Pediatrics Flashcards
(165 cards)
1
Q
What three qualities characterize constitutional bone delay?
A
Delayed growth spurt
Delayed puberty
Delayed bone age
2
Q
MCC of short stature and pubertal delay in adolescents?
A
Constitutional growth delay.
3
Q
When does constitutional growth delay occur?
A
Children born with normal weight and height at birth experience a slowed height velocity between 6 months to 3 years.
4
Q
In constitutional growth delay, when should normal growth resolve?
A
At 3 years of age the child regains normal growth velocity and follows the growth curve at the 5th to 10th percentile. However, puberty and adolescent growth spurt are delayed, though they will occur. They will reach a normal adult height.
5
Q
3yo boy presents with fever, cough, SOB. He recently recovered from Giardia and has an Hx of lobar pneumonia and ear infxns that were recurrent since age 6months. He has a mild fever. PE reveals small tonsils and crackles in the right lower lobe. He has normal growth. Cause of reccurrent infxns?
A
X-linked agammaglobinemia (Bruton agammaglobinemia). This results from failure of B cell development. Small or absent lymph tissue with recurrent sinopulmonary and GI infxns occur after maternal antibody protection wanes. T cells are normal. Rx: Ig replacement and antibiotics.
6
Q
X-linked agammaglobinemia (Bruton agammaglobinemia) presents as?
A
B cell failure causing small/absent lymphatics with recurrent sinopulmonary infxns and GI infxns after maternal antibodies wear off (after 6 months).
7
Q
Pts. with recurrent severe viral, fungal, and bacterial infxns who are also failure to thrive. Dx?
A
Adenosine deaminase deficiency. This causes SCID (severe combined immunodeficiency).
8
Q
Patients with complement deficiencies are at increased risk of what diseases?
A
Disseminated bacterial infxns, especially those caused by encapsulate species (e.g. S. pneumoniae, N. meningitidis). Giardia is not problematic in complement deficiency.
9
Q
Chronic granulomatous disease is due to?
A
Impaired oxidative burst that leads to recurrent skin/pulmonary infxns with catalase+ organisms (S. aureus, Serratia marcescens)
10
Q
DiGeorge syndrome (thymic hypoplasia) results in?
A
Hypocalcemia
Cardiac defects
Failure to thrive
Recurrent infxns (loss of T cell maturation)
11
Q
Common variable imunodeficiency presents with?
A
Normal B cells, but reduced IgG, IgM, and IgA.
12
Q
Selective IgA deficiency results in what Sx?
A
Usually asymptomatic, but some have recurrent respiratory, GI, urogenital infxns due to low serum IgA. IgM is normal.
13
Q
Patients with selective IgG subclass deficiencies have?
A
Recurrent infxns with low or normal total IgG and normal IgM.
14
Q
Young child presents with severe and recurrent sinopulmonary infxns as well as tympanostomy tube Hx and poor growth. His IgG and IgA are markedly decreased, but his elevated IgM is normal. Dx?
A
Hyper IgM syndrome. Presents with recurrent sinopulmonary infxns and poor growth. The lack of normal CD40 ligands prevents B cells switching to produce IgG and IgA, thus, encapsulated bacteria cause infxns often Opportunistic infxns (PCP) also can occur. Rx: IV Ig and ABx.
15
Q
Does a child with a grade III murmur that increases with standing, but decreases with laying supine warrant an echo?
A
Yes. The decreased preload when standing results in low venous return and preload leading to worsened obstrxn due to lower LV size. Harsh, holosystolic, or diastolic murmurs are concerning.
16
Q
Does a child with a grade II murmur that decreases with standing, but increases with laying supine warrant an echo?
A
No. This is more likely to be an innocent murmur. Grade 1 or 2 murmurs which decrease with standing and valsalva and are louder when supine are typically benign.
17
Q
Newborn presents with a 5-cm skin patch of dark skin with overlying hair on the upper back. Likely Dx?
A
Congenital melanocytic nevus. Solitary, hyperpigmented lesions with increased density of overlying dark, coarse hair. 5% increase in melanoma risk.
18
Q
Asian newborn presents with dark, blue-gray patches on the skin, especially the lower back. Dx?
A
Mongolian patch aka congenital dermal melanocytosis. These are poorly circumscribed and often fade with time.
19
Q
Blanchable red patch in newborn on one side of the face that overlies the eye. Dx?
