Peds

Question 1

What can occur in peds patients who are malnourished and receiving increased nutrition?

Answer 1

Refeeding syndrome (severe shifts in electrolytes & fluid)
Potentially fatal

Question 2

What is the goal weight for obesity in children?

Answer 2

< 85% BMI for the pts age

Question 3

What is the difference between anorexia nervosa and bulimia nervosa?

Answer 3

Anorexia: restricted eating due to fear of weight gain and/or body image disturbance
Bulimia: recurrent episodes of binge eating with a sense of lack of control/guilt which may include recurrent episodes of purging

Question 4

What BMI is common to see in pts with anorexia nervosa?

Answer 4

< 18%

Question 5

What are the 2 subtypes of ADHD?

Answer 5

Inattentive
Hyperactive

Question 6

For a diagnosis of ADHD, where should symptoms be present?

Answer 6

In multiple settings

Question 7

What is the treatment for ADHD?

Answer 7

Stimulants (amphetamines, methylphenidates)
SNRI (atomoxetine), NDRI (wellbutrin), TCA (amitriptyline)
Alpha-agonists (clonidine, guanfacine)

Question 8

What are contraindications to children playing sports?

Answer 8

Active myocarditis or pericarditis
Acute enlargement of spleen or liver
Recent concussion & symptoms of postconcussion syndrome
Hypertrophic cardiomyopathy
Long QT syndrome
Athletes w/bleeding disorders should not do contact/collision sports

Question 9

Which autosomal trisomies are not compatible with long-term survival?

Answer 9

Trisomy 13 (patau syndrome) (3rd most common)
Trisomy 18 (Edward syndrome) (2nd most common)

Question 10

What are the signs/symptoms of trisomy 13?

Answer 10

Microcephaly
Anophthalmia/microphthalmia
Abnormally shaped/low-set ears
Rocker bottom feet
Weak muscle tone at birth

Question 11

What are the signs/symptoms of trisomy 18?

Answer 11

Pinched face appearance
Clenched fists w/overlapping fingers
Club/rocker bottom feet

Question 12

What is the most common autosomal trisomy?

Answer 12

Trisomy 21 (down syndrome)

Question 13

What are the signs/symptoms of trisomy 21?

Answer 13

Flat facies
Brushfield spots in iris
Prominent epicanthic folds
Flat occiput
Simian crease

Question 14

What is the average life expectancy of a person born with trisomy 21?

Answer 14

60 yo

Question 15

What disorder is characterized by males being born with 2 or more X chromosomes?

Answer 15

Klinefelter syndrome

Question 16

What are the signs/symptoms of Klinefelter syndrome?

Answer 16

Increased height
Long extremities
Gynecomastia
Delayed/incomplete puberty
Speech/language delays

Question 17

What treatment is required for life starting in adolescence in pts with Klinefelter’s?

Answer 17

Testosterone

Question 18

What disorder is characterized by females born with 3 X chromosomes?

Answer 18

Triple X syndrome

Question 19

What are the signs/symptoms of triple X syndrome?

Answer 19

Increased height
Weak muscle tone
Kidney abnormalities
Increased of menstrual irregularity/infertility

Question 20

What disorder is characterized by males born with 2 Y chromosomes and 1 X chromosome?

Answer 20

XYY syndrome

Question 21

What are the signs/symptoms of XYY syndrome?

Answer 21

Increased height
Dental abnormalities
Scoliosis
Hand tremors

Question 22

What used to be thought about people with XYY syndrome but has been disproven?

Answer 22

That they are aggressive/violent

Question 23

What is the most diagnosed inherited cause of intellectual disability in males that is caused by a genetic abnormality of an X chromosome?

Answer 23

Fragile X syndrome

Question 24

What are the signs/symptoms of fragile X syndrome?

Answer 24

Physical/intellectual/behavioral problems
Large protruding ears
Prominent chin/forehead
Large testes
Hyperflexible joints

Question 25

What is the most common sex chromosomal abnormality in females who are born with 1 of 2 X chromosomes partially or completely missing?

