Peds General

Question 1

Higher functioning adolescents with autism are at increased risk for: a. Significant phobias b. Panic attacks c. Substance abuse d; Obsessive Compulsive disorder

Answer 1

Obsessive Compulsive disorder

Question 1

Treatment for AOM Antibiotic treatment after 48 - 72 hr of failure of initial antibiotic treatment and with PCN allergy

Answer 1

second Line treatment Amoxicillin-Clavulanate (Augmentin)—90 mg/kg/day of amoxicillin and 6.4 mg/kg of clavulanate in 2 divided doses OR Third line treatment Ceftriaxone—50 mg/kg 2 doses IM or IV/day for 3 days IF PCN ALLERGY (RASH NOT ANAPHYLAXIS) Use Ceftriaxone—50 mg/kg 2 doses IM or IV/day for 3 days OR Clindamycin (30 -40 mg/kg/d in 3 divided doses with or without a 3rd generation cephalosporin Consider tympanocentesis, referral to specialist.

Question 1

The most appropriate management of a 5-year-old with a firm, nontender nodule in the mid-upper eyelid for 3 weeks would be: a. Coolcompresses b. Topical ophthalmic ointment c. Oralantibiotics d. Oralsteroids

Answer 1

b. Topical ophthalmic ointment

Question 1

15. Prematurity increases the risk of developing which one of the following? a. Nystagmus b. Astigmatism c. Myopia d. Glaucoma

Answer 1

c. Myopia

Question 1

24. A 15-month-old failed treatment with amoxicillin for an otitis media. At his 2-week recheck, his TM remained red with distorted landmarks and he persisted with nasal congestion, poor nighttime sleeping, and with a 101°F fever for the past 2 days. The next best step would be to treat with: a. A 10-day course of Augmentin b. A 3-week course of a cephalosporin c. A higher dose Amoxicillin and topical antibiotics d. Ceftriaxone and an antihistamine

Answer 1

a. A 10-day course of Augmentin

Question 1

What is pyloric stenosis

Answer 1

Question 2

Never use SSRI with what herb?

Answer 2

St. John’s Wart

Question 2

Diagnosis of AOM in children

Answer 2

Inflammation of the middle ear with fluid in the middle ear space (suppurative otitis media); the 2013 American Academy of Pediatrics specify 3 criteria that must be present: 1. moderate or severe bulging of TM with otalgia (pain) OR new onset of otorrhea (drainage) not related to external OE with otalgia OR 2. Mild bulging of TM and recent (

Question 3

16. Fluorescein staining of the eye is used to detect a: a. Keratitis b. Foreignbody c. Corneal abrasion d. Hyphema

Answer 3

c. Corneal abrasion

Question 4

14. A 3-month-old has a mild asymmetrical corneal light reflex on physical exam. What is the next appropriate step? a. Observe and reevaluate at the next well check b. Refer immediately to ophthalmology c. Begin atropine drops or eye patching d. Protect eyes from sunlight

Answer 4

a. Observe and reevaluate at the next well check

Question 5

21. A 10-year-old has marked ear pain, not wanting anyone to touch his ear. The canal is edematous and exudate is present. TM is normal. How should this be managed? a. Topical fluoroquinolone b. Oral steroids and topical neomycin c. Oral amoxicillin and topical anesthetic d. Oral amoxicillin and topical steroid

Answer 5

a. Topical fluoroquinolone

Question 6

13. All but which one of the following assessments is used to determine the presence of a strabismus? a. Hirschberg test b. Cover-uncover test c. Extraocular movements d. Pupillary response

Answer 6

d. Pupillary response

Question 7

45. Conductive hearing loss can be caused by: a. Braintumor b. Ototoxic drug exposure c. Loudnoises d. Serous otitis

Answer 7

d. Serous otitis

Answer 8

b. Hearing loss Hearing loss is the most common complication of otitis media. Children who have multiple infections should have their hearing assessed. Tonsils are normally large in young children. Shotty lymph nodes are usually associ- ated with past infections and are not clinically significant.