A
Nevus flammeus aka port-wine stain. These tend not to regress.
20
Q
Blanching pink patches that fade with time. Tend to be located on the eyelids, glabella, and nape of neck in kids. Dx?
A
Nevus simplex.
21
Q
1 month old presents with frequent regurgitation of mild and painless bloody stools. He appears to have eczema on physical exam. Dx?
A
Milk-protein induced enterocolitis. A non-IgE mediated immunologic response to proteins in formula or milk causes inflammation in the colon leading to the Sx. Prognosis is excellent and most kids tolerate milk/soy products by 1 year old.
22
Q
Children with sickle cell trait are at increased risk for?
A
Renal issues, especially painless hematuria resulting from sickling in the renal medulla. Isosthenuria (trouble concentrating urine) is also common and can present as nocturia and polyuria.
23
Q
Sickle cell trait Hgb electrophoresis pattern?
A
50-60% Hgb A and 35-45% Hgb S.
24
Q
Sickle cell disease Hgb electrophoresis pattern?
A
85-95% Hgb S and 5-15% Hgb F.
25
Hgb electrophoresis pattern in person without sickle cell (normal person)?
~99% Hgb A and <1% Hgb F.
26
Rx for pinworms (Enterobious vermicularis)?
Albendazole OR
| pyrantel pamoate. These are given for the patient and all household contacts.
27
A febrile child presents with painful eyelid swelling and erythema. Eye movements are intact and no proptosis or conjunctival injeciton are noted. Vision is normal. Dx?
Preseptal cellulitis. The painful eyelid swelling with erythema is typical preseptal cellulitis. The infection is isolated to the anterior orbital septum and does not affect vision or the eye globe as in orbital cellulitis (proptosis/visual changes).
28
Young boy presents with redness and painful eyelid swelling. He also complains of seeing double. He is febrile and the right eye is abducted laterally. Dx?
Orbital cellulitis.
29
Child presents with swelling of the face and trouble breathing. His hands and legs are also swolen. No rash is present. He is afebrile with normal vitals otherwise. Mom states this has occurred before after getting a tooth extracted when he was 2. He has had bronchitis for a week. What is the pathology behind the disease?
He has a C1 inhibitor deficiency that has led to angioedema. Hereditary angioedema is rapid onset edema of the face, extremities, genitals, trachea, and abdominal organs without urticaria. Deficiency in C1 inhibitor eads to elevated C2b and bradykinin. ACE inhibitors can lead to this also. Episodes usually follow infxn or surgery/trauma.
30
A child presents after emigrating to the US. He has aheart murmur and has Hx of febrile illness 1 year ago with sore throat and joint swelling. Loud 1st heart tone with mid-diastolic rumble at the apex is present. What is the Rx, if any?
Long-term Penicillin. People with RH have an increased risk of recurrent spisodes and progression of the RH with repeat GAS infxn. Continuous antibiotic prophylaxis is recommended to limit progression.
31
What Xray finding in a child under 3 is common and normal within the chest?
Thymus. The thymus is quite large in children of this age.
32
What Xray finding in a child under 3 is common and normal within the chest?
Thymus. The thymus is quite large in children of this age.
33
What comorbidities are common in a child with absence Sz?
ADHD and anxiety.
34
What is the Rx in a child with absence Sz?
Ethosuximide.
35
Children living in a home before what year are at risk for lead poisoning?
1978. Usually houses under renovation or with peeling paint are the problem. Sometimes, children playing with toys from older generations may get it also.
36
What is the most appropriate next step in suspected lead poisoning?
Measure venous lead level, then if the levels are elevated, remove the child to a new environment.
37
When should aplastic anemia be suspected?
In any patient with pancytopenia following drug intake, toxin exposure, or viral infxns. Profound hypocellularity in the marrow biopsy with a decrease in all cell lines (including reticulocytes) and fatty infiltration of the marrow.
38
What physical quality leads to increased risk for rickets?
Darker skin pigmentations.
39
Child presents with a larger left arm and leg than the right and an enlarged, protuberant toungue. He is 99% on the growth chart and has an umbilical hernia. Dx?
Beckwith-Wiedemann syndrome. Inherited alteration to chromosome 11p15 that predisposes to macrosomia, macroglosia, hemihyperplasia, hernia, and hypoglycemia. Must be monitored for Wilms tumor or hepatoblastoma (do US).