Answer 25

Turner syndrome

Question 26

What are the signs/symptoms of Turner syndrome?

Answer 26

Short stature Webbed neck Low posterior hairline Shield chest Amenorrhea Absence of puberty

Question 27

What IQ score is indicative of an intellectual disability?

Answer 27

< or = 70

Question 28

What medications are commonly used in pts with intellectual disabilities?

Answer 28

Aggression/impulse control: anticonvulsants or lithium Anxiety/self-injurious behaviors: clomipramine, SSRIs, buspirone, naltrexone

Question 29

What are the signs/symptoms of Prader-Wili syndrome?

Answer 29

Obesity Decreased muscle tone Decreased mental capacity Sex glands produce little or no hormones

Question 30

What disorder is characterized by excess copper being deposited into the body tissues?

Answer 30

Wilson's disease

Question 31

What are the signs/symptoms of fetal alcohol syndrome?

Answer 31

Low IQ ADHD Faces w/broad set eyes Narrow eye slits Flat cheeks Thin upper lip Growth retardation

Question 32

What are the signs/symptoms of Autism spectrum disorder?

Answer 32

Sensory sensitivity Limited eye contact Repeat/echo words Difficulty w/schedule changes Fixate on objects or sounds Difficulty interacting Repetitive behaviors

Question 33

What is avoidant/restrictive food intake disorder (ARFID)?

Answer 33

Eating/feeding disturbance based on sensory characteristics w/failure to meet appropriate nutritional needs

Question 34

What is the FDA medication and off label medication used to treat ARFID?

Answer 34

No FDA approved treatment Periactin (cyproheptadine) off label

Question 35

What medication can be used when conservative management fails for enuresis?

Answer 35

Desmopressin

Question 36

What disorder is characterized by severe, recurrent temper outbursts, irritability/anger most of the day nearly every day?

Answer 36

Disruptive mood dysregulation disorder (DMDD)

Question 37

At what age do you provide pharm treatment for depression in pediatrics?

Answer 37

Fluoxetine (prozac) at age 8 Sertraline (Zoloft) or Escitalopram (Lexapro) at age 12

Question 38

What are the signs/symptoms of oppositional defiant disorder (ODD)?

Answer 38

Loses temper Easily annoyed Angry/resentful Argues with adults Actively defies rules Deliberately annoys others Blames others Spiteful

Question 39

What is a precursor to antisocial personality disorder?

Answer 39

Conduct disorder

Question 40

What are the signs/symptoms of tetralogy of fallot?

Answer 40

Hypercyanotic episodes ("tet spells") SOB Restlessness Gasping Syncope

Question 41

What are the 4 ways tetralogy of fallot can occur?

Answer 41

Overriding aorta R ventricle hypertrophy Ventricular septal defect R ventricle outflow tract obstruction

Question 42

What will you see on a CXR in a pt with tetralogy of fallot?

Answer 42

Boot sign

Question 43

What disorder has an egg on a string appearance on CXR?

Answer 43

Transposition of great vessels

Question 44

What disorder is due to a single artery arising from the heart that supplies both the aorta and the pulmonary artery?

Answer 44

Truncus arteriosus

Question 45

What disorder is due to the failure of the tricuspid valve to develop which leaves no connection between the right atrium and right ventricle?

Answer 45

Tricuspid atresia

Question 46

What is the mainstay treatment for cyanotic heart lesions?

Answer 46

Oxygen and prostaglandins

Question 47

Which cyanotic heart condition is most common overall, and which most commonly requires hospitalization in the first 2 weeks of life?

Answer 47

Overall: tetralogy of fallot Hospitalization: transposition of great vessels

Question 48

What is the most common acyanotic congenital heart lesion?

Answer 48

Ventricular septal defect

Question 49

What are the different types of innocent heart mumurs?

Answer 49

Still's (vibratory) (most common) Venous hum Pulmonary ejection murmur Carotid bruit Peripheral pulmonary stenosis (most common in 1st year of life but resolves)

Question 50

Are innocent murmurs systolic or diastolic?

Answer 50

Systolic They are NEVER diastolic