Peds

Question 1

What is Respiratory Syncytial Virus?

Answer 1

Under 2 years of age + wheezing = bronchiolitis (Inflammation of the bronchioles)
Increase in mucus production and the sloughing of airway epithelial cells from the viral illness–> wheezing
Tx: none (supportive)

Question 2

When should circumcision be delayed?

Answer 2

Epispadias (epi, on top of) or hypospadias (hypo, below)

leave the foreskin on for reconstruction at a later date

Question 3

Kid with strep gets hives on penicillin… What do you do?

Answer 3

Discontinue penicillin, start cephalexin, and start 2nd gen H1 antagonist (cetirizine)

Question 4

Baby with diarrhea due to milk products.. Next step?

Answer 4

Milk-soy protein often presents with failure to thrive and hematochezia. Switch to hydrolyzed formula to solve the problem.
There is only one true indication for soy formula - galactosemia

Question 5

What is Tetralogy of Fallot?

Answer 5

Cyanotic Heart + Diagnosis not at birth (the baby lived) = Tetralogy

Question 6

What is the treatment for otitis media?

Answer 6

Tugging on the ear without producing pain in the setting of febrile ear pain sounds like otitis media
Bulging tympanic membrane with pneumatic insufflation being positive
Tx: Oral amoxicillin

Question 7

Epidural hematome facts

Answer 7

unconscious–>Lucid period before becoming unconscious
Injury to the middle meningeal artery from skull trauma causes bleeding between the dura and the skull.
Lens-shaped () hematoma (biconvex shape)

Question 8

C5-C9 complement deficiency?

Answer 8

If a kid has infections with Neisseria they prob have terminal complement deficiency (C5-C9)

Question 9

What is intestinal atresia?

Answer 9

intrauterine vascular accident (maternal cociane use, cold meds)

Projectile vomiting of bilious contents in newborn

Multiple air-fluid levels on xray

Question 10

Child with fever and UTI… Next step?

Answer 10

First febrile UTI–> renal ultrasound

2nd febrile UTI or abnormal ultrasound–> VCUG to look for vesiculoureteral reflux (reflux of urine from bladder up into the ureters (and sometimes kidneys)

Question 11

Teen confidentiality laws

Answer 11

Confidentiality is conditional and should only be broken if there is concern for abuse, suicidal ideations, homicidal ideations, or any behaviors that would put the life of the patient or others in jeopardy.

Question 12

Testing for Tb in kids

Answer 12

When evaluating for tuberculosis, use the tuberculin skin testing (TST) in patients under 5 years of age. The interferon gamma release assay (IGRA) can be used in those 5 years of age or older.

Question 13

How is coarctation of the aorta diagnosed?

Answer 13

Coarctation of the aorta has a variable clinical presentation but should be considered whenever there is a difference in perfusion or blood pressure between upper and lower extremities. Echocardiogram is the next (and often times only) test you will need.

Question 14

Foreign body aspiration?

Answer 14

With acute onset dyspnea and an unsupervised child, you should think of foreign body aspiration. Suspect upper airway if stridor and lower airway if wheezing. Plain films can be diagnostic. Bronchoscopy will be therapeutic (and can be diagnostic as well).

Question 15

Treatment for Lyme disease

Answer 15

Use Doxycycline to treat Lyme disease in adults and in children 8 years of age and up

<8 use amoxicillin

Ceftriaxone is used to treat Lyme disease that has disseminated. you would expect to see Bell’s palsy, heart block, or Lyme meningitis

Question 16

Treatment for infantile spasms (west Syndrome)?

Answer 16

West syndrome (infantile spasms) should be treated with cosyntropin (ACTH). Look for hypsarrhythmia on EEG.

Question 17

2 year old boy with GI bleeding?

Answer 17

Painless bleeding in a patient who meets the rule of 2s should be evaluated for Meckel’s diverticulum via a technetium-99m scan.

Question 18

How will xrays for duodenal atresia and annular pancreas present?

Answer 18

Double bubble sign (gas in stomach and duodenum) and no gas pattern beyond

Both cause a bowel obstruction at the level of the duodenum

Both associated Down syndrome

Question 19

How will xray for malrotation present?

