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Flashcards in Pediatrics Deck (902):
1

meningite and refractaire hypotension

waterhouse fredrichsen syndrome

2

hemiplegia in chidren after having seizures

Todd paralysis

3

4 forms of tetanos(2)

generalisee
localisee
cephalic
Neonatale

4

dx differentiel of Lytic lesion on bone puls hypercalcemia(4)

osteomyelitis
endocrine
neoplastic
idiopathic

5

clue for lytic lesion induced by osteomyelitis

brodie abcess

6

endocrine cause of lytic bone lesion(2)

hyperparathyroidie
osteoid fibrosa cystica

7

Neoplastic cause of bone lytic lesion(3)

erwing sarcoma
Langerhans hystiocystosis
Metastases

8

quid of cephalhematoma

hemmoragie sous periostee

9

clue for cephalhematoma

it doesn't cross suture
limited to one cranial bone

10

clue caput succedaneum

it crosses suture

11

most common cause of functional asplenism in children

sickle cell disease

12

cause of sepsis in asplenia

encapsulated bugs

13

most common bug causing sepsis in asplenia

s pneumoniae

14

cyanosis in infant first 24 hours of life

transposition of great vessels

15

quid of transposition of great vessel

aorta in ventricule droit
artere pulmonaire in ventricule gauche

16

what to suspect in child with reccurrent sinopulmonary infection

cystic fibrosis

17

gold standard dx test for cystic fibrosis

sweat test for Na et CL-

18

consequence of cow milk consumption in infant

iron deficiency anemia

19

cyanosis in children less than 4 years

Fallot

20

tetralogie de Fallot(4)

overriding Aorta
VSD
Subpulmonary stenosis
right ventricular hypertrophy

21

Clue for PDA and VSD

no cyanosis

22

Prader willi syndrome(3)

binge eating
hypotonia
obesity

23

genetics of prader willi

paternal genetics deletion
15q11-q13

24

genetics problem in cat cry syndrome

5p deletion

25

genetics problem in angelman

15q11-q13

26

genetics in beckwith wiedman

11p15

27

clue for bweckwith

macroglossie

28

clue megaoblastic anemia

hypersegmentation of the nucleus of neutrophils and other blodd cells

29

most common cause of congenital hypothyroidism in the US

thyroid dysgenesis

30

quid of thyroid dysgenesis(3)

ectopie
aplasie
hypoplasia

31

Disease with Howell jolly bodies

sickle cell disease

32

Meaning of howell jolly bodies and why

no spleen
spleen normally removes nuclear rmnants of red blood cells

33

bite cells or heinz bodies(2)

G6PD deficiency
Thalassemia

34

Helmet cells(3)

DIC
HUS
TTP

35

cause of helmet cells

traumatic hemolysis

36

other finding in traumatic hemolysis

schistocytes

37

casue of basophilic stippling(2)

thalassemia
lead poisonning

38

quid diamond blackfan anemia(2)

macrocytic anemia
congenital malformation in baby

39

Mc cune albright syndrome(4) 3 P

femme
Puberte precoce
pigmentation
polyostotic fibrous dysplasia

40

what will happen in polyostotic fibrous dysplasia

fracture a repetition

41

casue of stroke in children(4)

internal carotid dissection
AF
homocystinuria
Todd paralysis

42

clue for homocystinuria(4)

Marfan's features
thromboembolic event
downward dislocation of the lens
mental retardation

43

clue for marfans features(3)

long emaciated arms and legs
arachnodactily
hyperlaxity of the skin and joints

44

cause of homocystinuria

deficiency in cystathione synthetase

45

Dx test for homocystinuria(2)

high methionine
high homocysteine

46

Rx of homocystinuria

B6

47

failure of B6 in rx of homocystinuria

cysteine

48

quid of leucocoria in USMLE

white eye reflex

49

cause of leucocoria in kid

retinoblastoma until proven the contrary

50

occlusion in first 24 hr in infant(2)

hirsprung
meconium ileus

51

cause of meconium ileus

cystic fibrosis

52

cause of intestinal occlusion from 24 h to 1 month

volvulus of midgut

53

cause of intestinal occlusion > 1 month of age

stenose pylorique

54

cause of cyanosis from 24 h to 4 ans

tetralogy de Fallot

55

cause of osteogenesis imperfecta

deficiency in type 1 collagen synthesis

56

congenital disease with coarctation of aorta

turner syndrome

57

complication of congenital adrenal hyperplasia

puberte precoce

58

enzyme deficiency in congenital adrenal hyperplasia

21 hydroxylase(CYP21A2)

59

baby with cyanosis during feeding and relieved by crying

choanal atresia

60

Dx of choanal atresia(2)

tube nasal
ct scan

61

Dx test for hereditary spherocytosis

osmotic fragility study

62

when to perform coombs test

autoimmune hemolytic anemia

63

most common cause of nephrotic syndrome in children

minimal change disease

64

next step when dx nephrotic syndrome in adult

biopsy renale

65

calculate APGAR score

A:appearance
P:pulse
G:grimace
A:activity
R:respiration

66

Monitoring Appearance in APGAR(3)

blue=0
blue pink=1
pink=2

67

Monitoring pulse in APGAR(3)

absent=0
,100=2

68

Monitoring grimace in APGAR(3)

absent=0
grimace,whimper=1
cough/cry=2

69

Monitoring activity in APGAR(3)

limp=0
flexion=1
spontaneous active=2

70

Monitoring respiration in APGAR(3)

absent =0
slow irregular=1
regular=2

71

Normal APGAR

7-9

72

abnormal APGAR

73

patient with delayed separation of umbilical cord more than 30 days

leucocytes adhesion defect type 1

74

clue for leucocytes adhesion defect type 1

CD18 expression deficiency

75

risk in in baby whom mother taking cocaine during pregnancy

jejunal atresia

76

xray abdomen in jejunal atresia(2)

tripple bubble sign
gasless colon

77

xray showing double bubble sign

duodenal atresia

78

abdomen xray in hirsprung

dilated loops of bowel

79

how to diffenrenciate microcytic anemia caused by iron deficiency from thalassemia

RDW

80

Clue for Iron deficiency anemia using RDW

RDW>20 %

81

Normal RDW with microcytic anemia

thalassemia

82

cause arthropathy in hemophilic patient(2)

deposit of hemosiderrin
fibrosis

83

hemophilic patient cause

deficiency in factor 8
et
9

84

children between 4-10 with hip pain(2)

Legg calve Perthes disease
avascular necrosis of femoral head

85

Quid of measles

rubeola
rougeole en francais

86

quid of koplik spots

bluish white lesions on buccal mucous membranes next to first and second molars

87

gender in Mc cune albright syndrome

femme

88

pigmentation in Mc cune Albright syndrome

cafe au lait spot

89

gender in Lesh Nyhan syndrome

Male

90

clue for Lesh Nyhan Syndrome(3)

Male
dystonia
self mutilation

91

Gout in male children

Lesh Nyhan Syndrome

92

physiopatho in Lesh Nyhan Syndrome

hypoxanthine guanine phophoribosyl transferase

93

black stool in children

Meckel Diverticulum

94

difference between congenital adrenal hyperplasia and hyperandrogenism

virilization in women

95

Quid of macrosomia

> 4 kg

96

risk in macrosomia

clavicular fracture

97

how to recognize fetal alcoholic syndrome(3)

small palpebral fissures
absence philtrum
thin upper lip border= thin vermillon border

98

Quid of Edward's syndrome(5)

micrognatia
microcephaly
absent palmar creases
rocker bottom feet
overlapping fingers

99

heart complication of Edward's syndrome

VSD

100

chromosome problem in Edward syndrome

trisomy 18
election age

101

Heart problem in trisomy 21

ASD

102

Heart problem in william's syndrome

supravalvular aortic stenosis

103

Heart problem in congenital rubella

PDA

104

young kid with stomatitis and cheilitis sore throat andscaly pathes on eyebrows cheek and nose and photophobia dx?

ariboflavinose

105

cause ariboflvinose in the US(3)

Anorexia nervosa
Malabsorption syndrome
Inborn defect in B2 synthesis

106

pain articulation in young kid(3)

Legg calve
transient synovitis
hemophilic arthropathy

107

infant with stridor acute respiratory distress toxic appearrance and fever first dx to think

epiglotitis

108

first step in epiglotitis

intubation

109

what to avoid in epiglotitis

never try to watch the epiglotte

110

Bloody diarrhea plus IR plus low platelet

HUS

111

cause of HUS in children

E coli 0157h7

112

how E coli causes HUS

by producing verotoxin

113

young kid with scrotal pain ,purpura and arthralgia

Henoch shonlein purpura

114

complication of Henoch shonlein purpura

intussiception ileoileale

115

age to have henock shonlein purpura

116

seizure in afebrile children with wide qrs complex dry oral mucosa and dilated pupils and hypotension


TCA intoxication to rule out

117

Rx of TCA intoxication

sodium bicarbonate

118

action of Hydroxyurea

Increase HB F

119

importance of hydroxyurea in sickle cell disease

prevention of painful crisis

120

clue for cystic fibrosis(2)

diarrhea
probleme respiratoire a repetition

121

breastfeeding contraindication(9)

herpes mammaire
HIV
TB
varicella
drug
alcohol
fetal galactosemia
chemotherapy
radiation

122

for TB when the mother can be allowed to breastfeed

2 weeks after debut of treatment

123

patient with blue eye and susceptibility to fracture

osteogenesis imperfecta

124

quid opalescent teeth

yellow teeth

125

disease with opalescent teeth

osteogenesis imperfecta

126

red eyes in children in the first 24 h(2)

iatrogenic
nitrate d'argent

127

red eyes in children in 2-5 days of birth

gonoccoque

128

rx of conjunctivitis caused by gonoccoque

ceftriaxone

129

red eyes in children 5- 24 jours of birth

chlamydia

130

rx for conjuctivitis induced by chlamidya

oral erythromycin

131

finding in severe combined immunodeficiency

low Lympho B and T

132

cause of post vermis syndrome(2)

medulloblastoma
astrocytoma

133

clue for scarlet fever(2)

sore throat
sand paper like appearrance

134

clue for 21 hydroxylase in children(newborn)(4)

high K+
low TA
Low NA+
high 17 hydroxyprogesterone

135

clue for 11 B hydroxylase

high 11 deoxycortocosterone
HTA

136

cause of HTA in 11 B hydroxylase

HTA

137

cause of HTA in 17 alpha hydroxylase

high corticosterone

138

substance produced by adrenal cortex

G,F,R
Aldoesterone=G
fascicule=F
reticule=androgen

139

clue for duchenne muscular dystrophy(2)

weakness in children before 5
wheelchair bound before 5

140

clue for Becker muscular dystrophy

weakness in children after 5

141

strawberry tongue in USMLE

kawasaki

142

clue for Kawasaki(5)