40
Proper management of a child with head trauma who briefly lost consciousness, but is vomiting. No Sz/AMS.
Head CT without contrast. MRIs take too damn long.
41
MCC of meningitis in kids 3 months-10yrs?
S. pneumoniae
| N. meningitidis
42
MCC of meningitis in kids ≥11yrs?
N. meningitidis
43
What classic characteristic would differentiate meningitis due to H. flu from N. meningitidis?
Petechial rash in N. meningitidis. H. flu does not have a rash.
44
A child with constipation and an anal fissure presents. He is normal physically despite the fissure. Appropriate Rx?
Laxatives. Constipation is common in toddlers due to transition to solid foods, milk, toilet training, and entrance to school.
45
Child presents with uncontrollable writhing movements of the arms/hands and Hx of a sore throat that resolved a month ago. Vaccinations are up to date and PE reveals pericardial friction rub with Sub Q nodules on the hands. ESR is elevated and ECG shows diffuse PR depressions and ST elevations. DX?
```
Acute Rheumatic Fever due to S. pyogenes. Typical symptoms can be recalled from the acronym JONES.
Joint pain
Heart
Nodules
Erythema marginatum
Syndenham's chorea
```
46
13yo girl with Down Syndrome presents with positive babinski sign and trouble moving her legs. She is ataxic and dizzy. She has urinary incontinence. Dx?
Atlantoaxial instability.
47
Baby presents with stridor. He is not sick and has no signs of illness. Eating normally. The stridor is inspiratory and expiratory. It is worse with crying. Breathing treatments are not useful. The stridor improves with extension of the neck, but not when prone. Dx?
Vascular rings from the aorta are encompassing the trachea. Inspiratory stridor that is most prominent in infants. It is improved by extending the neck. Think: the extensions from the aorta do not block the airway when the neck is extended too.
48
Infant presents with stridor that is inspiratory and expiratory. No recent illness and eating normally, the stridor improves when the child is prone, but worsened when supine. Dx?
Laryngomalacia. This condition is due to collapse of the supraglottic structures during inspiration. Think, laryngomalacia improves when the child is "laying flat" on their belly.
49
What is the MCC of pneumonia in a child under 20 with cystic fibrosis? After 20?
<20yo: S. aureus
>20yo: Pseudomonas *Though both are possible in either age group, younger CF patients are at higher risk of S. aureus than adults. Both should be considered as a potential infective organism in either age group.
50
What is the proper testing for a neuroblastoma?
Serum/urine catacholamines and homovanillyic acid as well as vanillyic acid are elevated. Arising from neural crest cells, the neuroblastoma arises from sympathetic chains and the adrenal medulla. Calcifications and hemorrhgage are classic on xray.
51
17yo female presents with difficulty breathing. Swollen lymph nodes and a red, sore throat and fatigue are her symptoms. Monospot is positive. PE reveals swollen tonsils and difficulty swallowing. Rx?
Steroids must be administered in rare cases to avoid airway obstrxn in mono.
52
Introduction of Cow's milk in an infant prior to 1 year and prematurity can lead to risk of what deficiency?
Iron. Thus, iron must be included with vitamin D in all preterm, exclusively breastfed children until they reach 1 year old to avoid deficiency.
53
When are the varicella vaccines typically administered?
1 and 4 years old.
54
Proper management of preseptal cellulitis vs orbital cellulitis?
Preseptal requires ABx orally only, while orbital cellulitis requires IV ABx +/- surgery.
55
Child presents with flat head on one side (plagiocephaly) and a preference to turn the head toward the right. A neck mass is palpable on the anterior neck. Where is the lesion?
Congenital muscular torticollis is a postural deformity that presents between ages 1-6 months due to increased tone in the SCM. RFs include crowding in the uterus (twins, breech, oligohydramnios).
56
A teenager has small bald spots on her head and her mother notes that she pulls her hair out when she is anxious. Dx?
Trichotillomania.
57
English-decent child presents with jaundice and fatigue. Labs reveal high reticulocytes, low Hgb and low hct with elevated unconjugated bilirubinemia. MCHC is elevated. LFTs are normal. PE reveals jaundice and splenomegaly. Coombs test is negative. Best test for diagnosis?
Acidified glycerol lysis test. Testing for spherocytosis is confirmed with this test and eosin-5-maleimide binding test (flow cytometry). Family history is commonly present and the typical affected population is those of European descent. MCHC is usually elevated due to cellular dehydration and membrane loss.
