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Flashcards in pediatrie 2 Deck (576):
1

kid with drooling fever odynophagia dysphagia muffled voice and trismus what can cause that(3)

infection of larynx
Pharynx
or

deep neck space

2

clue for retropharyngeal abcess in the setting of drooling fever odynophagia dysphagia muffled voice and trismus(2)

inability to extend the neck
widened prevertebral space in lateral xray

3

complication of retropharyngeal abcess(4)

airway compromise
bactriemia
carotid artery rupture
jugular venous thrombosis

4

cause of retropharyngeal abcess

direct spread infection from paharyngitis
tonsilitis
otitis media
or sinusitis

5

bugs involved in retropharyngeal abcess

polymicrobial

6

stable patient with retropharyngeal abcess

polymicrobial

7

clue for early congenital syphilis(5)

hepatosplenomegaly
cutaneous lesion
jaundice
anemia
rhinorrhea

8

xray in congental syphilis(2)

metaphyseal dystrophy
periostitis

9

late manifestation of congenital syphilis (7)

2 years
frontal bossing
high arched palate
hutchinson teeth
intersticial keratitis
saddle nose
perioral fissures

10

screening test for syphilis(3)

VDRL
RPR
Enzyme immunoassay

11

confirmatory test for syphilis(3)

FTA-ABS
TPPA=traponema particle agglutination assay

12

in the vignette the clue for syphilis congenital

ulcerative on his feet

13

3 phases of pertussis

catarrhal
paroxysmal
convalescent

14

immunisation in pertusis(2)

5 doses of Tdap from 2 months and 6 years
TDAP booster age 11-18 and during pregnancy

15

CBC in pertussis

lymphocyte predominant leukocytosis

16

does immunization protects for life

no immunity doen not provide lifelong immunity

17

confirmatory dx of pertussis(2)

bacterial culture
PCR

18

rx of pertussis

macrolides

19

complication of pertussis(5)

pneumonia
weight loss
subonjonctival hemorage
pneumothorax
respiratory failure and deat

20

clue in catarrhal phase

mild cough
rhinitis

21

duration of catarrhal phase

1-2 weeks

22

clue for paroxysmal phase(4)

20-30 mn coughing paroxysms
inspiratory whoop
staccato cough
posttussive emesis

23

duration of paroxysmal phase

2 - 6 weeks

24

clue for convalescent phase(2)

cough and
post tussive emesis resolve

25

duration of convalecent phase

weeks to months

26

osteomyelitis in sickle cell disease(2)

salmonella # 1
staph aureus

27

important clue to dx pertussis

inadequate vaccination

28

predisposing factor for sinusitis

viral upper respiratory infection

29

clue for sinusitis(4)

erythema and swelling of the nasal turbinates
purulent drainage
congestion
cough

30

quid of preseptal cellulitis

mild infection of the eyelid anterior to the orbital septum

31

quid of orbital cellulitis

seriuos infection post to the orbital septum

32

clue to distinguish preseptal from orbital cellulitis

ophtalmoplegia in orbital cellulitis(diplopia)

33

eye problem in orbiatl cellulitis(4)

decreased visual acuity
diplopia
ophtalmoplegia
proptosis

34

dangerous complication of orbital cellulitis(4)

blindness
intracranial infection
orbital abscess
cavernous sinus thrombosis

35

characteristic of non inflammatory joint fuid(3)

clear
200-2000 wbc
25% PMN

36

example of non inflammatory joint disease

OA

37

characteristics of inflammatory joint fluid(3)

translucent and opaque
2000-100000 wbc
often> 50% PMN

38

example of inflammatory joint disease(2)

crystal
RA

39

characteristics of septic joint(3)

opaque
50 000-150 000 WBC
often 80%-90 %

40

first bug in septic joint

staph aureus

41

rx of septic joint(2)

IV antibiotics
emergency surgical drainage

42

complication of septic joint

permanent joint destruction

43

most frequent complication of mumps

orchitis

44

febrile illness with development of rash 1 day after taking amox which infection should be suspected and dx(2)

epstein barr virus
post antibio rash

45

triad in Mononucleosis infection(3)

exsudative tonsillitis or pharyngitis
posterior or diffuse cervical lymhadenopathy
fever

46

presentation of post antibiotoc rash(2)

polymorphous
maculopapular

47

break time in sport during mononucleosis

> ou egal a 3 semaines

48

common oropharyngeal lesions in kid(5)

aphtous stomatitis
herpangina
herpes gingivostomatitis
group A streptococal pharyngitis
infectious mono

49

quid of aphtous lesions or canker sores(2)

reccurent ant oral mucosa ulcers
no fever

50

localisation of ulcers in canker sores(4)

lips
cheeks
mouth floor
ventrum of the tongue

51

clue for herpangina(2)

vesicles and ulcer on post oropharynx
fever

52

clue for gingivostomatitis

vesicles and ulcer on ant oropharynx
fever

53

clue for group A strep pharyngitis(3)

tonsillar exsudates
fever
anterior cervical lymphadenopathy

54

cause of unilateral cervical adenitis in children(5)

staph aureus and staph pyogenes
anaerobic bacteria
non tuberculos bacteria
Mycobacterium TB
bartonella henselae

55

clue for adenitis induced by staph and strep(2)

associated cellulitis
or
suppuration

56

rx of adenitis induced by staph or strep

clindamycin
incision and drainage

57

risk factor for anaerobic bacteria induced adenitis(2)

dental caries
periodontal disease

58

rx of anaerobe adenitis(2)

clindamycin
augmentin

59

clue for non TB mycobacteria adenitis

rarely tender

60

rx of non tb mycobacteria adenitis(2)

excision
macrolide +/- rifampin

61

clue for adenitis caused by bartonella hensellae

exposure to kittens or cats

62

rx for adenitis caused by bartonella hensellae

no needed

63

contraindication to rotavirus vaccination(4)

history of antissuception
anaphylaxis to vaccine ingredients
history of uncorrected congenital malformation in the GI like Meckel
severe combined immunodeficiency

64

age for administration of rotavirus

2-6 months

65

management of cat bite

augmentin pendant 5 jours

66

most common cause of osteomyelitis in kid

staph aureus

67

most common cause of acute tender lymph node in kids

staph aureus

68

clue for rhinosinusitis(3)

persistent symptom> ou egal a 10 jours without improvement
or
severe symptoms including fever> ou egal 39,purulent discharge or face pain> ou egal a 3 days
or
worsening symptoms > ou egal a 5 jours after initially improving viral upper respiratory infection

69

bugs causing rhinosinusitis(2)

step pneumoniae
nontypeable haemophilus influenzae

70

rx of choice of bact rhinosinusitis

augmentin

71

step in management of septic joint with effusion(4)

Labs de routine
xray
arthrocentesis

(in some vignette arthrocentesis is more important than Xray)