Fever
adenopathy
extremities swelling
red eyes
skin erythema

143

syndrome coronarien in kid

kawasaki

144

rx of kawasaki(2)

aspirin and
immunoglobulin

145

genotype of turner

45 XO

146

gendre in turner

woman

147

complication of turner(2)

osteoprosis
coarctation of aorta

148

physiopatho in Marfan syndrome

mutation of the fibrillin -1 gene

149

vascular problem in Marfan

aortic root dilation

150

eye problem in marfan

upward dislocation of the lens

151

children with unsteady gait ,and myocarditis

friedrich ataxia

152

cause of T wave inversion(5)

MI
Myocarditis
Pericarditis
digoxin toxicity
Myocardial contusion

153

EKG in friedrich ataxia

T wave inversion

154

CAT in club foot

treat immediately

155

clue hyper IGM syndrome(2)

Low neutophils
high IGM
low IGA and IGG
sinopulmonary infections and PCP pneumonia

156

Bruton's agammaglobulinemia

Low IG M
Low IG G
Low IG A

157

finding in chronic pyelonephritis in children

focal parenchymal scarring and blunted calices

158

bugs in otite moyenne(3)

strep pneumo # 1
non typable H flu # 2
Moraxella catharalis # 3

159

consequence of vit D deficiency in children

rickets

160

epidemiology for rickets

black children

161

clue for Neuroblastoma in children(2)

high homovanillic acid
vanylilmandelic acid in urine

162

origin of neuroblastoma

neural crest cells

163

origin tumor de wills

metanephros

164

renal tumor in children(2)

neuroblastoma
tumor de wilms

165

murmeur in tetralogy of Fallot

squatting increases murmur

166

cardiac problem in Down syndrome(3)

endocardial cushion defect #1 or complete atrioventricular canal
VSD
ASD

167

clue for cyclic vomiting in children(2)

any cause can be found
history of migraine in the family

168

bug in rheumatic fever

strep group A

169

cause of NEC in baby

formula use

170

abdomen xray in NEC

pneumatosis intestinalis

171

quid of pneumatosis intestinalis

intramural air with dilated loops pof bowel

172

rx of prematurity anemia

fer

173

Lab for prematurity anemia(5)

mormochromic
normocytic
anemia
low reticulocytes
total normal bilirubin level

174

vasoocclusive manif in hand in sickle cell disease(2)

dactilytis
hand foot syndrome

175

early manif of vasooclusive crisis in SCD(2)

dactilytis
hand foot syndrome

176

quid of gastrochisis

no peritoneum covers the intestines

177

quid omphalocele

ombilic ring herniation covered by peritoneum

178

most common bugs causing pneumonia in cystic fibrosis(4)

Hi flu # 2
pseudomonas # 1
staph aureus # 4
strep pneumo #3

179

gram positive diplococci

strep pneumo

180

gram positive cooci in clusters

staph

181

gram negativ cocci

neisseria

182

gram positive rods

Lysteria monocytogenes

183

gram negative rods(4)

Pseudomonas
Hi flu
Klebsiella
legionella

184

cause # 1 of bronchiolitis

VSR

185

risk future in bronchiolitis

asthma

186

risk in use of erythromycin in baby

hypertrophis pyloric stenosis

187

clue for Kartagena syndrome(3)

situs inversus
reccurrent sinusitis
bronchiectasis

188

risk for patient having received inactivated vaccine in 1960

can develop atypical measles

189

gold standard test for Duchenne muscular dystrophy

genetic studies

190

number one cause of sepsis in sickle cell disease

Pneumococcus

191

important thing to do in premature baby

iron till 1 year old

192

consequence of cow milk consumption

anemia

193

red blood cells in intrauterine growth restriction

polycythemia

194

clue for congenital foot deformity

adduction of the foot

195

Rx for congenital foot deformity(2)

reassurrance
no cast

196

cardiac problem in congenital rubella(2)

PDA
ASD

197

clue for turner (3)

feme naine
coarctation of aorta
Miley cyrus concert

198

cardiac problem in Edward

VSD

199

bugs causing infection in chronic granulomatosis disease

catalase positive organism

200

quid of catalase positive organism(5)

SPACE
S:STAPH AUREUS
P:PSEUDOMANAS
A:SPERGILUS
CANDIDA
ENTEROBACTERIACEA

201

quid of enterobacteriacae

klebsiella
.....

202

other name of laryngotracheobronchitis

croup

203

indication of epinephrine in respiratory problem(2)

croup
asthma

204

rx of in infection caused by pseudomonas in cystic fibrosis(2)

ceftazidine + gentamycine
or
ticarcilin + gentamycin

205

rx of CGD

gamma interferon

206

quid of henoch shonlein purpura

IGA vasculitis

207

how to prevent sudden infant death syndrome

supine position while sleeping

208

meaning of non pitting edema

lymphatic problem

209

why people with turner has edema in feet

lymphedema

210

kidney appearance in turner

horse shoe kidney

211

disease with webbed neck

turner syndrome

212

meaning of barking cough

croup

213

cause of barking cough

parainfluenza type 1

214

risk during delivery of macrosomia(3)

clavicle fracture
brachial plexus injury
perinatal asphyxia

215

intestinal malformation associated with chromosomal abnormality

dudenal atresia

216

risk in premature infant

intraventricular hemorrage

217

what disease you can perform gutry test

phenylketonuria

218

cause of avascular necrosis in children(3)

sickle cell disease
corticosteroid
alcoholism

219

immune thrombocytopenia and viral infection

corticosteroid

220

immune throbocytopenia and viral infection platelet 30 000

observation

221

dx digeorge syndrome(5)CATCH

conotruncal cardiac defects
abnormal facies
thymic aplasia
cleft palate
hypocalcemia

222

anomaly chromosomal in Digeorge

22q11,2

223

facies abnormaly in Digeorge(2)

low set ears
micrognatia

224

waiters tip attitude and erb duchenne palsy

atteinte C5 C6 C7
extended elbow
pronated forearm
flexed wrist and fingers

225

kid with failure to thrive and metabolic acidosis with normal anion gap,high urine PH 7,9 cause of failure to thrive

renal tubular acidosis

226

kid with giardiasis in fection a repetition

genetic b cell deficiency

227

physiopatho in nieman pick disease

sphingomyelinase deficiency

228

quid of adrenarche

axillary hair growth

229

quid of pubarche

pubic hair growth

230

clue for bruton's agamma globulinemia(2)

low IGM IGG and IGA
Lymphocytes B absent

231

how's temperature in neonatal sepsis(2)

high 30 C
low

232

jaundice in children cause(4)

breastmilk
breast feeding
sepsis
hematologic problem

233

peak in jaundice caused by breastmilk

2 weeks

234

complication of galactosemia(2)

E coli neonatal sepsis
cataract in newborn

235

enzyme deficiency in galactosemia

galactose 1 phosphate uridyl transferase

236

cause of cirrhosis in neonate

galactosemia

237

period of infantile colic

238

cause of alkali ingestion intox

liquid oven cleaner

239

management of alkali ingestion(4)

no charbon
no vinegar
no lavage gastrique
endoscopy

240

physiopatho od reye syndrome in aspirin ingestion in infant

hyperammonemia

241

advantage of breastfeeding in mother(7))

decreased the risk of
breast cancer
ovarian cancer
more rapid uterine involution and post partum bleeding
fastter return to prepartum weight
improved maternal infant bonding
imp[roved child spacing

242

advantage of breastfeeding in kid(5)

decreased risk of otite moyenne
improve immunity
prevention of respiratory illness
decreased risk of NEC childhood cancer and type 1 diabetes
prevent gastroenteritis

243

additionnal finding in atresia oesophagienne

tracheo esophageal fistula

244

clue for foreign body aspiration

wheezing in infant

245

best test in foreign body aspiration

bronchoscopy

246

enfant controle tete et cou a quel age

2 mois

247

controle du bassin(2)

4 mois
6 mois

248

pull to stand a quel age

9 mois

249

stand and marche a quel age

12 mois

250

can say papa mama

9 mois

251

language of baby in 12 months(3)

mama
papa
plus one word

252

fine motor development in baby a 2 mois

ferme les mains

253

fine motor development in baby a 4 mois

ouvre mains

254

fine motor development in baby a 6 mois

passe objet d'une main a une autre

255

fine motor development in baby a 9 mois

pince a 3 doigts

256

fine motor development in baby a 12 mois

pince a 2 doigts

257

skin rash and vasomotor collapse during meningoccemia cause of death in children

adrenal gland failure

258

meningoccemia and adrenal failure percentage of death

100%

259

hemiplegia in infant after seizures that usually improves within 24 hours

Todd paralysis

260

seizure description in infant in the USMLE

sudden loss of consciousness with following disorientationand slow gain of consciousness

261

importanse of todds paralysis

there 's a structural abnormality underlying the seizure

262

patient with spasms 14 yo and swollen and erythemastous ombilical cord dx

tetanus neonatal

263

major source of protein in milk

whey

264

advantage of human mlik

more easily absorbs
improves gastric emptying

265

evolution of cephalematoma

resorb spontaneously wuthin weeks to 3 months

266

clue for drinking cow milk in USMLE

whole milk

267

clue for tetralogy de fallot(2)

tet spell
cyanosis during tet

268

cause of tet spells

sudden spasm of the right ventricular outflow tract during exertion

269

murmur in Fallot

crescendo decrescendo systolic murmur over the left upper sternal border

270

complication of praderr willi syndrome(4)

sleep apnea
Type 2 diabetes mellitus
gastric distension and rupture
death by choking

