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USMLE Step 2 CK Flash Cards > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Adolescent, obese patient with thigh and knee pain, limp, limited internal rotation and abduction of the
hip, hip flexion produces obligatory external hip rotation, knee examination is normal.
1. Diagnosis and Rx
2. Differential diagnosis

A
  1. Slipped capital femoral epiphysis→Separation through growth plate of femoral epiphysis from metaphysis, 10-14 yrs. Rx►posterior and medial displacement of the femoral head from the femoral metaphysis
  2. Legg-Calvé-Perthes disease→AVN of capital femoral epiphysis, 3-8 yrs. Rx► asymmetric hips, small affected femoral head with sclerotic bone and widened joint space
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2
Q

Treatment for Lyme disease in patients younger than 8 years old

A

Amoxicillin

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3
Q

Complications of Slipped capital femoral epiphysis

A
  • Avascular necrosis (AVN)

- Chondrolysis (degeneration of cartilage)→Premature osteoarthritis

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4
Q

Risk factor for Slipped capital femoral epiphysis

A
  • Obese with delayed skeletal maturation
  • Thin with a recent growth spurt
  • Black race
  • Hypothyroidism➡❌ossification of growth plate. Thyroid hormone promotes ossification of growth plate.
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5
Q

Pathophisiology of Intussusception

A
  • No identifiable lead point (75%)→Preceding viral infection (ex, gastroenteritis)→inflaming intestinal lymphatic tissue (ex, Peyer patches)►lead point for intussusception
  • Identified triggers (25%)→Meckel’s diverticulum, polyps, hematomas (ex, Henoch-Schölein purpura)
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6
Q

Best initial test and most accurate test for intussusception. Which is the finding?

A
  • Best initial➡Ultrasound→”Target sign”, “Doughnut sign”

- Most accurate➡Air (preferred), saline, or barium enema (also therapeutic)

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7
Q

Treatment of intussception. How does it work?

A

Enema reduction→Air or water soluble contrast is instilled through the rectum►pressure reduces obstruction

*Air enema preferred→faster, cleaner, safer than contrast

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8
Q

Physiologic responses to transplacental maternal estrogen exposure in a newborn? Next step when identified

A
  • Mammary gland enlargement (girls and boys)
  • non-purulent vaginal discharge (leukorrhea)
  • Mild uterine withdrawal bleeding
  • Swollen labia
  • Work-up is unnecessary→routine care and reassurance
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9
Q

Common clinical presentation of renal tubular acidosis in children

A
  • Normal anion gap metabolic acidosis

- Failure to thrive→poor cellular growth and division in acidic conditions

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10
Q

Most appropriate next step when stablished gonadotropin-dependent (central) precocious puberty and why?

A

MRI of the brain with contrast→Hypothalamic or pituitary tumors (more cases in boys but must be ruled out in girls)

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11
Q

What suggest a left axis deviation on neonatal electrocardiogram? Which other findings do you expect?

A
  • Tricuspid valve atresia→lack communication between right chambers►hypoplastic right ventricle►↓right ventricular forces on ECG
  • Decreased pulmonary markings on chest x-ray (hypoplasia of the right ventricle and pulmonary outflow tract)
  • Small or absent R waves on ECG
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12
Q

Secondary causes of enuresis

A
  • Psychological stress
  • Urinary tract infection
  • Diabetes mellitus
  • Diabetes insipidus
  • Obstructive sleep apnea
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13
Q

Treatment of common variable immunodeficiency

A

Intravenous immunoglobulin infusion→avoid infection, prevent some complications of chronic infection

*Also for X-linked agammaglobulinemia

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14
Q

How can you differentiate severe combined immunodeficiency and common variable immunodeficiency?

A
  • SCID→tipically begin early in infancy

- CVID→present at chilhood (around puberty), or more commonly in adulthood (20-40)

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15
Q

Treatment of the radial head subluxation (Nursemaid’s elbow)

A

Hyperpronation and/or supination with hyperflexion while continuously applying force over the radial head

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16
Q

How can you distinguish functional constipation vs Hirschprung disease by physical examination?