72

osteomyelitis in kid less than 3 years(3)

staph
group B streptococcus
gram negative bacilli

73

osteomyelitis in kid more than 3 years(3)

staph aureus
group A streptococci
strep pneumo

74

rx of osteomyelitis in kid less than 3(2)

nafcillin or vancomycin
plus
gentamycin or cefotaxime

75

rx of osteomyelitis in kid more than 3(4)

nafcilin
or
clindamycin
or
cefazolin
or
vancomycin

76

quid of howel jolly bodies(2)

single round blue inclusions on wright stain
nuclear remnants

77

quid of aplastic anemia

everything is low

78

acquired cause of aplastic anemia(6)

drugs
toxic chemicals
idopathic
viral infection
immune disorder
thymoma

79

drugs causing aplastic anemia

NSAIDS
sulfonamides

80

toxic chemicals causing aplastic anemia(2)

benzene
glue

81

congenital cause of aplastic anemia

fanconie anemia

82

inheritance of fanconi(2)

autosomal recessive
or xlinked

83

risk in fanconi

cancer by the age of 16

84

Dx of fanconi

chromosomal breaks

85

clue for fanconi(4)

congenital marrow failure
poor growth
morphologic abnormalities
macrocytic anemia

86

disease with cafe au laits spots(2)

fanconi
neurofibromatosis

87

eyes and ears problem in fanconi(3)

strabismus
lot set ears
middle ear abnormalities

88

middle ear abnormality in fanconi(4)

hemorrgae
incomplete development
chronic infections
deafness

89

definitive rx in fanconi for the anemia

hematopoietic stem cell transplantation

90

most common complication of sickle cell disease

painless hematuria

91

why patient will sickle cell disease pee a lot at night

isisthenuria=inability to concentrate urine

92

kid with foot refent foo woung you decide to vaccinate for tetanos mother who is the guardian accepts but the father not what to do

administer the vaccine

93

in case of separated couple how do you proceed for the consent

the consent of one parent or the guardian is sufficient to perform

94

clue for wiskott aldrich syndrome(3)

low platelet
plus eczema
plus reccurent bacterial infection

95

cause of thrombocytopenia in wiskott

decreased platelet production

96

platelet in wiskott aldrich

small

97

inheritance of aldrich wiskott

x linked

98

clue for acute lymphoblastic leukemia(5)

bone pain
lymphadenopathy
hepatosplenomegaly
pallor from anemia
petechia from throbocytopenia

99

dx of acute lymphoblastic leukemia

bone marrow biopsy with >25 % lymphoblasts

100

most common cancer in childhood

ALL

101

peak of ALL

2 - 5 ans

102

rx of ALL

chemotherapy

103

clue in the USMLE for ALL(2)

infant
high WBC

104

nosebleed and congestion in a patient with CT shows visible mass at the back of the left nostril and erosion of the adjacent bone dx

angiofibroma

105

male adolescent with epistaxis and bone erosion on the back of the nose

angiofibroma until proven otherwise

106

when to rx angiofibroma(3)

if juvenile angiofibroma is enlarging
obstructing the airway
cause chronic nosebleeds

107

surgery in angiofibroma

risk of recurrence

108

xray in osteosarcoma of humerus(2)

sunburst periostal reaction
codman triangle

109

the most common bone tumor in kid and young adults

ostosarcoma

110

bone of predilection of osteosarcoma

long bone

111

quid of codman triangle

periostal elevation

112

rx of osteosarcoma(2)

tumor excision
chemotherapy

113

when to suspect herediatary spherocytosis(4)

coombs negative
hemolytic anemia
splenomegaly in the setting of reticulocytosis hyperbilirubinemia spherocytosis and family history of anemia

114

confirmatory dx of hereditary spherocytosis

eosin 5 maleimide and acidified glycerol lysis tests

115

stroke in kid next step

peripheral smear and reticulocyte count

116

stroke in kid cause

SCD

117

physiopatho of stroke in SCD(3)

unknown but we think
red blood cell adherence to endothelium
activation of von willbrand's factor's
hyperviscosity

118

patient with history of easy bruising develops knee swelling after trauma first step

platelet count and coagulation studies

119

3 clue for bleeding disorders

prolonged bleeding after dental or minor procedures
bruising at pressure points
hemarthrosis

120

cause of bleeding disorder(4)

hemophilia A
hemophilia B
von willebrand disease
platelet function disorder

121

disease with platelet dysfunction(2)

bernard souilier
glanzman thromboasthenia

122

patient knee pain and swollen without trauma xray show central lytic lesion onion skinning appearrance dx

ewings sarcoma

123

type of tumor in erwing sarcoma

malignant

124

xray in erwing sarcoma(3)

onion skin, lamelated appearance
with a moth eaten or mottled appearance and extension in soft tissue

125

dx differenciel in erwing sarcoma

osteomyelitis

126

lieu for metastasis in erwing cell sarcoma(2)

lung
lymph nodes

127

patient with reccurrent sinopulmonary infection and diarrrhea since childhood develops anaphylactic transfusion reaction after blood transfusion cause of that

IgA deficiency

128

confirmatory dx of IGA deficiency(2)

low IGA level
normal IGM and IGG

129

prevention of infection and death in SCD(2)

give PNC prophylaxis
plus
pneumococcal vaccination

130

admistration of PNC in SCD

twice a day
until they reach five yo

131

factors of coagulation missing in cystic fibrosis(3)

vit K dependent
2, 7,9 ,10
protein C et S

132

why you have problem of bleeding in cystic fibrosis(2)

pancreatic insufficiency
problem in liposoluble vit absorbtion

133

toddler with unilateral firm mass and hematuria

tumeur de wilms(nephroblastoma)

134

peak for wilms tumor

2-5 ans

135

associated syndrome with wilms tumor(3)

wagr
beckwith wiedman syndrome
denys drash syndrome

136

quid of WAGR syndrome(4)

wilms tumor
aniridia
genitourinary anomalies
retardation mental

137

most common primary renl neoplasm in kid

wilms

138

dx of wilms(2)

1- contrast enhanced CT
2- chest xray for metastasis

139

rx of wilms(3)

tumor excision or nephrectomy
chemo
+/- radiation therapy

140

prognosis for rx wilms

5 year survival rate with rx :90%

141

role of hydroxyurea

increase fetal Hb

142

side effect of hydroxyurea(3)

leukopenia
anemia
thrombocytopenia
bref marrow suppression

143

marrrow suppression with hydroxyurea

temporary

144

polycythemia in newborn quid

central nervous hematocrit level greater than 65%

145

cause of polycythemia in newborns

delayed clamping of the umbilical cord

146

risk foor neonate in polycythemia(3)

respiratory distress
poor feeding
neurologic manif

147

clue for ALL(4)

more then 25 % de lymphoblast
lymphoblast lacks of peroxydase positive granules
but contain periodic acid schiff positive material
immunostaining for terminal deoxynucleotidyltransferase

148

immunostaining in ALL

TDT expression dans 95% des cas

149

cells expressing TDT(2)

pre T lymphoblastes
Pre B lymphoblastes

150

SCD patient with hip pain first dx

osteonecrosis(avascular nerosis)