271

howel jolly bodyes

nuclear remnant of red blood cell

272

congenital malformation in diamond blacfan diamond(4)

short stature
webbed neck
shieleded chest
triphalangeal thumbs

273

lens dislocation in marfan syndrome

upward

274

lens dislocation in homocystinuria

down ward

275

what to do devant leukocoria

refer to ophtalmologist

276

clue for midgut volvulus(3)

child less than 1 month with bilious vomiting
abdominal distension
passage of bloodstained stools

277

development of child of 2 years(3)

speak in 2 words
follow two steps command
two quarters of speech intelligible

278

development of child of 3 years(3)

use three word sentences
threequarters of speech intellible
ride tricycle

279

complicationin severe type 2 osteogenesis imperfecta(4)

death in utero
multiple intrauterine fracture
blue sclera
growth retardtion

280

patient with menigitidis requires urgent LP who must give consent for the procedure and why(2)

no consent is needed
it's an emergency procedure

281

emergent act with no need of consent(2)

intubation for respiratory failure
LP

282

xray finding in coarctation of the aorta

rib notching

283

cause of rib nocthing in coarctzation of aorta in turner

dilatation of the collaterals between the hypertensive chest walls vessels

284

characteristics of coarctation of aorta(2)

hypertension in upper part of the body
hypoperfusion in the lower part of the body

285

why continuous murmur on chest in coarctation of aorta

development of collaterals betweenthe hypertensive and hypoperfused vessels

286

young boy with bitemoral hemianopsia,symptom of intracranial pressure calcified lesion above the sella dx

craniopharyngioma

287

MRI with cystic calcified parasellar lesion

craniopharyngioma

288

clue for congenital adrenal hyperplasia late onset(non classic)(4)

advanced bone age
coarse axillary and pubic hair
severe cystic acne
normal electrolytes

289

clue for peripheral precocious puberty(2)

low baseline levels of LH
no modification of LH after stimulation with a gonadotrophin releasing hormone agonist

290

clue for classic CAH(3)

neonatal period manifestation
adrenal insufficiency
ambiguous genitalia

291

hemolytic anemia characteristics(5)

mild to moderate anemia
reticulocytosis
unconjugated bilirubinemia
low to absent serum haptoglobin
high lactate dehydrogenase

292

first step in children with meningitidis(2)

LP
followed by ceftriaxone plus vancomycine

293

when using imaging prior to LP(3)

focal neurologic finding
coma
history of neurosurgical surgery

294

local impetigo characteristics

vesiculopustular lesions golden yellow and encrusted

295

rx of impetigo

topical mupirocin

296

spherocytose hereditaire in new born(3)

hemolytic anemia
jaundice
splenomegaly
increased mean corpuscular hb concentration

297

problem in hereditary spherocytosis

defect of red blood cell membrane
ankyrin gene abnormality causes spectrin defivciency

298

dx of spherocytosis(2)

high osmotic fragility in acidified glycerol lysis test
abnormal eosin5 maleimide binding test

299

rx of hereditary spherocytosis(3)

folic acid supplementation
blood transfusions
splenectomy

300

complication of hereditary spherocytosis(2)

pigment gallstones
aplastic crisis from parvovirus B19

301

hemiplegia in child after accident with pencil penetration in mouth at school

traumatic carotid artery dissection

302

consequence of trauma in the soft palate

risk of stroke in children

303

rx of minimal change

prednisone

304

during apgar evaluation baby has HR

pulse oxymetry monitoring
positive pressure ventilation

305

clue for impaired leucocytes adhesion type 1(5)

delayed separation od umbilical cord
reccurrent bacterial infections of skin and mucosal surfaces
necrotic perriodontal infection
no pus in inflamed or infected tissue
leucocytosis with neutrophil predominance

306

maternal I drug user , baby with failure to thrive,lymphadenopathy,thrush dx

HIV infection

307

hiv testing in hiv drug use during pregnancy(2)

1 trimestre
3e trimestre

308

xray in duodenal atresia

double bubble sign

309

cause of microcytic anemia in children

consumption of > 24 ounces per day of cow milk(700ml)

310

inheritance of hemophilia

Xlinked recessive

311

screening test of hemophilia(2)

coagulation studies
platelet count

312

rx of hemophilia

administration of factor 8 et 9

313

boy 4 -10 ans with hip and knee pain with insidious onset and antalgic gait.xray

legg calve perthes disease

314

adolescent with hip pain obese

slipped femoral capital epiphysis

315

when to suspect respiratory distress syndrome in premature infant(3)

premature infant with
grunting
flaring
retraction immediately after birth

316

dx in prematured infant with respiratory distress

hyaline membrane disease

317

xray in hyaline membrane disease

fine reticular granularity

318

treatment of hyaline membrane disease

continuous positive air pressure ventilation

319

charactheristics of acquired aplastic anemia

everything is low=pancytopenia

320

cause of acquired aplactic anemia(2)

drugs
infectiom

321

drug causing acquired aplastic anemia

chemo
chloramphenicol

322

toxins causing aplastic anemia(2)

benzene
carbon tetrachloride

323

mode de contamination of measles

infected droplets from respiratory secretions

324

rash characteristic in measles(2)

cephalocaudal and
centrifugal spread

325

confirmatory dx of measles

PCR

326

complication of measles(4)

otitis media
pneumonia
neurologic
gastroenteritis

327

neurologic complication of measles(2)

encephalitis within days
subacute sclerosing panencephalitis within years

328

premature child with seizures hypotension focal neurologic findings bulging and tense fontanel apna and bradychardia cause of symptoms

intraventricular hemmorage

329

what do to in any premature infant even if asymptomatic

transfontanel ultrasound

330

why gout in lesh nyhan syndrome

deficiency in hypoxanthine guanine phosphorybosil transferase

331

role of hypoxanthine guanine phosphorybosil transferase


purine metabolism

332

young boy with gout

lesh nyhan syndrome

333

clue for intussuception in USMLE

palpable cylindrical mass on the right side of the abdomen

334

patient with recurrent intussuception

rule out meckel

335

cause of intussuception(3)

recent viral illness
rotavirus vaccination
pathological lead point

336

quid of pathological lead point(5)

congenital malformation of the intestines like meckel
henoch shonlein purpura
celiac disease
intestinal tumor
polyps

337

clue for meckel(3)

suden intermittent abdominal pain
currant jelly stools
sausage shaped abdominal mass

338

dx of Meckel(3)

target sign on ultrasound
technetium 99m pertechnetate scanning
explorative laparoscopy

339

rx of intussuception(2)

enema
surgery for removal of lead point

340

management of cyanosis in fallot(2)

knee chest positionning
inhaled o2

341

definitive rx of Fallot

surgery before age of 6

342

the most common cause of congenital adrenal hyperplasia

21 hydroxylase deficiency

343

what will happen in 21 hydroxylase deficiency(2)

hyeperandrogenism=hirsutism
Plus virilism

344

clue for congenital adrenal hyperplasia(2)

elevated 17 hydroxyprogesterone
certain degree of dsalt wasting

345

most common cause of hyperandrogenism and oligo ovulation

PCOS

346

cause of hyperandrogenism en dehors de PCOS(6)

ovarian or adrenal tumors
late onset of adrnal hyperplasia
hyperprolactinemia
hyperprolactinemia
acromegaly
cushing disease

347

hyperandrogenism plus high 17 hydroxyprogesterone

CAH

348

clue for acromegaly

high insulin like growth factor

349

clue for clavicular fracture in baby(2)

crepitus
moro reflex asymetric

350

consequence of hyperinsulinism in macrosome(2)

viceromegaly
fat accumulation

351

cause of intellectual disability(3)

fetal alcohol syndrome
down syndrome
fragile X syndrome

352

clue fragile x syndrome(5)

macroorchidism
macrocephaly
large ears
long narrow face
prominent forehead and chin

353

face of patient with down syndrome

flat facial profile
slanted palpebral fissure
small low set ears

354

body of patient with Down(4)

excessive skin at nepe of the neck
single transvers palmar crease
clinodactyly
large space between the first 2 toes

355

2 yo kid with noisy breathing worsen when lying on his back or crying or feeding dx?

laryngomalacia

356

2 yo kid with noisy breathigh worset when lying on his back or crying way to confirm the dx

flexible laryngoscopy

357

flexible laryngoscopy of laryngomalacia(2)

collapse of supraglottic structures with inspiration
omega shape epiglottis

358

evolution of laryngomalacia

spontaneous resolution by age of 18 months

359

inspiratory stridor in laryngomalacia

noisy breathing

360

peak for laryngomalacia

4-8 mois

361

clue for hypothyroidism in infant(6)

baby normal at birth
later apathy
hypotonia
sluggish movement
abdominal bloating
umbilical hernia

362

screening test in baby in the US(3)

hypothyroidism
Phenylketonuria
galactosemia

363

murmur in VSD

holosystolic murmur at the left sternal border

364

most common cause of congenital abnormality

VSD

365

best tes if you suspect VSD

echocardiography

366

evolution of vSD

75% des cas close spontaneously by age 2

367

blood stained odorless vaginal discherger in kid

reassurrance

368

cause of vaginal discherge in infant

effect of maternal estrogen

369

how many doses a kid from 6 weeks to 6 years should receive

5 doses

370

patient in the past has febrile seizure when receiving DTP acellular can we give this patient hs 4 th dose and why (2)

yes
febrile seizure is not a contrindication for acellular pertussis

371

contrindication for further administration of pertussis(3)

immediate anphylaxia
unstable neurologic disorder
encephalopathy
wthin a week administration of pertussis containing vaccines

372

child from 3-10 year old develops hip pain following rhinorrhea and intermittent cough xrayu is normal no history of fever is noted dx

transient synovitis

373

rx of transient synovitis(3)

Ibu
rest
follow up in 1 week

374

indicator to look at in dx septic arthritis

fever > 38.5
inability to bear weight
wBC> 12000
ERS > 40
CRP>2.0 mg/dl

375

normal CRP

20 mg/l

376

why you should ask bilateral hip xray even if you suspect transient synovitis

to rule out leg calve perthes disease

377

patient presenting in consultation a 24 mois d'age with .cover test reveals moderate deviation of the left eye dx

strabismus

378

complication of strabismus

amblyopia

379

what to do in dx of strabismus

occlusion of the normal eye

380

cause of amblyopia(3)

strabismus
errors of refraction
opacity of the media along the visual axis

381

can you see a patient with epiglotittis like out patient

no because it's a medical emergency

382

patient dx with epiglotitis with respiratory distress next step

endotracheal intubation with a set up for tracheostomy

383

why you can 't encounter epiglotitis caused by HIB

because of vaccination

384

after bloody diarrhea patient develops anemia
low platelet
and renal insufficiency dx?

