal masses, measurement of urinary HVA and VMA levels, and radiologic imaging of the head, neck, and chest.

Answer 326

Superior tarsal muscle vs the Levator palpebrae

Answer 327

Similar to the microbiology of AOM, the most common etiologic agent of acute mastoiditis is Streptococcus pneumoniae, even in the era of the pneumococcal conjugate vaccine (PCV). Other bacterial causes include Staphylococcus aureus (including methicillin-resistant S aureus), group A Streptococcus, nontypeable Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus anginosus

Answer 328

Pheochromocytoma is commonly associated with familial syndromes such as von Hippel-Lindau syndrome, multiple endocrine neoplasia type 2, and neurofibromatosis type 1 All children diagnosed with pheochromocytoma should undergo genetic testing because of the association with these familial syndromes

Answer 329

Pheochromocytomas are catecholamine-secreting tumors that develop from the chromaffin cells of the adrenal medulla TIP: DO NOT mistake pheochromocytomas with neuroblastomas. Former from chromafinn cells and latter from embryonic neural crest cells that are supposed to give rise to the sympathetic chain.

Answer 330

New-onset bilateral lower extremity weakness, a neuroblastoma should be suspected. Neuroblastoma is the most common extracranial solid tumor in children. Can arise from the paraspinal ganglia. It can invade through the spinal neural foramina and create an epidural mass causing spinal cord compression

Answer 331

Patients of Asian descent who have the HLA-B*1502 allele are at risk for serious hypersensitivity reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis (TEN), when treated with oxcarbazepine. FDA recommends testing.

Answer 332

MMR: 12-15 mos and 4-6 years

Answer 333

Hypophosphatemia, hypomagnesemia, and hypokalemia can occur due to intracellular electrolyte shifts as refeeding begins

Answer 334

Risk for invasive pneumococcal pneumonia is increased in children with HIV disease, primary immunodeficiency, immunosuppression related to medical therapy for cancer or inflammatory processes, cochlear implants, or sickle cell disease. Hence, PCV 13 followed by PPSV 23 in this population TIP: - Cochlear implants are a risk factor for invasive pneumococcal diseases - NOT meningococcal disease - Complement deficiencies are a risk factor for invasive meningococcal disease - NOT pneumococcal disease

Answer 335

These may include pleural effusion, empyema, necrotizing pneumonia, lung abscess, atelectasis, pneumatocele, or pneumothorax

Answer 336

Appear within 1 month of age (BUT not present at birth! That would be congenital hemangioma) Grows until 6 months the most Starts to involute by 12 mos Completely gone by 4 years

Answer 337

Propanalol COOL History: The effectiveness of propranolol was first discovered in 2008 when it was observed that infants with infantile hemangiomas who received propranolol for cardiac abnormalities had improvement of their hemangiomas compared to infants who did not receive propranolol

Answer 338

Supravalvular aortic stenosis 75% of individuals!

Answer 339

Penetrance refers to the probability of a gene or trait being expressed. In some cases, despite the presence of a dominant allele, a phenotype may not be present. Expressivity on the other hand refers to variation in phenotypic expression when an allele is penetrant

Answer 340

A contiguous gene deletion syndrome is caused by a microdeletion that encompasses 2 or more genes in tandem position along a chromosome. By virtue of the fact that several genes are involved, contiguous gene syndromes often affect multiple systems of the body. William Syndrome!

Answer 341

Privately run child care centers are considered "public accommodations," similar to private schools, recreation centers, restaurants, hotels, movie theaters, etc, and must comply with the ADA (Americans with Disabilities Act)

Answer 342

Oral valganciclovir for 6 months for SYMPTOMATIC CMV

Answer 343

Cytomegalovirus is the most common congenital viral infection in the United States, occurring in 0.5% to 1% of all live births

Answer 344

Primary infection | Early gestation

Answer 345

Nearly all children with labial adhesions will have complete self-resolution within 18 months, therefore asymptomatic individuals should receive reassurance. Symptomatic individuals (those with urinary problems such as urinary tract infections or urinary retention) should first undergo a trial of twice daily topical estrogen cream.