151

mosr common affected bone in osteonecrosis in (2)

humerus
fever

152

patient with SCD presenting with dyspnea fatigue Hg: hb 4,5 wbc: 10000 platelets:300 000 reticulocytes=0,1% dx

aplastic crisis

153

low HB in SCD causes (3)

aplastic crisis
hemolysis
splenic sequestration

154

differentiate aplastic crisis from aplastic anemia

aplastic anemia =pancytopenia in a patient without SCD

155

characteristics of iron deficiency anemia(8)

Hmt

156

characteristics of alpha thalassemia anemia(8)

Hmt.> 30%
RDW normal
total RBC normal
normal to increased serum iron ferritin
TIBC normal
no responds to iron supplementation
normal electrophoresis
target cells

157

characteristics of beta thalassemia anemia(8)

Hmt.> 30%
RDW normal
total RBC normal to increased
normal to increased serum iron ferritin
TIBC normal
no responds to iron supplementation
electrophoresis=elevated hb A2
target cells


158

shistocytes in the settting of bloody diarhea administration of antibiotics,low Hb low platelet and high creat

microangiopathic hemolytic anemia

159

bugs involved in hus(5)

E coli 0157h7
shigella
campylobacter
salmonella
yersinia

160

peripheral smear in HUS

schistocytes

161

continuous flow murmur in left sternla border in young child (son)

Patent ductus arteriosus

162

knee chest position of in fallot how it will improve cyanosis (2)

increased systemic vascular resistance
increases pulmonary blood flow

163

viral prodrome(rhinorrhea,fever) and heart failure

viral myocarditis

164

chest xray in viral myocarditis(2)

cardiomegaly
pulmonary edema

165

ECK in viral myocarditis

sinus tachycardia

166

echo in viral myocarditis(2)

decreased ejection fraction
diffuse hypokinesis

167

Biopsin in viral myocarditisdium with myocite necrosis(2)

gold standard
inflammatory infiltrate of the myocardium with myocite necrosis

168

prognosis of viral myocarditis in newborns

mortality 75%

169

prognosis of viral myocarditis in older infants and children

mortality in 25%

170

out come in viral myocarditis

full recovery within2-3 months 66%
dilated cardiomyopathy /chronic heart failure 33%

171

what dysfunction you have in viral myocarditis

systolic and diastolic

172

management of viral myocarditis(3)

ICU
to reduce the risk of acute decompensatio
fatal arythmia

173

antibiotics used in rheumatic fever prophylaxis

IM PNC G given q 4 semaines

174

duration of prophylaxis of rheumatic fever without carditis

5 years or until the patient reaches 21 yo

175

duration of prophylaxis of rheumatic fever with carditis but no residual heart or valvular disease clinical or by echo

10 years or until the patient reaches 21 yo

176

duration of prophylaxis of rheumatic fever with carditis and persistent heart or valvular disease

10 years or until 40 yo

177

why you give PNC in patient rheumatic fever(2)

to prevent recurrent group A streptococcus pharyngitis
limit progression of rheumatic heart disease

178

patient one day old comes for cyanosis ,pulse oxymetry 80% with no improvement with 100% inspired o2.continuous machine like murmur is heard on auscultation oral mucosa is blue dx

cyanotic heart disease

179

central cyanosis plus 70-90% oxygen saturation dx

cyanotic heart disease

180

what to do in front of cyanotic heart disease

prevent closure of ductus arteriosus by giving prostaglandine E 1

181

PDA dependent congenital heart disease(5)

coarction of the aorta
D transposition of the great arteries
hypoplastic left heart syndrome
total pulmonary venous connection
tricuspid atresia

182

cause of supraventricular tachycardia in adolescent

WPW

183

mechanism involved in WPW

accessory atrioventricular pathway

184

EKG of WPW(3)

shortened PR interval
delta waves
widening qrs complex

185

clue for tricuspid atresia

left axis deviation
decrease pulmonary markings on chest xray

186

why tricuspid atresia you have decrease pulmonary markings on chest xray

due to hypoplasia of the right ventricle and pulmonary outflow tract

187

neonatal with EKG shwsleft axis deviation

it's never normal

188

quid of tricuspid atresia

cyanotic heart disease

189

post pericardiotomy syndrome

pericardial effusion occurring within days or months after cardiac surgery

190

cardiomegalie with hypotension tachycardia muffled heart sound after surgery

pericardial effusion

191

most common heart malformation

VSD

192

clue for VSD

holosystolic murmur in left sternal border
plus
apical diastolic rumble

193

when will you have cyanosis in VSD

eisenmenger syndrome

194

quid of eisenmenger syndrome(2)

right to left shunt
unrepaired large VSD causes permanent pulmonary Hypertension and right to left shunt

195

cause of diastolic rumble in VSD at the apex

increased flow across the mitral valve

196

patietn 5y0 with asymptomaticgrade 2 left sternal border systolic ejection murmur best heard when the child is lying down and decreases with standing dx

benign chilhood murmurs

197

what to do in benign childhood murmur

observation

198

characteristics of inocent murmur(6)

asymptomatic
no structural heart disease associated
grade 2/6
early or mid systolic
decreases with standing and valsalva
have a normal associated s2

199

characteristics of pathologic murmur(6)

syptomatic
structural heart disease associated
grade 3/6 or higher
hars and holosystolic or diastolic
increases with standing and valsalva
loud s2 fixed s2 splitted

200

adolescent losing consciousness after crying or anytime she gets frustrated .EP normal dx and rx

breath holding spell
reassure the patients

201

type of breath holding spell(3)

pallid =patient pale
cyanotic=
mixed=cyanose plus seizure/pallid plus seizure

202

stridor improving with neck extension chez 1 patient de moins d'un an with cardiac abnormalities no improvement with epinephrine corticosteroids or bronchodilators

vascular ring

203

where can you have vascular rings(2)

trachea=stridor wheezing

esophagus=dysphagia

204

age pour vascular ring

mois d'un an

205

risk in long Qt syndrome(3)

syncope
ventricular arythmia
sudden cardiac death

206

medication used in prevention of death in long Qt syndrome(2)

betablocker
pacemaker

207

what a patient with long qt syndrome should avoid(2)

electrolyte derangement
medications that block K+ channels

208

ventricular arythmia in long Qt syndrome

torsade de pointes

209

congenital cause of long Qt syndrome(2)

Jervell and lange nielsen syndrome=autosomal recessive

romano ward syndrome=autosomal dominant

210

jervel and lange nielsen syndrome(3)

family history of sudden death
congenital neurosensorineural deafness
qt interval=600ms

211

what happen in jervell and lange nielsen syndrome

molecular defect in potassium channels

212

rx of JLN syndrome(3)

refrain from vogorous exercice
maintaining normal ca++,K+and Mg++
avoid medication that can lengthen the qt interval