SHU

385

cause of SHU

E coli producing verotoxin

386

patient between 2-12 ans with bilateral lower extremities pain occurring at night bilateral with normal physical exam with normal activity leveldx?

growing pain

387

cause of growing pain

unknown

388

rx of growing pain(4)

observation
parental reassurance
massage
over the counter pain medications

389

quid of purpura in USMLE

non blanching rash

390

pathogenesis of Henoch shonlein purpura(2)

IG A deposit in affected organs
immune mediated leukocytoclastic vasculitis

391

role in sodium bicarb in the rx of TCA intoxication(2)

correct the acidosis
narrow the qrs complex prolongation

392

patient presenting with microcephaly,hypotonia
short stature and cat like cry

cri du chat syndrome

393

weight loss in baby

up to 7% in the first 5 days

394

baby comes by the day five with weight loss of

continue exclusive breast feeding

395

baby comes by the day five with weight loss of > 7% next step(4)

assess for oromotor dysfunction
assess for lactation failure
daily weights
consider formula supplementation

396

in vignette diaper with brick dust appearance or pink stains in baby with dehydration why

it's caused by uric acid crystals

397

when should a babay regain weight after losing weight during the 5 first days

entre 10 a 14 jours

398

cause of growth failure in cystic fibrosis

pancreatic insufficiency

399

cause of pancreatic insufficiency in cystic fibrosis(2)

inspissation
obstructionof pancreatic ducts

400

tests for cystic fibrosis(3)

Sweat chloride test
genotyping
fecal elastase

401

kid with growth failure and reccurrent respiratory infection

cystic fibrosis

402

contrindication of breast feeding maternal conditions(8)

active unrx TB
maternal hiv infection
herpetic breast lesions
varicella infection

403

when a mother on anti TB can begin to breast feed baby

2 weeks after beginning anti TB drugs

404

infants condition with contrindication of breastfeeding

galactosemia

405

clue for osteogenesis imperfecta(5)

autosomal dominant
osteopenia
blue sclerae
hearing loss
dentinogenesis imperfecta

406

quid of dentinogenesis imperfecta

opalescent blue gray to yellow brown discoloration caused by discolored dentin shining through the transluscent and weak enamel

407

what about intelligence in patient with osteogenesis imperfecta

normal intelligence

408

rx of neonatal conjunctivitis induced by gonoccoque

parenteral ceftriaxone
or
cefotaxime

409

rx of neonatal conjunctivitis induced by chlamydia trachomatis

oral erythromycin

410

characteristic of chlamydial neonatal conjunctivitis(2)

blood stained eye discharge
mucoid discharge

411

patient with reccurent sinopulmonary infections oral candidiasis persistent diarrhea absent lymp nodes Low B and T cells and natural killer absent thymic shadow dx

severe combined immunodeficiency

412

most 2 common tumor of posterior fossa(infratentorial tumor) in children(2)

astrocytoma
medulloblastoma

413

if a kid has a medulloblastoma what area of the brain will be most likely affected

cerebellar vermis

414

post vermis syndrome(4)

unbalanced gait
trunk dystaxia
horizontal nystagmus
papilledema

415

vaginal discharge and enlargement of mammary glands in newborn infants next step?

observation

416

bugs causing scarlet fever

Group A streptococcus producing exotoxins

417

kid with sore throat ,fever sand paper rash stawberry tongue and circumoral pallor dx

scarlet fever

418

rx of choice of scarlet fever

penicillin V

419

first born boy 3 a 5 semaines de naissance with projectile nonbilious vomiting after feed
physical exam reveals palpable olive shaped mass in the RUQ

pyloric stenosis

420

metabolic problem in pyloric stenosis(3)

hypochloremic
hypokalemia
metyabolic acidosis

421

dx of pyloric stenosis (2)

abdominal US
elongated and thickened pylorus

422

rx of choice of pyloric stenosis

pylotomyotomy

423

what to do before surgical rx of pyloric stenosis and why(2)

correct metabolic problem
sinon risque of post op apnea

424

characteristics in 21 hydroxylase deficiency(5)

anbiguous genitalia in girl
salt wasting
hypotension
low NA+
high K+

425

hormone abnormality in 21 hydroxylase deficiency(3)

low cortisol and aldosterone
high testo
high hydroxyprogesterone

426

characteristics in 11 B hydroxylase deficiency(3)

ambiguous genitalia in girls
fluid and salt retention
hypertension

427

hormone abnormality in 11 B hydroxylase deficiency(4)

low cortisol and aldosterone
high testo
high 11-deoxycorticosterone
high deoxycortisol

428

characteristics in 17 @ hydroxylase deficiency(3)

all patients are female
fluid and salt retention
hTA

429

hormone abnormality in 17 2 hydroxylase deficiency(3)

low cortisol and testo
high mineralocorticoids
high corticosterone

430

first step in the management of choanal atresia(2)

placing oral airway
lavage feeding

431

definitive rx of choanal atresia(2)

repairing obstruction with surgery
or
with endoscopy

432

child less than 5 years with proximal muscles weakness gower sign and bilateral calf pseudohypertrophy dx

duchenne muscular dystrophy

433

quid of gower sign

patient uses hands to walk up the legs in order to stand up


434

cause of DMD

dystrophin gene deletion on XP 21

435

cause of death in DMD(2)

respiratory failure
or
heart failure

436

clue for kawasaki disease(6)

fever > ou egal a 5 jours plus > ou egal a 4 findings
bilateral non exsudative conjunctivitis
mucositis
cervical lymph node with at least one > 1,5 in diameter
erythematous polymorphous rash
extremity changes( edema or erythema)

437

mucositis in kawasaki disease(3)

strawberry tongur
injected or fissured lips
injected pharynx

438

complication of kawasaki(2)

coronary artery aneurism
myocardial infarction and ischemia

439

rx of kawasaki(2)

aspirin
plus
IV immunoglobulin

440

role of aspirin and immunoglobulin in kawasaki

to reduce incidence of complications such as coronary artery aneurisms

441

clue for turner(4)

short height
high arched palate
widely spaced nipples
45 X0 karyotype

442

why osteoporosis in turner(2)

low estrogen levels
only one X chromosome involved in bone metabolism

443

patient with an autosomal dominant disorder presenting with tall stature,long and emaciated extremities,arachnodactyly hypermobility of joints upward lens dislocation aortic root dilation dx

Marfan syndrome

444

patient at risk for transposition of great vessels(2)

diabetic mother
males

445

physical examination in transposition of great vessels(2)

loud second heart sound
cyanosis

446

patietn with history of diabetes mellitus type 1 presents with conjonctival pallor and micrcytic anemia but no blood in feces examination.skin with vesicule erythemateuses symmetrically distributed over the extensor surfaces of elbows and knees .dx

celiac disease

447

extraintestinal manifestation on celiac disease in the vignette(3)

diabete type 1
dermatitis herpetiforme
iron deficiency anemia

448

skin problem in celiac disease(2)

dermatite herpetiforme
vitiligo

449

endocrine problem in celiac disease(2)

diabete type 1
autoimmune thyroiditis (hypo ou hyper)

450

psychiatric problem in celiac disease(2)

depression
psychosis

451

musculoskeletal problem in celiac disease(2)

osteopenia/osteoporosis
osteomalacia

452

dx of celiac disease

upper GI andoscopy with biopsy of small intestine

453

marker of celiac

IG A antitissue transglutaminase

454

9 yo girl with unsteady gait and weakness in the lower limbs .On examination widebased gait and constant shifting of position to maintain her balance.you have decreased vibratory and position sense in lower extremities

friedrich ataxia

455

MRI in friedrich ataxia(2)

marked atrophy of cervical spinal cord
minimal cerebellar atrophy

456

what you should advise to mother with kid suffering from friedrich ataxia

prenatal counselling if the mother desires any future pregnancy

457

quid of friedrich ataxia(2)

autosomal recessive
abnormality in tocopherol transfer protein

458

infectious protection by sickle cell trait

severe complication of malaria

459

differenciate hyper IGM syndrome from xlinked agammaglobulinemia(3)

in hyper IgM syndrome
opportunistic infection+++
neutropenia
high IGM levels

460

risk factor for chronic pyelonephritis

vesicoureteral reflux

461

clinical feature of media otitis(2)

middle ear effusion\
bulging tympannic membrane

462

complication of otitis media(3)

conductive hearing loss
mastoiditis
meningitis

463

rx of otitis media(2)

amox
or
amox clavulanate

464

risk factor for media otitis in children(4)

age 6-36 months
formula intake
exposure to cigarette smoke
upper respiratory infection

465

Ct for mastoiditis(2)

no air in mastoid air cells
they are opacified

466

patient 11 months with pliable skull bones,bony prominences of costochondral junctions genu varum cause of these findings(2)

nutritionnal deficiency
vit D

467

costochondral joint hypertrophy in rickets quid?

rachitic rosary

468

genu varum in rickets

femoral and tibial bowing

469

risk factor for Vit D deficiency(4)

increasd skin pigmentation(black)
exclsive breastfeeding
inadequate sun exposure
maternal vit D deficiency

470

pliable skull bones with step offs in rickets or ping pond ball skull

craniotabes

471

xray in rickets

metaphysal cupping and fraying of long bones

472

rx of rickets

Vit D 1000-2000 UI daily

473

most common form of cerebral palsy seen in premature infants

spastic diplegia

474

quid of spastic displegia(4)

hypertonia
hyperreflexia
involving lower extremities
clasp knife

475

quid of clasp knife in cerebral palsy

resistance to passive muscle movement increases with more rapid movement of the affected extremity