Answer 346

``` Gross motor: Pedals a tricycle (3 wheels) Alternates feet going up stairs (3 points of contact) Walks on tiptoe Catches a ball Dresses with supervision ``` ``` Fine motor (3 table things) - fork, spoon, pitcher ``` Language: - 3/4 words understandable - 3-4 word phrases Social emotional - Knows first and last name and age - Engages in make-believe play - Understands turn taking

Answer 347

"9, 18, 27" (TIP: technically 24-30 months) Every 9 months

Answer 348

Nasal septal hematomas should be drained expeditiously to prevent permanent cosmetic defects

Answer 349

ON presentation. Sometimes reduced on the spot, but sometimes within 5 days since there is so much swelling initially

Answer 350

Laboratory evaluation showing evidence of muscle breakdown, including elevated levels of creatinine kinase, lactate dehydrogenase, and aldolase, is consistent with dermatomyositis

Answer 351

In addition to confirming the plasma glucose level, measurements of insulin, β-hydroxybutyrate (a ketone body), free fatty acids, growth hormone, and cortisol levels are useful tests to perform. Results consistent with hyperinsulinism include a detectable insulin level, low β-hydroxybutyrate and free fatty acid levels, and appropriately high growth hormone and cortisol levels. Insulin, an anabolic hormone, suppresses fatty acid oxidation and ketone body formation. Hypoglycemia is a normal stimulus for growth hormone and cortisol secretion

Answer 352

Immediate treatment of hypoglycemia includes an intravenous bolus of 2 mL/kg of 10% dextrose followed by continuous infusion of dextrose.

Answer 353

AKA Reactive arthritis, that is, reactive to an infection 1) Arthritis 2) Conjunctivitis 3) Urethritis

Answer 354

Asymmetric, large joints

Answer 355

PPV: HR < 100 despite warm, dry, stim CPR: HR < 60 despite the above

Answer 356

If neonate HR < 100 regardless of PPV, MRSOPA is an aid to re-evaluate/adjust MR-SOPA: M-adjust the mask, R-reposition the head, S-suction the mouth then nose, O-open the mouth and lift jaw forward, P-gradually increase the pressure, A-consider airway alternative (endotracheal tube).

Answer 357

Commonly used standardized measures of adaptive behaviors include the Vineland Adaptive Behavior Scales (VABS) and the Adaptive Behavior Assessment System (ABAS). These rating scales gather information from parents, caregivers, and teachers. The results can be used to assist with diagnosis, identify the child’s strengths and weaknesses, monitor progress, and develop treatment plans. TIP: level of adaptive functioning determines the severity of impairment and is related to the amount of care and supervision that a person needs in the future.

Answer 358

The majority of adolescent pregnancies end in school drop out 60% drop out 2% finish a college degree by 30 yo

Answer 359

Imperforate hymen will present during adolescence in the form of primary amenorrhea, cyclical abdominal or pelvic pain, a lower abdominal mass, or a blue discoloration of the hymen because of hematocolpos. Due to vaginal distention, it can also present with back pain, or difficulty with urination and defecation

Answer 360

RUS findings of hydronephrosis WITHOUT ureteral dilation favor a UPJ obstruction.

Answer 361

Ureterovesical junction obstruction, ureterocele, and an ectopic ureter have ureteral dilation along with hydronephrosis favoring a distal obstruction

Answer 362

Viral: Adenovirus, enterovirus, parvovirus, Epstein-Barr virus, influenza, and human herpesvirus 6 TIP: bacteria, parasites, tick can cause it too! Borrelia! Chlamydia! Listeria!

Answer 363

HPV Almost all sexually active people acquire human papillomavirus at some point in their lifetime.

Answer 364

Condyloma lata - Syphilis - you get it "later" because of secondary syphilis Condyloma acuminatum - HPV

Answer 365

Topical ofloxacin is the treatment of choice for tympanostomy tube otorrhea. TIP: imagine water entering the ear and pseudamonas colonizing the inner ear causing infection

Answer 366

Chronic suppurative otitis media is defined as purulent otorrhea that lasts for longer than six weeks

Answer 367

Aside from the typical AOM organisms, Pseudamonas and Staph Aureus are causative agents TIP: Once you have a tympanostomy, you are exposed to the organisms of EOM, hence staph and pseudomonas

Answer 368

Based on the 2018 Clinical Practice Guideline for diagnosis of PCD , the preferred test in a patient five years of age or older with at least two of the four key clinical features and for whom cystic fibrosis (CF) has been ruled out, is measurement of exhaled nasal nitric oxide

Answer 369

The four key clinical features of PCD are 1) year round, daily, productive cough; 2) year round, daily non-seasonal rhinitis; 3) neonatal respiratory distress in a term infant; and 4) laterality defects (eg, situs inversus totalis). Clinical tip: 2/4 features AND ruled out CF -> pursue exhaled nasal nitric oxide test

Answer 370

The sweat chloride value for this patient is <30 mMol/L

Answer 371

Although a variety of treatments for common warts are available, for most children keratolytic therapy using topical salicylic acid is the preferred initial approach.

Answer 372

A subcutaneous ring block or dorsal penile block should be used during circumcision Acetaminophen and oral sucrose can be used as adjunct therapies but should not be used as monotherapy during a circumcision

Answer 373

Fatty Acid Oxidation Deficiency (FAOD) Naturally, in hypoglycemic states, fatty acids are broken down to provide another source of glucose. The lac of ketones, especially in the face of hypoglycemia means FA aren't being broken down - FAOD

Answer 374

Heart Skeletal muscles Liver Thus, fatty acid oxidation disorders commonly lead to hypoketotic hypoglycemia, hepatomegaly, hepatic dysfunction, myopathy, rhabdomyolysis (elevated creatine kinase), and encephalopathy Phys: Heart and skeletal muscles use fatty acids as their PRINCIPAL source of energy during exercise. Hepatic fatty acid oxidation is an important source of ketone synthesis

Answer 375

1) Urine organic acids 2) Plasma amino acids 3) Plasma acylcarnitine profile 4) Carnitine Analysis (aka total and free carnitine and carnitine esters) - TIP: only one of the labs is from the urine (UOA) urine organic acids - Interesting thing is that each lab can help diagnose disease in multiple categories. For example, PAA will help diag not only amino acidopathies, but also organic acidemias - 1) Urine organic acids (UOA)- helps diagnose organic acidemia - Tip: can help diag amino acidopathies since AA that can't be broken down may go down other pathways and form organic acids instead 2) Plasma amino acids (PAA) - helps diagnose aminoacidopathies 3) Plasma acylcarnitine profile (PAC) - profile of acylcarnitine means which acylcarnitines predominate. For example, acylcarnitine profile with C6-C10 is indicative of MCAD. Diagnose most FAOD and organic acidemias - TIP: Carnitine commonly known because it helps transport fatty acid chains across the mitochondrial membrane for break down. Generally, it is used in BOTH fatty acid break down and organic acid break down. 4) Carnitine Analysis (aka total and free carnitine and carnitine esters). - TIP: For example, simple deficiency of free carnitine is suggestive of carnitine deficiency. Helps diagnose FAOD and organic acidemias

Answer 376

- Pig on a long chain leash - Pulling ship with flag - Magnet pulling the pig - Liver dysfunction - Heart failure - Rhabdomyolysis

Answer 377

Present in 1 of 3 scenarios: 1) severe early-onset cardiac failure that can progress to multiorgan failure 2) hepatic or hypoketotic hypoglycemic form; this type presents in early childhood with hypotonia and hepatomegaly but typically lacks cardiomyopathy 3) Later onset, manifesting with episodic myopathy and intermittent rhabdomyolysis typically provoked by muscle cramps, pain, or exercise PICMONIC: - long bouncy chain attached to a pig vascillating back and forth hitting 1) heart and causing blood to gush out 2) liver on a swan 3) hulk's arm with a heart tattoo

Answer 378

Physical examination in a patient with medial epicondyle apophysitis or avulsion reveals tenderness and possible swelling over the medial epicondyle. There is often pain with full extension and with resisted wrist flexion and pronation.

Answer 379

For the premature infant, after gestational age, intraventricular hemorrhage (IVH) of any grade is the risk factor most closely associated with neurodevelopmental impairment

Answer 380

Intraventricular hemorrhage is primarily seen among neonates of less than 32 weeks' gestation or with birthweights of less than 1,500 g TIP: Just like ROP, size is just as important as age.

Answer 381

The extra digit is most common on the ulnar (little finger) side of the hand, less common on the radial (thumb) side, and very rarely within the middle three digits. Postaxial (little finger) Preaxial (thumb) Central (ring, middle, index fingers) TIP: axial means central, like axial skeleton, which refers to the spine. In the anatomic position, the palms of the hand are facing forward, pinky toward the body and thumb lateral. PICMONIC: imagine the little pinky holding up a POST with a monster truck (Auto dominant). Post axial

Answer 382

Children with polydactyly in the preaxial (thumb) and central locations are more likely to have other congenital abnormalities

Answer 383

In the nonsyndromic patient with intellectual disability, chromosomal microarray and DNA analysis for fragile X are the recommended first-line tests for identifying a cause

Answer 384

"Array-based" describes the use of preselected segments of DNA, which are adhered to a surface. Detecting gains or losses involves either comparison of the patient sample with that of a normal control individual or comparison of signal intensity at the various probes to expected intensity levels. For example, if there is loss of a gene, then the probe will have a low intensity. If there is gain in the gene, the probe will have a higher intensity. Short answer: CMA only quantifies the amount of DNA present- either too much or too less.

Answer 385

CMA only quantifies the amount of DNA present. Therefore, it does not detect structural chromosomal changes that do not result in deletions or duplications (eg, balanced translocations or balanced inversions) as the total amount of DNA is normal.

Answer 386

Benign familial neonatal convulsions Benign neonatal seizures TIP: Terrible names! They both sound the same

Answer 387

Gross motor delays, but otherwise normal development (e.g. cognitive, fine motor, social/langauge, etc)

Answer 388

- Autosomal dominant - Shortened long bones - mainly femur and humerus - Brachydactyly - short fingers and toes - Macrocephaly - Elves/dwarves riding a monster truck - Monster truck has a large a bobble head

Answer 389

Mutation in the fibroblast growth factor receptor 3 gene (FGFR3) that affects bone development

Answer 390

0-3 months: 30 gm/day (TIP: 1 oz every day) 3-6 months: 15 gm/day (TIP: 1 oz every 2 days) 7-12 months: 10 gm/day (TIP: 1 oz every 3 days)

Answer 391

Refers to rate of weight gain > 50th percentile for age. That is, a preterm infant reaches the 50th percentile for his/her adjusted gestational weight

Answer 392

72 fL + age in years

Answer 393

- Aplastic anemia: hypocellular | - Leukemia: hypercellular

Answer 394

Tied to its ability to create a BIOFILM Risk factors for CoNS infection include prematurity, especially in infants who weigh less than 1,500 g, and foreign devices or material. Indwelling devices at risk for colonization with CoNS include central venous catheters, ventriculoperitoneal shunts, and peritoneal catheters. Other foreign material at risk for colonization includes orthopedic hardware, baclofen pumps, prosthetic joints, pacemakers, and prosthetic valves

Answer 395

Salicylates are found in over-the-counter products that have a wintergreen odor including topical analgesics (methyl salicylate) and anti-indigestion medications (bismuth subsalicylate). Oil of wintergreen is a highly concentrated methyl salicylate solution that has a variety of uses ranging from topical analgesics to fragrances. Just a few milliliters of oil of wintergreen can be lethal to a young child

Answer 396

Aggressive intravenous fluid resuscitation is done with the addition of sodium bicarbonate to promote urinary alkalinization to facilitate salicylate excretion. Hemodialysis may be indicated in extremely severe cases of salicylism.

Answer 397

17-hydroxyprogesterone level is the first-line diagnostic test for congenital adrenal hyperplasia 17-hydroxyprogesterone is an intermediate steroid in the adrenal glucocorticoid pathway, which is a substrate for 21-hydroxylase and builds up in 21-hydroxylase deficiency

Answer 398

Males: no PE findings; later adrenal salt-wasting crisis, hence the importance of the newborn screen COOL PHYS: defect in production of glucocorticoids and adrenal mineralocorticoids Females: virilization of the genitalia and no palpable testis COOL PHYS: This defect in adrenal glucocorticoid production results in an elevated adrenocorticotropic hormone (ACTH) level, which stimulates the adrenal gland to make excess androgen

Answer 399

21 hydroxylase deficiency

Answer 400

Surgical treatment of undescended testes is recommended between 6 and 12 months of age

Answer 401

By 3 months of age, only 1% remain undescended Those infants with testes that remain undescended require surgery to bring the testicle into the scrotum (orchiopexy) or remove the testicle (orchiectomy) because they will not spontaneously descend from the abdomen into the scrotum after this age

Answer 402

Mechanical (muscular) lower back pain

Answer 403

Physical therapy for core stabilization is the next best step in management

Answer 404

Spondylolysis is a crack in the pars interarticularis, the posterior aspect of the vertebral ring When spondylolysis is bilateral (ie, 2 cracks occur in the same vertebral ring), the vertebral body may shift forward leading to spondylolisthesis

Answer 405

Fecal elastase < 100 Demonstrates a deficiency in the pancreas to secrete proteases

Answer 406

``` Swachman-Diamond: Short stature Bone involvement Pancreatic insufficiency (exocrine) Pancytopenia (particularly neutropenia) Associated increased infections ```

Answer 407

The most common cause of EPI in children is cystic fibrosis, which is caused by mutations in the cystic fibrosis transmembrane regulator protein, many of which can result in pancreatic insufficiency

Answer 408

Clinical presentation may include: - steatorrhea - fat soluble vitamin deficiency - weight loss - poor growth in children - nonspecific abdominal symptoms (such as bloating, diarrhea)

Answer 409

Tobacco Alcohol Cocaine

Answer 410

An authoritarian style of parenting, characterized by a high level of control and low level of warmth (eg, orders and commands given with expectations for obedience) is the parenting style most associated with aggression. Better psychosocial and mental health outcomes are seen with an authoritative parenting style, where a high level of control occurs in the setting of a high level of warmth (eg, expectations and rules clearly established with engaging and interactive parents) TIP: difference between authoritaRIAN vs authoritaTIVE

Answer 411

Antecedent respiratory or gastrointestinal infection, back surgery, and bone marrow transplantation

Answer 412

Cerebrospinal fluid white blood cells more than 50 per high-power field should prompt a search for concurrent infection.

Answer 413

Thyroid disease

Answer 414

Presence of hives, with or without angioedema, for a period of 6 weeks or longer.

Answer 415

H1 antihistamines, sometimes in higher than usual doses, serve as first-line treatment in combination with H2 antihistamines and leukotriene modifiers.

Answer 416

Asymptomatic, even in severe enzyme deficiency, there is no anemia and no hemolysis. Symptoms ONLY occur in the setting of acute sickness, infection, ingestion of sulfa drugs and fava beans