213

metabolic derangements causing long Qt syndrome(3)

hypocalcemia
hypoK+
hypoMg++

214

antibiotics induced long qt syndrome(2)

macrolide
fluoquinolone

215

psychotics meds induced long qt syndrome(3)

antipsychotics
TCA
SSRI

216

opioids meds induced long qt syndrome(2)

methadone
oxycodone

217

antiemetics meds induced long qt syndrome(2)

ondansetron
granisetron

218

antiarythmics meds induced long qt syndrome(5)

quinidine
procainamide
flecainide
amiodarone
sotalol

219

Qt interval

debut qrs a fin onde T

220

scaly rash in eyebrows nasolabial fold and scalp dx

seborrheic dermatidis

221

rx of seborheic dermatidis(3)

moisturisers
antifungals
topical steroids

222

quid cradle cap

seborrheic dermatidis

223

platelet in henock shonlein purpura

normal

224

problem in henock shonlein purpura

IGA mediated vasculitis

225

clue for Henock shonlein purpura(4)

palpable purpura on lower extremities
abdominal pain
arthralgia
renal involvement

226

atopic dermatitis in infant(2)

pruritis
skin lesions

227

skin lesions in atopic dermatitis localisation(4)

face
scalp
extensor surfaces
diaper region is spared

228

rx of atopic dermatitis in kid

improve the skin barrier function through the use of mild cleanserss and thick bland emollients in addition to mild topical antiinflammatory ointments

229

Tinea corporis=date

erythematous scaly pruritic rash with central clearing

230

rx of tinea corporis

topical antifungals

231

dx of tinea corporis(2)

skin scraping
koh examination

232

rash in neonates(4)

erythema toxicum neonatorium
neonatal herpes simplex virus
neonatal varicella
staphyloccocal scalded skin syndrome

233

quid of erythema toxicum neonatorium(2)

asymptomatic erythematous blanching macules ,papules and pustules throughout the bodies
resolves spontaneously within 2 weeks after birth

234

Rx of erythema toxicum neonatorium

none

235

quid of neonatal herpes simplex virus(3)

vesicular clusters on skin eyes and mucous membranes
central nervous system involvement
fulminanat multiorgan failure

236

rx of neonatal herpes simplex virus

acyclovir

237

neonatal varicella(3)

fever
vesicular clusters on skin
fulminant disseminated disease

238

rx of neonatal varicella

acyclovir

239

quid of staphyloccocal scalded syndrome(4)

fever
irritability and diffuse erythema
followed by blistering and exfoliation
positive nickolsky sign

240

rx of staphyloccocal scalded syndrome(3)

oxacillin
or nafcillin
or vancomycin

241

recommendtion during sunburn even if if the patient is suing factor 50 sunscreen and develops sunburn(prevention)

apply sun protection factor(15-30) or higher 50 sunscreen 15- 30 mn before sun exposure
avoid tannig beds

242

rx of mild to moderate sunburn(4)

cool compresses
aloe vera
calamine lotion
NSAIDS

243

severe sunburn rx(4)

hospitalization
IV fluids
analgesia
wound care

244

complications of sunburn(2)

cancer
photoaging

245

cancer in sunburn(4)

melanoma
basal cell carcinoma
squamous cell carcinoma

246

after camping patietn presents with itching,burning and oozing skin lesions in both legs dx

allergic contact dermatitis

247

type of hypersenstivity in allergic contact dermatitis

cell mediated hypersensitivity

248

bugs in impetigo(2)

staph aureus
strep

249

2 types of impetigo

vesicular pustulous
bullous

250

cause of bullous impetigo

staphylococcus

251

characteristics of impetigo(3)

erythmatous papules
rapidly evolves in vesicles and pustules
and at last honey colored crusted exsudates

252

primary herpes simplex virus associated with dermatitis atopic

eczema herpeticum

253

clue for eczema herpeticum(2)

numerous vesicles over area of atopic dermatitis
fever

254

rx of eczema herpeticum(2)

can be life threatning
acyclovir

255

physiopatho of staphylococal scalded skin syndrome

toxins produced targeting desmoglein 1

256

role of desmoglein 1

keratinocyte adhesion in the superficial dermis

257

rash in staphylococal scalde skin syndromeSSSS(5)

1- erythema starting on the face
2-generalizes in 24-48 h
3-superficial flaccid blisters develops
4 nickolsky sign posive
5-fever

258

age de SSSS(3)

children below 10
adults with kidney disease
immune compromise patient

259

capillary hemangioma(strawberry)(2)

tumors composed of capillaries separated by connective tissues
appear first week and regress by 5-8 yo

260

clue for measles(rubeola)(4)

cough
coryza
conjunctivitis
koplik spots

261

rash in measles

maculor papular rash spreading in a cranial caudal pattern sparing palms and soles

262

prevention of measles

vaccination

263

rx of measles(2)

isolation in private room with negative air pressure and a minimum of 6-12 air changes per hour with door closed
wear of facemask N95 by staff and parents

264

transmission of measles

respiratory droplets

265

dx of measles(2)

PCR
serology

266

what should be given to any kid with measles

vit A

267

complications of measles(4)

otitis media
pneumonia
neurologic
gastroenteritis

268

neurologic complications in measles(3)

encephalitis within days
acute disseminated encephalomyelitis(within weeks)
subacute sclerosing panencephalitis(within years)

269

after trauma 5 yo kid develops headcahe vomiting and left pupil dilation dx possible

epidural hematoma

270

ct of epidural hematoma

biconvex mass on ct

271

indication of emergent craniotomy in epidural hematoma(5)

GCS

272

6 yo boy with poor feeding and bulging anterior fontanelle best next step in the management ot this baby

CT of the brain

273

clue for hydrocephalus

rapidly increasing in size of head circumference greater than the 97 th percentile(growth chart)

274

symptoms in hydrocephalus(4)

poor feeding
irritability
decreased activity
vomiting

275

physical exam in hydrocephalus(4)

tense and bulging fontanelle
prominent scalp veins
widely spaced cranial sutures
rapidly increasing head circumference

276

when using ultrasound in the setting of hydrocephalus

kid less than 6 months

277

drug of choice for absence seizure in kid(2)

ethosuximide(++++++)
or
acid valproic

278

patient with ear pain on antibio develops vomiting and awakened headaches inthe morning.Physical exam shows left tender mastoid next step in the patient

CT of brain

279

red flag for intracranial pathology

morning vomiting
nocturnal headaches

280

risk in otitis media or mastoiditis

brain abcess formation

281

dx of brain abcess formation

ring enhancing and hypointense center lesion on CT or MRI

282

ceiteria dx for febrile seizure(5)

age 6 months -6 years
T.> ou egal a 38
no history of previous afebrile seizures
no CNS infection
no acute metabolic cause of seizure

283

quid of simple febrile seizure(3)

non focal (tonic clonic or atonic)
one episode last

284

quid of complex febrile seizure(3)

focal
one episode > ou egal a 15 mn
or multiple episode > ou egal a 30 mn

285

risk factor of febrile seizure

infection virale
immunization
family history

286

immunization involved in febrile seizure(2)