A
  • Functional constipation→stool in ampulla

- Hirschprung disease→NO stool in ampulla

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17
Q

Most appropriate next step in management when suspect hirschprung disease

A

Anorectal manometry→No sphincter relaxation

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18
Q

Most appropriate next step in management when you identify a patient with epiglottitis

A

Intubate→Do not waste time with anything else, the airway may close off any minute

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19
Q

Clinical presentation of epiglottitis

A

In a patient with uncertain history of vaccination:

  • Muffled (“Hot potato”) voice
  • Fever
  • Drooling in the tripod position
  • Refusal to lie flat
  • Extremely hot cherry-red epiglottis
  • Inspiratory stridor
  • Toxic appearance
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20
Q

Etiology of epiglottitis. Empiric antibiotic treament.

A
  • H. influenzae type B (now less common), S. pyogenes, S. pneumoniae, S. aureus (including MRSA), Mycoplasma
  • Ceftriaxone + Vancomycin
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21
Q

Most common causal agent of croup

A
  1. Parainfluenza virus type 1 and 2

2. Respiratory syncytial virus

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22
Q

Rare but potentially serious complication of infectious mononucleosis and treatment

A
  • Acute airway obstruction

- Intravenous corticosteroids

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23
Q

Most common cause of acute unilateral cervical lymphadenitis in children

A
  1. Staphylococcus aureus

2. Group A streptococcus

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24
Q

Gold standard to diagnose vesicoureteral reflux in children

A

Voiding cystourethrogram

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25
Q

Cause of vesicoureteral reflux

A
  • Defective valve in the ureter (Primary VUR)

- High bladder pressure (Seconday VUR)

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26
Q

Long-term complication of renal scar formation (due VUR for example)

A

Secondary Hypertension and Chronic renal insufficiency

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27
Q

Common sympyoms of craniopharyngioma

A
  • Compression of optic chiasm→bitemporal hemianopsia►run into the corners of walls or furniture
  • Pituitary stalk compression→multiple endocrinopathies►Ex: GH deficiency; diabetes insipidus (polydipsia/polyuria, high-normal serum sodium, dilute urine)
  • Compression of nearby structures or obstructive hydrocephalus►headache
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28
Q

How do you see a craniopharyngioma on MRI or CT scan?

A

Calcifications

*Key finding to differentiate it from pituitary adenoma, that can cause bitemporal hemianopsia as well

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29
Q

How do you differentiate craniopharyngioma from rathke cleft cysts?

A
  • Rathke cleft cysts→sellar region and no calcifications
  • Craniopharyngioma→suprasellar region and calcification
  • If Rathke cleft cysts are large may yield similar symptoms as craniopharyngiomas
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30
Q

Key to distinguish benign vs pathologic chilhood murmurs

A
  • Benign→Reduce intensity with maneuvers that decrease the venous blood return to the heart (standing, valsalva)
  • Pathologic→Increase intesity with standing and valsalva
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31
Q

How is the murmur of hypertrophic cardiomyopathy with valsalva maneuver or standing?

A

Drecrease venous return and preload→Increase the obstruction→Increase murmur intensity

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32
Q

Most likely diagnosis in a fetus with ultrasound findings of periventricular calcifications, intrahepatic calcifications and fetal growth restriction with a negative treponemal antibody absorption test in the mother

A

Congenital Cytomegalovirus infection

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33
Q

All immunoglobulins levels on Hyper-IgM syndrome and why does it happen?

A
  • Increase IgM, Low Others (IgA, IgG)
  • CD40L deficiency X-linked recessive→Defective Ig class switching

*Normal B-cell count

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34
Q

What do you suspect when see a child with severe and recurrent sinopulmonary infections with viruses and encapsulated bacteria, and poor growth?

A

Primary humoral deficiency

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35
Q

Treatment of Hyper-IgM syndrome

A

Antibiotic profilaxis and interval administration of intravenous immunoglobulin

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36
Q

What is congenital dermal melanocytosis? Why is Important to document in the child?

