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PREP Flashcards

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1
Q

Adolescent with imbalance, tinnitus, hearing loss

A

Vestibular schwannoma, NF2 (autosomal dominant)

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2
Q

meningiomas, ependymomas, astrocytomas, schwannomas of other cranial and peripheral nerves, mononeuropathy, and posterior subcapsular lens opacities

A

NF2

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3
Q

Posterior subcapsular lens opacity

A

a unique ocular finding that can be the first sign of neurofibromatosis type 2 in childhood

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4
Q

male taller than normal stature, speech and language delay, cystic acne in adolescence, lack of facial dysmorphology, and learning disabilities but normal intelligence

A

47,XYY syndrome

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5
Q

female tall stature, learning disabilities, and speech/language delay, but typically have normal intelligence, sexual development, and fertility

A

47,XXX syndrome, also known as triple X syndrome

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6
Q

congenital heart disease, palatal abnormalities, characteristic facial dysmorphology, learning difficulties, renal anomalies, and immune deficiency. hypocalcemia in 17% to 60% of patients and thyroid dysfunction

A

22q11.2 deletion syndrome, also known as velocardiofacial syndrome or DiGeorge syndrome

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7
Q

coloboma, heart defects, choanal atresia, retarded growth and development, genital abnormalities, and ear anomalies

A

CHARGE syndrome

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8
Q

Huntington disease, fragile X syndrome, and myotonic dystrophy

A

Types of trinucleotide repeat disorders

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9
Q

Neurofibromatosis type 2, neurofibromatosis type 1, and tuberous sclerosis, what inheritance type?

A

neurocutaneous disorders with autosomal dominant inheritance

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10
Q

microcephaly, microphthalmia, low-set ears, cleft lip and/or palate, holoprosencephaly, cutis aplasia, polydactyly, clenched hands, rocker bottom feet, cryptorchidism, renal anomalies, and cardiac malformations

A

Trisomy 13

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11
Q

Young male children who have a history of nontraumatic severe bleeding should be evaluated for

A

factor VIII and IX deficiencies

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12
Q

girl in this vignette has an unremarkable medical and developmental history, pallor and tachycardia, a severe, normocytic anemia, absolute reticulocytopenia, and a normal white blood cell count, differential, and platelet count

A

Transient erythroblastopenia of childhood is an idiopathic, self-limiting disease that should be followed by serial complete blood cell counts and reticulocyte counts

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13
Q

neonate with absent radius

A

may need platelet transfusions, Thrombocytopenia with absent radius syndrome

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14
Q

Children with isolated fractures to the paranasal sinuses should be treated with

A

1-week course of antibiotics and oral analgesics. “Sinus precautions” should be implemented for patients with paranasal sinus fractures. These include avoidance of nose blowing, swimming, straw use, and playing wind instruments. follow up 1 week later with an otolaryngologist

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15
Q

Patients with persistent otorrhea and/or a white mass behind the tympanic membrane

A

referred to an otolaryngologist for further evaluation and management. Most cholesteatomas require surgical treatment.

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16
Q

severe sore throat (sometimes unilateral), fever, a muffled or “hot potato” voice, trismus, and odynophagia. They typically have a swollen tonsil or swelling of the adjacent soft palate as well as deviation of the uvula to the opposite side

A

Needle aspiration of a peritonsillar abscess is both diagnostic and therapeutic.

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17
Q

children with persistent purulent and/or foul-smelling nasal discharge (especially when unilateral) and malodorous breath. Tx?

A

Use of a topical vasoconstricting agent, such as neosynephrine or oxymetazoline, is generally recommended before any attempt is made to remove a nasal foreign body. These agents decrease localized swelling (which improves the chances of successful foreign body removal) and decrease bleeding.