DTAP
MMR

287

management of febrile seizure(2)

reassurance
abortive rx if seizure lasts more ou egal a 5 mn

288

prognosis of febrile seizure(3)

normal intelligence and development
environ 30% risk of recuurrence
less than 5% risk of epilepsy

289

quid of petit mal

absence seizure

290

confirmatory test for petit mal

EEG studies

291

clue for generalised seizures(3)

can have loss of consciousness
bilateral motor findings
can be convulsive or non convulsive(bsence)

292

physiopatho of generalised seizures

both hemisphere is involved

293

seizure activity in partial seizures

appears limited to part of oen hemisphere in brain

294

quid of simple partial seizures(4)

no loss of consciousness
feeling of deja vu(familiarity)
can have aura
patient remeber event well

295

partial seizure with generalisation(2)

1- loss of consciousness
2-tonic clonic activity

296

complex partial seizures(6)

loss of consciousness
can have aura
motor automatism
bilateral motor findings
staring spells
postictal confusion

297

motor automatism in complex partial seizures(4)

chewing
swallowing
sucking
picking movements

298

clue for partial seizure with secondary generalisation(2)

blood tinged sputum suggesting bite tongue
urinary incontinence

299

fever with tonic clonic seizure in a patient with digeorge during exam babay cries and develops cyanosis

brain abcess

300

risk factor for brain abcess

otitis media /mastoiditis
frontal and ethmoidal sinusitis
dental infection
cyanotic heart diasease
bacteriemia from ather sites of infection

301

pathogenesis of brain abcess in otitis media and mastoiditis(2)

direct spread
temporal lobe and cerebellum abcess

302

pathogenesis of brain abcess in frontal and ethmoidal sinusitis(2)

direct spread
frontal lobe

303

pathogenesis of brain abcess dental infection(2)

direct spread
frontal lobe

304

pathogenesis of brain abcess in bacteriemia from other sites of infection and cyanotic heart disease(2)

hematogenous spread
mulptiple abcess along the distribution of middle cerebral artery(gray white matter junction)

305

most common cause of headaches acute and reccurent in the pediatric population

migraine headache

306

firs-line regimen in rx migraine(2)

acetaminophen
NSAID

307

EEg in complex partial seizures(2)

normal
or
show brief discharges

308

day dreaming episodes in 4 to 8 yo child , brief staring spells and decline in school performance and post ictal phase rx and dx(3)

ethosusuximide
valproate
dx absence seizures

309

skin changes in aptient taking anabolic steroid(2)

acne
accelarated male pattern baldness

310

why gynecomastia in patient taking anabolic steroid

testosterone is converted to estrogen and will drive breast enlargement

311

psychiatric problem in anabolic steroid(2)

aggresssion
major mood disorder

312

metabolic problem in anabolic steroid

low HDL

313

cardiac problem in anabolic steroid

cardiac dysfunction in high dose of anabolic steroid use

314

why erythrocytosis in anabolic steroid use

androgen stimulating erythropoiesis

315

endocrine problem in patient taking anabolic steroid(3)

decreased testicular size
low sperm count
virilization

316

quid of anabolic steroids(3)

testosterone
stanalozolol
nadrolone

317

clue for neurofibromatosis type 1(7))

cafe au lait spots
axillary freckles
lish nodules ot the iris
bony lesion
neurofibroma
macrocephaly
short stature

318

complication or assoiciated problem in neurofibromatosis(4)

tumor in CNS
tumor in peripheral nervous system
skin
viscera

319

learning problem in neurofibromatosis

learning disability

320

dx differetiel in delayed passage of meconium(2)

hirshprung
meconium ileus

321

level of obstruction in hirsprung

rectosigmoid

322

level of obstruction in meconium ileus

ileum

323

consistency of meconium in hirsprung

normal

324

consistency of meconium in meconium ileus

inspissated

325

earliest manif of cystic fibrosis

ileus meconial

326

associated condition in cystic fibrosis

rhinosinusitis

327

clue for duodenal atresia(2)

bilious vomiting
double bubble sign

328

congenital problem associated with down

duodenal atresia

329

blood in stool of 2 yo boy

meckel

330

rule of 2's in Meckel(4)

2% prevalence
2/1 male to female ratio
2% asymptomatic at age 2
located 2 feet of ileoceacal valve

331

dx of Meckel

technetium 99 m pertechnetate scan

332

clinic of Meckel(4)

painless hematochezia
intussuception
intestinal obstruction
volvulus

333

most common congenital small intestine anomaly

meckel's diverticulum

334

cause of Meckel(2)

incomplete obliteration of vitelline duct(omphalomesenteric duct)

335

why bleeding in meckel

ectopic gastric tissue secretes HCL

336

risk factor for NEC(4)

prematurite
very low birth weight
reduced mesenteric perfusion by hypotension and congenital heart disease
enteral feeding

337

pathogenesis of NEC(2)

gut immaturity
expose to bacteria from enteral feeds

338

measure to decrease NEC

breast feeding premature infant

339

clue for NEC in abdominal xray(4)

visible air in bowel wall=pneumatosis intestinalis
portal venous air
normally you have inside the bowell
train track appearance or double line

340

complication of NEC(5)

necrosis and pneumoperitoneum
septic shock
intestinal strictures
short bowel syndrome
death

341

patient with ulcerative colitis develops diarrhea irritability and poor concentration rash resembles to sunburn on distal arms and legs dx

niacin deficiency

342

4 D in Niacin deficiency

Diarrhea
Dermatitis
Dementia
Death

343

clue for intussuception (3)

periodic abdominal pain associated with drawing the legs up the abdomen
vomiting
intestinal obstruction
currant jelly stools

344

most common cause of intestinal obstruction in kid

intussuception

345

why currant jelly stools in intussuception(2)

ichemia of bowel wall
occult bleeding

346

risk factor for intussuception

viral infection plays role in inflaming intestinal lymphatic tissue(payers patches) which can serve as a lead point for intussucetion

347

ultrasound in intussuception

target sign

348

rx of intussuception

reduction with air or water soluble enema

349

role of lead point in intussuception

75% des cas no lead point identified

350

25 % des cas cause of intussuception(2)

meckel
polyps and hematoma in case henock shonlein purpura

351

esophageal coin in asymptomatic patient

observe for 24 hours after ingestion

352

symptomatic esophageal coin or time of ingestion is unknown

prompt removal with flexible endoscopy

353

most common foreign body ngested by children

coin

354

when to suspect foreign body aspiration(3)

difficulty swallowing
feeding refusal
vomiting

355

rx of NEC(3)

supportive care
IV antibiotics
surgery

356

supportive care in NEC(2)

bowel rest
parenteral hydration /nutrition

357

importanceof abdominal xray in the setting of intestinal occlusion

to rule out pneumoperitoneum

358

next step after ruling out pneumoperitoneum in teh setting of intestinal occlusion

contrast enema to determine the level of obstruction

359

contrast enema in meconium ileus

microcolon

360

role hyperosmolar enema

can break up the inssipated meconium and remove the obstruction

361

physiopatho in cystic fibrosis(2)

delta F508 mutation responsible chlorde transport and tenacious secretions in multiple organs