476

leading cause of cerebral palsy

prematurity

477

other causes of cerebral palsy(7)

intrauterine growth restriction
intrauterine infection
antepartum hemorrage
placental pathology
multiple gestation
maternal alcohol consumption
maternal tobacco use

478

rx of cerebral palsy in spasticity(2)

baclofen and
botulinum toxin

479

comorbidities associated with cerebral palsy(4)

intellectual disability
epilepsy
strabismus
scoliosis

480

localisation of neuroblastoma(2)

adrenal gland
any location along the paravertebral sympathetic chains

481

quid of neural crest cells

precursor cells of the sympathetic chains and adrenal medulla

482

CT or Xray in neuroblastoma(2)

calcifications
hemorrage

483

quid of metanephros

embryologic precursor of renal parenchyma

484

quid of metabolites of cathecholamines found in neuroblastoma(2)

HVA
VMA

485

key physical exam for down syndrome(5)

upslanting palpebral fissures
epicanthal folds
brushfield spots
single transverse crease
sandal gap toes

486

GI problem associated with Down(2)

duodenal atresia
hirshprung disease

487

neurocognitive problem associated with Down syndrome(2)

intellectual disability
early onset alzheimer

488

hematologic problem associated with Down syndrome

acute leukemia

489

endocrine problem associated with Down syndrome(2)

hypothyroidism
type 1 diabetes mellitus

490

musculoskeletal problem associated with Down syndrome(2)

atlantoaxial instability

491

porcentage of down with heart problem

50%

492

what age down syndrome patient will have heart failure

around 6 weeks

493

auscultation finding in heart failure in patient with down

S2 due to pulmonary hypertension

494

patient with circular rash after trip in connecticut dx

lyme disease

495

prevention of lyme in lyme endemic area(2)

wear permethrin treated pants
long sleeved shirts

496

7 yo girl comes for vomiting,this is the 3 episode the last two were self limiting .Physical exam is ok dx

cyclical vomiting

497

parental antecedent for children with cyclical vomiting

migraine in parents

498

patient with severe dehydration IV line can be found next step

intraosseous access

499

how long can you use an intraosseous access

24 a 48 heures

500

patient with difficulty writting and jerky movements,days later he has sore throat but now has low grade fever.pericardial friction,a subcutaneous nodules over the hands dx?

rheumatic fever

501

cause of rheumatic fever

Group A streptococus

502

5 major criterai in jones criteria(5)

polyartritis
carditis
chorea
subcutaneous nodules
erythema marginatum

503

3 minor criteria for jones

fever
athralgia
previous rheumatic fever

504

dx of rheumatic fever(3)

one major pour 2 minor
or
two major
plus detection af antistreptolysin antibodies or cultures or varrious antigens detection

505

rx of rheumatic fever

PNC G

506

2 day old baby is seen with irritabilioty,high pithed cry,poor sleeping tremors,seizures sweating sneezing tachypnea poor feeding vomiting and diarrhea dx

neonatal abstinence syndrome

507

drug involved in neonatal abstinence syndrome(2)

heroin
methadone

508

time of apparition of neonatal abstinence syndrome(2)

48 h after birth for heroin withdrawal
48 a 72 h for methadone withdrawal

509

clue for NEC(5)

newborn with
abdominal distension
bloody diarhea
and leucocytosis
after introduction of formula feeding

510

clue for craniopharyngyoma(3)

young boy with increased intracranial pressure
bitemporal hemianopsia
calcified lesion above the sella

511

clue for cranyopharyngioma

cystic clcified parasellar lesion on MRI

512

cause of anemia in premature infant(4)

transition in the erythropoiesis sites of the neonate
shorter red blood cells in neonates
diminished fetoplacental transfusion
blood loss

513

black child 9 month old with augmentation de volume des pieds et mains et douleur dx

dactylitis caused by sickle cell anemia

514

pathophysiology of dactilytis

vaso occlusive phenomena

515

what the earliest manif of vasoocclusive disease in sickle

dactylitis

516

neonate seen in with matted mass of edematous bowel loops protruding from the abdomen .There is no covering ovr the bowel loops dx

gastrochisis

517

gastrochisis next step after the DX

sterile saline dressing and wrapping of exposed bowel

518

characteristics of gastrochisis(4)

bowel protrude through a defect on the right side of the ombilical cord
bowel is not covered by protective membrane
bowel looks angry and matted
no other abnormalities associated

519

characteristics of omphalocele(3)

intera abdominal contents through the umbilical ring
bowel is covered with amnioperitoneal membrane
associated with other abnormalities(heart ,kidney)

520

patient with omphalocele what other organ to look at(2)

heart
kidney

521

why you should wrap and dress bowel in gastrochisis(2)

to minimize heat loss
and fluid loss

522

most common cause of pneumonia in cystic fibrosis

Pseudomonas aeruginosa

523

mode de transmission de cystic fibrosis CF

autosomal recessive

524

why bronchiectasia in CF

recuurrent pneumonia

525

quid of clubbing

bulbing enlargement of the tips of digits

526

cause of clubbing in CF

chronic hypoxia

527

appearance of thorax in CF

barrel chest

528

3 phases in developping bordetella pertussis(3)

catarrhal phase
paroxysmal phase
convalescent phase

529

whooping chronic cough in kid with delayed immunization with posttussive emesis

bordetela pertussis infection

530

clue for catarrhal phase in pertussis(2)

mild cough
rhinitis

531

clue for paroxysmal phase in pertussis(4)

coughing paroxysm lasting 20 a 30 mn
inspiratoty whoop
staccato cough
posttussive emesis

532

clue for convalescent phase in pertussis(2)

cough
posttussive emesis resolve

533

duration of paroxysmal phase

4-6 weeks

534

dx pf pertussis(2)

PCR
pertussis culture

535

hemogramme in pertussis

lymphocyte predominant leukocytosis

536

complication of pertussis(6)

pneumonia
weight loss
subconjonctival hemorrage
pneumothorax
respiratory failure
death

537

rx of pertussis

macrolides

538

macrolides used in pertussis(3)

azythromycin
erythromycin
clarythromycin

539

what age you can have death in infant with pertussis

less than 6 months

540

the only way to prevent chlamydial conjunctivitis in neonates

maternal prenatal testing

541

clue for duchenne muscular dystrophy(3)

bilateral calf pseudohypertrophy
gower sign
mx weakness

542

transmission of Duchenne

x linked recessive transmission

543

screening of Duchenne muscular dystrophy(2)

elevated serum creatine phosphokinase
elevated aldolase levels

544

dx support of duchenne(2)

fibrosis
fatty infiltration in biopsy

545

gold standard to confirm the dx of DMD

genetic studies

546

risk factor for iron deficiency anemia in kid(3)

cow's milk before 12 months
prematurity
maternal iron deficiency

547

why you should introduce vit D to all chldren exclusively breastfed during first month of life

human milk does not contain enough VIT D to meet daily requirement of the infant

548

dose of VIT D to give in infant exclusively breast fed

400 UI

549

quid of small for gestationnal age infant for age

weight under 10 th percentile for gestationnal age at birth

550

complication of small gestationnal age child(5)

hypoxia
polycythemia
hypoglycemia
hypothermia
hypocalcemia

551

classification of intrauterine growth restriction(2)

symmetrical
assymetrical

552

clue for symmetrical intrauterine growth restriction

head weight and head are equally affected

553

clue for asymmetrical intrauterine growth restriction

weight is affected more than height and head circumference

554

quid of metatarsal adductus(2)

deformity of foot
adduction of the anterior aspect of the foot with convex lateral border and concave medial border

555

rx of metatarsal adductus

reassurrance

556

rx of internal torsion of tibia in infant

reassurrance

557

baby 4 months old with blue macules on buttocks and and lower back (2)

mongolian spot
also called congenital dermal melanocytosis

558

epidemiology of mongolian spots(4)

african
asian
hispanic
native american

559

evolution of mongolian spots

fades spontaneously in the first decade of life

560

is mongolian spot dangerous

no its benign

561

triad for congental rubella(german measles)(3)

sensorineural deafness
cardiac defects
cataracts

562

complication of first trimaester rubella(2)

spontaneous abortion
congenital rubella syndrome

563

clue cataract in USMLE

leukokoria

564

cardiovascular anomaly in turner

bicuspid aortic valve

565

face and neck of turner patient(3)

narrow high arched palate
low set ears
low hairline
webbed neck

566

chest of turner(3)

broad chest with widely spaced nipples
coarctation of aorta
bicuspid aortic valve

567

abdomen of turner

horse shoe kidney

568

limbs of turner(2)

cubitus valgus
short stature

569

pelvis of turner(3)

streak ovaries
amenorrhea
infertility

570

why echo coeur should be done in patient with turner(3)

to dx
bicuspid aortic valve
coarctation of aorta
aortic root dilation

571

dx of chronic granulomatus disease(3)

nitro blue tetrazolium slide test
flow cytometry
cytochrome c reduction

572

Rx of CGD(2)

daily TMS
gamma inrterferon 3 f jour

573

patient with recurrent or unusual lymphadenitis hepatic abcess or osteomyelitis at multiple sites or infection with catalase positive organisms

CGD

574

patient seen in emergency with barking cough and difficulty respiratoire DX

croup

575

first thing to do in croup

racemic epinephrine before any invasive procedure

576

pneumonia plus influenza in young children with CF, bugs in cause

staphyloccocus aureus

577

medication to use in patient with cystic fibrosis in a context of influenza

vancomycin

578

most common cause of pneumonia in cystic fibrosis in young children

staph aureus

579

most common cause of pneumonia in cystic fibrosis in adult

pseudomonas aeruginosa

580

Henoch shonlein purpura clue(4)HSP

lower extremity purpura
athralgias and arthritis
coliky abdominal pain
reenal involvement