A
  • Flat, blue-gray, no tender patches fund in infants over lower back and buttocks, fade in first decade→Melanocytes within skin dermis
  • May be mistaken for bruises→coagulopathy or child abuse►Tender, varied in color and fade quickly
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37
Q

Most common cause (agent) of very acute unilateral cervical adenitis in children. Clinical features. Treatment

A
  • Staphylococcus aureus, Streptococcus pyogenes
  • Erythematous, enlarged, markedly tender submandibular nodes
  • Clindamycin
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38
Q

Most common causes of red eyes or conjunctivitis of the newborn based upon day of beginning from the delivery

A
  • Day 1→chemical irritation
  • Days 2 - 7→Neisseria gonorrhoeae (Ophtalmia neonatorum)
  • > 7 Days→Chlamydia trachomatis (Ophtalmia neonatorum)
  • > 3 weeks→Herpes simplex
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39
Q

Contraindications for breastfeeding

A

HIV, TB, Herpes of the nipple

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40
Q

What is failure to thrive?

A

Persistent weight less than the fifth percentile for

age or “falling off the growth curve”

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41
Q

Most common causes of polyhydramnios

A

Not swallowing

  • Werdnig-Hoffman syndrome (unable to swallow)
  • Intestinal atresias (Ex, Tracheoesophageal fistula, Gastroschisis, Omphalocele, Duodenal atresia)
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42
Q

Most common causes of oligohydramnios

A

Cannot urinate

  • Prune belly
  • Renal agenesis (associated with Potter syndrome, incompatible with life)
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43
Q

Screening tests for omphalocele

A

Alpha fetoprotein (AFP) levels and ultrasound

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44
Q

What is the Wilms tumor and its most important clinical feature? Most valuable clinical clue to suspect it.

A
  • Nephroblastoma→Most common abdominal mass in children

- Aniridia

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45
Q

What is the WAGR syndrome and its cause?

A
  • Wilms tumor + aniridia + genitourinary malformations + mental retardation
  • Deletion in chromosome 11
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46
Q

Three leading causes of meconium

A
  • Physiologic maturational event
  • Acute hypoxic event
  • Chronic intrauterine hypoxia
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47
Q

Best initial diagnostic test for necrotizing enterocolitis and what expect to find?

A

Abdominal x-ray→pneumatosis intestinalis, pneumoperitoneum if perforation, hepatobiliary gas, portal venous gas

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48
Q

Common age of presentation of coarctation of the aorta and why?

A

Around day 3 - ductus arteriosus begins to close

*Severe aortic narrowing makes systemic blood flow dependent on the ductus arteriosus

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49
Q

Until which age you may find babinski reflex in children?

A

Up to age of 2, but can disappear at 12 months

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50
Q

Cause and pathogenesis of infant botulism

A

Ingestion of Clostridium botulinum spores (environmental dust/soil, honey)→spores colonize GI tract→produce toxin→✖presynaptic acetylcholine release in neuromuscular junction

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51
Q

Typical clinical manifestations of cranial nerves compromised in infant botulism

A

Oculobulbar weakness or palsies►absent gag reflex, ptosis, ophthalmoplegia, impaired pupil constriction

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52
Q

Why tet spell helps to relieve dyspnea in children with tetralogy of fallot?

A

Squatting during exercise (playing)→↑preload, ↑systemic vascular resistance→↓right-left shunting→↑pulmonary blood flow►↑oxygen saturation

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53
Q

Most common cyanotic lesions in children

A
  • Tetralogy of fallot→after neonatal period (most overall)

- Transposition of great vessels→during neonatal period

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54
Q

What do the transposition of great vessels need to maintain the blood oxygenated?

A

Patent ductus arteriosus OR atrial septal defect OR ventricular septal defect

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55
Q

Chest x-ray finding of transposition of great vessels

A

“Egg on a string”→Narrowing of superior mediastinum and globular shape of the heart

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56
Q

Chest x-ray finding of Total anomalous pulmonary venous return (TAPVR) without obstruction

A

Snowman or figure of 8 sign

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57
Q

Most common congenital heart disease

A

Ventricular septal defect

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58
Q

Auscultatory finding of ASD and VSD

A
  • VSD→Holosystolic murmur over lower left sternal border

- ASD→fixed wide splitting S2

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59
Q

Chest x-ray finding of tetralogy of fallot

A

Boot-shaped heart

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60
Q

Jug handle appearance on chest x-ray

A

Primary pulmonary artery hypertension

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61
Q

Best initial treatment for Long QT syndrome

A

Beta blockers→↓activation of stellate ganglion, ↓cardiac excitation during exertion→may shorten QT interval

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62
Q

In which congenital heart diseases are needed the PDA for survival?