362

when to perform sweat chloride testing(2)

age > 2 weeks
or
weight > 2 Kg

363

timing in breatfeeding failure jaundice

first week of life

364

timing in breast milk jaundice(2)

starts at 3-5 days
peaks at 2 weeks

365

physiopatho of breastfeeding failure jaundice(3)

lactation failure results in
decreased bilirubib elimination
increased enterohepatic circulation

366

physiopatho of breast milk jaundice

high levels of B-glucuronidase in breast milk deconjugate intestinal bilirubin and increase enterohepatic circulation

367

clinical features in breastfeeding failure(2)

suboptimal breastfeeding
signs of dehydration

368

clinical features in breastfeeding failure(2)

adequate breastfeeding
normal examination

369

normal number of wet diaper in the first week of life

should equal the infants age in days

370

sign of dehydration in infant during first week of life(3)

slightly decreased urine output
brick red urate crystals in diaper
lost of weight

371

rx of breastfeeding failure(2)

breakfast 15 mn per side every 2-3 hours
supplementation with cow's milk if the mother's milk supply is inadequate

372

squirt sign in hirshprung

positive

373

squirt sign in meconium ileus

negative

374

baby with failure to pass meconium within 48 hours in the setting of down syndrome

hirsprung

375

presentation of hirshprung(3)

poor feeding
abdominal distension
absent air in the rectum

376

associated disease with hirsprung

down

377

associated disease with meconium ileus

cystic fibrosis

378

differential dx in vomiting and regurgitation in infants(4)

physiologic GER
Milk protein allergy
GERD
pyloric stenosis

379

clue physiologic gastroesophageal reflux(2)

happy spitter
asymptomatic

380

clue milk protein allergy(3)

regurgitation
eczema
bloody stools

381

GERD in baby(3)

failure to thrive
significant irritability
sandifer syndrome

382

pyloric stenosis in baby(3)

projectile non bilious vomiting
olive shaped abdominal mass
dehydration and weight loss

383

management of physiologic GER(2)

reassurance
positionning therapy

384

management of milk protein allergy

elimination of dairy and soy protein from diet

385

management of GERD(4)

thickened feeds
antacid therapy
esophageal PH probe monitoring
upper endoscopy

386

management of pyloric stenosis(2)

abdominal US
pylomyotomy

387

why post prandial regurgitation is frequent in infant(4)

shorter esophagus
decreased angle between the stomach and the esophagus
incomplete closure of the lower esophageal sphincter
greater time spent in the suoine position

388

management of physiologic GER(2)

frequent small volume feeds
hold the infant upright 20-30 mn after feeds

389

Mild dehydration in kid(2)

3 a 5 % volume loss
minimal or no clinical symptoms

390

moderate dehydration (7)

6 -9 % volume loss
decreased skin turgor
dry mucus membranes
tachycardia
irritability
a delayed capilary refill(2-3 seconds)
decreased urine output

391

severe dehydration (10)

10-15 % volume loss
cool clammy skin
delated capillary refill> 3 seconds
cracked lips
dry mucous membrane
sunken eyes
sunken fontanelle
tachycardia
lethargy
minimal or no urine output

392

rx of moderate to severe dehydration

IV bolus of isotonic fluid

393

indication for renal and bladder US(4)

infants and children age

394

children

rx for 7-14 jours antibio
renal and bladder US for structurakl abnormality that could predispose to UTI

395

first cause of vulvovaginitis in prepubertal children

vaginal foreign bodies

396

most common vaginal foreign body in kid

toilet paper

397

removing of toilet paper in vaginal(2)

calcium alginate swab
or
irrigation with warmed fluid

398

quid of monosymptomatic enuresis

urinary incontinence occuring at least twice a week after age of 5 without any medical condition

399

first line rx of enuresis

enuresis alarm

400

second line regimen in enuresis

medication

401

first line medication used in enuresis

desmopressin

402

second line medication used in enuresis

TCA

403

most efficient long term rx of enuresis

enuresis alrm

404

inconvenient with desmopressin

high risk of relapse

405

normal age for bedwetting

before 5

406

mastery of the nightime continence in kid

can take months to years

407

gender in nightime continence

boys generally achieves this milestone later than girls

408

most common urologic problem in children

vesicoureteral reflux

409

quid of vesicoureteral reflux

retrograde flow of urine from the bladder up into the ureter and renal pelvis

410

long term complication of vesicoureteral reflux

renal scarring

411

best test to Dx vesiculo ureteral reflux

voiding cystourethrogram

412

first UTI next step

renal ultrasound

413

reccurent UTI next step

voiding cystouretrogram

414

acute pyelonephritis next step(2)

bood and urine culture
hospitalizatin and empiric therapy with IV antibiotics

415

patient with fever and rhinorrhea ,an incidental urine shows 2 + protein

transient proteiunuria

416

what to do in transient proteinuria

repeat urine dipstick testing on 2 separate occasions to rule out persistant proteinuria

417

most common cause of isolated proteinuria

transient proteinuria

418

transient proteinuria cause(5)

fever
exercice
seizure
stress
volume depletion

419

causes of secondary enuresis(5)

psychological stress
urinary tract
diabetes mellitus
diabetes insipidus
obstructive sleep apnea

420

associated symptom of secondary enuresis with psychological stress(2)

behavior regression
mood lability

421

secondary enuresis in urinary tract infection(4)

dysuria
hesitancy
urgency
abdominal pain

422

diabetes mellitus (6)

polyuria
polydipsia
polyphagia
weight loss
lethargy
candidiasis

423

diabete insipidus in secondary enuresis(2)

polyuria
polydipsia

424

assoicated symptom in obstructive sleep apnea(4)

snoring
dry mouth
fatigue hyperactivity
irritability

425

syndrome nephrotic in kid eleven YO with postive HBsag HBe ag dx

membranous glomerulonephritis

426

what marker will be positive in membranous glomerulonephritis induced by infectious viral hepatitis B

HBe ag

427

Potter sequence

urinary tract anomaly--->anuria and oligoanuria in utero------> oligohydramnios

428

three consequences of oligohydramnios in potter (3)

pulmonary hypoplasia
flat facies
limb deformities

429

prenal US showing bladder distension ,bilateral hydronephrosis and bilateral hydroureters Dx?