58
What is proper management of a subluxed radial head in the pediatric population?
Hyperpronation of the forearm can reduce the subluxation or forearm supination with elbow flexion. If the child resumes full use of the arm after reduction, no films are needed to confirm.
59
Hyaline casts and/or bland sediment are seen in?
Prerenal AKI
60
RBC casts are seen in?
Glomerular AKI
61
WBC casts are seen in?
Nephritis or inflammatory renal disease.
62
Fatty casts are seen in?
Nephrotic syndrome.
63
"Muddy brown" casts or granular casts or tubular cells are seen in?
Acute tubular necrosis (later stage of prerenal AKI).
64
Postrenal urine sediment?
None/benign or may see some RBCs or WBCs.
65
Child presents with abd. pain, nausea, vomiting, and diarrhea. Mother notes that an empty bottle was found at the house from grandma's old supplies. The child begins vomiting blood. What'd she take?
Iron poisoning. Within 30 minutes to 6 hours of ingestion, elemental iron corrodes the GI mucosa causing GI symptoms. Hypotensive shock and anion-gap metabolic acidosis occur in severe cases due to poor perfusion and lactic acid buildup. Gastric scarring and pyloric stenosis can develop after weeks if acute toxicity is survived.
66
Chelation therapy for iron OD?
Deferoxamine
67
What is the leading RF for cerebral palsy?
Prematurity (usually under 32 weeks gestation as the greatest RF). Spastic deplegia is MC seen in preterm infants.
68
What is the MC primary immune deficiency?
Selective IgA deficiency. Presents with recurrent sinopulmonary and GI infxns as well as atopic and autoimmune disease.
69
Path of anaphylaxis during blood transfusion with Selective IgA deficiency?
Formation of IgE antibodies directed against IgA (anti-IgA antibodies) causes mast cell degranulation. Washed blood products are required.
70
Comorbid conditions associated with Tourette syndrome?
ADHD and OCD.
71
A 1yo child presents with a faint maculopapular rash on the face and arms after getting the MMRV vaccine 7 days ago. What is the next best step?
Reassurance. The live vax can cause fever and maculopapular rash a week after receiving the MMR vax. It can lead to a mild measles-like rash within 1-3 weeks.
72
Organism that causes hypo or hyperpigmented patches of skin on the face in a child?
Malassezia globosa causes Tinea versicolor (pityriasis versicolor). May have scaled lesion and pruritis. KOH prep for Dx (spaghetti and meatballs). Topical ketoconazole, terbinafine, or selenium.
73
What is the MC sequelae of bacterial meningitis in kids?
Hearing loss. Screening is recommended.
74
6yo child presents with advanced growth (height/weight) and secondary sexual characteristics. What cause is likely?
Precocious puberty.
Two types: central or peripheral. Central is early activation of hypothalamic-pituitary-gonadal (HPG) axis from pulsatile GnRH secretion stimulating FSH/LH release.
Peripheral is due to gonadal or adrenal release of excess sex hormones. FH and LH are typically low and remain low following GnRH agonist stimulation.
75
Children with normal bone age, but isolated breast development have?
Premature thelarche.
76
Children with normal bone age, but isolated pubic hair development have?
Premature adrenarche.
77
Precocious puberty starts before?
8 years of age.
78
Child presenting with low WBCs, Hgb, platelets, has short stature and unusually shaped thumbs. His skin is freckled and he has strabismus with low-set ears. Likely Dx?
Fanconi syndrome. This is the MCC of aplastic anemia and progressive bone marrow failure. Short stature, microcephaly, abnormal thumbs, and hypognoadism are typical. Skin pigmentation changes may be present (hyper/hypopigmentation) and strabismus with low-set ears, or middle ear abnormalities. It is congenital caused by breaks in chromosomes.
79
Inspiratory stridor that worsens when supine in an infant is likely?
Laryngomalacia. Must be observed with flexible laryngoscope for Dx. Usually resolves by 18 months spontaneously.
80
MCC of osteomyelitis in children?
S. aureus via hematogenous spread.
81
Infant presents with small macular papules and pustules that blanch when touched. Dx?
Erythema toxicum neonatorum.
82
Child presents with Hx of abscess drainage and yet another abscess to be drained. Likely cause?
Chronic granulomatous disease. Presents with recurrent cutaneous and pulmonary infxns due to catalase-positive organisms (Staph A., Serratia, Burkholderia, Aspergillus) due to abnormal oxidative burst.