A
  • Transposition of great vessels
  • Hypoplastic left heart syndrome
  • Tetralogy of fallot (severe RVOT obstruction)
  • Critical coarctation of the aorta in infancy
  • Tricuspid valve atresia
63
Q

Most accurate test for pyloric stenosis and which signs you expect to find?

A

Upper GI series

  • String sign→severe narrowing of loop of bowel►thin stripe of contrast within the lumen looks like a string
  • Shoulder sign→filling defect in the antrum due to prolapse of muscle inward
  • Mushroom sign→hypertrophic pylorus against the duodenum
  • Railroad track sign→excess mucosa in the pyloric lumen►2 columns of barium
64
Q

Best initial test for pyloric stenosis

A

Abdominal ultrasound→thickened pyloric sphincter

65
Q

Electrolytic and acid-base disturbance from vomiting in pyloric stenosis

A

Loss of H+, loss K from aldosterone release in response to hypovolemia→Hypochloremic, hypokalemic metabolic alkalosis

66
Q

Which findings can help to identify homocystinuria? From Which disease yo may differentiate?

A
  • Both Marfanoid habitus→differentiate from Marfan Sx
  • Fair eyes and hair, developmental delay, thrombosis (stroke, MI, venous thromboembolic disease), downward lens dislocation
67
Q

Treatment of homocystinuria

A
  • Vitamin B6, Folate, Vitamin B12→↓homocysteine

- Antiplatelets or anticoagulation

68
Q

What is the Breastfeeding jaundice?

A

Unconjugated hyperbilirubinemia in first week of life due insufficient intake of breast milk

69
Q

Which is the clinical presentation of Breastfeeding jaundice?

A
  • Suboptimal breastfeeding (normal is >10-20 min/breast every 2-3 hours)
  • Signs of dehydration➡⬇urinary output➡⬇diapers/day (equal of age in 1st wk); excessive ⬇weight; delayed stooling

*Total Bilirubin may be >10mg/dL

70
Q

Pathophysiology of breastfeeding jaundice

A
  • ⬇Bilirubin elimination

- ⬆Enterohepatic circulation

71
Q

What is the Breast milk jaundice?

A

Physiologic jaundice persists beyond 1st wk of life; starts 3-5 days and peaks 2 wks due to ⬆glucuronidase in breast milk

72
Q

Cause of Breast milk jaundice

A

⬆️Glucuronidase in breast milk➡️deconjugate intestinal bilirubin, ⬆️enterohepatic circulation

73
Q

Total Bilirubin threshold for phototherapy and exchange transfusion in fullterm healthy newborn with jaundice

A
  • Phototherapy in >20mg/dL

- Exchange Transfusion in>25mg/dL or bilirubin-induced neurologic dysfunction

74
Q

Most common cancer in children. Peak age of incidence.

A

Acute lymphoblastic leukemia

Peak age 2-5 years

75
Q

Clinical presentation of Acute lymphoblastic leukemia

A
  • Nonspecific symptoms (fever, fatigue, weight loss)
  • Bone pain
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Pallor (anemia)
  • Petechia (thrombocytopenia)
76
Q

Laboratory findings and diagnosis of ALL

A
  • Bone marrow failure➡Pancytopenia (severe neutropenia)

- BM biopsy➡>25% lymphoblasts

77
Q

Treatment of slipped capital femoral epiphysis

A
  • Non-weight-bearing status and bedrest if bilateral

- Surgical screw fixation➡stabilize the physis, prevent further slippage

78
Q

Auscultatory finding of patent ductus arteriosus

A

Continuous flow murmur

*If small PDA➡mildly accentuated peripheral pulses

79
Q

Classic clinical presentation and finding on diagnostic test of duodenal atresia

A
  • Bilious vomiting within 12 hours of birth

- Chest x-ray➡double bubble sign

80
Q

Diagnosis in a patient with currant jelly stool, bilious vomiting, colicky abdominal pain, right quadrant sausage-shaped mass, neurologic signs