Question 9

What are the side effects of stimulants in ADHD? (mnemonic)

Answer 9

TASHI Tics (tourettes syndrome) Anorexia Suicide Headaches Insomnia

Question 9

A conjunctivitis appearing in a 2-day-old newborn is likely due to: a. Chemical irritation from eye drops b. Group B streptococcus c. Chlamydia d. Gonorrhea

Answer 9

a. Chemical irritation from eye drops

Question 11

23. All but which one of the following patients are at an increased risk of developing otitis media? a. 2-year-old with cleft palate repair at 1 year of age b. 15-month-old with Down syndrome c. 9-month-old with lactose intolerance d. 3-year-old with IgA immune deficiency

Answer 11

d. 3-year-old with IgA immune deficiency

Question 12

What is severe illness in AOM? choose all that apply a. mild otalgia for 48 hrs e. Fever more or equal than 39 C (102.2 F)

Answer 12

c. moderate to severe otalgia OR d. otalgia for > 48 hrs OR e. Fever more or equal than 39 C (102.2 F)

Question 13

22. Patients with otitis externa should be instructed to do which one of the following? a. Keep ear dry until symptoms improve b. Limit swimming for remainder of summer c. Wear ear plugs at all times with swimming d. Use alcohol drops before swimming each day

Answer 13

a. Keep ear dry until symptoms improve

Question 14

What pharmacological treatments are used for ADHD

Answer 14

Stimulants Amphetamines: (Adderall, Vyvanse) Non-stimulants Atomoxetine (straterra) Antihypertensives: Propanalol and clonidine

Question 15

What is at -risk children with OME?

Answer 15

Persistent effusion accompanied by language delay and or suspected or documented hearing loss.

Question 16

What are the 3 main organisms for Otitis Media?

Answer 16

S. pneumonia (Treatment target in AOM) gram + H. Influenza (gram -ve) M. Catarrhalis (gram -ve)

Question 18

25. A 2-year-old male with a history of chronic serous otitis media is noted to have a pearly white opacity in the upper outer quadrant of his TM. He currently has no symptoms and appears to hear “okay.” The most likely diagnosis and appropriate management would be: a. Tympanosclerosis; no treatment is necessary b. Persistent perforation; prescribe topical antibiotic drops c. Foreign body; perform an ear wash for removal d. Cholesteatoma; refer to otolaryngology

Answer 18

d. Cholesteatoma; refer to otolaryngology

Question 19

What intervention with the at-risk children for OME?

Answer 19

Tympanostomy or adenoidectomy surgical intervention should be considered.

Question 20

What is prevention of otitis externa (swimmers ear)?

Answer 20

Prevention—instillation of white vinegar and rubbing alcohol (50/50) in both ear canals after swimming; avoid water in canals, vigorous cleaning, scratching, or prolonged use of cerumenolytic agents

Question 21

What age is watchful waiting appropriate in AOM? When do you give antibiotics and follow up?

Answer 21

This is in the otherwise well child: 6 months and older with non-severe illness based on joint decision making with parents/caregivers for UNILATERAL AOM. Follow up must be ensured with ability to start Antibiotic therapy within 48 - 72 hrs if child fails to improve or worsen.

Question 22

Daily eyelid cleansing with diluted baby shampoo and a cotton-tipped applicator would be appropriate in the treatment of which one of the following conditions? a. Dacryostenosis b. Chalzion c. Hordeolum d. Blepharitis

Answer 22

d. Blepharitis

Question 23

Conjunctivitis-otitis syndrome occurs in about 25% of young children ( 􏰃 3 years) and most often associated with a. Streptococcus pneumoniae b. Haemophilus influenza c. Moraxella catarrhalis d. Staphylo coccusaureus typically in \_\_\_\_\_\_eye/ear ipsilateral or contalateral

Answer 23

Haemophilus influenza ipsilateral (same side ear/eye)

Question 25

The most common cause of autism is: Fragile X syndrome Klinefelter syndrome (XXY)

Answer 25

Fragile X syndrome

Question 26

What is first line intervention for OME

Answer 26

Watchful waiting in the majority. 75% - 90% resolve within 3 months without specific treatment.