83
Child presents with perianal rash that is bright, sharply demarcated erythema over or around the anus and perineal area. Dx?
Perianal Streptococcus. Oral ß-lactam is Rx. This is MC in school aged kids and not in infants.
84
In slipped capital femoral epiphysis, where is the disruption?
The femoral growth plate. Requires surgical pinning.
85
Child presents with pain in his shoulder and swelling of the skin overlying the joint. Xray reveals a solitary lytic bone lesion in the humerus head. He is mildly hypercalcemic. Dx?
Langerhans histiocytosis with eosinophilic granuloma variant. These lesions typically resolve spontaneously and are therefore considered benign. Treat conservatively.
86
Child presents with limited upward gaze and non-reactive pupils to light, but normal in accomodation. He has papilledema and headaches. Gait is ataxic. Dx?
Parinaud syndrome due to pinealoma. Penealomas are rare and present as germ cell tumors. Classically, limitation of upward gaze with downward gaze preference and bilateral eyelid retraction, and light-near dissociation (pupillary symptoms) occur. CSF flow blockage causes HA and papilledema.
87
Typical Sx of craniopharyngiomas?
Compression of optic chiasm leads to visual field defects.
88
Typical medulloblastoma Sx?
Cerebellar vermis typically involved leading to ataxia and truncal instability.
89
Congenital absence of vas deferens occurs in?
Cystic fibrosis.
90
Child with hemarthrosis and hematomas in deeper tissues or intramuscular hematomas need to be tested for?
Hemophilia A and B. CBC and coag studies.
91
Child presenting with easy mucosal bleeding and echymoses or petechiae require testing for?
vWF most commonly. Bernard-Soulier, ITP, or Leukemia may present also. ITP and leukkemia will have lower platelets.
92
1 day old infant presents with cyanosis and left axis deviation on ECG. Decreased pulmonary markings are present on Xray. Dx?
Tricuspid valve atresia. Absence of the valve or opening between the vent and atria lead to a hypoplastic right ventricle with hypertrophied left heart.
93
Proper prevention of gonococcal conjunctivitis in newborns?
Erythromycin ophthalmic ointment.
94
Findings on sickle cell blood smear in RBCs?
Howell-Jolly bodies. Nuclear remnants of RBCs that are normally removed by a functional spleen.
95
Findings in G6PD deficiency on blood smear?
Heinz bodies. Aggregates of denatured Hgb form these. Bite cells occur also when these are removed.
96
DIC, HUS, or TTP present with what on blood smear?
Schistocytes or helmet cells.
97
All sexually active women ≤24 should be screened for?
Chlamydia and gonorrhoeae by PCR.
98
Child presents with abdominal pain that is worse with meals. he tried omeprazole, but to no avail of the symptoms. Likely Dx?
Eosinophilic esophagitis. Inflammation occurs due to food allergens. Accompanied eczema, allergic issues, and atopic symptoms often occur.
99
MCC of bone tumor in children/young adults?
Osteosarcoma.
100
Teenager presents for sports physical with pain in his shoulder and night sweats. Xray reveals sunburst appearance and codman triangle in the metaphysis. Dx?
Osteosarcoma.
101
Child presents with bone pain and sweating at night. Xray shows an osteolytic lesion with layering of bone around lesion that appears like an onion. Dx?
Ewing sarcoma.
102
Child with holosystolic murmur in LLSB?
VSD. MCC of congenital heart disease. Perform echo. Most small VSDs close spontaneously.
103
pH, PaCO2, HCO3, K, and Cl levels (up or down) in pyloric stenosis with vomiting?
```
Alkalotic (pH up)
PaCO2 up
HCO3 up
K down
Cl down
```
104
Herald patch and christmas tree sign are associated with?
Pityriasis rosea. Often a viral prodrome followed by herald patch and oval lesions in tension lines.
105
Rx for Tourette disorder?
Antipsychotics (Haldol, risperidone)
Alpha 2 agonists (clonidine, guanfacine)
Behavioral therapy
106
Howell-Jolly bodies are associated with?
Physical or fxnal hyposplenism. Lack of spleen leads to retention of splenically cleared nuclear remnants. Often this is seen in sickle-cell disease.
107
Heinz bodies are associated with?
Hgb precipitation as in G6PD deficiency. Hgb is oxidized forming precipitants.