581

why coliky abdominal pain in HSP

local vasculitis

582

dx of HSP

clinical

583

dx of HSP in atypical presentation

renal biopsy

584

renal biopsy in HSP

deposition of IGA in the mesangium by immunofluorescence

585

peak of incidence sudden infant death syndrome

1 month and 1 year in the US

586

cause of edema in turner syndrome

lymphedema

587

cause of lymphedema in turner

dysgenesis of the lymphatic network

588

kid with with ascending symmetric flaccid paralysis in both legs absent deep tendon treflexes and decreased superficial touch and vibratory senses.dx

guillain barre

589

structures affected in guillain barre

peripheral motor nerves

590

albumino cytologic dissociation dx

guillain barre syndrome

591

rx of Guillain barre(2)

plasmapheresis
or
human immunoglobulin

592

cause of GBS

most of the time follows viral infection

593

macrosome with clavicle fracture next step

reassurrance and gentle handling

594

period of time for healing clavicle fracture

7-10 jours

595

prema with neurologic symptoms

intraventricular hemorrage

596

risk for intracerebral hemorrage in prema(2)

597

screening test for intracerebral hemorrage in prematurity

serial head ultrasounds

598

clue for intracerebral hemorrage(4)

rapidly increasing head circumference
bulging fontanel
hypotonia
lethargy

599

cranial ultrasound of intraventricular hemorrage in prema(2)

bilateral IVH
dilated ventricles

600

why communicating hydrocephalus in intracerebral hemorrage

accumulation of blood in subarachnoid space impaitr the ability of the arachnoid villi to absorb cerebrospinal fluid

601

main problem in phenylketonuria(2)

deficiency in phenylalanine hydroxylase
accumulation of phenylalanine in the blod and body tissues

602

screening test for phenylketonuria

gutrie test

603

clue for phenylketonuria(4)

faitr hair and skin
blue eyes
eczematous changes
urine with mousy odor

604

what to avoid in phenylketonuria

protein

605

12 yo with back pain with or without incontinence ,physical exam reveals step off of lumbosacral area dx

spondylisthesis

606

physiopatho of spondylisthesis

developmental disorder with forward slip of vertebra usually L5 over S1

607

6 yo with down syndrome presents urinary incontinence,hyptonic and hyperreflexia wit positive babinski

atlanto axial instability

608

cause of atlanto axial instability in down syndrome

excessive laxity in the post transverse ligament causing increased mobility between atlas C1 ant the axis C2

609

upper motor neuron findings in patient presenting with down syndrome

atlantoaxial instability

610

children with inattention impulsivity and hyperactivity in 2 or more settings dx

deficit hyperactivity syndrome disorder

611

patiuetn with sickle cell disease presents with pain in his right hip that started several days ago dx

avascular necrosis

612

cause of avascular necrosis(6)

sickle cell disease
SC hemoglobin disease
corticosteroid therapy
SLE
alcoholism'
Gaucher disease

613

physiopatho of aeptic necrosis in sickle cell disease(3)

occlusion of end arteries supplying the femoral head
bone necrosis
colapse of the periarticular bone and cartilage

614

children with isolated thrombocytopenia and petechiae after viral infection dx

immune thrombocytopenia

615

children with isolated thrombocytopenia and petechiae after viral infection next step

observation regardless the level of platelet

616

children with isolated thrombocytopenia and petechiae after viral infection ,experiencing bleeding next step(2)

IV glucorticoids
or
IV immunoglobulin

617

physiopatho of immune purpura(2)

antibody binds to platele
destruction of complex antibody-platelet-in spleen

618

period of time to recover from immune purpura

6 months

619

hemogram in measles(2)

leukopenia(T cell cytopenia)
thrombocytopenia

620

what seem to decrease the morbidity and mortality in measles

vit A

621

regression of milesstones after meningitis cause of that

meningitis

622

neurologic sequelae associated with bacterial meningitis(5)

hearing loss
loss of cognitive functions
seixures
mental retardation
spasticity or paresis

623

principal risk in Digeorge

hypocalcemia

624

tests to ask if youb suspect Digeorge(2)

serum calcium levels
echocardio

625

risk associated with hypocalcemia(3)

tetany
seizures
arrythmia

626

complication of absent thymus in Digeorge

T cell lymphopenia

627

complication of T cell lymphopenia(2)

viral
fungal infection

628

bay born with cyanosis,tremulation,low set ears,micrognatia and cleft palate.No thymic shadow in chest xray DX

Digeorge syndrome

629

macrome presenting with right upper extremity held in adduction and rotation interne,with the elbow pronated and wrists and fingers flexed,moro and biceps reflexes absent bilateraly next step in the management in the patient and dx

Erb Duchenne
reassurance about prognosis

630

maternal risk factor for macrosomia

advanced age
diabetes
excessive weight gain during pregnancy
preexisting obesity
multiparity

631

fetal risk factor for macrosomia(3)

african american or hispanic ethnicity
male sex
post term pregnancy

632

evolution of erb duchenne

80 % spontaneous recovery within 3 months

633

quid of renal tubular acidosis

inability for renal tubules to reabsorb bicarb or excrete hydrogen

634

quid of type 1 renal tubular acidosis

defect in hydrogen secretion

635

cause of type 1 renal tubular acidosis

genetic disorder

636

metabolic problem in type 1 renal tubular acidosis(4)

acidotic
hypokaliemic
high PH urinaire
nephrolithiasis commonly develops

637

quid of type 2 renal tubular acidosis

decreased bicarb reabsorbtion in proximal tubule

638

cause of type 2 renal tubular acidosis

Fancony syndrome

639

quid of type 4 renal tubular acidosis

defect in sodium potassium exchange in the distal tubule

640

metabolic problem in type 4 renal tubular acidosis(2)

hyperkaliemie
hyperchloremie

641

cause of type 4 renal tubular acidosis(3)

obstructive uropathy
renal disease
multiplastic dysplastic kidneys

642

patient with less than 3 yo with impairment of social interaction and communication delayed language and stereotypical behaviors

autism

643

what will need patient with autism

behavioral and educationnal programs

644

patient with respiratory distress ,examination reveals nasal falring grunting,and barre shaped chest.auscultation reveals absent breath sounds in the left abdomen is scphoid .chest xray shows devation pf the heart in the right and gasless abdomen dx ?

congenital diaphragmatic hernia

645

next after dx of congenital diaphragmatic hernia

endotracheal intubation

646

complication of diaphragmatic hernia(2)

pulmonary hypoplasia
pulmonary hpertension

647

sites of diaphragmatic hernia in the chest(2)

85% in the left
15 % in the right

648

why polyhydramnios in congenital diaphragmatic hernia

esophageal compression

649

consequence of abdominal viscera in the chest(2)

concave abdomen
barrel shaped chest

650

congenital diaphragmatic hernia with respiratory distress

emergency intubation

651

why you cannot use blow by oxygen and bag and mask ventilation in congenital diaphragmatic hernia

you will pump air in the intestines ,and further compromise the pulmonary function

652

why after intubation in diaphragmatic hernia ,gastric tube should be used

to decompress the stomach and bowel

653

in vignette patient after 6 months of age with reccurrent sinopulmonary infections and giardiaisis, DX

abnormal B lymphocyte maturation

654

problem with genetic B cells deficiency(2)

ressurrent infections after 6 months with encapsulated organisms
lack of IGA predisposes to infection

655

clue for Nieman pick disease(5)

cherry red macula
protruding abdomen
hepatosplenomegaly
lymphadenopathy
regression of developmental milestones

656

complication of sphingomyelinase deficiency in Nieman pick

sphingolipidosis

657

risk of premature adrenarche(2)

obesity
hispanic and black ethnicities

658

risk in patient with isolated premature adrenarche(3)

PCOS
Diabete type 2
metabolic syndrome

659

cause of premature adrenarche

early activation of adrenal androgen relaease

660

characteristics premature (5)

pubic hair
axillary hair
acne
body odor in girls
before 8 for girl before 9 for boy

661

role of adipocytes during obesity(2)

increase secretion of insulin
increase secretion of leptin

662

consequence of increased insulin secretion in obesity(2)

increase adrenal production---->periphera activation of adrenarche
increase ovarian estrogen production------->peripheral activation of thelarche

663

consequence of leptin secretion in obesity

axctivation of the axis hypothalamus pituitary gonadal axis------->central activation of puberty-----> LH ans FSH release --->ovarian stimulation and estrogen production

664

patient with reccurrent sinopulmonary infection with deceased IGA,IGM IGD and IGG absence circulating B cells Dx

bruton's agammaglobulinemia

665

transmission of Bruton agammaglobulinemia

X linked recessive

666

differenciation between Bruton and common varable immunodeficiency(3)

CVID occurs later 15-35 ans
CVID no decrease or no absence of Lymphocytes B circulant
in CIVD all gender can be touched by the disease

667

male 6-9 ans with recurrent sino pulmonary infection

Brutons agammaglobulinemia

668

most common cause of neonatal jaundice

breastfeeding jaundice
breast milk jaundice
sepsis

669

when to suspect neonatal sepsis(3)

fever or hypothermia
ictere
neurologic symptom

670

patient with ictere and neurologic symptom and hypothermia next step(2)

PL
blood culture

671

patient with ingestion battery plain xray shows battery in esophagus next step?

immediate endoscopic removal

672

why you should remove battery in esophagus

to prevent mucosal damage and esophageal ulceration

673

patient with ingestion battery plain xray shows battery in distal to esophagus next step?

observe stool

674

newborn with failure to thrive,bilateral cataracts,jaundice and hypoglycemia DX

galactosemia

675

whta to do after dx galactosemia

elimination of galactose in from the diet

676

healthy infant crying for than three hours a day, more than three days a week and more than 3 weeks a month

colic

677

rx of infantile colic

simethicone
or
probiotics

678

steatorrhea in USMLE

oily and nasty smelling stools

679

gold standard test for cystic fibrosis

swaet testing by quantitative pilocarpine iontophoresis

680

why you can have ADEK deficiency in cystic fibrosis(2)

because of pancreatic insufficiency
no absorption of fat soluble vit

681

consequence of ADEK deficiency

A=Night blindness
D=ricket
E=neuropathy
K=coagulapathy

682

value of chloride to confirtm the DX of CF

> ou egal a 60 mmol /l on 2 separate occasions

683

organ always involved in Cystic fibrosis(2)

respiratory tract
and
Pancreas

684

problem in cystic fibrosis

defective chloride transport results in inpissated secretions in multiple organs

685

clue for CF(3)

steatorrhea
failure to thrive
respiratory infections

686

step in management of children after ingestion of oven cleaner liquid(4)