Answer 417

``` Heinz bodies (denatured, precipitated hemoglobin) Bite cells ```

Answer 418

- Africans - Malaria - X linked - Oxidative burst: - Sulfa drugs - Fava beans - Hemolysis - Jaundiced baby - Blister cells/Heinz body/Bite cells

Answer 419

Intranasal Fentanyl Studies have demonstrated that doses of fentanyl delivered via a transmucosal route have similar analgesic action to intravenous opioids. An advantage of transmucosal analgesics is the ability to provide rapid pain relief without the need for intravenous access.

Answer 420

Hemolytic uremic syndrome is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury SUSPECT in ALL children with the combo of bloody diarrhea AND AKI

Answer 421

The most common cause of diarrhea-positive HUS is Shiga toxin–producing Escherichia coli (STEC). Enterohemorrhagic E coli (EHEC) is the most common organism identified in STEC HUS; EHEC O157:H7 is the most common strain of EHEC associated with HUS in the United States

Answer 422

400 IU of Vit D daily

Answer 423

Vitamin D is naturally found in liver and other organ meats; egg yolk; oily fish such as salmon, sardines, and mackerel; and cod liver oil.

Answer 424

Bony abnormalities including delayed dental eruption, valgus deformity of the leg, kyphosis, widening of the metaphysis of the wrists, and rachitic rosary (an enlarged costochondral junction along the anterolateral aspect of the rib cage) Tip: Bowing of the legs and spine Long bones are osteopenic with thin cortices Widened cranial sutures, frontal bossing

Answer 425

Haemophilus influenzae type b, a gram-negative coccobacillus, is the most frequent cause of epiglottitis in unimmunized children, followed in order by group A Streptococcus (GAS), Streptococcus pneumoniae, and Staphylococcus aureus

Answer 426

Acute epiglottitis can also be caused by viruses (eg, herpes simplex virus), fungi (eg, Candida albicans), and noninfectious sources (eg, physical trauma, chemicals, and heat), especially in adults

Answer 427

Peripheral parenteral nutrition may be considered for very short-term parenteral nutrition supplementation in patients who are not at significant nutritional risk

Answer 428

N. Gonorrhea Neonatal conjunctivitis HISTORICAL DETAIL: Historically, ophthalmia neonatorum was the leading cause of neonatal blindness, caused primarily by Neisseria gonorrhoeae.

Answer 429

Less than 4 mL in volume or 2.5 cm in length prior to age 14 years in boys.

Answer 430

Lack of smell

Answer 431

Delayed puberty caused by Kallmann syndrome is due to a hypogonadotropic hypogonadism associated with anosmia or hyposmia, the lack of or reduced ability to smell. The association results from disrupted migration of gonadotropin-releasing hormone and olfactory neurons in the developing brain. Testosterone and DHT are both essential in gonadarche

Answer 432

Phenylketonuria is a metabolic disorder caused by the enzymatic deficiency of phenylalanine hydroxylase

Answer 433

Universal newborn screening can detect PKU in nearly 100% of cases, thus preventing significant cognitive deficits through early intervention and treatment.

Answer 434

PKU - pikachu epilepsy - static bowl eczema - rash on mice varying levels of intellectual disability and behavioral problems that also include autistic features Parkinson-like features (especially in adults) musty body odor - mustard decreased skin and hair pigmentation - albino mouse Pickachu in a glass bowl causing electricity, white mice running around, putting mustard on their rashes

Answer 435

- Lack of joint attention - Does not copy others’ actions - Has fewer than 6 words - Is not learning new words - Does not show distress when separated from a familiar caregiver

Answer 436

Psychoeducational evaluation through the school

Answer 437

The 2014 International Society of Pediatric and Adolescent Diabetes (ISPAD) guidelines recommend an initial normal saline bolus of 10-12 mL/kg over 1-2 hours, followed by initiation of an insulin infusion. Subsequently, the free water deficit should be corrected over 48 to 72 hours.

Answer 438

In the United States, a total of 4 doses of inactivated polio vaccine at ages 2, 4, and 6 to 18 months and 4 to 6 years is currently recommended for all infants and children TIP: Two 6 mos, pediatric politicians...

Answer 439

Adults and children who intend to travel to and stay for more than 4 weeks in a polio-affected country should receive a single lifetime booster dose of IPV before departure- REGARDLESS if received a complete polio immunization series in childhood and

Answer 440

Over 90% of cases of superior vena cava syndrome are caused by cancer In children the most common cause is a mediastinal mass.

Answer 441

There should be concern not just for compression of the superior vena cava, but also of the right atrium. Should the mass completely compress the right atrium, there would be no blood return to the heart, and cardiac arrest would ensue.

Answer 442

Thumb sign - that is the epiglottis is enlarged and swollen, appearing like a thumb

Answer 443

Intramuscular dexamethasone would not be the recommended first step in management of epigottitis. The role of corticosteroids in the treatment of epiglottitis has not been clearly established, as retrospective studies have not supported their efficacy in improving outcomes, and data from randomized clinical trials are not available.

Answer 444

The presence of pulmonary hypertension or an aortic obstruction (coarctation of aorta or interrupted aortic arch) with a PDA can result in differential cyanosis, which is characterized by a pulse oximetry reading that is higher in the right hand relative to a lower extremity. TIP: in BOTH scenarios, the pulmonary system has higher pressure than the systemic pressures Explain: - In coarctation, if the PDA is after the obstruction, blood will shunt from pulmonary system to systemic system via the PDA, since post obstruction, the systemic pressure is low. And since blue blood to red blood, hypoxia or lower saturations - In pulmonary HTN, blood will shunt from pulmonary system to systemic system via the PDA because the pressure is greater in the pulmonary system in comparison to the systemic circulation, that is, blue good to red blood

Answer 445

Reverse differential cyanosis is seen in D-transposition of the great arteries when either pulmonary hypertension or aortic arch obstruction is also present Explanation: - In coarctation, if the PDA is after the obstruction, blood will shunt from pulmonary system to systemic system via the PDA since post obstruction, the systemic pressure is low. In the case of TGA, blood from the pulmonary system is red blood, so RED, oxygenated blood, is entering the systemic circulation, hence higher O2 saturations in the leg - In pulmonary HTN, blood will shunt from pulmonary system to systemic system via the PDA because the pressure is greater in the pulmonary system in comparison to the systemic circulation. In the case of TGA, the pulmonary system is RED, oxygenated blood, hence oxygenated blood is entering the systemic system via the PDA and the lower extremities have higher O2 sats.

Answer 446

Although it is normal for infants to have a disconjugate gaze in the first 2 to 4 months after birth, eye movements should be conjugate by 6 months. AKA strabismus - abnormal alignment of eyes

Answer 447

Amblyopia, or reduced visual acuity because of abnormal visual development early in life, is the most common cause of visual impairment in children

Answer 448

In childhood, a total of 6 doses of pertussis-containing vaccine are recommended: - DTaP in a 5-dose series, typically at ages 2, 4, 6, and 15 to 18 months as well as 4 to 6 years - 1 dose of Tdap at 11 to 12 years.

Answer 449

Infection with Bordetella pertussis provides only short-term protection against future pertussis infection. Thus, a documented infection should not alter the standard immunization schedule.

Answer 450

The only group for which more than one dose of Tdap is recommended is pregnant women. The vaccine should be administered with each pregnancy between 27 and 36 weeks’ gestation as the best means of protecting young infants from pertussis.

Answer 451

The greatest risk for child sexual abuse is living in a single parent family (family structure) TIP: NOT associated with socioeconomic status or ethnicity

Answer 452

Normal after the first year of life The thrombocytopenia in the first year of age can be life-threatening, but severe bleeding can be prevented through the use of prophylactic transfusions of single-donor platelets when the platelet count drops below a predetermined, age-dependent threshold

Answer 453

These products may cause significant toxicity if ingested. Caustics—also known as corrosives—are concentrated acidic, alkaline, or oxidizing agents.

Answer 454

Many are found in common household products including drain cleaners, toilet bowl cleaners, laundry detergents, stain and mildew removers, floor cleaners, oven cleaners, swimming pool cleaners, rust removers, phenol-based disinfectants, swimming pool products, and batteries. NOT BLEACH

Answer 455

Hypercalciuria is the most commonly identified metabolic cause of renal stones

Answer 456

Citrate (most important), magnesium, and pyrophosphate

Answer 457

Patients 2-8 years of age whose parents have a total cholesterol >240

Answer 458

Middle adolescence (14-17yo): most STI, #1 cause of injury and death are accidents

Answer 459

Late adolescence (18-21 yo)

Answer 460

- Early adolescence (10-13): concrete thinking - Middle adolescence (14-17): concrete thinking and some abstract - Late adolescence (18-21): abstract TIP: abstract thinking allows you to plan and to contemplate consequences

Answer 461

Common pathogens causing recreational water–associated outbreaks of acute gastroenteritis include Cryptosporidium, Shigella, Giardia, norovirus, and Escherichia coli O157:H7

Answer 462

Shigella Clinical tip: no need to treat the seizures with AED as they are self-limited

Answer 463

It is not necessary to perform ultrasonography to screen for renal anomalies in newborns with isolated preauricular skin tags or pits and no other congenital anomalies or risk factors

Answer 464

In newborns with external ear anomalies who have other congenital anomalies or dysmorphic features, a family history of deafness, ear, or renal anomalies, or a maternal history of gestational diabetes, the likelihood of clinically significant structural renal anomalies is higher, and renal ultrasonography is warranted. TIP: the ear and the kidneys look similar. Think of kidneys with ears

Answer 465

Hydrocarbons are volatile substances with low viscosity and surface tension, which favors aspiration, as opposed to swallowing. When aspirated, low surface tension causes the substance to be distributed over a large surface area in the lungs. Aspiration of hydrocarbons causes direct injury to airway and alveolar epithelium. It also causes surfactant inactivation and decreased production of surfactant because of injury to type II alveolar pneumocytes. The decreased quantity and function of surfactant leads to increased alveolar surface tension, alveolar collapse, hypoxia, and increased pulmonary vascular resistance

Answer 466

Demonstrate low to absent levels of β-hexosaminidase A enzymatic activity in the white blood cells

Answer 467

Combination of LMN and UMN (like ALS!) Spasticity, hyperreflexia, ankle clonus, and diffuse muscular hypotonia

Answer 468

The American Academy of Pediatrics recommends developmental screening at 9, 18, and 24 or 30 months, and screening specifically for autism at 18 and 24 months.

Answer 469

Because renal abnormalities can be clinically silent, renal ultrasonography should be performed for all children with Klippel-Feil syndrome Thoracolumbar radiography should be performed to look for additional vertebral fusions and associated scoliosis TIP: Children with vertebral anomalies often have associated renal anomalies.

Answer 470

1) Find the midpoint between the acromion and the olecranon 2) Measure the circumference of the arm and note what length is 40% of the circumference and what length is 80% of the circumference 3) Find appropriate blood pressure cuff: - bladder width is 40% arm circumference - bladder length is 80% arm circumference

Answer 471

Development of unilateral or bilateral salivary gland swelling, typically parotitis, occurs in 95% of patients with symptomatic disease

Answer 472

This refers to the providers involved in medical errors. The can be second victims as these adverse events may negatively impact them. Hence, counseling is recommended for all parties involved to insure appropriate coping skills

Answer 473

In adolescents and young adults, seborrheic dermatitis affects the scalp, eyebrows, glabella, alar or retroauricular creases, beard or sideburn areas, or ear canals TIP: Dandruff is seborrheic dermatitis of the scalp!

Answer 474

Seborrheic dermatitis is a chronic and relapsing inflammatory disorder that affects areas in which sebaceous glands are concentrated. It is especially common in adolescents and young adults in whom sebaceous gland activity is greatest. Although the cause is not fully understood, it may be the result of an inflammatory response to the yeasts of the genus Malassezia Clinical Tip: Hence, treatment is either low potency steroids to address the inflammation or anti fungals to treat the underlying yeast or the combination of both.

Answer 475

GROSS: - Stands well - Starts to take independent steps FINE: - Pincer grasp (pick up 1 thing) - Holds 1 crayon SOCIAL: - Points (1 finger) to desired objects LANGUAGE: - Follows 1 step command

Answer 476

The guidelines now state that universal screening should take place between the ages of 9 and 11 years and then again at age 17 to 21 years. TIP: Additionally, it is normal for lipid levels to decrease during puberty.

Answer 477

"Early" is considered to be age 55 years or younger for a man and age 65 years or younger for a woman.

Answer 478

Children with a positive family history or a moderate- or high-risk medical condition (Item C112) should be screened at ages 2 to 8 years and 12 to 16 years with 2 fasting lipid profiles. (See suggested reading 1 for more information.) The average of these 2 results should be used to dictate next steps.

Answer 479

The narrowest part of the upper airway in a child is the subglottic region

Answer 480

Extrathoracic airway obstruction tends to cause inspiratory stridor, because the highly negative intrathoracic pressure required to draw air into the lungs causes the obstructed area to collapse during inspiration. - TIP: inspiratory stridor = extra-thoracic location In contrast, intrathoracic airway obstruction tends to cause expiratory wheezing, because the positive intrathoracic pressure required to push air out of the lungs causes the obstructed airway to collapse during expiration. - TIP: expiratory stridor = intrathoracic obstruction Caveat: Biphasic obstructive sounds can occur in ANY pathology if moderately severe.

Answer 481

Most prenatal multivitamins contain 60 to 65 mg of elemental iron, which is much higher than the 15 to 18 mg in a typical multivitamin.

Answer 482

4-6 hours after ingestion as that is when serum peaks for supra therapeutic ingestions of iron. Serum iron level aids in determining the use of deferoxamine

Answer 483

TIP: MOST are GI-related, one is total system related Gastrointestinal phase: - Abdominal pain, nausea, vomiting, diarrhea, hematemesis, melena, lethargy, shock, metabolic acidosis Latent phase: recovery Shock phase: shock, coagulopathy, ARDS, renal failure, GI hemorrhage Hepatic phase: hepatic injury Bowel obstruction phase: GOO

Answer 484

Unexpected event that threatens or results in serious injury or death. This is in contrast to potential adverse event in which NO harm is done to the patient

Answer 485

BOTH are potential adverse events, in that , BOTH don't lead to any harm to the patient. (otherwise, called sentinel) There are 2 types of potential adverse events: intercepted and nonintercepted. - An intercepted error is recognized and corrected before it reaches the patient. - A nonintercepted error actually reaches the patient but does not result in harm

Answer 486