Answer 19

Double-bubble WITH distal air is indicative of malrotation.

Question 20

What is breast milk jaundice?

Answer 20

Breast milk jaundice is a “quality” issue with breast milk. Enzymes in the milk result in decreased conjugation of enteral contents and result in unconjugated hyperbilirubinemia.

Question 21

What is VACTERL syndrome?

Answer 21

VACTERL stands for (V)ertebral anomalies, (A)nal atresia, (C)ardiac defects, (T)racheoesophageal fistula, (E)sophageal fistula, (R)enal anomalies, and (L)imb defects

At least 3 of them need to be present for diagnosis

Question 22

what is the treatment for imperforate anus?

Answer 22

Imperforate anus can either be directly reanastomsed or require a colostomy depending if the lesion is “low” or “high”, respectively. However, evaluate for VACTERL before any surgical intervention is done so that a full understanding of the infant’s anatomy is obtained.

Question 23

How is osteosarcoma diagnosed?

Answer 23

Bone destruction (alkaline phosphatase and LDH are elevated)
Mass with a sunburst pattern on x-ray that is proximal
Bone cancer + child + proximal long bone = Osteosarcoma

Question 24

How is Ewing sarcoma diagnosed?

Answer 24

Fever, leukocytosis, anemia, and an elevated ESR
Onion-skinning with a lytic appearance plus periosteal elevation
Ewing sarcoma is bone cancer + shaft + in a child

Question 25

What is leukocyte adhesion deficiency?

Answer 25

Large leukocytosis Recurrent abscesses with non-purulent drainage Positive nitro blue test (oxidative burst) Delayed umbilical cord separation. LAD = leukocytes can burst but cannot get where they need to go

Question 26

What is chronic granulomatous disease?

Answer 26

Large leukocytosis Recurrent abscesses with Purulent drainage Negative nitro blue test (no oxidative burst) CGD = leukocytes can get where they need to go but cannot burst

Question 27

What are some conditions associated with Tuberous sclerosis?

Answer 27

``` Ash- leaf lesion sebaceous adenoma angiofibromas of the face mental retardation (usually mild) seizure ```

Question 28

What is the effect of sickle cell on the spleen?

Answer 28

Since the spleen auto-infarcts by age 5, red blood cells that are prematurely released do not have the nucleated component removed (which is done by the spleen). This leads to Howell-Jolly bodies on a peripheral smear. Look for sickled cells and howell jolly bodies

Question 29

what is an example of a holosystolic murmur?

Answer 29

Mitral regurgitation and ventricular septal defect are the only two possible diagnoses. Kids- VSD Adults- MR

Question 30

What is peritonsillar abscess?

Answer 30

Tonsillar shift in the setting of a febrile illness Incision, drainage, and antibiotics that cover Group A Strep, anaerobes, and Staph aureus are sufficient. There is a normal x-ray

Question 31

What is epiglottitis?

Answer 31

Thumb print sign (swollen epi) | tripoding child who is unvaccinated and toxic

Question 32

What is the treatment for intussusception?

Answer 32

Can be diagnosed with an abdominal ultrasound Air enema (both diagnostic and therapeutic) is the preferred treatment of intussusception when the bowel isn’t dead Intussusception can progress and lead to ischemic bowel. Surgical intervention is needed.

Question 33

What is low implantation of ureter?

Answer 33

One of the ureters has implanted (likely) in the proximal urethra which can cause continuous leakage as the sphincter is bypassed. Urine generated by the kidney goes straight to the urethra and out the door. The fact that she has the urge to void and can void on her own control at times shows the other ureter is properly implanted.

Question 34

When should someone with concussion be sent to ER?

Answer 34

A GCS <15 focal neurological deficits loss of consciousness >30-60 seconds progressively worsening symptoms should prompt brain imaging CT preferred over MRI

Question 35

What is Mongolian Spot/congenital dermal melanocytosis?

Answer 35

Mongolian spots are commonly mistaken as ecchymosis, raising concern for abuse and hemophilia. If present at birth, they are not ecchymosis. blue spots on buttocks

Question 36

What is an absolute contraindication to DTap?

Answer 36

Absolute contraindications to future DTaP administrations include anaphylaxis and encephalopathy after receiving previous dose.

Question 37

What is apnea of prematurity?

Answer 37

Apnea of prematurity is typically seen in neonates < 35 weeks. Diagnose with apnea episodes greater than 20 seconds (drop in O2 sats and heart rate). Treat with caffeine (and additional respiratory support if needed).

Question 38

Transposition of the Great Arteries

Answer 38

diagnosed at birth. If not, baby dies as the ductus closes. “Endomethacin Ends the ductus (Indomethacin is an NSAID) and so prostaglandins prolong the ductus and are required to support life. Mom will have a history of diabetes (NOT gestational diabetes) when becoming pregnant.

Question 39

Treatment for acute chest syndrome?

Answer 39

1) treat any underlying infection 2) achieve adequate hemoglobin levels 3) maintain adequate oxygenation 4) aggressively treat pain try regular transfusion, if no improvement then do exchange transfusion

Question 40

Treatment for gonococcal conjunctivitis?

Answer 40

