Peds 12

Question 1

Tx of cat scratch fever

Answer 1

Macrolides

Question 2

Tx of bacillary angiomatosis

Answer 2

Doxycycline or Macrolides

Question 3

Sx of Brucellosis

Answer 3

Fever, chills, anorexia, hepatosplenomegaly, osteomyolitis

Question 4

Tx of Brucellosis

Answer 4

Tetracyclines

Question 5

Tx of Tularemia

Answer 5

Aminoglycosides (streptomycin)

Question 6

Stage 1 of Lyme disease

Answer 6

• Erythema chronic migrans (Bulls eye rash)

- Fever and sweats

Question 7

Stage 2 of lyme disease

Answer 7

Heart block

Bell’s palsy

Question 8

Stage 3 of Lyme disease

Answer 8

• Joint pain - migratory polyarthritis

- Encephalopathy

Question 9

Tx of Lyme disease

Answer 9

Stage 1 = doxycycline

Later stages = ceftriaxone

Question 10

Tx of Immune thrombocytopenia

Answer 10

• Usually a self-limited disease – observe and get a peripheral blood smear to rule out other disease
• Steroids and IVIG (autoimmune treatment) – if severe bleeding

Question 11

What is CHARGE syndrome

Answer 11

• Coloboma (congenital malformation of eye), Heart defects, Atresia choanae, Retardation of growth/development, Genitourinary anomalies, Ear abnormaltiie/deafness

Question 12

What bug presents with grayish ulcerated lesions on posterior pharynx

Answer 12

Herpangina caused by Coxsackie virus

Question 13

Describe pathophys of agammagloblulinemia

Answer 13

♣ Defect in BTK gene (tyrosine kinase)
♣ No B-cell maturation
♣ Decrease in all immunoglobulin levels

Question 14

Clinical manifestations of agammaglobulinemia

Answer 14

♣ Recurrent sinopulmonary and GI infections

♣ Absence of lymphoid tissue on exam (e.g. tonsils, lymph nodes)

Question 15

Lab findings of agamma

Answer 15

♣ Decreased immunoglobulins and B cells
♣ Normal T cell concentration
♣ No response to vaccinations

Question 16

Tx of Brutons

Answer 16

aka agamma

♣ Immunoglobulin replacement therapy
♣ Prophylactic antibiotics if severe

Question 17

Contact dermatitis (poison ivy) is a Type __ HSR?

Answer 17

Type IV = T-cell mediated

Question 18

Thumb print sign on X-ray = ?

Answer 18

Epiglottitis

Question 19

Complications that can occur with slipped capital femoral epiphysis (SCFE)

Answer 19

Osteonecrosis and chondrolysis

Question 20

What is chondrolysis

Answer 20

Breakdown of the femoroacetabular joint cartilage with no clear etiology

Question 21

Management of SCFE

Answer 21

Consult ortho surgery for in situ pinning

Question 22

Describe Legg Calve Perthes disease

Answer 22

o Idiopathic avascular necrosis of the femoral head
o Typically presents as thigh or knee pain with limp in a child
o X-ray in the frog position will show joint space widening due to loss (necrosis) of the femoral head height

Question 23

Tx of Legg Calve Perthes

Answer 23

♣ Pt made non-weight bearing with immediate ortho referral
♣ Goal is to prevent further necrosis and promote bone remodeling by maintaining femoral head within the acetabulum
♣ Best accomplished by casting the affected leg in abducted and internally rotated fashion

Question 24

What are prophylaxis meds for migraines

Answer 24

Topiramate, valproic acid, beta blockers, TCAs, CCBs

Question 25

What heart disorder is associated with "snowman" appearance on X-ray

Answer 25

Total anomalous pulmonary venous return

Question 26

What bug is responsible for Otitis externa

Answer 26

Pseudomonas ("swimmers ear")

Question 27

Describe transmission of Coxiella

Answer 27

o Forms spore-like structure that comes in animal droppings (can survive GI of animals) o It gets into humans through aerosol transmission - outbreaks from farm animals to farmers or placental excretions

Question 28

Describe presentation of Q fever

Answer 28

Pneumonia, HA, fever, hepatitis

Question 29

Tx of coxiella

Answer 29

Not needed - is self- limiting

Question 30

Tx of hydrocele

Answer 30

Observation - most are self-resolving

Question 31

How can constipation lead to recurrent UTI

Answer 31

Fecal retention can cause rectal distension, which in turn compresses the bladder and prevents compelete voiding. Residual urine is a potential breeding ground for bacteria that ascend to the urethra from the perineum

Question 32

What leads to hemophilic arthropathy (joint pain and swelling) in pts with hemophilia

Answer 32

Caused by iron/hemosiderin deposition leading to synovitis and fibrosis within the joint

Question 33

Sx of Lupus

Answer 33

- R = rash - A = arthalgias - S = Serositis (pleuritis or pericarditis) - H = Hematologic disorders - O = oral/nasopharyngeal ulcers - R = Renal disease - P = photosensitivity - A = antinuclear antibody - I = immunologic disease (anti-dsDNA, anti-Smith, anti-histone, anti-phospholipid) - N = neruologic (seizures, psychosis)

Question 34

What strep infection can lead to RF vs PSGN

Answer 34

PSGN can follow pharyngitis or skin lesions RF only follows pharyngitis

Question 35

Abx for pharyngitis can prevent RF or PSGN?

Answer 35

Can prevent RF

Question 36

What is the most important laboratory test for post-strep glomerulonephritis

Answer 36

Serum C3 and C4 levels C3 will be low and C4 will be normal

Question 37

Txt of PSGN

Answer 37

Supportive: - Fluid balance (diuretics, fluid restriction) - Restriction of Na and K - CCBs to control HTN

Question 38

Describe levels of C3 and C4 in Lupus

Answer 38

Low C3 and low C4 | vs PSGN which will have low C3 and normal C4

Question 39

How do you diagnose celiac disease?

Answer 39

Duodenal biopsy

Question 40

Lab test used to diagnose rhabdomyolysis

Answer 40

Elevated CK levels

Question 41

Complications of rhabdomyolysis

Answer 41

cardiac arrhythmias secondary to hyperkalemia, AKI, compartment syndrome, DIC

Question 42

Tx of rhabdomyolysis

Answer 42

Aggressive rehydration and correction of electrolyte abnormalities

Question 43

What is Spondylolisthesis and how does it present

Answer 43

o Developmental disorder characterized by a forward slip of vertebrae (usually L5 over S1) that usually manifests in preadolescent children o Often presents with back pain, neurologic dysfunction (e.g. urinary incontinence), and a palpable “step off” at the lumbosacral area

Question 44

What substance is responsible for effects of refeeding syndrome

Answer 44

insulin

Question 45

What is the primary deficient electrolyte in refeeding syndrome

Answer 45

Phosphorus (required for energy via ATP)

Question 46

Describe language of a 9 month old

Answer 46

Says "dada" "mama"

Question 47

Tx of HUS

Answer 47

• Supportive (e.g. fluid/electrolyte management), blood transfusions, dialysis

Question 48

What is a cholesteatoma

Answer 48

o Abnormal skin growth that can develop in middle ear (behind TM) o Can be congenital or acquired secondary to chronic otitis media o Complications include hearing loss, cranial nerve palsies, vertigo, and potentially life-threatening infections (e.g. brain abscess, meningitis)

Question 49

Tx of laryngomalacia

Answer 49

• Management = reassurance in most cases; supraglottoplasty in severe cases