Question 28

Treatment for AOM 1st line treatment and with PCN allergy

Answer 28

First line therapy - Amoxicillin—80–90 mg/kg/day (maximum 4 g/day) for 10 days in 2 divided doses. (shorter courses possibly with older children with milder cases) High dose OR Amoxicillin-Clavulanate (Augmentin)—90 mg/kg/day of amoxicillin and 6.4 mg/kg of clavulanate in 2 divided doses IF PCN ALLERGY (RASH NOT ANAPHYLAXIS) Use cefdinir (14 mg/kg/d in 1 or 2 divided dosess) OR cefuroxime (30 mg/kg/d in 2 divided doses) OR cefpodoxime (10mg/kg/d in 2 divided doses), OR Ceftriaxone—50 mg/kg 2 doses IM or IV/day for 1 or 3 day (Use this only if pt cannot be given any of the PO above first)

Question 30

AAP recommends screening of Autism at which of the following times in early childhood? a. 6 and 18 months b. 12 and 24 months c. 18 and 24 months d. 24- 36 months

Answer 30

c. 18 and 24 months

Question 31

11. Concurrent otitis media and conjunctivitis is likely due to which organism? a. Streptococcus pneumoniae b. Haemophilus influenza c. Moraxella catarrhalis d. Staphylo coccusaureus

Answer 31

b. Haemophilus influenza

Question 32

What is the most common cause of TEMPORARY speech delay in early childhood?

Answer 32

Persistent OME

Question 33

Pain and fever control for AOM How long does it take before the fever is resolved when prescribed Antibiotics

Answer 33

a. Analgesics—acetaminophen, ibuprofen b. Local anesthetic otic drops can provide short term pain relief (20 -30 minutes) (contraindicated in acute/chronic perforations and ventilation tubes) It takes 2- 3 days.

Question 35

Pneumatic otoscopy used for

Answer 35

—visualize degree of Tympanic mobility impairment in AOM

Question 37

Autism Spectrum Disorder includes:

Answer 37

Autistic disorder, childhood disintegrative disorder, Rett's disorder (Female) and pervasive developmental disorder

Question 38

What is nonsevere illness in AOM? Choose all that apply a. mild otalgia for 48 hrs e. Fever more or equal than 39 C (102.2 F)

Answer 38

a. mild otalgia for

Question 39

A 3-year-old has an edematous, mildly erythematous right upper eyelid for one day with a fever of 103°F. An important eye assessment would be: a. Ocular mobility b. Conjunctival inflammation c. Pupillary reaction d. Optic disc papilledema

Answer 39

a. Ocular mobility

Question 41

what is the first line treatment for ADHD

Answer 41

Stimulants: Methylphenidate (Ritalin, Concerta)

Question 42

What is Otitis media with effusion (OME)

Answer 42

Definition: Inflammation/fluid accumulation in middle ear (serous, not purulent fluid) with decreased TM mobility on pneumatic otoscopy but without signs and symptoms of ear infection; formerly known as serous otitis "glue ear".

Question 43

12. All but which one of the following is consistent with glaucoma? a. Photophobia b. Epiphora (increase tears) c. Blepharospasm d. Leukocoria (white red reflex)

Answer 43

d. Leukocoria (white red reflex)

Question 44

When is antibiotic therapy given for AOM?

Answer 44

1. Non-severe or severe illness whether unilateral or bilateral AOM in children younger than 6 months. 2. Non severe illness with bilateral AOM in younger children (6-23 months) 3. Severe illness with unilateral or bilateral AOM in children older than 6 months.