``` ceftriaxone IM/IV Topical therapies (silver nitrate) are for prophylaxis only. ```

Question 41

A newborn baby is being evaluated at 24 hours for the absence of urinary output. Next step?

Answer 41

Newborns should have urine output within the first 24 hours of life. Posterior urethral valves is a common cause of obstructive uropathy in newborn males. Relieve obstruction with urinary catheterization (which will also give you diagnosis). Will see Mild degree of oligohydramnios in a male w/ posterior valves Can also do renal ultrasound but this ^ kills 2 birds with 1 stone

Question 42

What is Osgood-Schlatter disease?

Answer 42

Osgood-Schlatter disease is apophysitis (inflammation/nodule) of the tibial tubercle. There is tenderness and swelling over the tibial tubercle. Conservative management (NSAID and rest) is the mainstay of therapy.

Question 43

How will xray for Osgood-Schlatter disease look?

Answer 43

X-rays show irregularities and a haziness over the metaphyseal border of the proximal tibia.

Question 44

What is reye syndrome?

Answer 44

In the setting of a viral illness, aspirin use in children and adolescents can precipitate Reye syndrome (hepatic encephalopathy) Check with ammonia and BUN

Question 45

What is the treatment for retinopathy of prematurity?

Answer 45

Abnormal blood vessel development | Laser photocoagulation treatment of the affected eye(s)

Question 46

Treatment for strabismus?

Answer 46

Alternate eye patching

Question 47

Treatment for acute otitis media?

Answer 47

In children 2 years and older without severe symptoms, antibiotics (oral amoxicillin) or observation Tugging at ear relieves pain

Question 48

What is treatment for otitis externa?

Answer 48

Ciprofloxacin drops or steroid drops Tugging on otitis externa is painful

Question 49

How should transient proteinuria after viral illness be treated/ followed up?

Answer 49

Transient proteinuria can be caused by a febrile illness. | It should be followed-up (dipstick) to ensure there is no other underlying process.

Question 50

Who should receive tetanus immunoglobulins?

Answer 50

For patients who have received at least 3 lifetime doses, no tetanus immunoglobulin is needed

Question 51

Whoo should receive tetanus booster?

Answer 51

Tetanus booster is needed for 1) clean wounds with 10 or more years since booster and 2) dirty wounds with 5 or more years since booster.

Question 52

For a patient who has not received at least 3 lifetime doses to Tetanus vaccine, how should wound be treated?

Answer 52

clean wounds receive tetanus vaccine only Dirty wounds receive both vaccine and tetanus immunoglobulin.

Question 53

Kid has transposition of great arteries, what should be done immediately?

Answer 53

Prostaglandins Prolong the ductus, Endomethacin (Indomethacin) ends the ductus. use prostaglandin infusion to keep the PDA open and prevent death

Question 54

What are the congenital cyanotic diseases?