A

Intussusception

81
Q

Classic presentation of Meckel’s diverticulum

A

Painless rectal bleeding (bright red blood)

*May have palpable mild mass left quadrant

82
Q

Most accurate test for Meckel’s diverticulum

A

Technetium-99m (99mTc) pertechnetate scan (Nuclear scintigraphy)→detects gastric mucosa
*Also known as Meckel scan

83
Q

Most accurate test for Osteogenesis Imperfecta

A

Skin biopsy➡analyze for collagen synthesis culturing dermal fibroblasts

84
Q

How do you differentiate clinically croup and epiglottitis? Best next step when identifying each one.

A
  • Croup➡Hypoxia on presentation, mild symptoms▶steroids; severe symptoms▶racemic epinephrine
  • Epiglottitis➡Hypoxia, imminent respiratory failure➡Intubate
85
Q

Best long-term treatment for severe combined immunodeficiency

A

Stem cell transplant

86
Q

Important fact to diagnose severe combined immunodeficiency disease

A

Absence T cells (CD3+), dysfunctional B cells (Low CD19+)

87
Q

Important findings in the hemogram and peripheral blood smear in Hemoglobin H disease (Alpha-thalassemia)

A
  • ⬇MCV RBC’s (microcytic, hypochromic)▶Target cells

- Chronic hemolysis➡⬆RBC’s and reticulocytosis (replenish hemolyzed RBC’s)

88
Q

Most common cause of short stature and pubertal delay in adolescents

A

Constitutional growth delay➡⬇height growth velocity at 6 mo to 3 yr➡at 3 years regain normal growth velocity➡delayed puberty and adolescent growth spurt, but occur➡normal growth spurt and adult height

*Bone age radiographs➡delayed bone age compared to chronological age

89
Q

How do you suspect the childhood phenotype of myotonic dystrophy?

A
  • Cognitive manifestations➡Intellectual impairment
  • Behavioral manifestations➡ADHD, mood disorder
  • Sleep disturbances➡excessive daytime sleepiness
  • Hallmark: Muscle weakness, myotonia (grip myotonia)

*By Age 10

90
Q

How do you identify a transient tachypnea of the newborn?

A

Newborn (premature, cesarean, maternal diabetes) with tachypnea, ⬆work of breathing, clear breath sounds, chest x-ray➡hyperinflation, fluid in fissures

91
Q

Pathophysiology of transient tachypnea of the newborn

A

Delayed resorption and clearance of alveolar fluid

92
Q

Common clinical presentation of Celiac disease in children

A
  • Growth delay (often initial sign)
  • Nonspecific gastrointestinal symptoms (bloating, abdominal discomfort; classic diarrhea might not be present)
  • Malabsorption➡microcytic anemia
93
Q

Head CT scan findings of congenital toxoplasmosis

A

Diffuse intracerebral calcifications and ventriculomegaly

94
Q

Clinical presentation of Reye syndrome

A
  • Acute liver failure: Nausea, vomiting, hepatomegaly

- ⬆⬆Ammonia neurotoxic➡cerebral edema▶Encephalopathy: mental status changes (lethargy, sleepy)

95
Q

Findings on liver biopsy in a patient with Reye syndrome

A

Microvesicular fatty infiltration or steatosis

96
Q

Causes of chronic stridor in infants and toddlers and key finding of each one

A
  • Laryngomalacia➡inspiratory stridor worsens feeding, crying, supine, improves prone
  • Vascular ring➡Biphasic stridor improves with neck extension (can also compress esophagus)
  • Airway hemangioma➡worsening biphasic stridor, concurrent skin hemangiomas (“beard distribution”)
97
Q

What do you suspect in a patient with recurrent stones since childhood, family history of nephrolithiasis, hexagonal crystals on urinalysis?

A

Cystinuria➡impaired transport of cystine and dibasic amino acids (ornithine, lysine, arginine) by renal tubular and intestinal epithelial cells➡⬇cystine reabsorption➡⬆urinary excretion

*Cystine is poorly soluble in water➡cystine stones (radiolucent)

98
Q

Which test may aid in the diagnosis of cystinuria?