posterior uretral valves

430

why respiratory distress in oligoamnios

pulmonary hypoplasia

431

most common cause of secondary HTA in children

fibromuscular dysplasia

432

clue fibormuscular dysplasia(2)

hum or bruit in the costovertebral angle due to well developped collaterals
HTA

433

angiography in fibromuscular dysplasia

strings and beds pattern of renal artery

434

most common artery involved in fibromuscular dysplasia

right one

435

patient with severe pneumonia with absolute level of CD3 normal and low CD19 dx(2)

x linked agammaglobulinemia
or
bruton's agammaglobulinemia

436

rx in bruton's

regular infusion of IV immunoglobulin

437

quid of CD 3

lymphocytes T

438

quid of CD 19

Lymphocytes B

439

lymho low in bruton's

lympho B

440

indication of endotracheal intubation and mechanical ventilation in asthma(6)

asthma unresponsive to medications who have
Fatigue
altered mental status
Co2 retention
worsening hypoxemia
poor air movement on examination

441

first line rx of anaphylaxis

IV epinephrine

442

age for brutons

6-18 mois

443

physical exam in brutons

absent tonsils and other palpable lymphoid tissue

444

chest xray in infant les than 3

tonsils will be seen

445

tonsil on xray(2)

sail sign
triangular shape

446

role of thymus

production of lymphocyte and maturation

447

what to do in a patient with history of anaphylaxis

patient should carry self injectable epinephrine

448

next step in hymenoptera sting triggers

refferal to an allergist for venom immunotherapy

449

patient with neck swelling and irritability ,he keeps his head rotated slightly to the right side dx

acquired torticollis

450

next step in acquired torticollis

xray of the neck

451

most common cause of acquired torticollis(5)

upper respiratory infections
minor trauma
cervical lymphadenitis
retropharyngeal abcess
atlantoaxial subluxation

452

why neck xray in acquired torticollis(3)

to rule out cervical spine fracture
dislocation
which requires extreme caution

453

prematured infant with respiratory distress dx

hyaline membrane disease

454

risk factor for hyaline membrane disease(5)

prematurity
maternal diabetes
c section without labor
perinatal asphyxia
sexe male

455

how maternal diabetes increases the risk of respiratory distress syndrome or hyaline membrane disease(2)

delays maturation of surfactant
hyperinsulinism antagonizes the action of cortisol and the lung maturation process

456

how do you differentiate artralgia in jones criteria

if you choose arthritis in major criteria you can't choose arthralgia anymore

457

clue for lyme disease

trip in northeastern and upper midwestern united states

458

time to have early localised Lyme

days to 1 month after the bite

459

clue for early localised Lyme disease(2)

erythema migrans
myalgias and arthralgias

460

time to have early disseminated lyme

weeks to months

461

carditis in early disseminated lyme(2)

AV block
cardiomyopathy

462

neurologic problem in early disseminated lyme(3)

unilateral or bilateral cranial nerve defects
meningitis
encephalitis

463

cranial nerve most commonly involved in Lyme disease

7

464

muscular problem in early disseminated lyme

migratory arthralgias

465

skin problem in early disseminated lyme

multiple erythema migrans

466

eye problem in early disseminated lyme

conjunctivitis

467

most common finding in early disseminated Lyme

migratory arthralgia dans 60% des cas non traites

468

time for late or chronic manif of Lyme disease

months to years after the bite

469

problem in late or chronic manif of Lyme disease(3)

muscular =arthritis dans 60% des cas non traites
encephalomyelitis
peripheral neuropathy

470

adolescent male athlete with knee pain

osgood schlatter disease

471

quid of osgood schlatter disease

traction apophysitis of the tibial tubercle

472

xray finding in osgood schlatter(3)

soft tissue swelling
lifting of tubercle from the shaft
irregularity and fragmentation of the tubercle

473

rx osgood schlatter(3)

activity restriction
strectching exercice
NSAIDS

474

synovial fluid in lyme disease

average leucocyte count 25000

475

patient rx for sore throat fever difficulty swallowing ,symptom subsides rapidly with PNC.ten days later the patient presents with fever ,skin rash fleeting joint pain in lower extremities dx

serum sickness like reaction

476

quid of serum sickness like reaction

hypersensitivity reaction occurring one to 2 weeks after administration of certain drugs

477

drugs involved in serum sickness like reaction (4)

PNC
amox
TS
cefaclor

478

physiopatho of serum sickness like reaction

immune complex mediated hypersensitivity reaction to non human proteins

479

age for kawasaki

less than 5 years

480

conjunctivitis in kawasaki

spares limbus

481

oral mucosae changes in kawasaki(3)

erythema
fissure lips
strawberry tongue

482

extremity changes in kawasaki(3)

erythema
edema
desquamation of the hands and feet

483

quid of kawasaki

vasculitis

484

lab in kawasaky(4)

elevated CRP and ESR
leucocytosis with neutrophilia (viral= lymphocytosis)
reactve thrombocytosis
sterile pyuria in uninalysis

485

rx of kawasaki(2)

aspirin
plus IV immunoglobulin

486

complications of kawasaki(2)

coronary artery aneurisms
myocardial infarction and ischemia

487

consequense of coronary artery aneurism

thrombotic occlusion ---> myocardial ischemia and death

488

echocardiography in kawasaki(2)

at the time of Dx
repeat 6-8 weeks later

489

baby born at 33 semaines de gestation how will you deal with immunization

immunization should be given according to chronologic age

490

what is the rule to administer hep B vaccine

weight should be > ou egal a 2 kg

491

region with high level of hepatitis b infection(2)

asia
and
africa

492

cancer preventable by vaccination

hep B

493

congenital manif of german measles(4)

sensorineural hearing loss
cardiac anomalies
cataracts
glaucoma

494

cardiac problem in rubella(german measles)

PDA

495

children with german measles(4)

low grade fever
conjunctivitis coryza and cervical lymphadenopathy
cephalocaudal spread of blanching erythematous maculopapular rash

496

german measles in adults (5)

low grade fever
conjunctivitis coryza and cervical lymphadenopathy
cephalocaudal spread of blanching erythematous maculopapular rash
arthritis

497

prevention of german measles in baby

vaccination (live atenuated vaccine )

498

rubella in first trimester

teratogenic

499

screening test in infant 0-5 ans recommneded by the USPSTF(united preventive services task force)(3)

strabismus
amblyopia
refractive errors( bref vision screening)

500

the most common reservoir for rabies in the US(2)

racoon
bats

501

clue for encephalitis rabies(2)

hydrophobie
aerophobie

502

post exposure prophylaxis of rabies(2)

rabies immune globulin
plus
rabies vaccine

503

quid of encephalitic rabies(5)

hydrophobie
aerophobie
pharyngeal spasm
agitation spastic paralysis

504

quid of paralytic rabies

ascending flaccid paralysis

505

complication of rabies(3)

coma
respiratory failure
death within weeks

506

transmission of rabies

exposure to saliva

507

clue for acute otitis media(2)

middle ear effusion
plus
acute eardrum inflammation

508

quid of acute eardrum inflammation(2)

bulging eardrum
fever

509

clue for otitis media with effusion(2)

middle ear effusion
without
acute inflammation

510

clue for bullous myringitis

serous liquid filled blisters on the tympannic membrane

511

clue for cerumen impaction(2)

liquid or wax in auditory cana
no visualisation of eardrum

512

clue for hemotympanum

purple or red eardrum plus ou moins bulging

513

clue for otitis externa(3)

pain with tragal traction
erythematous and swollen external auditory canal
+/- otorhea