``` Increased core temperature < 104 Vomiting, nausea Cramping Dizziness, syncope Tetany ```

Answer 487

Because cow milk is intended for calves, protein and minerals (such as sodium, potassium, calcium, chloride, and phosphorus) essential for the higher growth velocity, are significantly higher than human milk. TIP: think of cow's milk and protein used by body builders - higher protein. cow's milk can lead to GI bleed, hence iron is lower. All solutes are higher, which can cause dehydration given high solute load

Answer 488

Gut bacteria synthesize vitamin K2, an important isoform of vitamin K. Disruption of the gut microbiome (eg, by broad-spectrum antibiotics) can result in vitamin K deficiency For children on long-term antibiotic therapy or prophylaxis, vitamin K deficiency can be prevented through the administration of vitamin K orally once weekly.

Answer 489

Some vitamin K (phylloquinone [vitamin K1]) is derived through the ingestion of green leafy vegetables, but an important isoform of vitamin K (menaquinones [vitamin K2]) is dependent on synthesis or modification by gut bacteria

Answer 490

- UTI/pyelonephritis - Trauma - Perineal irritation - PSGN (PISGN) - tends to be cola colored

Answer 491

- Urinalysis with microscopy (to differentiate between RBC and heme pigments) - Rrine calcium-creatinine ratio (for hypercalciuria) which may be indicative of nephrolithiasis - Serum creatinine and C3 levels (for nephritis) - Renal ultrasonography (for congenital anomalies or bladder mass) - Hemoglobin electrophoresis (for sickle cell disease) since the most common complication of sickle cell trait is renal papillary necrosis

Answer 492

Submucosal cleft palate

Answer 493

Midface hypoplasia describes a situation in which the upper jaw, cheekbones and eye sockets have not grown as much as the rest of the face.

Answer 494

Magnetic resonance imaging

Answer 495

Certain sports, such as swimming, diving, archery, and powerlifting, may pose a high risk to an athlete with a poorly controlled seizure disorder (and potentially to teammates and officials)

Answer 496

Girl's height = [ (father’s height - 5 inches) + mother’s height]/2 Boy's height = [(mother’s height + 5 inches) + father’s height]/2 TIP: The patient's potential height will be within 2 SD of this value TIP: - G, B, G - B, G, B

Answer 497

Tuberous Sclerosis

Answer 498

Ash-leaf spots, which are flat, white, oval macule. TIP: As if ash has fallen around a leaf and you removed the leaf and see a clear spot

Answer 499

Neomycin plus polymyxin B plus hydrocortisone solution or suspension (considered the first-line therapy due to efficacy and low cost)

Answer 500

Dislocations

Answer 501

BOTH are characterized by chronic pain

Answer 502

Work up baby at 24 hours: - If mother with preceding HSV infection (that is, this new infection i more likely recurrent): HSV surface culture and HSV blood PCR - If mother with NO preceding HSV infection (that is, concern for primary HSV infections): HSV surface/blood and CSF + start empiric acyclovir Reason: primary HSV infection higher risk of perinatal transmission (as high as 50%) and need to be conservative

Answer 503

Because perianal bacterial dermatitis may be caused by Streptococcus pyogenes or Staphylococcus aureus, empiric treatment is with oral cephalexin or another antistaphylococcal antibiotic based on local sensitivity patterns. Perianal bacterial dermatitis = cellulitis of the anus

Answer 504

Classic features include taller than normal stature, speech and language delay, cystic acne in adolescence, and learning disabilities. TIP: interesting that the triple sex chromosomal disorders all have tall stature including XXY and XXX and all have learning disabilities , but relatively normal intelligence

Answer 505

Poor CSF penetration

Answer 506

Enthesitis is defined as inflammation at the site of insertion of ligaments, tendons, joint capsule, or fascia to bone.

Answer 507

Use of a topical vasoconstricting agent, such as neosynephrine or oxymetazoline, is generally recommended before any attempt is made to remove a nasal foreign body. These agents decrease localized swelling (which improves the chances of successful foreign body removal) and decrease bleeding. TIP: if you rearrange the letters, neosynephrine looks like NOSE SYNEPHRINE, which looks like Epinephrine for the nose

Answer 508

- Patient blows her nose - Suction catheter - Alligator forceps or a hook can be used to grasp and remove foreign objects from the nose. - Insertion of a small French foley catheter beyond the object followed by gentle retraction of the catheter with its balloon inflated to dislodge the object.

Answer 509

Yes, think of it as an abscess that needs both drainage and diagnosis, but happens to be in the mouth

Answer 510

Clinda and Cefotaxime

Answer 511

A peritonsillar abscess in a child may present with a severe sore throat (sometimes unilateral), fever, muffled or “hot potato” voice, and trismus. Patients may have drooling and decreased oral intake because of odynophagia.

Answer 512

Viral bronchiolitis

Answer 513

TIP: They are asymptomatic in most cases, but when they are symptomatic, they have a wide range of GI manifestations: - abdominal pain - abdominal distention - intestinal obstruction - biliary obstruction- colic, cholangitis, pancreatitis - intestinal perforation - peritonitis

Answer 514

The oral communication method uses the child’s residual hearing, speech, and lipreading to develop spoken language and thus facilitate participation in mainstream environments. In short, the goal of oral communication method is to help the child develop spoken language with what residual hearing he has left

Answer 515

Following symptoms occur at least 50% of the time for patients: 1) Headache 2) Visual changes, especially visual darkening 3) Pulsatile tinnitus 4) Dizziness 5) Back pain

Answer 516

Normal cerebrospinal fluid opening pressure in pediatric patients is between 10 and 28 cm H2O

Answer 517

Tetracyclines (eg, doxycycline and minocycline), excess vitamin A ingestion (including medications that are vitamin A derivatives such as isotretinoin), and growth hormone.

Answer 518

25% to 50%; around 45% Retinoblastoma acts like autosomal dominant in the hereditary type and autosomal recessive in the non-hereditary type. Explain: - Hereditary: offspring receive mutated RB1 gene from parent (mutation in the ova or sperm, aka germ line mutation) and one somatic mutation silences. In this case, there is 90% penetrance. Hence, 50% chance of receiving the gene from mom, and 90% chance that the gene penetrates, that is, 0.5 x 0.9 = 0.45 - Nonhereditary: Child is born with 2 normal RB1 genes, but has 2 somatic mutations in life so that he has 2 abnormal RB1 alleles

Answer 519

Thyroid-binding globulin deficiency is associated with: - normal TSH - normal free T4 levels - low total thyroxine - low thyroid-binding globulin Clinical tip: in reality, I will likely NOT diagnose this as most thyroid disease work up dose NOT include total thyroxine. Since, TSH and Free T4 are normal, I would rarely know that a patient has thyroid binding globulin deficiency. Total T 4 is low because TBG is low

Answer 520

- Palivizumab - Born < 28 weeks + 6 days - Hemodynamically significant congenital heart disease - Chronic lung disease of prematurity

Answer 521

Stop Palivizumab

Answer 522

There is a distinct seasonality to RSV infections. Although the pattern varies by region, outbreaks usually begin in November or December. The peak usually occurs 2 months into the season and ends by March or April.

Answer 523

Granuloma annulare may be differentiated from tinea corporis by the absence of scale, the firmness of the border, and tendency of lesions to have a violaceous color Because the pathology of GA occurs in the dermis, lesions have a “deeper” or “firmer” feel than the border of a tinea corporis lesion

Answer 524

Math - Dyscalculia Reading - Dyslexia Writing - Dysgraphia

Answer 525

2 SD below the mean Each SD is 15 Hence IQ <70 is considered ID

Answer 526

2 SD below the mean Each SD is 15 Hence IQ <70 is considered ID

Answer 527

- 5 days of Augmentin - Sinus precautions: avoidance of nose blowing, swimming, straw use, and playing wind instruments should be put in place. - Follow up ENT 1 week

Answer 528

Reliability is the ability of a tool to give consistent results on repeated trials Validity is the ability of a tool to measure what was intended. For example, a personality test that scored an outgoing individual as an introvert would be a invalid test. If an instrument is valid, it should be reliable. But, not all reliable instruments are valid.