Answer 54

``` Truncus Arteriosus Tricuspid Atresia Total Anomalous Pulmonary Venous Return Tetralogy of Fallot (can survive past the neonatal period undiagnosed) Transposition of the Great Vessels ```

Question 55

What is choanal atresia?

Answer 55

failed recanalization of the nasal fossae Cyanosis during feedings, pinking up when crying 1st step in diagnosis: Pass a flexible catheter through the nose

Question 56

What is esophageal atresia?

Answer 56

Esophagus doesn't develop properly Feeds are regurgitated Secretions are aerated or aspirated into the lungs, thus the gurgling and bubbling between feeds Confirm diagnosis with NG tube and see (with xray) that it coils in the esophagus (or even goes into the lung) rather than into the stomach

Question 57

How can sepsis be prevented in a patient with sickle cell disease?

Answer 57

There is a higher risk of infection with encapsulated organisms in the setting of sickle cell disease. Penicillin prophylaxis can be used up to the age of 5 years but ultimately immunization (conjugate CAPSULAR polysaccharide (Strep pneumo vaccine)) is the best prevention of severe pneumococcal infections (which can be fatal).

Question 58

What is croup and treatment for it?

Answer 58

Caused mainly by Parainfluenzae Inspiratory stridor and a seal-like cough Racemic epinephrine and dexamethasone are your first line therapies.

Question 59

Meningitis in infant?

Answer 59

Lethargy, fever, irritability, nausea and vomiting, rigid muscles In a pediatric patient with meningitis who has contraindication to lumbar puncture (i.e has increased ICP/ bulging fontanelles), obtain blood cultures then administer antibiotics then get a CT scan of the head ( needed due to increased intracranial pressures).

Question 60

Treatment for hypoglycemic baby?

Answer 60

Ideal glucose levels in a neonate should be at least 40 mg/dL You can allow the infant to feed but since this is symptomatic hypoglycemia (jittery, agitated, obtunded, seizing) he needs the good stuff via IV. IV administration of D10 bolus is the correct answer. A continuous dextrose infusion may be needed if hypoglycemia persists, but not yet.

Question 61

Treatment of Kawasaki disease

Answer 61

Kawasaki’s Disease may be complicated by the development of coronary artery aneurysm. Intravenous immunoglobulin and aspirin significant reduce the incidence of coronary artery aneurysm formation and improve overall morbidity and mortality.

Question 62

WAGR syndrome

Answer 62

Loss of part of the short arm of chromosome 11 that contains the Wilms tumor gene (causes GU abnormalities and increasing the likelihood of Wilms tumor) and PAX6 (causes aniridia and is one possible cause of mental retardation). Wilms tumor, Aniridia, GU abnormalities, and mental Retardation.

Question 63

Scoliosis treatment

Answer 63

20º or less- home exercises, OMT 20º- 45º- Spinal bracing > 45°- Surgical correction

Question 64

Pregnant female with HIV

Answer 64

If viral load less than 1000 then normal delivery can occur V or C If viral load >1000 than scheduled C section at 38 weeks with 3 hours of zidovidune before delivery

Question 65

staph infection treatment

Answer 65

Cephalexin is the most appropriate choice of antibiotics for methicillin-SENSITIVE Staphylococcus aureus infections.

Question 66

Henoch-Schonlein purpura

Answer 66

Henoch-Schonlein purpura is a vasculitis caused by IgA and C3 deposition in the small vessels. It primarily affects children and is classically characterized by palpable purpura, abdominal pain, joint pain, and hematuria.

Question 67

Cephalohematoma

Answer 67

Birth trauma injury that consists of bleeding under the periosteum and is limited by the suture lines

Question 68

caput succedaneum and subgaleal hemorrhage

Answer 68

likely to cross suture lines

Question 69

Developmental dysplasia of the hip (DDH)

Answer 69

Abnormal development or dislocation of the hip due to capsular laxity and improper uterine packing. asymmetric gluteal (and/or thigh) folds, a positive Galeazzi sign (apparently shortened femur when comparing knee heights)

Question 70

Diagnosis of Developmental dysplasia of the hip (DDH)