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18
Q

ocular abnormalities (myopia, cataracts, and/or retinal detachment), midface abnormalities (flattened midface, depressed nasal bridge, short nose, anteverted nares, micrognathia, and cleft palate), hearing loss, and joint hypermobility

A

Stickler syndrome

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19
Q

12 yo healthy, first seizure, all labs (including UTox) nl, nl neuro exam, what order at PCP f/u? EEG, EKG, CT, MRI?

A

EEG next (background epilepsy but also if focal, then brain imaging). Only start with brain imaging if focal seizure or abnl neuro exam (likely CT first b/c acute)

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20
Q

6 mo, lethargic in am, hypoglycemia with ketones?

A

Glycogen storage disease (fatty acid oxidation disorder would have hypoglycemia without ketones. organic acid disorders are neonatal. mitochondrial is lactic acidosis and hypotonia, ragged red fibers on muscle biopsy)

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21
Q

Neonate IUGR and SGA, She has a small jaw, clenched hands with overlapping fingers, rocker-bottom feet, a short sternum, and hypoplastic nails. Echocardiography shows a ventricular septal defect. Renal ultrasonography shows a horseshoe kidney. Dx?

A

Trisomy 18 (Edward). IUGR, SGA, heart, kidney in neonates with trisomy 13 or trisomy 18. trisomy 13 also have a scalp defect called “cutis aplasia” and midline defects such as holoprosencephaly, cleft lip, cleft palate. Clenched hands with overlapping fingers and rocker-bottom feet can be seen in trisomy 13, but they are more common in trisomy 18. Trisomy 18 is characterized by distinctive dysmorphic features: clenched hands with overlapping fingers, rocker-bottom feet, and short sternum. Trisomy 13 is characterized by midline and scalp defects and rocker-bottom feet.

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22
Q

16 yo prev healthy F, 2 days fatigue, pallor, dyspnea. Hb 4, retic 13, nucleated RBCs present, LDH elevated, bili elevated, direct antibody test IgG positive. Spleen tip palpated. Tx? Methylprednisolone, normal saline, rasburicase, pRBCs?

A

Steroids. Acute hemolytic anemia. Her unremarkable personal medical history suggests that she does not have a heritable hemolytic disorder, and the positive direct antibody test finding for IgG is diagnostic of a warm antibody-mediated autoimmune hemolytic anemia (AIHA). Whereas AIHA can be associated with medications, the girl in the vignette has an unremarkable medical history, suggesting that she has idiopathic AIHA. (NS dilute further, rasburicase for TLS, RBCs only if end organ b/c will just hemolyze)

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23
Q

34 week, mom febrile, baby resp distress, streaky CXR, green amniotic fluid. What bug?

A

Listeria (GBS often reticulogranular CXR. green fluid classic listeria. Chlamydia later. E coli bloodstream sepsis).

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24
Q

testicular torsion based on history and physical. US or consult uro?

A

Consult Uro (emergency!)