Answer 529

- Associated with zoonotic (livestock, especially preened calves), recreational water sources (untreated like lakes and treated like pools) and consumption of meals from farms and gardens - Eval with direct immunofluorescence Ab or Ag testing x 3 in the stool Floating coffin, mushrooms growing in it, being grazed by cow, sitting on top is Zangief; floating flower pots as well

Answer 530

Neurofibromatosis type 2, neurofibromatosis type 1, and tuberous sclerosis are neurocutaneous disorders with autosomal dominant inheritance

Answer 531

Bilateral vestibular schwannomas that result in balance dysfunction, tinnitus, and hearing loss typically in the adolescent or early adult years. Other tumors include meningiomas, ependymomas, astrocytomas, and schwannomas of other cranial and peripheral nerves as seen in this boy’s mother

Answer 532

Serum antibodies to Entamoeba histolytica are detectable in 95% of individuals with invasive amebiasis

Answer 533

Metronidazole and intraluminal agent (Paromamycin, Iodoquinol or Dilaoxanide) COOL: intraluminal agent since E. Histolytica resides in the large intestine and produced most of its symptoms there.

Answer 534

>4 hours prior to delivery TIP: think that you need time for the antibiotics to kicki in

Answer 535

- Well-Appearing, >37 weeks, GBS negative mothers OR GBS positive BUT received adequate IAP - All others discharge at 48 hours at least

Answer 536

Asymptomatic neonates born before 37 weeks of gestation whose mothers received inadequate group B Streptococcus prophylaxis may be evaluated with a complete blood cell count and blood culture, and should be monitored in the hospital for 48 hours before discharge.

Answer 537

Hypospadias can occur as a result in disrupted masculinization, hence a sign of disorder of sexual development

Answer 538

This condition usually affects children between 18 and 26 months of age

Answer 539

Any patient with respiratory distress

Answer 540

The pediatric chest wall is much more pliable than the adult chest wall, therefore providing less protection from blunt traumatic forces. In children, energy forces applied to the thorax are likely to be transferred through the chest wall to the underlying organs, resulting in internal injuries such as pulmonary contusions without evidence of external injuries (such as rib fractures).

Answer 541

The classic findings on renal ultrasonography include UNILATERAL multiple noncommunicating cysts of varying sizes with intervening dysplastic renal tissue.

Answer 542

ARPKD presents normally in childhood ADPKD normally presents in adulthood

Answer 543

Multi cystic Dysplastic Kidney Disease (basically non-functioning unilateral kidney)

Answer 544

Studies have shown that adolescents of parents who communicate early on about decision making and sexual behavior often have a delay in sexual debut, use a contraceptive method when they do become sexually active, and have fewer sexual partners

Answer 545

A varicocele is an abnormal collection of tortuous veins in the pampiniform plexus surrounding the spermatic cord in the scrotum

Answer 546

- Secondary varicoceles are do not vary in size from supine to standing - Right sided varicoceles (It is important to remember that 85% to 95% of idiopathic varicoceles occur on the left side)

Answer 547

Hypoglycemia is the predominant presenting symptom of congenital hypopituitarism.

Answer 548

<2.5 cm phallic length stretched

Answer 549

Otitis media and other middle ear conditions are the most common cause of vertigo in young children.

Answer 550

1) Otological complications of otitis media, including cholesteatoma, can cause vertigo as well. 2 ) Benign paroxysmal vertigo of childhood is the next most common etiology in younger children. 3) A vestibular migraine can also cause vertigo, and children with this condition will have a history of migraine but may not consistently have a headache along with episodes of vertigo.

Answer 551

>6 CALMS (cafe au lait macules): 75% of patients end up with NF1 diagnosis Lisch nodules (or iris hamartomas) present in 95% of patients with NF1 by age 20

Answer 552

1) Has the child received 3 TDaP's? (2,4,6 most and 15-18 most, 4-6 years) - If no: automatic needs Tetanus vaccine 2) Clean or dirty? - < 3 vaccines/clean: Tetanus vaccine - < 3 vaccines/dirty: ONLY scenario TIG/Tetanus vaccine - > 3 vaccines/clean: if > 10 years since last vaccine, Tetanus vaccine - > 3 vaccines/dirty: if > 5 years since last vaccine, Tetanus vaccine 3) How old is the child? (determines the form of tetanus the child gets) - <7 TDaP - 7-10 Td - >11 Tdap

Answer 553

Post inflammatory hypo pigmentation that occurs in children with eczema.

Answer 554

Treatment of pityriasis alba is with an emollient or a short course (7 days) of a low-potency topical corticosteroid.

Answer 555

Tinea corporis tends to have scaling, and the borders are distinct between normal and abnormal skin TIP: fungus eating melanin

Answer 556

The expert pannel recommends that children with severe eczema, egg allergy, or both have introduction of age-appropriate peanut-containing food as early as 4 to 6 months to reduce the risk of peanut allergy BUT! Prior to introducing peanut, the expert panel recommends evaluation with serum peanut-specific IgE (sIgE) measurement 2017 addendum to the 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States

Answer 557

A peanut sIgE of less than 0.35 kU/L has a strong negative predictive value for the diagnosis of peanut allergy. However, the expert panel emphasizes that a peanut sIgE level of 0.35 kU/L or greater lacks adequate positive predictive value for the diagnosis of peanut allergy, and infants should be referred to a specialist for further evaluation during which a supervised oral challenge may be attempted

Answer 558

Serum IgE level for peanuts: good NPV, poor PPV Skin prick test: performed at any age. For patients under 2 years of age, skin prick test reactions to peanuts that have wheal diameters of 8 mm or greater are almost 95% predictive of clinical reactivity TIP: Expert panel does not recommend food allergen panel testing or the addition of sIgE testing for foods other than peanut because of their poor positive predictive value, leading to misinterpretation, overdiagnosis, or unnecessary dietary restriction

Answer 559

Approximately 90% of children with nephroblastoma will be cured of their disease, although the prognosis varies with the age of the child, the stage and histology of the tumor, and the presence or absence of 1p and 16q loss of heterozygosity

Answer 560

When the genomic copies derived from each parent have different bases for these polymorphic regions (SNPs) the region is said to be heterozygous. Most of the chromosomes within somatic cells of individuals are paired, allowing for SNP locations to be potentially heterozygous. However, one parental copy of a region can sometimes be lost, which results in the region having just one copy. The single copy cannot be heterozygous at SNP locations and therefore the region shows loss of heterozygosity (LOH).

Answer 561

A collection of squamous epithelial cells in the middle ear or mastoid

Answer 562

All children with a suspected or confirmed cholesteatoma should undergo audiologic evaluation. Referral to ENT for removal. The recurrence rate after surgical excision is high (up to 50%), so children must have regular follow up

Answer 563

Candidates who should receive varicella-zoster immune globulin as postexposure prophylaxis include: Immunocompromised: - Immunocompromised children without a history of varicella disease or varicella vaccination - HSCT patients regardless of previous vaccine history Pregancy: - Susceptible pregnant women Newborns: - Newborns whose mothers have signs and symptoms of chickenpox within 5 days before delivery to 48 hours after delivery - Hospitalized preterm infants (≥ 28 weeks of gestation) whose mothers lack varicella immunity - Exposed hospitalized preterm infants (< 28 weeks of gestation or ≤ 1,000 g birth weight), regardless of maternal history of varicella or VZV serostatus

Answer 564

- Prematurity (<37 weeks of gestation) - Post-term gestation (>40 weeks of gestation - Intrapartum maternal fever

Answer 565

Within 24 hours of birth

Answer 566

There are 2 types of meningococcal vaccines: - 1) Quadrivalent - AWCY - 2) Serogroup B In regards to the quadrivalent (ACWY): - All patients: 11-12 and booster at 16 Exception: special populations get it sooner Anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, or use of complement inhibitor (such as eculizumab or ravulizumab) There are 2 types of quadrivalent vaccines available: Menveo and Menactra. They differ in how young they can be given and the total number of of doses Special populations will need booster every5 years given persistent risk