108
Pharmacotherapy in a child with enuresis?
Desmopressin (ADH). Urinalysis used first to r/o secondary causes. Lifestyle changes and enuresis alarm are tried first.
109
MCC of viral meningitis?
Non-polio enteroviruses like echovirus and coxsackievirus.
110
Only immune disease in children with low B cells?
X-linked (Bruton's) agammaglobulinemia.
111
Only immune disease in children with low IgG, A, M, and E?
X-linked (Bruton's) agammaglobulinemia.
112
Only immune disease with low IgA, but normal B cells, IgG, M, E?
Selective IgA deficiency.
113
Immune disease with low IgG, A, M, and E, but normal B cell count?
Common variable immunodeficiency.
114
Immune disease with low IgG, A, and E, but normal IgM and normal B cell counts?
Hyper IgM syndrome (CD40 ligand deficiency).
115
Immune disease with high IgE, but normal B cell count and IgG, A, and M?
Hyper-IgE syndrome (Job syndrome).
116
How is CBC affected in DiGeorge syndrome?
T cell deficiency (cellular immunity deficient = recurrent viral/fungal infxn) due to lack of thymus. B cell levels unaffected.
117
Affected patients with this disease present with life-threatening bacterial, viral, fungal, and opportunistic infxn in infancy. T and B cells markedly decreased. Dx?
SCID (severe combined immunodeficiency).
118
Transient hypogammaglobulinemia of infancy is characterized by?
Affected Pts have increased sinopulmonary and GI infxns that are often mild, rather than life threatening (as in SCID). Decreased IgG and variable IgM concentrations. IgA and B cell concentrations are normal. Ig normalizes by 9-15 months.
119
Rubella in adults/adolescents has what additional symptom than the typical SS in children?
Arthralgias/arthritis in adults/adolescents accompany fever and the cephalocaudal spread of the maculopapular rash.
120
Rubella rash spread pattern?
Head down to chest, arms, then pelvis, legs, etc. Cephalocaudal spread.
121
When might EBV infxn lead to maculopapular rash?
ß-lactam administration. Otherwise, not typical.
122
Gonococcal infxn rash appearance?
Pustular.
123
Rocky Mt spotted fever rash spread pattern?
Erythematous macular rash starts on wrists and ankles and DOES involve palms/soles that spread centrally.
124
Measles rash spread pattern?
Cephalocaudal (like Rubella) over many days with high fever.
125
Typical strabismus Rx?
Patch the normal eye or special glasses or cycloplegic drops to blur normal eye. Surgery is an option also.
126
Rash for scabies?
Small erythematous papules or vesicles. Burrows (<1cm lines in skin).
127
Classic autism presentation?
Impaired communication, restricted or focused interests, and repetitive behaviors. Lack of interest in social play and language deficits.
128
Peritonsillar abscess acuity presents differently from epiglotittis how?
Abscess is slower in onset and more typical in older children/adolescents. Epiglotittis is an acute onset in younger children.
129
Type 4 or delayed hypersensitivity rxns are mediated by?
T-cell/Mphage mediated (contact dermatitis, TB).
130
Type 3 hypersensiticity rxns mediated by?
Antibody-antigen complex deposition (serum sickness, PSGN, Lupus nephritis).
131
Type 2 hypersensitivity rxns are mediated by?
IgG and IgM autoantibody-mediated (autoimmune hemolytic anemia, goodpastures).
132
Type 1 hyperseensitivity rxns mediated by?
IgE. Anaphylaxis, urticaria.
133
What electrolyte abnormality is expected in DiGeorge?
Hypocalcemia due to lack of PTH.
134
Neonatal fracture of the clavicle during birth requires what management?
Usually none. Spontaneous healing with no long-term sequelae. Decreasing pain may be accomplished by immobilizing the arm.
135
WBC count in synovial fluid of septic joint?
>50,000
136
3 heart anomalies in Turner syndrome?
Bicuspid aortic valve
Coarc of aorta
Aortic root dilation with increased risk dissxn
137
Management of 2 day old baby with purulent eye drainage and chemosis (injxn) who was born at home?
Single IM dose ceftriaxone or cefotaxime
138
In a child, bacterial sinusitis is predated by?
Viral URI.
139
Sx of sinusitis in kids?
```
Persistent:
Nasal drainage (purulent)
Congestion
Cough
High fever (102+)
```
140
Infant botulism pathogenesis?