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25
2 yo croup, stridor and retractions with activity only, day 2, symptoms worsening. Dex or supportive care?
Dex! Because early in course and worsening even though no stridor at rest
26
Delayed puberty? Breast, testicular, menarche?
No breast at 13 yo, no testicular growth (4 ml, 2.5 cm) at 14, no menarche at 15
27
11 mo exposed to Hep A at daycare 2.5 weeks ago?
No prophylaxis given >2 weeks ago (if <14 days, give Hep A vaccine to >12 mo or immune globulin to <12 mo)
28
Knock knees. What age and supine intermalleolar measurement cut off to do xrays?
If at least 7 yo and intermalleolar 8cm or greater
29
Infective endocarditis. Most likely pathogen?
Staph aureus
30
Head banging 5yo boy normal?
No, should resolve by age 4. Eval for developmental disability (autism, ID).
31
Acne inflammatory papules and blackheads treatment?
Benzaclin (inflammatory) AND retinoid (follicular blockage)
32
15 yo itchy, tender, pink area of hair loss (smooth skin w/o broken hairs in one area)?
linear scleroderma (alopecia areata smooth plus broken or exclamation point hairs. tinea has black dots. trichotillomania patchy)
33
SGA newborn, hypoglycemia at 18 hours cause?
Decreased glycogen stores (because growth restricted)
34
Post burn nutrition? Higher or lower? which vitamins?
More calories than normal. Vit A and C and zinc for wound healing
35
neutropenic cancer patient, nodular appearance on CT?
Aspergillus, NOT PJP (ground glass)
36
Prader Willi. treat with glucocorticosteroids or growth hormone in first year of life?
GH
37
LSD, at risk for what?
serotonin toxicity. NO physical dependence/withdrawal/addiction
38
tumor lysis syndrome. which direction phosphorus, potassium, calcium, uric acid?
high, high, low (hypocalcemia because binds to phosphorus spilled from cells), high
39
teen, chronic cough, fatigue, weight loss, hilar adenopathy, restrictive lung disease, elbow nodules?
sarcoidosis (can bx nodules - noncaseating granulomas)
40
Difference between: benign focal epilepsy of childhood juvenile absence epilepsy juvenile myoclonic epilepsy progressive myoclonic epilepsy
-benign focal epilepsy of childhood- most common childhood epilepsy. during sleep unilateral facial twitching, orofacial paresthesias, and speech arrest, with preservation of consciousness. It typically presents between 5 and 10 years of age and resolves by adolescence. -juvenile absence epilepsy - absence only -juvenile myoclonic epilepsy - early adolescence with myoclonus, generalized tonic-clonic, and/or absence seizures; seizures often occur in the morning. provoked by sleep deprivation, photic stimulation, alcohol consumption, or stress. -progressive myoclonic epilepsy - rare genetic, supportive care. myoclonic, generalized tonic-clonic seizures and accompanying progressive neurodegeneration. Clinical findings include cognitive decline, ataxia, neuropathies, and myopathies
41
CAG repeats in HTT CGG repeats in FMR1 CTG repeats in DMPK GAA repeats in FXN
Huntington Disease Fragile X Type 1 myotonic dystrophy Friederich Ataxia
42
What repeat Fragile X?
CGG (See G G, macroorchidism)
43
case-control study cohort study cross-sectional study randomized controlled trial Which most likely to yield valid info about: benefits and harms of intervention, prognosis of a condition, accuracy of diagnostic test?
RCT, cohort, cross-sectional
44
febrile neonate, meningitis, CSF smear with green rods in twos. What bug and antibiotic?
Listeria (gram positive rods), ampicillin
45
Side effects of ketogenic diet (3)?
GI (constipation), hyperlipidemia, kidney stones
46
16 yo sex traffic (sex for jewelry). who contact?
national sex hotline (not parents or law or DCF)
47
football tackle, spleen injury, BP nl, which imaging? (XR, CT, MRI, US)
CT b/c hemodynamically stable (US otherwise)
48
what kind of JIA has uveitis? (oligoarticular, polyarticular, systemic onset, enthesitis related)
oligoarticular, especially when ANA positive (most of the time)