A

Urinary cyanide-nitroprusside test (qualitative)➡suggest ⬆cystine levels

*Used as a qualitative screening test as well

99
Q

Management for neonatal varicella-zoster infection prevention

A
  • Isolate infant from varicella contact

- VZ immunoglobulin (VZIG) if maternal infection developed 5 days before or 2 days after delivery

100
Q

Causes of monoarticular joint effusion in an adolescent when you did rule out trauma, septic arthritis and inherited blood disorders

A

Late Lyme disease, Juvenile arthritis, Serum sickness

*All accompanied by preceding/ongoing rash (ask for it)

101
Q

Best first step in a patient less than 6 months with fever and seizure

A

Lumbar puncture for CSF study

*Do not require neuroimaging before LP➡⬇risk of herniation (if non-focal signs and open fontanelle)

102
Q

Cause of edema at birth in a patient with Turner syndrome

A

Lymphatic network dysgenesis➡⬆protein-rich interstitial fluid in hands, feet and neck (nonpitting)▶Congenital lymphedema

*Severe obstruction of lymphatic vessels➡Cystic hygroma

103
Q

Most common gastrointestinal complication of Henoch-Schönlein purpura

A

Intestinal edema and bleeding➡lead point to the intestines to telescope into the adjacent bowel (ileoileal)▶Intussusception

*Others GI complications: bowel perforation, GI hemorrhage

104
Q

Screening for critical congenital heart disease in a newborn. How do you interpret it?

A
  • Pre- (right arm) and post-ductal (either leg) pulse oximetry
  • Positive: <90% in either extremity, <95% in both upper and lower extremity, or >3% difference between upper and lower extremities➡Echocardiogram

*1/3 of newborns with critical CHD are asymptomatic for the first few days (patent ductus arteriosus)

105
Q

Indications of echocardiogram in a newborn

A

Postive screening for CHD and cyanosis

*No acrocyanosis, might be benign in first days of life due peripheral vasoconstriction

106
Q

Treatment of bloody diarrhea in a patient with stool

culture confirming shiga toxin-producing E. coli O157:H7 (STEC)

A

Supportive only (ex, rehydration)

*Antibiotics and antimotile agents ⬆risk of HUS, specially in children <5 years

107
Q

Most common cause of chronic renal insufficiency/failure in children

A

Posterior urethral valves➡distal urinary tract obstruction

  • May cause secondary urinary reflux
  • Only in boys
108
Q

What age the speech of children is completely intelligible? Most common cause when It is not after that age?

A
  • 4 years

- Hearing impairment➡Isolated speech delay▶Articulation disorder

109
Q

Best first step to evaluate a child with speech or language disorder

A

Hearing test

*Regardless of history of frequent ear infections or abnormalities on otoscopy

110
Q

Most common cause of hearing impairment in young children

A

Conductive hearing loss from recurrent acute otitis media

111
Q

Renal manifestations of Henoch-Schölein purpura

A
  • 1/3 of cases➡at symptoms onset or months later
  • Hematuria followed by mild (non-nephrotic range) proteinuria

*Nephrotic syndrome, HTN, ⬆creatinine is more common un adults with HSP

112
Q

How do you confirm the diagnosis of laryngomalacia?

A

Flexible fiberoptic laryngoscopy➡omega-shaped epiglottis and collapse of supraglotic structures during inspiration

113
Q

Which cephalosporine must be avoided in neonates and why?

A

Ceftriaxone➡impairment of biliary metabolism

114
Q

What etiology may you consider in a child with seizures and acute infectious bloody diarrhea?

A

Shigella sonnei

115
Q

Potential complications of shigella infection

A
  • Seizure (severe)➡Febrile seizure or enterotoxins
  • Rectal prolapse (severe rectal inflammation)
  • Bacteremia (⬆fatality)
  • Hemolytic uremic syndrome (antibiotics do not increase the risk, in contrast to E. coli O157:H7)
116
Q

Most specific physical findings of acute otitis media

A
  • Middle air inflammation
  • Bulging tympanic membrane
  • Middle ear effusion
  • ⬇tympanic membrane mobility on tympanic insufflation
  • Visible air-fluid levels
117
Q

Clinical presentation in an infant with shoulder dystocia

A

Klumpke palsy▶excessive traction of the C8 and T1 nerves during delivery➡”claw hand”, Horner syndrome (miosis, ptosis)

118
Q

When do you suspect chronic granulomatous disease?