ABC assessment
remove contaminated clothing
chest xray if respiratory symptom
endoscopy within 24 hours

687

when to perform upper endoscopy after alkali ingestion

within 24 hours

688

risk for delay in performing upper endoscopy in alkali ingestion

risk of perforation during procedure

689

quid of alkali ingestion

oven cleaner liquid

690

complication of alkali ingestion(5)

uppper airway compromise
perforation
stricture /stenosis(2-3 weeks)
ulcers
cancer

691

what to not do if alkali ingestion

try to neutralize the alkali with vinegar or lavage

692

symptom in reye syndrome and lab finging(6))

vomiting
increased AST and ALT
PT prolonged
Normal bilrubin
hyperammonemia
hypoglycemia

693

context for reye syndrome

chil less than 15 years treated with salycilates after viral infection

694

Ct scan in reye syndrome

cerebral edema

695

viral infection and fever

no salycylates

696

biopsy of liver in reye syndrome

microvesicular steatosis

697

newborn with choking spell and coughing after first feeding

atresia oesophagienne with possible fistule tracheo esophagienne

698

what will happen in attempting to pass a nasogastric tube in case of esophageal atresia

xray will show the tube in proximal esophageal pouch

699

why you can have pneumonia par aspiration in esophageal atresia

gastric reflux can go into the distal esophagus through the fistula and into trhe trachea and lungs

700

prenatl clue for osophageal atresia

polyhydramnios

701

toddler with sudden onset respiratory istress bwith focal findings in auscultation

foreign body aspiration

702

why chest xray is limited in foreihn body aspiration

because most object are radioluscent

703

next step in foreign body aspiration

bronchoscopy

704

most common aspirated foreign body*3)

peanuts
popcorn
pieces of toys

705

physical exam in foreign body aspiration(2)

focal monophonis wheezing on affected side
diminished aeration on affected side

706

gross motor in 2 months

lift head/chest in prone position

707

gross motor in 4 months(12)

sits with trunk suppotrt
begins rolling

708

gross motor in 6 months

sits momentarilypropped on hands( unsupported by 7 months)

709

gross motor in 9 months(2)

pull to stand
cruises

710

gross motor in 9 month(3)

stands well
walks first steps independently
throws ball

711

fine motor in 2 months(2)

hands unfisted 50 % of the time
track past midline

712

fine motor in 4 month(2)

hands mostly open
reaches midline

713

fine motor in 6 month(2)

transfers objects hand to hand
raking grasp

714

fine motor in 9 month(2)

3 finger pincer grasp
hold bottle or cup

715

fine motor in 12 month

2 finger pincer grasp

716

language in 2 month(2)

alerts to voice and sound
coos

717

language in 4 month(2)

laughs
turn to voice

718

language in 6 month(2)

responds to name
babble

719

language in 9 month

say dada mama

720

language in 12 month

say first words

721

social cognitive in 2 months(2)

social smile
recognizes parents

722

social cognitive in 4 months

enjoys looking around

723

social cognitive in 6 months

stranger anxiety

724

social cognitive in 9 months(2)

wave bye
plays pat a cake

725

social cognitive in 12 months(2)

separation anxiety
comes when called

726

what a 6 month baby can do(4)

should be able to sit momentarily
transfer objects from hand to hand
respond to name
stranger anxiety

727

language development in 2 yo child(3)

vocabulary of hundred words
able to combine words into short sentences
half of the baby speech should be understood by stranger

728

neonate with painless bloody stools dx

milk or soy protein proctocolitis

729

what to do in soy protein proctocolits(2)

elimination of soy and dairy product in mama diet
initiation of hydrolysed formula in formula fed children

730

symptoms of soy protein proctocolitis(3)

severe reflux or vomiting
painless bloody stools
eczema

731

peak of apparition of soy protein proctocolits and prognosis(2)

2 a 8 semaines
resolution by age of one

732

neonatal jaundice with conjugated bilirubinemia DX

neonatal cholestasis

733

indication for further evaluation of jaundice(6)

conjugated hyperbilirubinemia > 2 mg/dl
jaundice that apperas in the first 24-36 hours of life
serum bilirubin greater than 12 mg/dl in full term infantor 10-14 in preterm infant
jaundice persist after 10-14 days of life
the presence of sign and symptom
serum bilirubin rising at a rate faster than 5 mg/24 hours

734

cause of neonatal cholestasis in infant

biliary atresia

735

quid of friedrich ataxia

the most common spinocerebellar ataxia

736

triad of friedrich(3)

neurologic (atxia and dysarthria)
skeletal(scoliosis, foot deformities
cardiac(concentric hypertrophic cardiomyopathy)

737

cause of death in friedrich(2)

cardiomyopathy
respiratory
failure

738

speech difficulty in USMLE

dysartria

739

hammer toe

friedrich

740

quid of overlapping finger s in edwards

third and the 5 th overlaping the 4 th

741

dx diffrentiel of flaccid pralysis in kid(3)

infant botulism
foodborne botulism
guillain barre syndrome

742

pathogenis of infant botulism

ingestion of clostridium spores from environmental dust

743

pathogenis of food borne botulism

ingestion of preformed C botuinum toxin

744

pathogenis of Guillain barre syndrome

autoimmune peripheral nerve demyelination

745

differentiate GBS and botulism(2)

descending flaccid paralysis in botulism
ascending flaccid paralysis in GBS

746

rx of infant botulism

human derived botulism immune globulin

747

rx of food borne botulism

equine derived botulism immune globulin

748

rx of GBS

pooled human immune globulin

749

clue for infant botulinism(4)

constpation
hypotonia
bulbar palsies
no honey feeding

750

what to do in neonates in term of screening

hip dysplasia

751

maneuver to screen hip dysplasia(2)

barlow
and
'orthelani

752

next step if you feel palpable clunk during maneuvers in screening of hip dysplasia

referral to orthopedic surgeon

753

hip dysplasia suspected soft click during barlow and orthelani or asymmetric inguinal skin folds or leg lenght discrepancy (2)

Ultrasound in ou egal a 4 a 6 mois

754

rx of choice for hip dysplasia in kid >

pavlik hip harness

755

complication of hip discrepancy

limp=trndelenburg gait

756

risk in supracondylar fracture

brachial artery injury

757

consequence of brachial artery injury

loss of radial artery pulse

758

what to in household with one person with pertussis even if the contact has received immunizations

prescribe macrolide antibiotic for all households contacts

759

pertussis rx and post exposure prophylaxis in person

azytromycin for 5 days

760

pertussis rx and post exposure prophylaxis in person > 1 an(3)

azytromycin for 5 days
clarythromycin for 7 days
erythromycin for 14 days

761

basics in post exposure prophylaxis for pertussis(3)

rx regardless of age
statut immunitaire
symptoms

762

clue for nursemaid's elbow

infants or children whenare lifted or pulled by the hand or arm you have rasdial head subluxation

763

clue for nursemaids elbow

child keeps hand in a pronated position and refuses attempted forearm supination

764

clue for fragile X syndrome(6)

low to normal IQ
generalised language disability
short attention span large head
prominent jaw
large low set ears
macroorchidism

765

cause of mental retardation in fragile X syndrome

increased number of CGG trinucleotide repeats

766

overweight adolescent 10-16 yo with hip pain dx

slipped capital femoral epiphysis

767

rx of slipped femoral capital epiphysis

immediate surgical screw fixation

768

complication untreated slipped capital femoral epiphysis

avascular necrosis

769

xray slipped capital femoral epiphysis

glissement du reste de la tete humeral asur l'epiphyse

770

xray slipped legg calve

lyse of the head of femur

771

developmental milestone in child by age of 12 months(6)

they should triple weight
height should be increased by 50%
walk independently
using 2 pincre grasps
saying few words like mama dada
imitate action of others

772

Ct scan finding in congenital toxo(3)

inflammatory lesions
hydrocephalus
intracranial calcificaions

773

triad for congenital toxo(3)

chorioretinitis
hydrocephalus
intracranial calcifications

774

clue for von gierke(8)

hypoglycemia
lactic acidosis
hyperuricemia
hyperlipidemia
doll like facies
thin extremities
short stature
protuberant abdomen

775

Age for von gierke

3 -4 month

776

why seizure in von gierke

hypoglycemia

777

why protuberant abdomen in von gierke (*2)

enlarged liver
and
kidney

778

physiopatho for von gierke

glucose 6 phosphatase deficiency

779

quid of von gierke

type 1 collagen storage disease

780

what to do if apgar is 8 in infant (3)

removal of airway secretions
drying and keeping him warm
early preventive measures

781

first thing to do in neonates

APGAR calculation

782

quid of early preventives measure in newborn(2)

gonococcal ophtalmia prevention
vit K supplementation

783

first step in children with speech delay

audiology evaluation

784

confirmatory test for SLE(2)

anti SM
anti DsDNA

785

risk factor for pyloric stenosis(3)

first born boy
erythromycin
formula feeding

786

why peak of incidence of infantile hypertrophic pyloric stenosis

age 3-5 weeks

787

dx of pyloric stenosis clinic(2)

projectile nonbilious vomiting
olived shaped presentation

788

lab finding in infantile pyloric stenosis

hypochloremic metabolic alkalosis

789

paraclinic dx in infantile pyloric stenosis

abdominal ultrasound

790

finding in infantile pyloric stenosis

thick and elongated pylorus

791

physiopatho of formula feeding inducing pyloric hypertrophy(2)

slower gastric emptying
increase burden stimulates growth of the pylorus muscle

792

2 day baby with jaundice mother A positive and negative screening for GBS during pregnancy.lab show 7 mg/dl bilirubin with 0.4 conjugated bilirubin Dx

physiologic jaundice

793

peak of incidence of physiologic jaundice

2-4 days of life

794

resolution of physiologic jaundice

1-2 weeks

795

physiopatho of physiologic jaundice(3)

increased bilirubin production due to high Hb turn over
decreased bilirubin clearance
increased enterohepatic cycling

796

why in newborn you can have decreased bilirubin clearance

decreased hepaticuridine diphosphoglucuronate transferase activity until age 2 weeks