Answer 567

With traffic flow

Answer 568

Recommends against tanning salons

Answer 569

``` UVA = A for aging UVB = B for burns/block ``` SunBlock only Blocks B, that is, UVB. SPF is the rating for how well sunblock protects against UVB, NOT UVA

Answer 570

Infants younger than 6 months should avoid direct sunlight, stay in shaded areas, wear a protective hat and clothing, and have sunscreen applied to unprotected sun, including face and hands, when sun exposure is unavoidable

Answer 571

The “normal” course for a PDA in a term neonate is closure within 72 hours of birth. In preterm neonates, this course is delayed, and the PDA remains open in 10% of neonates born at 30 to 37 weeks’ gestation, 80% born at 25 to 28 weeks’ gestation, and 90% born at 24 weeks’ gestation. By 7 days after birth, these rates decline to 2%, 65%, and 87%, respectively.

Answer 572

Yes, as the pulmonary vascular resistance drops, the amount of blood being shunted away from the body increases and in turn the amount of blood being shunted to the lungs increases. This leads to pulmonary overcirculation resulting in pulmonary congestion, edema, and worsening respiratory status.

Answer 573

Controversial: Prolonged presence of a PDA has been associated with prolongation of mechanical ventilation, bronchopulmonary dysplasia, increased mortality, pulmonary hemorrhage, necrotizing enterocolitis, impaired renal function, and intraventricular hemorrhage. However, no study has shown that closing a PDA improves long-term outcomes.

Answer 574

Children younger than 3 years have a normal passive neck rotation of about 100° and a lateral flexion of about 70° on each side If NOT, then torticollis

Answer 575

Congenital muscular torticollis is a major risk factor for positional plagiocephaly; likewise, positional plagiocephaly is a major risk factor for CMT TIP: Test for torticollis in ALL patients with plagiocephaly.

Answer 576

Ethmoid sinus

Answer 577

No real regimen preferred Generally, coverage should include Staph aureus, Streptococci, organisms of sinusitis and possibly anaerobes Ex: - Third generation cephalosporin + Clinda (or Metro) - Simply Zosyn

Answer 578

The clinical manifestations of orbital cellulitis include proptosis, ophthalmoplegia, and pain with eye movement

Answer 579

Functional neurologic symptom disorder that doesn't correlate with the known pathophysiology of the medical or neurologic condition

Answer 580

Video electroencephalography (EEG) is the gold standard test for this diagnosis and will have normal findings at the time of the apparent seizure behavior

Answer 581

Forward pelvic thrusting, side-to-side head or body movements, closed eyes resistant to opening, and a lack of postictal confusion are more often seen in PNES

Answer 582

The moment the airway is submerged below the surface of the water, reflex laryngospasm is initiated by the contact of liquid with the larynx. As the larynx relaxes after a period of hypoxia and hypercarbia, water is aspirated into the lungs. When the water reaches the alveoli, hypoxia occurs due to ventilation-perfusion mismatch. The most important consequence of drowning is decreased oxygen delivery to the tissues. Decreased myocardial oxygen delivery can result in asphyxial cardiac arrest

Answer 583

BAV can develop regurgitation, stenosis, endocarditis, and aortopathy, and therefore need follow-up throughout life.

Answer 584

Moderate to large muscular and perimembranous VSDs

Answer 585

Slight increase risk of intussusception TIP: Reason we give RV so young is that at older ages patients are at higher risk of intussusception. So there is an age limit to receiving RV.

Answer 586

Small lymphocytes are the same size as red blood cells and will therefore not be removed through leukodepletion. When presented with a foreign HLA type, lymphocytes (from donor or recipients) are activated and undergo massive replication. Blood products are matched for red blood cell surface antigens (A, B, and O), not HLA types. The immune system of an immunocompetent recipient will recognize HLA-mismatched donor lymphocytes as foreign and eliminate them. However, the immune system of an immunocompromised recipient may be unable to eliminate the donor lymphocytes. In this situation, the donor lymphocytes may recognize the HLA-mismatched host as foreign, undergo massive replication, and cause transfusion-associated graft-vs-host disease (GVHD). Irradiation of a blood product will damage the DNA of donor lymphocytes, thereby rendering them replication incompetent and definitively eliminating the risk for transfusion-associated GVHD.

Answer 587

Skin/GI/Liver are the MOST common organs involved

Answer 588

In contrast to tics, there is no internal compulsion in stereotypy to do the movement or sense of relief afterwards.

Answer 589

The 2 medications approved by the Food and Drug Administration for use in tics are haloperidol and pimozide. The side effects of these medications often outweigh the benefit. Many providers first try an α2-adrenergic agonist, such as clonidine or guanfacine, but this is an off-label use. Another treatment for tics is comprehensive behavioral intervention for tics (C-BIT), a behavioral technique or therapy taught by psychologists or other behavioral health specialists that has been shown to reduce tic severity.

Answer 590

1 year of symptoms

Answer 591

Discussions regarding transition of care for adolescents and young adults with chronic medical conditions should be started around age 12 years

Answer 592

Release of AVP is induced by hyperosmolality detected by osmoreceptors in the hypothalamus and by low cardiac output detected by baroreceptors located in the carotid sinus, aortic arch, and left atrium.

Answer 593

High urine sodium for the degree of hyponatremia

Answer 594

- Oligoarthritic JIA - Polyarthritic JIA - Systemic JIA - ERA - enthesitis related arthropathy - Psoriatic arthritis

Answer 595

TIP: Systemic JIA = JIA + systemic signs - Arthritis in ≥ 1 joints (> 50% of arthritis is destructive) - Fever - Rash - Lymphadenopathy - Hepatosplenomegaly - Serositis

Answer 596

4 doses of inactivated polio vaccine: - at ages 2, 4, and 6 to 18 months - 4 to 6 years TIP: "2,4,6 and 4-6" TIP: imagine 4 polo players on horses and in the iron lung machine

Answer 597

YES, in the case of stays > 4 weeks Adults: 1 dose even if 4 doses already obtained Children: 1 dose IF last dose > 12 months before trip departure. Children do NOT need to have all 4 doses prior to traveling to a polio endemic country

Answer 598

Neonates should be treated with partial exchange transfusion if - they are symptomatic with a Hct greater than 60% - Hct greater than 70%, whether symptomatic or not.

Answer 599

- Delivery in high-elevation areas - gestational age of >40 weeks - small size for gestational age - maternal diabetes - hypertension - history of cigarette smoking - trisomy 13, 18, or 21 - neonatal Graves disease and hypothyroidism - congenital adrenal hyperplasia - cyanotic congenital heart disease.

Answer 600

Polycythemia is defined by a hematocrit (Hct) greater than 65% on a sample obtained from a vein or central vessel. TIP: Samples obtained by heel stick often have a falsely elevated Hct.

Answer 601

ABCDE Rule! A = Amelanotic: Most amelanotic melanomas (70%) will appear pink or red and may mimic a pyogenic granuloma or be skin colored like warts B = Bleeding, bump: Lesions often are papules or nodules that may ulcerate or bleed, not flat lesions. C = Color uniformity D = De novo (that is, do not arise from previously existing melanocytic nevi), any diameter E = recent evolution

Answer 602

Intentional insulin omission for weight loss

Answer 603

4 major criteria OR 3 major/3 minor criteria TIP: ChArgE Major criteria: - Coloboma - Atresia, choanal atresia - Ear anomalies - Cranial nerve dysfunction

Answer 604

Autosomal Dominant

Answer 605

Fever and limited range of motion

Answer 606

Modified Kocher criteria: (each criteria leads closer to the diagnosis of septic arthritis) - Fever > 38.5 - ESR >40 - CRP > 25 - WBC >12 - Inability to ambulate

Answer 607

- Athletes are considered functionally 1-eyed if they have corrected vision of worse than 20/40 in 1 eye.

Answer 608

Baseball, basketball, hockey, lacrosse, and racket sports are considered high risk for eye injury.

Answer 609

Bloating, cramping and diarrhea TIP: All related to osmotic load and increased distention in the intestines

Answer 610

African Americans, Native Americans, and Asian Americans

Answer 611

DIGFAST ``` D - Distractible I - Impulsivity G - Grandiosity F - Flight of ideas A - Increase activity S - Sleep T - Talkative ```

Answer 612

TIP: - Bipolar 1: just 1 manic episode - Bipolar 2: 2 things - 1 hypomanic episode and 1 major depressive episode Hence, the presence of full mania precludes bipolar 2. Mania and hypomania easily distinguished because 1 needs hospitalization or 4 days worth

Answer 613

A cataract is a lens opacity that may occur at any age PICMONIC: Cat stuck in a lens

Answer 614

``` Facial edema Prominent superficial chest veins Cough Wheezing Shortness of breath Stridor ``` TIP: Note the prevalence of respiratory symtpoms

Answer 615

Kidneys (always) Ears (often) Eyes (occasionally)

Answer 616

Male patients fare poorly, with progression to renal failure by age 20 years (juvenile type) or 40 years or later (nonprogressive or adult type).

Answer 617

It is an X linked basement membrane disease a collagen Type 4 defect Genes encoding for these chains have been identified most commonly on chromosome Xq22 (COL4A5, COL4A6)

Answer 618

- Hypoxia is the decreased delivery or supply of oxygen Ex: Sepsis can lead to hypoxia without hypoxemia being present - Hypoxemia is a low partial pressure of O2 in the blood

Answer 619

Hypercapnia can lead to vasodilation of the cerebral vasculature, and subsequent elevation in cerebral blood flow, cerebral blood volume, and intracranial pressure. TIP: think hypercapnia is interpreted by the body as impending hypoxia, so it increases blood flow to the brain

Answer 620

Amblyopia, or reduced visual acuity due to abnormal visual development early in life, is the most common cause of visual impairment in children. It can be caused by strabismus, refractive errors that differ significantly between the 2 eyes, or by interruption of the visual axis

Answer 621

6 months, hence normal to be dysconjugate prior, but abnormal if present after. Needs referral to Ophtho TIP: Straight eyes at Six months

Answer 622

5 types of amblyopia classified by cause - strabismic amblyopia - due to misalignment of eyes - stimulus deprivation amblyopia - due to obstacle in anterior visual pathway e.g. one eye with cataracts or ptosis - anisometropic amblyopia - due to difference in refractive (focusing) error of both eyes - ametropic amblyopia - significant refractive error of both eyes - meridional amblyopia - astigmatism of both eyes

Answer 623

- Abnormal curvature of the cornea or lens leading to inability to focus, which in itself can lead to refractive errors TIP: you can have refractive errors not related to astigmatism

Answer 624

Adenovirus Actually called "adenovirus associated epidemic keratoconjunctivitis"

Answer 625

Symptoms include significant PAIN, PURULENT discharge, PHOTOPHOBIA, and blurry vision. Sensation of something on the eye. Preauricular lymphadenopathy and subconjunctival hemorrhage may be noted. Symptoms are based on the fact that the cornea is involved. Just as in corneal abrasion, pain, sensation of foreign body, tearing and photophobia are present

Answer 626

Distal limbs are affected and proximal limbs are normal

Answer 627

Either constrictive bands of amniotic tissue of ischemic insult

Answer 628

Oligohydramnios sequence describes pulmonary hypoplasia, growth restriction, compressed facies, and abnormal positioning of the hands and feet in neonates born to mothers with low amniotic fluid levels

Answer 629

Inspiration Hence, VCD is on the differential diagnosis of inspiratory stridor

Answer 630

Flattened inspiratory arm of the flow-volume loop

Answer 631

Firm, noncompressible, slowly growing FLESH COLORED nodules located most often on or near the LATERAL EYEBROW, present since BIRTH (congenital)

Answer 632

Lesions involving the nose or midline scalp may be associated with intracranial extension, and lesions over the spine may be associated with spinal dysraphism All patients who have midline dermoid cysts or sinuses should undergo imaging

Answer 633

Thyroid cancer occurs in about 25% of pediatric thyroid nodules, vs about 5% in adults.

Answer 634

Papillary thyroid carcinoma, the most common thyroid cancer type in both children and adults, is more aggressive in childhood than adulthood but survival is better

Answer 635

Autosomal dominant TIP: Men think they are dominant, especially in groups - hence MEN 2 and NOT MEN 1

Answer 636

Mr Fantastic from Fantastic 4 Rubber band ball Gumby

Answer 637

- Cardiovascular: - MVP, TVP - Aortic root dilation, Proximal pulmonary artery dilation TIP: BOTH systemic and pulmonary systems are affected, like mirror images, so not only aortopathy, but pulmonary arteriopathy, not only MVP, but also TVP@ - Ocular: - Len dislocation, glaucoma, cataracts, retinal detachment, myopia - Skeletal: - Pectus excavatum/carinatum, scoliosis, arachnodactyly

Answer 638

- Arachnodactyly/bone manifestation - spider made up of bones - Heart involvement - *** - Connective tissue disease - Mr fantastic riding spider - Ocular manifestations - each leg pierces an eyeball - Autodominant - monster truck

Answer 639

- MANY overlapping feature and they both are autosomal dominant - Distinguishing features - hypertelorism, bifid uvula, craniosynostosis, cleft palate, and generalized arterial tortuosity along with dissections throughout the ENTIRE arterial tree.