Answer 70

Ultrasonography is the first-line imaging modality for the diagnosis of DDH in patients age 4-6 months. After age 6 months, plain radiographs of the hips consisting of AP (anteroposterior) and frog-leg views are used for evaluation of DDH.

Question 71

Duchenne muscular dystrophy

Answer 71

Caused by a mutation in the dystrophin protein Muscle breakdown with normal muscle usage (Gower sign) Dx: Serum creatine kinase can be used to rule out muscular dystrophy because all patients with the disease have muscle breakdown that liberates creatine kinase into the bloodstream

Question 72

When foaming at the mouth is mentioned in a baby less than 24 hours of age, think

Answer 72

Esophageal atresia Other feeding difficulties can be noted with esophageal atresia, including gagging, coughing, and frank aspiration. Emesis should never be bilious.

Question 73

patients with a tracheoesophageal fistula should have a

Answer 73

Renal ultrasound, echocardiogram, and x-ray of the spine, to evaluate for associated anomalies (VACTERL)

Question 74

Treatment for Acute epiglottitis

Answer 74

Vancomycin and ceftriaxone

Question 75

Causes of acute epiglottitis

Answer 75

Haemophilus influenzae type B (HIB) Fever, sore throat, stridor (audible inspiratory sound), muffled voice, and difficulty breathing that worsens when lying supine Tripoding”, and drooling

Question 76

Most appropriate diagnostic test for duodenal atresia?

Answer 76

Abdominal Xray Double bubble sign Bilious emesis and gastric distension in the first 24 hours of life 1/3 infants with duodenal atresia have Trisomy 21 (Down's)

Question 77

Diagnosis of intussusception

Answer 77

Barium enema can diagnose and treat intussusception Sausage-shaped abdominal mass "target sign" on Abdominal ultrasound

Question 78

Diagnosis of Hirschsprung disease

Answer 78

Failure to pass meconium, generally after 24 hours of life Abdominal distension and nonbilious emesis Rectal biopsy revealing a lack of ganglionic cells in the submucosa

Question 79

Bacterial meningitis in neonates

Answer 79

In newborns, meningitis is most commonly caused by Group B Streptococci, Escherichia coli, and Listeria monocytogenes. The combination of ampicillin and an aminoglycoside (gentamicin) provides coverage against these bacteria.

Question 80

Laryngotracheobronchitis (croup)

Answer 80

High-pitched whooping sound (characteristic barking cough) inspiratory stridor

Question 81

Croup vs Epiglottitis

Answer 81

Croup- no position preference. Onset is slow with 1-7 day prodrome of URI Epiglottitis- Extended neck, tripod position. Onset is acute within 4-12 hrs

Question 82

Otitis externa

Answer 82

Pain with traction of the tragus If not responding to initial empiric therapy would warrant further investigation with ear culture.

Question 83

X-linked agammaglobulinemia

Answer 83

Deficiency of humoral immunity caused by a mutation in the Bruton's tyrosine kinase Without the activity of this Bruton's tyrosine kinase, B cells do not mature properly. This leads to the low production of IgG and low numbers of mature B cells. leads to infections with encapsulated organisms (strep pneumo, H flu, N menin) Tx: antibiotic prophylaxis and IVIG.

Question 84

Chediak-Higashi syndrome

Answer 84

Microtubular dysfunction ocular albinism and neutropenia

Question 85

ADHD treatment

Answer 85

1st- amphetamine and methylphenidate compounds 2nd- Atomoxetine, Bupropion Alpha-2 agonists (guanfacine and clonidine)

Question 86

Treatment for painful diabetic neuropathy

Answer 86

Pregabalin or gabapentin Amitriptyline, venlafaxine, and duloxetine

Question 87

Most common area for berry aneurysm

Answer 87

anterior circulation of the circle of Willis. The most common sites include the branch point of the anterior communicating artery with the anterior cerebral artery, the junction of the posterior communicating artery and the internal carotid artery, and the bifurcation of the middle cerebral artery.

Question 88

Beckwith-Wiedemann syndrome

Answer 88

Presents with hemihypertrophy Asscoiated with omphalocele, macroglossia, polyhydramnios