A

Recurrent, severe cutaneous and pulmonary infections with catalase-positive bacterial and fungal organism (Staphylococcus aureus, Serratia, Burkholderia, Aspergillus, Nocardia)

119
Q

Prophylaxis in chronic granulomatous disease

A
  • TMP-SMX and Itraconazole

- Severe phenotypes: interferon-gamma injections

120
Q

Most common complications of sickle cell trait

A
  1. Sickling in the renal medulla▶Hematuria (microscopic or gross)
  2. Hyposthenuria➡nocturia and polyuria
  3. ⬆Risk of UTI (during pregnancy)
121
Q

Empiric treatment for urinary tract infection in infants

A

Third-generation cephalosporin (Ex, cefixime)

122
Q

Most common cause of delayed meconium passage

A
  • Normal rectal tone + negative squirt sign: meconium ileus▶blockage of the terminal ileum by inspissated meconium (cystic fibrosis)
  • Increased rectal tone + positive squirt sign: Hirschsprung disease▶failure of neural crest cell migration
123
Q

Most common cause of anemia in preterm infants

A

Anemia of prematurity: ⬇erythropoietin, shortened RBC life span, blood loss (exsanguination in NICU)

124
Q

Empirical treatment for whooping cough

A

Macrolide (eg, Azithromycin) by 10 days in the meantime the confirmatory test comes out

125
Q

Most common complication of nonbullous impetigo

A

Poststreptococcal glomerulonephritis

126
Q

Treatment for nonbullous impetigo

A
  • Localized: Topical antibiotic (Mupirocin)
  • Extended: Oral cephalexin or Dicloxacillin (impractical to use topically)

*No use amoxicillin (no good coverage for staph)

127
Q

Findings in head CT scan of congenital CMV infection

A

Periventricular calcifications and microcephaly

128
Q

Most likely diagnosis (etiology) in a 15-month-old patient with chronic viral meningitis, history of sinopulmonary infections and prolonged diarrhea

A

X-linked agammaglobulinemia

129
Q

Most common associated malformation or abnormality with myelomeningocele

A

Chiari II malformation➡inferior displacement of medulla and cerebellum through foramen magnum, and obstructive hydrocephalus

130
Q

Most likely etiology in a 5-year-old patient with gray vesicles/ulcers on oropharynx

A

Coxsackie A virus

*Herpangina

131
Q

Surveillance tests for an infant patient with fetal macrosomia, macroglossia, hemihyperplasia, omphalocele or umbilical hernia, rapid growth until late childhood

A

Most likely Beckwith-Wiedemann syndrome➡overgrowth disorder with predisposition to neoplasm

  • Abdominal ultrasound and alpha-fetoprotein every 3 mo until age 4, and renal ultrasound every 3 mo from age 4-8
  • ⬆Risk hepatoblastoma, wilms tumor
132
Q

Pathologic findings of bronchopulmonary dysplasia

A
  • Reduced number and septation of alveoli

* Increased distance between alveoli and pulmonary capillaries

133
Q

Contraindications of Rotavirus vaccine

A
  • Allergy to vaccine ingredients (previous anaphylaxis)
  • Severe combined immunodeficiency
  • History of Intussusception
134
Q

Most common complications in an infant with small gestational age

A
  • Hypoxia▶Polycythemia
  • Hypoglycemia
  • Hypothermia
  • Hypocalcemia

*Small gestational age➡birth weight<10th percentile for gestational age

135
Q

What do you suspect on an infant with macrocytic anemia, reticulocytopenia, normal leukocytes and platelets; and craniofacial abnormalities, triphalangeal thumbs?

A

Diamond-Blackfan Anemia➡congenital erythroid aplasia▶⬆apoptosis of RBC

136
Q

When do you suspect a pathologic lead point in a patient with intussusception?