797

why in asian newborn you can have decreased bilirubin clearance

Asian have decreased UGT activity

798

why enterohepatic cycling is increased in new born

because sterile newborn gut

799

possible complication of physiologic jaundice

kernicterus

800

indication of exchange transfusion in physiologic jaundice

total bilirubin levels > 20-25 mg/dl

801

phototherapy for physiologic jaundice

gold standard rx for rapidly increasing hyperbilirubinemia to prevent kernicterus

802

quid of bitot spots

gray silver plaques on the bulbar conjunctiva

803

manif of vit A deficiency(7)

impaired adaptation to dryness
photophobia
dry scaly skin
xerosis conjonctiva
xerosis cornea
keratomalacia
bitot spots
hyperkeratosis

804

localization of hyperkeratosis in vit A deficiency(3)

shoulders
buttocks
extensor surfaces

805

microscopy light finding in nephrotic syndrome

normal findings

806

immunofluorescence finding in SN

no abnormality

807

electron microcopy finding in SN

difuse effacement of foot process of podocytes

808

quid of podocytes

renal epithelial cells

809

kids seen with seizures EP reveals decreased muscle strength of the left side of the body with brisk deep tendon reflexes in the left arm and leg.MRI reveals space occupying lesions of the parietal lobe droit dx

benign astrocytoma

810

the most common solid tumors in kids

CNS tumors

811

the most common malignancy in kid

leukemia

812

the second most common malignancy in kid

CNS tumor

813

most common localization of CNS tumor

supratentorial

814

the most common tumon which could be found infratentorial and supratentorial localization in kid

astrocytoma

815

most common complication of E coli 0157h7

renal damage

816

mortality in renal damage in HUS

5 a 10%

817

the organ system with higher mortality and morbidity after HUS

kidneys

818

complication of shoulder dystocia(5)

fractured clavicle
fractured humerus
erb duchenne
klumpke paralysis
perinatal asphyxia

819

clue for clavicular fracture in macrosome(4)

clavicular crepitus
bony irregularity
decreased Moro reflexe due to pain on affected side
intact biceps and grasp reflexes

820

clue for humerus fracture in macrosome(4)

upper arm crepitus crepitus
bony irregularity
decreased Moro reflexe due to pain on affected side
intact biceps and grasp reflexes

821

moro and biceps reflexes in erb duchenne

decreased on affected side

822

clue for klumpke palsy(3)

claw hand
ipsilateral horner syndrome
intact moro and bicep reflexes

823

claw hand in klumpke(4)

extended wrist
hyperextended metacarpophalangeal joints
fixed interphalangeal joints
absent grasp reflexes

824

clue for horner syndrome(2)

ptosis
miosis

825

manif of perinatal asphyxia(4)

altered mental status
poor tone
seizure
difficulte respiratoire

826

nerve fibers involved in Klumpke(2)

c8
T1

827

rx for klumpke(2)

controverse
physical therapy to prevent contracture

828

klumpke with no improvement after 3-9 months

surgery

829

clue for myotonic muscular dystrophy type 1(8)

grip myotonia=delayed muscle relaxation
facial weakness
foot drop
dysphagia
cardiac conduction abnormalities
cataracts
testicular atrophy/infertility
baldness

830

transmission of muscular dystrophy type 1

autosomal dominant

831

other name of muscular dystrophy type 1

steinert disease

832

why dysphagia is the most dangerous smooth muscle manif in steinert disease

because of risk of aspiration pneumonia

833

reflexes in steinert disease

normal

834

quid of sturge weber

neurocutaneous syndrome characterized by
congenital unilateral hemangioma along the trigeminal nerve

835

xray in sturge weber

intracranial calcifications that resemble a tramline

836

usual neurological symptom in sturge weber

seizures

837

other neurological finding in sturge weber(4)

hemianopsia
hemiparesis
hemisensory disturbance
ipsilateral glaucoma

838

skin problem in sturge weber

port wine stain or nevus flammeus along the trigeminal nerve

839

rx of sturge weber

controlling seizures
reducing intraocclualr pressure

840

how to remove skin lesions in sturge weber

argon laser

841

7 yo boy with decreased urine output and lethargy and high creat and BUN appropriate next step in this patient

urinalysis

842

first test to di in all patient with renal disease

urinalysis

843

14 yo boy is seen in the clinic for fire setting in the neigbor's house.months later he has been arrested by police for stealing,parents say one time he steals money and tries to hurt the pets dx

conduct disorder

844

quid of conduct disorder

disruptive behavioral patterns that violate basic social norms for at least one year in patients less than 18 years

845

19 yo boy is seen in the clinic for fire setting in the neigbor's house.months later he has been arrested by police for stealing,parents say one timeone year he steals money and tries to hurt the pets dx

antisocial personality disorder

846

5 year old boy born at home developed bruises and prolonged PT> 15 cause of that

vit K deficiency

847

origin of vit K in the body(2)

gut flora
diet

848

why can you have Vit K deficiency in baby(3)

poor placental transfer
absent gut flora
inadequate levels in breast milk

849

what to do to avoid hemorrhagic disease of newborn

all new born babies must receive vit K injection

850

mild vit K deficiency

prolonged PT
normal PTT

851

barking cough in patient less than 3 years hoarseness and varying degree of respiratory distress DX

croup

852

lateral neck xray in croup

subglottic narrowing

853

bug causing croup

parainfluenza virus

854

quid of chickenpox

varicella

855

Manif in chicken pox

pruritic vesicles appearing in different stages across the face and the body and usually fully crusted within a week

856

child > ou egal a 1 an asymptomatic who never received varicella vaccine is exposed to chickenpox what to do

administer varicella vaccine

857

contagiosity in chikenpox

patient is contagious 2 days prior to rash

858

child > ou egal a 1 an immunodeprime asymptomatic who never received varicella vaccine is exposed to chickenpox what to do

givevaricella zoster immunoglobulin

859

physical examination in beckwith wiedemann syndrome(6)

fetal macrosomia during delivery
rapid growth until late childhood
omphalocele or ombilical hernia
macroglossia
hemihyperplasia
hypoglycemia

860

complications of beckwith wiedmann(2)

wilms tumor
hepatoblastoma

861

surveillance in beckwith wiedmann

serum alpha fetoprotein
abdominal and renal ultrasound

862

serum alpha protein surveillance of beckwith wiedman

every 3 months from birth to 4 years for

863

abdominal ultrasound in surveillance ofbeckwith wiedman

every 3 months from age 4-8

864

renal ultrasound surveillance in beckwith wiedmann

from age 8 years to adolescent

865

patient who is particular at risk for hepatoblastoma or wilms tumor in wiedmann beckwith

patient with hemihyperplasia

866

example of hemihyperplasia

right upper and lower extremities are significantly larger in circumference than the left extremities

867

pathogenesis of wiedman beckwith

deregulation of imprinted gene expression in chromosome 11p15

868

quid of parinaud syndrome

paralysis of vertical gaze =paralysis of downward and upward gaze

869

quid of collier sign

poor pupillary reaction to light and eyelid retraction

870

meaning of parinaud syndrome and collier's sign

rostral midbrain lesion

871

cause of rostral midbrain lesion(2)

germinoma
pinealoma

872

why you can have development of dark facial hair ,deeping voice and rapid croissance in lesion pinealoma(2)

interruption of hypothalamic inhibiting pathways
bhcg secretion and consequent leydig's cells stimulation

873

why eye problem in pinealoma

the lesion is located at the level of superior colliculus and CN3

874

patient with multiple skin infection and recurrent pneumonia.In the last bout of skin infection cultures of secretions reveals S aureus Dx probable

CGD

875

problem in CGD(2)

impaired metabolism within phagocytes
a mutation causes loss or inactivation of the NADPH oxidase responsible for oxydation

876

main pathogenesis in CGD

intracellular killing deficiency

877

clue for CGD

gram stain of fluid aspirated from the affected lymph nodes reveals numerous bacteria filled segmented neutrophils

878

most common infection in CGD(2)

pneumonia
suppurative adenitis

879

5 yo Mexican girl is seen for nocturnal vulvar itching next step

do a scotch tape test

880

5 yo Mexican girl is seen for nocturnal vulvar itching dx

pinworms infection

881

rx of pinworms

mebendazole

882

clue for ombilcal hernia(2)

abdominal swelling
more pronounced when crying or coughing

883

3 yo girl with ombilical hernia next step

refer to pediatric surgeon for operative management

884

indication of surgery in ombilical hernia(5)

persistence to the age of 3 and 4 years
exceeds 2 cm in diameter
causes symptom
becomes strangulated
progressively enlarges after the age 1 and 2 years

885

evolution of ombilical hernia

disappear spontaneously by age of 1

886

patient with severe coughing develops subcutaneous emphysema over the anterior chest most appropriate next step

chest xray

887

why chest xray in case of emphysema secondary to severe coughing

to rule out pneumothorax

888

patient newborn seen with mild atrophy of the calf,clcaneum and talus are in equinus and varus positions his midfoot is in varus position and his forefoot in adduction dorsiflexion and plantar flexion is limited dx

club foot

889

management of clubfoot(3)

stretching
manipulation of the foot
followed by serial plaster casts

890

indication of surgery in clubfoot(2)

failure in conservative management
surgery is performed within 3 and 6 months of age

891

why polycythemia in small gestational age

increased erythropoietin secretion in response to fetal hypoxia

892

rx of Lyme disease in children less than 8 years

oral amox

893

anal pruritis in kid dx

enterovermicularis infection

894

rx of enterovermicularis infection(2)

albendazole/mebendazole
or
pyrantel pamoate

895

dx of enterovermicularis infection

scotch tape

896

the most common causes of viral meningitis(2)

echoviruses
coxsakievirus

897

brudzinsky ????????

you flexe the neck lower leds are flexed too

898

quid of non-polio viruses

echoviruses
coxsakievirus

899

clue for meningococcal meningitis(3)

fever
neurologic finding
petechial or purpuric rash

900

most common cause of neonatal sepsis

GBS

901

prevention of GBS(2)

maternal testing and
rx with intrapartum IV antibiotics

902

antibio used in prevention of GBS sepsis

PNC