49
PFAPA
periodic fevers (4-5d q month), aphthous stomatitis, pharyngitis, adenopathy. T&A works! steroids work but increase attack frequency and severity
50
newborn white forelock. what syndrome? what GI complication?
Waardenburg syndrome is characterized by a prominent white forelock, wide nasal bridge, sensorineural deafness, heterochromia iridis, and in some types, lateral displacement of the inner canthi. Waardenburg syndrome type 4 (Waardenburg-Shah syndrome) is always associated with Hirschsprung disease.
51
Risk factors for postconcussive syndrome (>3 mo sx)?
Risk factors for postconcussive syndrome include severe initial symptom burden or delayed onset; loss of consciousness for more than 1 minute at the time of injury; vestibular symptoms; and preinjury history of psychiatric disorders, migraine headache, learning disorder, or repeated concussions.
52
best EBM question has what?
The four elements of a PICO question are patient problem or population, intervention, comparison group, and outcome measure.
53
neonate microcephaly, cataracts, sensorineural deafness, peripheral pulmonic stenosis, and radiolucent bone lesions?
Rubella
54
neonate hydrocephalus, chorioretinitis, and cerebral calcifications?
toxoplasmosis
55
neonate snuffles, mucocutaneous lesions, osteochondritis, pseudoparalysis, hepatosplenomegaly, and lymphadenopathy?
syphilis
56
Stage 2 HTN, sports restrictions?
Do aerobic low-intensity only (until under better control). Contact vs non contact doesn't matter. But high intensity can make BP worse.
57
baby inspiratory stridor crying and supine, not prone, retractions but nl O2, next step?
reassurance (laryngomalacia, self resolve), not ENT
58
neonate wet blanket, cause hypothermia? (conductive, convective, evaporative, radiant?)
Evaporative (conductive would be loss to touching object unlikely because warm mom holding, convective would be AC blowing, radiant would be loss to air unlikely because covered)
59
treatment of nephrotic syndrome?
prednisolone (IV furosimide +- albumin only if severe edema = pleural effusion, ascites, etc)
60
bronchiolitis, not RSV, what most likely?
Metapneumovirus (NOT flu - usually febrile, sometimes sepsis. Adenovirus often pneumonia)
61
yellow frothy vaginal discharge?
trichomoniasis (chlamydia = mucopurulent, BV = thin white gray fishy, candida = thick white odorless)
62
PICU, failed subclavian central line, successful IJ, hours later resp worsen and white out lung on right side only. Next step?
chest tube, likely hemothorax from 1st failed line
63
dental abscess, what bacteria?
Anaerobes (Actinomyces israelii). NOT staph, strep, pseudomonas.
64
how diagnose pertussis?
NP swab PCR
65
3 teens GI sx 1 day after bomb at protest. what agent - anthrax, phosgene gas, radiation, VX gas?
radiation (delayed 2-3 days, often GI, but can be neuro or cutaneous or hematological). Anthrax is cutaneous (ulcer after handling animals), GI (eating contaminated meat, NOT bioterrorism), or respiratory (bioterrorism, fever, resp, death).
66
Neonate IDM poorly controlled, echo with asymmetric hypertrophic septum. Poor perfusion, HR 205, BP 45/23. Tx - adenosine, digoxin, dopamine, propranolol?
Propranolol (decrease afterload, helps poor CO, likely plus NS bolus to maintain preload). Dopamine ionotrope would worsen functional obstruction
67
vomiting and diarrhea few hours after school served breakfast, Campylobacter, listeria, staph aureus, Yersinia?
Staph aureus (only one with fast onset, others at least 1 day, and campy is bloody diarrhea)
68
14 yo 2x2 cm rubbery mobile breast nodule, started before last menses, pain gone but mass still there, GMa BCa 60s. US or monitor x2 cycles?
Monitor (benign fibroadenoma), US only if predisposed (radiation, Ca hx so mets) or concerning exam findings
69
complete newborn hearing screen by 1, 3, 6, 9 months if not able to do in hospital?
3 months
70
side effect of propranolol for hemangioma (not just hypotension)?