A

25% of patients with intussusception may have a pathologic lead point:

  • Recurrent episodes
  • Atypical location (eg, small bowel into small bowel)
  • Atypical age
  • Persistent rectal bleeding despite reduction
137
Q

Indication of tympanocentesis and culture during tympanostomy tube placement in acute otitis media

A
  • Multiple episodes of AOM (≥3 in 6 months)

- Persistent (>3 months) middle ear effusions with hearing loss

138
Q

What is fetal hydantoin syndrome?

A

Teratogenic effect of phenytoin: orofacial clefts, microcephaly, nail/digit hypoplasia, cardiac defects, dysmorphic facial features

139
Q

Most common cause of congenital hypothyroidism worldwide

A

Thyroid dysgenesis

140
Q

Clinical presentation of neonatal abstinence (withdrawal) syndrome

A
  • Maternal opioid exposure (methadone, buprenorphine, heroin)
  • Fetal growth restriction
  • After 48 (heroin) to 72 (methadone) hours of delivery
  • CNS: Short sleep-wake cycles, irritability, hypertonicity, tremors, jitteriness
  • ANS: Sweating, sneezing, nasal stuffiness, yawning
  • GI: Poor feeding, vomiting, diarrhea
141
Q

Treatment for Neonatal abstinence (withdrawal) syndrome

A
  • Mild withdrawal: low-stimulation environment, swaddling, small, frequent feeds
  • Severe withdrawal: Opioid replacement (methadone, morphine)
142
Q

Most common cause of nonhereditary sensorineural hearing loss in children

A

Congenital CVM infection

143
Q

Best next step in infants, toddler and preschool children with balanitis or balanoposthitis

A
  • KOH microscopy to rule out Candida if thick and white discharge
  • Sexually transmitted disease if urethral discharge
  • Screen for Diabetes mellitus if Candida➕ with no associated risk factors (diaper dermatitis, recent antibiotic use)
144
Q

Annual screening tests for a child with Neurofibromatosis type 2

A
  • Annual audiometry

- Annual brain MRI beginning at 10 years➡⬆rate of intracranial tumors▶schwannoma, ependymoma, meningioma

145
Q

Most important risk factor for orbital cellulitis

A
  1. Sinusitis (ethmoid, maxillary)
  2. Dental maxillary infection (caries, abscess)
  3. Skin infection
146
Q

Most common sequela of congenital cytomegalovirus

A

Sensorineural hearing loss

147
Q

Indication of pharmacologic treatment for infantile hemangioma

A

Beta-blocker therapy (eg, oral propranolol)

  • Large, facial, segmental, &/or rapidly growing (ulcerations, scarring)
  • Periorbital (visual impairment)
  • Hepatic (high-output heart failure)
  • Subglottic (airway obstruction)
148
Q

Most common cause of acute bacterial rhinosinusitis in children

A
  1. Nontypeable Haemophilus influenzae (40-50%)
  2. Streptococcus pneumoniae (20-50%)
  3. Moraxella catarrhalis (25%)
149
Q

Treatment of hypertrophic cardiomyopathy in infants of diabetic mother

A

Intravenous fluids and beta-blockers to increase LV blood volume

150
Q

Most common complication of diamniotic, monochorionic twins

A

Twin-twin transfusion syndrome➡heart failure/neonatal mortality in both twins

151
Q

Most common complication of monochorionic monoamniotic gestations

A

Cord entanglement

152
Q

Most likely predisposing factor of recurrent UTI in a 5-year-old girl with chronic renal insufficiency and renal scintigraphy with dimercaptosuccinic acid showing bilateral focal parenchymal scarring and blunted calyces

A
  • Vesicoureteral reflux
  • Posterior urethral valves is wrong because even though they are the most common cause of chronic renal insufficiency in children, they only affect boys
153
Q

Treatment for neonatal chlamydial conjunctivitis

A

Oral erythromycin

*Topical erythromycin alone has high failure rates

154
Q

Most likely cause of acute otitis media after 2 weeks of antibiotic treatment and infection persistence and concurrent purulent conjunctivitis (otitis-conjunctivitis syndrome)

A

Non-typeable Haemophilus influenzae

USMLE Step 2 CK Flash Cards (17 decks)

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