Clostridium botulinum spores ingested from environment. Rx: human Ig against botulism
141
Adult botulism pathogenesis?
Clostridium botulinum toxin ingested from food. Rx: equine Ig against botulism
142
S/S in Diamond-Blackfan anemia?
Macrocytic anemia
Low reticulocyte count
Congenital anomalies (webbed neck, cleft lip, shielded chest, triphlangeal thumbs, etc.)
143
S/S in Fanconi's anemia?
```
Pancytopenia (vs only RBCs down in Diamond-Blackfan)
Macrocytosis
Congenital anomalies (microcephaly, micropthalmia, short stature, absent thumbs vs triphalangeal thumbs in Diamond-blackfan)
```
144
MC in children, HUS is characterized by the triad of?
Hemolytic anemia
Thrombocytopenia
AKI
145
4yo girl arrives with an Hx of runny nose and congestion that started 2 wks ago. It improved initially, but now presents with thick, yellowish nasal discharge. Vitals normal, but PE reveals child with cough and thick, purulent mucus dripping from the nares. Turbinates are red/swollen. Tenderness in maxillary sinus. Lungs clear. Next step?
Oral antibiotics. Child presents with URI that improves initially, then worsens. This is typical of acute bacterial rhinosinusitis. If a likely viral URI persists, is severe, or worsens, then bacterial infxn is likely and requires ABx. Uncomplicated acute bacterial sinusitis is Rx with oral amox/clav.
146
Proper Dx tool for dysplasia of the hip in early infancy?
Hip ultrasound if <4 months. If >4months, hip radiograph.
147
Postexposure prophylaxis for rabies?
Rabies Ig and vaccine
148
Symptoms in rabies?
Hydrophobia/aerophobia cause pharyngeal spasms
Agitation
Ascending flaccid paralysis
149
Gower sign seen in?
Duchenne MD
150
MC muscular dystrophy in kids?
Duchenne. Presents at 2-5yo with calf pseudohypertrophy and Gower sign.
151
Duchenne muscular dystrophy transmission?
X-linked. Dystrophin gene on Xp21 dysfxn.
152
Screening in kids for Duchenne MD?
Serum creatine phosphokinase and aldolase levels are elevated in screen.
153
Confirmational studies for Duchenne MD?
Genetic studies.
154
Parents refuse to consent for Rx of their child with acute lymphoblastic leukemia due to a belief she will suffer more from chemo. Next step?
Court order mandating treatment should be sought. Parents are not allowed to refuse life-saving Rx for a child and a doctor should seek a court order.
155
Fetal hyperglycemia during the first trimester is associated with what problems in the child?
Malformations.
| Heart disease, neural tube defects, small left colon syndrome, spontaneous abortion.
156
Fetal hyperglycemia in the second and third trimesters are associated with what problems in the child?
Fetal hyperglycemia and hyperinsulinemia. Organomegaly, macrosoma, and polycythemia can result. Hypoglycemia can also occur after delivery.
157
How long is the risk for sepsis increased in a patient after splenectomy?
30 or more years. Pts. need anti-pneumococcal, Haemophilus, and meningococcal vaccines several weeks before operation and daily oral PCN prophylaxis for 3-5 YEARS following procedure.
158
What medications are required after splenectomy?
PCN given for prophylaxis for 3-5 years after removal of spleen.
159
Urine collection in a child in diapers?
Straight cath to obtain sterile specimen.
160
Urine collection in a child not in diapers?
Clean-catch specimen is acceptable over straight cath.
161
Prepatellar bursitis Sx?
Anterior knee pain
Pain with direct pressure over kneecap
Superficial swelling over patella
162
Patellar tendonitis Sx?
Overuse/repetitive jumping and kicking causes anterior knee pain after exercise.
Point tenderness at inferior pole of patella.
163
Patellofemoral stress syndrome Sx?
Overuse injury in runners leads to anterior patella pain that worsens with descending steps/hills.
Pain isolated to patella.
164
Osgood-Schlatter disease Sx?
Adolescent with pain in anterior proximal tibia. Xray shows tissue swelling, lifting of tubercle from shaft, and irregularity of fragmentation of tubercle of tibia.
165
A lateral Xray of a child showing the prevertebral soft-tissue space as significantly wider than the vertebral bodies is suspicious for?
Retropharyngeal abscess. Fever, dysphagia, and inability to extend the neck, and muffled voice are also suspicious.