hypoglycemia (and bradycardia)
71
11 mo pakistan, jaundice, anemia, no Hb A or A2, all Hb F. most likely complication?
iron overload (beta thalassemia major, reliant on lots transfusions in life)
72
18 mo F head growth stopped 6-8 mo, now developmental regression?
Rett syndrome (also loss purposeful hand movements like pointing FOLLOWED by wringing later)
73
hip dysplasia from breech - association, deformation, disruption, malformation?
deformation (external sources). Association like VACTERL. Disruption amniotic bands. Malformation AV canal defect in Tri 21.
74
mexico ate cheese, now 10d fever hepatosplenomegaly?
Brucellosis
75
post strep glomerulonephritis, edema, HTN, treatment?
IV furosemide. NOT steroids - no role.
76
Pressor treatment in cardiogenic shock? Septic shock?
Milrinone. Norepi (or vasopressin)
77
Chalazion treatment?
Warm compresses only. Stye (painful, along lid margin) warm compresses and maybe topical antibiotics if significant blephritis.
78
neonate, distress, high ammonia, elevated anion gap metabolic acidosis, ketones in urine?
organic acid disorder (urea cycle defect would have alkalosis. fatty acid oxidation disorder would not have ketones. PKU is fine at birth)
79
30 mo, both height, weight, HC symmetric slowing after 6 mo (normal/preserved BMI), hx significant hemorrhage after birth. Dx?
Growth hormone deficiency (vascular insult to pituitary). Insufficient calories would have low BMI.
80
watery diarrhea 1 day after public lake, whole family?
norovirus (campylobacter is food borne and bloody)
81
Boy chronic kidney disease, what restricted in diet?
Phosphorus (controls hyperphosphatemia and secondary hyperpit), NO sodium restriction, sometimes potassium if high
82
Think Duchenne muscular dystrophy, next best diagnostic test: brain MRI, CK, EMG, muscle biopsy?
CK
83
10 yo boy, short, high upper-to-lower body segment ratio (U/L ratio) (1.2, normal 1), normal bone age, Tanner 1, MPH 25th%. dx?
skeletal dysplasia. A high U/L ratio indicates a relatively longer trunk and shorter legs, and it can be seen in skeletal dysplasias and precocious puberty. A low U/L ratio indicates a relatively shorter trunk and longer legs, and it can be seen in Klinefelter syndrome and delayed puberty.
84
white spots teeth, along gum lines, cause?
early childhood dental caries. (fluorosis is more scattered white spots)
85
7 yo F, muscle cramps, hypocalcemia, hyperphosphatemia. dx?
hypoparathyroidism (PTH remove Ca from bone and resorb in GI tract = increase CA, excrete Ph from kidney = decrease phosphorus)
86
Kerion tx? Keflex, clinda, griseofulvin, vancomycin?
Griseofulvin (or antifungal), it's inflammatory reaction to tinea/fungus, NOT bacterial
87
oral human growth hormone in protein powder. dangerous?
no, broken down by stomach acid, GH only given subQ/IV to affect serum level. But still dangerous given lack regulation / heavy metal contaminants, etc.
88
4 mo sensorineuronal hearing loss since birth. Rec what device?
Behind the ear hearing aid. Cochlear implant only if 12 mo or older and hearing aid didn't work.
89
10 yo soccer player, new heart block after tournament New England, admitted for tele. Tx? Oral doxycycline or IV ceftriaxone?
IV ceftriaxone (Lyme carditis, what red book recommends if "admitted")
90
teen male having sex with male, first lifetime partner, condoms every time. screen HIV and what?
Syphilis (and GC/C, not trichomoniasis or Mycoplasma genitalium)
91
Neonate with bradycardia and a diffuse rash characterized by elliptical erythematous, papulosquamous lesions with central clearing, annular erythema, and a fine scale. What will EKG likely show?
3rd degree / complete heart block (neonatal lupus)
92
Is NF1 Autosomal Dominant with incomplete penetrance or variable expressivity?
AD with variable expressivity (everyone with gene affected, just different symptoms. IP would be some have gene and no clinical features)
93