514

dx in otalgia(6)

acute otitis media
otitis media with effusion
bullous myringitis
cerumen impaction
hemotympanum
otitis externa

515

cardinal clue for otitis media(2)

bulging of the tympannic membrane
which reflects middle ear effusion

516

peak for otits media(2)

6-18 mois in daycare
around 5 when school initiation

517

next step in any children with trouble in school to understand or behavioral disorder in childhood dx

undetected hearing impairement

518

first cause of hearing impairment

conductive hearing loss due to repeated ear infection

519

when to suspect hearing inpairment(3)

poor language development
social skills
inattentiveness

520

patient with sore throat dysphagia odynophagia pharyngeal and tonsillar erythema dx(2)

viral pharyngitis
strep pharyngitis

521

when to think about strep pharyngitis(5)

presence of exsudates
edema
palatal petechiea
tender anterior cervical lymphadenopathy
absence of viral symptoms

522

when to think of viral pharyngitis

presence of viral symptoms

523

quid of viral symptoms(4)

cough
rhinorrhea
conjonctivitis
oral ulcers

524

what to do if you suspect strep paharyngitis

rapid antigen test

525

what to do if you suspect strep paharyngitis with neagtive rapid antigen test

obtain throat culture

526

left sided ear discherge resistant to antibiotics EP reveals granulation and some skin debris

cholesteatoma

527

new onset of hearing loss or chronic ear drainage despite antibiotic therapy dx

cholesteatoma

528

otoscopy in cholesteatoma(3)

granulation tissue
skin debris
retraction pockets of the tympannic membrane

529

cause of cholesteatoma(2)

congenital
ssecondary to chronic middle ear disease

530

criteria to dx attention deficit hyperactivity disorder

symptoms present before age of 12
in at least 2 settings(schoole home and other)

531

what is so improtant to make the dx of attention deficit hyperactivity disorder

teachers evaluation

532

clue for night terrors(5)

fear
crying
screaming
decreased level of consciuosness
amnesia of the event

533

when does night terror occurs

during non REM sleep

534

triggers for night terrors(4)

acute stress
sleep deprivation
illness
medication affecting central nervous system

535

peak of incidence of night terrors

2 a 12 ans

536

patient 11 yo with continuous thought of stabbing his mother dx

Obssessive compulsive disorder

537

rx of obssessive compulsive disorder (2)

CBT
plus
high dose of selective serotonin inhibitor

538

rx of obssesive compulsive disorder with no response to CBT and serotonin reuptake inhibitor(2)

clomipramine
or
increase dose of antipsychotic rx

539

severe refractory obsessive compulsive disorder

deep brain stimulation

540

which of the following behaviors should be concerning in a young children 2-5 years(extensive sexual knowledge)(5)

simulating forplay
simulating intercourse
preoccupation of masturbation
touching other genitals
excessive talk about swxuality

541

what sexual extensive knowledge can teach us in kid

possibility of sexual abuse

542

quid of constitutionnal growth delay(3)

delayed growth spurt
delayed puberty
delayed bone age

543

14 yo boy with feeling of a mass under his right nipple.Physical exam is normal dx

gynecomastia

544

physiologic cause of gynecomastia(3)

preburte
can be unilateral or bilateral
you have firnm subareolar nodules sometimes tender with the touch

545

rx of pubertal gynecomastia (2)

nothing
resolve within few months to years

546

percentage of adolescent with gynecosmatia in prepuberte

2/3

547

pathological causes of gynecomastia(2)

increased estrogen production or peripheral conversion
androgen deficiency

548

pathology with increased estrogen production or peripheral conversion causing gynecomastia(9)

testicular adrenal or HCG secreting tumors
cirrhosis
malnutrition
thyrotoxicosis
congenital excessive aromatase activity
androgen use
medications
herbal products
illicit drugs

549

medication induced gynecomastia by increasing estrogen production or peripheral conversion(2)

spironolactone
cimetidine

550

illicit drugs induced gynecomastia by increasing estrogen production or peripheral conversion(4)

alcohol
amphetamines
heroin
marijuana

551

herbal products induced gynecomastia by increasing estrogen production or peripheral conversion(2)

tea tree oil
lavender oil

552

androgen deficiency causing gynecomastia(3)

primary or secondary male hypogonadism
hyperprolactinemia
renal failure

553

cause of primary or secondary male hypogonadism(2)

klinefelter syndrome
testicular damage

554

4 yo boy comes with nausea vomiting and abdominal pain.parents found pills scattered on the kitchen floor next to an open unlabeled bottle.boys develops hematemesis abdominal xtay reveals several small opacities in teh stomach and duodenum dx

iron poisonning

555

acid base problem in iron poisonning

metabolic acidosis with anion gap

556

complication of iron poisonning within 2 days

hepatic necrosis

557

complication of iron poisonning within 2-8 weeks

pyloric stenosis

558

rx of iron poisonning(3)

whole bowel irrigation
deferoxamine
supportive care for circulation airway and breathing

559

risk for factor for lead poisonning(5)

home built before 1978 under renovation with peeling paint
Pica
sibling with lead poisonning
low socio economic status
immigrant or international adoptee

560

screening for lead poisonning

capillary blood specimens

561

confirmatory test for lead poisonning when lead level > ou egal a 5 microgram/dl

vcenous lead

562

venous lead 2-44 Micro/dl (mild)next step(2)

nothing
repeat in

563

venous lead 45-69Micro/dl(moderate) next step

use meso 2,3 dimercaptosuccinic acid(DMSA)

564

venous lead > ou egal a 70 Micro/dl(moderate) next step(2)

use meso 2,3 dimercaptosuccinic acid(DMSA)
plus
calcium dodium edetate(EDTA)

565

action of iron pills

disruption of basic cell process

566

action of deferoxamine(2)

binds ferric iron
allowing urinary excretion

567

cause of hypervolemic hypernatremia

renal losses
extrarenal looses

568

renal losses in hypervolemic hypernatremia(2)

diuretic use
glycosuria

569

extrarenal losses cause of hypovolemic hypernatremia(2)

GI upset
excessive sweating

570

rx of hypovolemic hypernatremia

nacl 0,9 %

571

cause of hypervolemic hypernatremia(2)

exogenous sodium intake
mineralocorticoid excess(hyperaldosteronism)

572

patient with vomiting caused by pyloric stenosis metabolic disturbance(5)

Hco3increased
cl decreased
K+ decreased
Paco2 increased
PH increased

573

metabolic problem in pyloric stenosis induced vomiting

hypochloremic hypokaliemic metabolic alkalosis

574

complication of supracondylar fracture in kid

compartment syndrome

575

clue for compartment syndrome

severe pain
pallor
paresthesia

576

late finding in compartment syndrome(2)

pulselessnes
paralysis