Answer 640

Initial dosing is 1 to 3 mg given 30 to 60 minutes prior to bedtime. The dose can be increased by 1 to 3 mg every 1 to 2 weeks up to a maximum dose of 10 mg. If there is no response after titrating to 6 mg per night, higher doses are unlikely to be helpful.

Answer 641

In childhood, a total of 6 doses of pertussis-containing vaccine are recommended: - DTaP in a 5-dose series, typically at ages 2, 4, 6, and 15 to 18 months as well as 4 to 6 years - 1 dose of Tdap at 11 to 12 years TIP: - Don't confuse with IPV - IPV: 2,4,6 mos, then 4-6 years - DTaP: 2, 4, 6 mos, then 15-18 mos, then 4-6

Answer 642

- Risk for pathologic fractures Ex: - Non ossifying fibromas: low risk for pathologic fractures - Non ossifying fibromas >50% of cortex or diameter: risk of pathologic fractures - Fibrous dysplasia: : risk of pathologic fracture

Answer 643

Small, well-defined radiolucent cortical lesion with a surrounding rim of sclerosis

Answer 644

Alcohol remains the most common date rape drug

Answer 645

- Direct microscopic examination of a diarrheal stool (ova and parasite examination) has a sensitivity of 75% to 95%. - Specific enzyme immunoassay has a sensitivity of 95% and specificity of 98% to 100%

Answer 646

- steatorrhea, gas, and/or bloating TIP: Malabsorption is quite the large umbrella terms.It can encompass carbohydrate malabsorption, which would be categorized under osmotic diarrhea. It could encompass fat malabsorption from pancreatic insufficiency. It could encompass bile acid malabsorption which would be categorized under the secretory diarrhea

Answer 647

Trauma focused CBT

Answer 648

The Langley Model of Improvement is a framework for quality improvement that addresses 3 questions: 1) What are we trying to accomplish? - Increased efficiency in admitting direct admission patients 2) How will we know that a change is an improvement? - Decrease the total time of the admission process from start to finish to 1 hour maximum 3) What changes can we make that will lead to an improvement using multiple, rapid Plan-Do-Study-Act cycles. - Reviewing records: 2) Review records - Interview/Med rec/Examine patient: 4) - Note: 5) - Problem list: 3) List problems - Admission orders: 1) Place admission orders and order set first (except for home meds)

Answer 649

The most common type of bariatric surgery is the Roux-en-Y gastric bypass, during which the surgeon creates a small gastric pouch (about 1 ounce in size, like a newborn!). The small intestine is then divided into 2 portions. The Roux limb, which connects the small gastric pouch to the jejunum, is then attached to the bottom portion of the duodenum, creating the Y connection TIP: ultimately there are gastric contents entering the JEJUNUM at 2 entrances: Gastric to jejunum; distal duodenum to jejunum (at the Y portion)

Answer 650

Symptoms of mild zinc deficiency include taste and smell impairment, night blindness, and depressed immunity. Severe zinc deficiency is associated with alopecia, bullous pustular dermatitis, diarrhea, and frequent infections due to a depressed immune system TIP: Severe zinc deficiency presents with mucocutaneous manifestations

Answer 651

- Zinc - Copper - Iron - Vit D - Calcium

Answer 652

TAR - affects the radius bilaterally Fanconi - affects the THUMB, hands, wrists

Answer 653

Although household bleach (sodium hypochlorite) is a substance with an alkaline pH (pH ~12), retrospective studies of children ingesting liquid household bleach have found that accidental ingestion is typically associated with a benign clinical course and does not require hospitalization or pharmacologic interventions

Answer 654

Basic underlying concept: Oxygen consumption is directly related to cardiac output. In low cardiac output states, for example, tissue will extract more O2, to compensate physiologically. Hence, O2 sat from the arterial to the venous side will demonstrate greater difference given more extraction. Hence the SaO2 – SmvO2 is an indirect measure of cardiac output. High difference: low cardiac output Low difference: sepsis (hyperdynamic state) 20-30%: normal cardiac output (since normal SmvO2 = 70, hence difference is between 20-30%)

Answer 655

GOLD standard: pulmonary artery from PAC 2nd best: Internal jugular vein Antecubital fossa/capillary stick/radial artery are NOT representative of the whole body venous return

Answer 656

The extent of skin/mucous involvement - <10%, SJS - 10-30%: SJS/TEN overlap - >30%: TEN

Answer 657

Medications Clinical tip: If no identifiable meds, evaluate for underlying infection as a trigger: Mycoplasma, CMV, HSV and HAV

Answer 658

Macules with purpuric centers that evolve into vesicles and bullae

Answer 659

After age 3 AND outside of the peripubertal period

Answer 660

Decreased height velocity, BUT preserved weight

Answer 661

Use the midparental height equation: For girls: [(Dad’s height -5 inches) + mom’s height]/2 For boys: [(Mom’s height + 5 inches) + Dad’s height]/2 The final height is within 2 inches of the calculated height (that is, 1 SD)

Answer 662

Normal growth velocity along the a percentile consistent with an individual’s genetic growth potential How: 1) Calculate midparental height 2) Find the percentile that corresponds to parent’s height 3) Compare to the percentile of the child’s current height (normally, will be within 2 percentiles in the setting of familial short stature) Clinical Tip: - Height Velocity is a key point of narrowing the differential - Normal height velocity: Familial short stature and constitutional delay

Answer 663

2 separate points of growth 3 months apart (ideally 6-12 months apart)

Answer 664

Normal growth velocity along a percentile below expected individual’s genetic growth potential

Answer 665

The palpebral fissure is the elliptic space between the medial and lateral canthi of the two open eyelids.

Answer 666

Growth deficiency Abnormal Facies CNS problems

Answer 667

Epicanthal folds are the folds of skin that run from the upper eyelid to the inner corner of the eye, sometimes covering the medial canthus

Answer 668

5x at risk for permanent hearing loss compared to the general population

Answer 669

Thrombocytopenia, Hyponatremia and elevated liver enzymes occur in over half of the cases of RMSF

Answer 670

Central and South America

Answer 671

South central US and Midatlantic North Carolina, Tennessee, Oklahoma, Arkansas, and Missouri is where > 60% of cases occur

Answer 672

Whenever encountering the illness script involving FEVER RASH HEADACHE

Answer 673

High arch Adducted forefoot Hindfoot varus Plantar flexion contracture – unable to dorsiflex on exam TIP: Varus = supination or inversion

Answer 674

Metatarsus adductus – ankle motion is normal While TEV patients have fixed, plantar flexed ankles

Answer 675

Juvenile TIP: funny that the most common polyp in “children” is the “juvenile” one

Answer 676

- Juvenile Polyposis Syndrome (JPS) (hamartomatous polyps) - Peutz Jeghers Syndrome (hamartomatous polyps) - PTEN Hamartomatous Tumor Syndrome - Lynch Syndrome (adenomatous polyps) - FAP (adenomatous polyps)

Answer 677

Normal: toes down Abnormal: toes upward TIP: Toes point to the brain because there is problem. OR toes go up, upper motor neuron

Answer 678

Screen at 12 and 24 months for children - Eligible for Medicaid - Receiving government assistance - Live in high risk environments Upon arrival for all refugees

Answer 679

O- They have NO antigens to be immunogenic

Answer 680

``` CBC Total bili Direct/Indirect Reticulocyte DAT – shows presence of Ab on RBC ```

Answer 681

TIP: Think of hemolytic disease of the newborn simply as transfusion of mismatched blood products EX: If pregnant patient experiences maternal-fetal hemorrhage, it is as if mother has received a small transfusion from the fetus. If the ABO or Rh are incompatible, there can be a transfusion reaction

Answer 682

Hemolysis caused by ABO mismatch does not need a prior exposure

Answer 683

Preambulatory children

Answer 684

4/11 ``` Skin: 1) Malar rash – ACLE 2) Photosensitive rash – SCLE 3) Discoid lupus – CCLE 4) Oral ulcers Serosal 5) Pericarditis/Pleuritis Hematologic 6) Anemia/Thrombocytopenia/Leukopenia Kidney: 7) Nephritis CNS 8) Psychosis/Seizures Joint 9) Non-erosive arthritis Lab 10) ANA 11) Anti DS DNA and Anti Smith ```

Answer 685

B12 deficiency since that is only found in animal based products

Answer 686

Known association between the two diseases as varicella can act as portal entry for any spectrum of invasive group A streptococcal infection, including necrotizing fasciitis

Answer 687

- A: Appearance (skin color) - P: Pulse - G: Grimace (aka reflex irritability) - A: Activity (muscle tone) - R: Repirations

Answer 688

How the newborn is transitioning soon after birth

Answer 689

EASY: ANY severity, as long as patient fits the definition of "persistent" asthma Out side of inhaled glucocorticoids, ALL other options are considered second-line add-on therapy e.g. leukotriene antagonist

Answer 690

GINA Guidelines: - Asthma symptoms or need for SABA > 2 times/week (BEST EVIDENCE) Other soft reasons: - risk for severe exacerbations, e.g. admitted to ICU or needed steroids in the past year - Symptoms or SABA use 2 times/month or wakes up 1/week due to asthma

Answer 691

Typical lichen sclerosus lesions are shiny, wrinkled, ivory-colored atrophic patches located in a figure-of-8 or hourglass distribution surrounding the vulva, perineum, and anus. Blisters may occur Interesting: almost exclusively girls younger than 7 years (outside of the classic prevalence in older women) TIP: Hourglass around the private parts

Answer 692

Turner Syndrome Short stature is apparent in childhood and may be the only presenting feature. Turner syndrome should be considered in all girls with short stature.

Answer 693

Surveillance is defined as a physician's observation and physical exam of a child for developmental delay. Known to have good specificity, but poor sensitivity. Hence, good PPV, but poor NPV. Hence can miss developmental delay when it is there. Hence, AAP recommendations for screening tools.

Answer 694

The American Academy of Pediatrics recommends developmental screening at 9, 18, and 24 or 30 months, and screening specifically for autism at 18 and 24 months.

Answer 695

Universal precautions

Answer 696

Children with vertebral anomalies should undergo renal ultrasonography to look for underlying renal anomalies

Answer 697

Caput succedaneum is localized superficial edema of the scalp most likely due to venous congestion from cervical pressure on the presenting part during delivery or the use of vacuum extraction Between the periosteum and the skin

Answer 698

Caput: - Between skin and above the periosteum - Crosses midline/sutures, discoloration Cephalohematoma: - Between the skull (specific cranial bone) and periosteium - Does NOT cross suture lines, NO discoloration Subgaleal : - beneath the epicranial aponeurosis and above the periosteum of the skull, which can extend the length of the occipitofrontalis muscle - fluctuant mass that increases in size soon after birth

Answer 699

Loperamide (an antimotility agent) is not indicated in the treatment of infectious diarrhea, given the potential risk of ileus or toxic megacolon.

Answer 700

By age 3 years, colonization rates approach adult colonization rates, which range between 0% and 3%.

Answer 701

Tethered cord - which can present later in life Shunt falilure Clinical tip: Meylomeningocele, like cerebral palsy, is a static problem (does not worsen or change over time). Hence, new symptoms indicate a new problem, NOT progression of disease

Answer 702

TIP: depend on the age group: infants vs toddlers vs adolescents vs adults Toddler and adolescents: - Worsening lower extremity weakness/sensory changes - Worsening gait from (above) - Scoliosis - Bladder function regression - Back and leg pain

Answer 703

Acquired cholesteatomas, which result from a history of prolonged eustachian tube dysfunction, retraction pockets, and chronic middle ear effusion and inflammation (otitis media). Congenital - rare TIP: imagine recurrent inflammation that encourages replication of the epithelial cells as in healing that then leads to benign tumor

Answer 704

The evaluation for vWD includes tests for vWF antigen and activity, which are commercially available as a test panel

Answer 705

A greenstick-type injury is the most common fracture pattern seen in children, making up 50% of the fractures

Answer 706

Greenstick fractures with angulation of more than 15 degrees require closed reduction, immobilization in a splint, and orthopedic follow-up.

Answer 707

The growth plate, that is, the physis

Answer 708

The physis is between the metaphysis and epiphysis

Answer 709

Type I S: Straight across the physis Type II A: Above the physis Type III L: Lower (or beLow) the physis Type IV T: Through the physis (involves the metaphysis, physis and epiphysis) Type V ER: Erase the growth plate, that is, Crush injury

Answer 710

Orthostatic proteinuria occurs when the patient is active (random urine sample) and disappears when the patient is supine/asleep for at least 2 hours (first-morning sample).

Answer 711

COMBINED hormonal contraceptives of any kind

Answer 712

Copper IUD, which would be a good option for the patient who'd prefer not to be exposed to hormones.

Answer 713

Hormonal IUD's have progestin in the form of Levonorgestrel. Progestin only hormonal contraceptives thin the endometrium while thickening the cervical mucosa. Thin mucosa means less bleeding/cramping, thick cervical mucosa means no sperm to penetrate

Answer 714

Estrogen promotes the proliferation of he endometrium (e.g. higher estrogen exposure is a risk factor for endometrial cancer) Progresterone is the opposite, in that it is anti-mitogenic, combating the effects of estrogen. It maintains the endometrium. Progresterone is also called the pregnancy hormone, hence it makes sense that it thickens the cervical mucosa to prevent any further sperm from entering It is the withdrawal of progesterone that leads to menses

Answer 715

Corpus Luteum and if patient becomes pregnant, the placenta takes over as the progesterone-producing factory After every ovulation, corpus luteum produces progesterone to make the endometrial lining ready for implantation if it does occur. If implantation doesn't occur, the corpus luteum will involute, progesterone will decrease and menses from progesterone withdrawal will occur since no hormone is left to maintain the endometrial lining

Answer 716

"gest" = gestation, as in, progestational which is progesterone's purpose Ex: Levonorgestrel, Etonogestrel

Answer 717

Progestin-only methods are also used to treat catamenial (menstrual-associated) epilepsy and suppress menstruation in patients with physical and mental disabilities.

Answer 718

Inadequate sedation is a risk factor for the development of subglottic stenosis

Answer 719

Retrognathia and adenotonsillar hypertrophy, laryngomalacia, and epiglottitis TIP: Anything from the entrance of the mouth to the vocal cords is technically supraglottic, such as OSA

Answer 720

Subglottic obstruction can be caused by laryngotracheitis (croup), bacterial tracheitis, complete tracheal ring, laryngeal web, and subglottic stenosis TIP: Anything affecting the trachea is automatic sub-glottic

Answer 721

20mg/kg TIP: Good to know since prenatal vitamins and iron pills have very specific dosages and a good history can lead to a good assessment

Answer 722

Children with severe symptoms, a significant number of radiopaque pills on radiography, or a peak serum iron concentration above 500 μg/dL (90 μmol/L) should receive intravenous deferoxamine

Answer 723

Epstein-Barr virus is a ubiquitous human γ-herpesvirus that infects more than 95% of the global population by adulthood

Answer 724

1) In a patient with symptoms and signs consistent with a diagnosis of acute IM 2) the detection of more than 10% atypical lymphocytes on a peripheral blood smear 3) in conjunction with a positive heterophile antibody test result is diagnostic of acute EBV infection

Answer 725

Chilldren < 4 yo since they don't like "heterophiles" OR Heterophile negative IM in adolescent Sounds like "pedophile" Heterophiles are often absent in children < 4 yo

Answer 726

Hematologic complications include hemolytic anemia, thrombocytopenia, aplastic anemia, disseminated intravascular coagulation, and hemophagocytic lymphohistiocytosis (HLH). Neurologic complications include aseptic meningitis, encephalitis, optic neuritis, facial nerve palsy, transverse myelitis, and Guillain-Barré syndrome. Malignancy: solid tumors (eg, Burkitt lymphoma, nasopharyngeal carcinoma) and lymphoproliferative disorders in immunocompromised patients TIP: reason why EBV is so often tested in patients with strange presentations of any kind

Answer 727

Duodenoal: incomplete recanalization of intestine in utero, 25% related to T21 and have other congenital anomalies Jejunal/Ileal atresia: vascular insult leading to ischemia and infarction such as tobacco use/cocaine use; NOT associated with other congenital defects

Answer 728

Treatment of X-linked hypophosphatemic rickets is with phosphorus and calcitriol (activated vitamin D or 1,25-dihydroxyvitamin D

Answer 729

It is a renal phosphate wasting disease caused by defect in 1 alpha hydroxylase that prevents the production of 1,25OH Vitamin D in the face of hypophosphatemia In unaffected individuals, low phosphorus levels stimulate 1α-hydroxylase, resulting in increased conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D, the activated form of vitamin D Presents as rickets, but "hypophosphatemic rickets"

Answer 730

TIP: profile shows an inappropriately normal or low 1,25 OH Vitamin D in the face of low phosphate Low Phosphate, Normal 1,25 OH Vit D Normal Ca, PTH (since Ca is normal) High Alk Phos

Answer 731

Spares the face (BUT however, suck and swallow capabilities are typically affected) Proximal mm then distal

Answer 732

Fasciculations of the tongue are seen in most children, which is a defining physical examination finding not commonly seen in pediatric neuromuscular disorders

Answer 733

7 in 1 year 5 or more in each of the past 2 years TIP: While tonsillectomy is very effective in reducing the frequency of episodes of severe pharyngitis, most children meeting the Paradise criteria but who did not undergo tonsillectomy in controlled trials experienced a natural reduction in the frequency and severity of throat infections.

Answer 734

CRAFT BRUE ``` C – color change R – respirations A – AMS F – Fully resolved T – Tone ```

Answer 735

Infant < 2 mos Born < 32 weeks (with corrected gestational age < 45 weeks) Previous BRUE

Answer 736

``` Eye pain Foreign body sensation Conjunctivitis Photophobia Tearing ```

Answer 737

ANTIBIOTIC eye drops NOT analgesic eye drops NOT steroid eye drops. BOTH are contraindicated

Answer 738

Flourescein staining

Answer 739

Anesthetics – delay healing, mask worsening symptoms and toxic to corneal epithelium Steroids – delay healing and increase risk for infection

Answer 740

12-15 mos 4-6 years

Answer 741

It targets sebaceous glands which are quite active in the adolescent period

Answer 742

``` Eyelid Eyebrows Glabella Alar region Retroauricular creases ```

Answer 743

Cradle cap vs dandruff TIP: Treat cradle cap with shampoo: selenium sulfide or ketoconazole of pyrithione zinc

Answer 744

Hashimoto’s thyroiditis

Answer 745

Congenital hypothyroidism AND Acquired thyroid disease: BOTH Hashimoto’s and Graves

Answer 746

Deficiency in the GALT enzyme, that is, the galactose 1 phosphate uridylyltransferase enzyme

Answer 747

100% screened in the newborn screen

Answer 748

Gross: First place stance (stand with arms up and legs splayed) ``` Fine: - Pincer grasp (grasp 1 thing) - Points with 1 finger - Holds 1 crayon Social - Points with 1 finger to desired object ``` Language: - Follows 1 step command - 1 word

Answer 749

100-fold increase!

Answer 750

``` Hep B E Antigen Viral load Hepatic dysfunction HCV HIV ```

Answer 751

Metatarsus Adductus Internal tibial rotation Femoral anteversion

Answer 752

Intrauterine positioning

Answer 753

Polyhydramnios

Answer 754

Add a short acting medication to be taken in the afternoon Yes, she will be on a long acting AND a short acting

Answer 755

Autosomal dominant

Answer 756

15-34 That is, high schoolers, college students, med students, residents and new attendings are all at risk of developing testicular cance

Answer 757

Lymph nodes are structured buildings that house lymphocytes. Lymph carries antigens from the vasculature along the lymphatic vessels. When lymph enters lymph nodes, the lymphocytes that recognize the specific antigens presented will react, replicate and be sent off to attack.

Answer 758

Reactive lymphadenopathy is a reactive process to distant infection. Lymphocyte replication in the lymph node leads to enlarged lymph nodes Infectious lymphadenitis is an infection of the lymph node itself (NOTE: how ballsy, that a pathogen would enter the lymph node, house of all the lymphocytes, and try to infect it) Infectious lymphadenitis: very tender, overlying erythema, systemic signs

Answer 759

Black widow – Lactrodectus Brown recluse

Answer 760

Rigidity and severe pain NOTE: these signs may warrant antivenin

Pediatric Board Study #1 10/2020 Flashcards

(811 cards)