Which developmental delay most associated with eventual ID? (adaptive, expressive language, fine motor, receptive language)?
Receptive language (closest to cognition)
94
5 yo M, GI sx 5 days, now low UOP, labs with Nl CBC, AKI, UA with granular casts. Dx?
Acute tubular necrosis (renal AKI. Not HUS, would have low Hb and plt)
95
7 yo M, generalized tonic clonic seizure in am. Hx several self-resolving episodes of waking in the middle of the night unable to talk, with associated drooling and facial twitching. Dx? (benign rolandic epilepsy, childhood absence epilepsy, juvenile myoclonic epilepsy, panayiotopoulos syndrome)
Benign rolandic epilepsy, often outgrow
96
Retropharyngeal abscess. Most likely bug?
Strep pyogenes / group A strep. NOT Strep pneumo. (also staph aureus common)
97
Teen hospitalized with viral meningitis from mumps. What kind of isolation precautions?
Droplet (spread via contact with respiratory droplets and saliva)
98
FMR1 DNA test for what?
Fragile X
99
testing for the MECP2 mutation, for what?
Rett syndrome
100
6 mo intubated in PICU for RSV resp failure. Nutrition via NJ tube, NG tube, or parenteral?
NJ (NG aspiration, likely short term so parenteral not preferred)
101
UTI ppx ABx choice?
TMP-SMX (bactericidal, even if 1st UTI bug was resistant to it!), followed by nitrofurantoin (if sulfa allergy, or breakthrough infection on TMP-SMX), followed by amoxicillin (<2 months old, TMP and nitro increase bilirubin)
102
anesthesia sevo, after in pacu, hyperthermic, hypercarbic, muscle rigidity. tx?
dantrolene (malignant hyperthermia)
103
Difference between Hunter and Hurler syndrome?
Hunter (MPSII) has better cognitive outcome, and absence of corneal clouding. Hurler (MPSI) worse outcome. Both coarse facial features, HSM.
104
hallucinations, nystagmus, skin flushing, slurred speech, excessive salivation, and altered mental status. What drug?
Inhalant (dysrhythmias common cause of death)
105
14 yoF, scoliometer 10 deg, xray T11 wedge vertebrae, Cobb angle 15 degree. Next step? Bracing, refer ortho, flexion/extension xray, renal ultrasound?
wedge vertebrae = congenital scoli, associated with GU abnormalities, so renal US. Cobb angle >20 for ortho
106
5 yo M, hx cardiac repair, residual AV regurg, exam normal except for stable murmur. At cards, heart function depressed and started new med, which one?
ACEi like enalapril b/c = first stage heart failure even though don't hear crackles or hepatomegaly. beta blockers and ARBs later on (Carvedilol, losartan)
107
kid in PICU with sulfa allergy, given med, now anaphylaxis, which of the following most likely given digoxin, enalapril, furosemide, spironolactone?
furosemide, a sulfonamide, should be avoided in kids with sulfa allergy
108
6 mo, diaper rash = perianal abscess, temp 38.1, WBC 4,500, Hb 10.5, plt 255k, neut 1%, lymph 80%, mono 19%. how tx? IV abx, oral abx, reassess in 1 week, topical abx?
IV abx. Febrile neutropenia! 1% of 4,500 = ANC of 45!
109
5 yo M from indonesia, played barefoot, microcytic anemia, eosinophilia, bug? Enterobius vermicularis, Giardia duodenalis, Necator americanus, Taenia saginata
Necator (even though has america in it), type of hookworm, the other hookworm is Ancylostoma duodenale. (Enterobius is anal pinworm, Giardia is diarrhea, Taenia is tapeworm)
110
exercise intolerance, presenting with fatigue, pain, and cramps in the exercising muscle. Coca cola urine, CK up. Which glycogen storage disease (I-V)?
V = muscle type. I = first few months of life with failure to thrive, seizures, developmental delay, and severe hypoglycemic episodes. II = Pompe, marked hypotonia, failure to thrive, and hypertrophic cardiomyopathy within the first year of life. IV = several Subtypes include: classic progressive hepatic, nonprogressive hepatic, the rare childhood neuromuscular form, as well as lethal forms (perinatal and congenital neuromuscular subtypes).
111
14 yo basketball, mom wants to wear mouthguard. what rec?
Yes! Recommended for any contact/collision sport. Boil and bite should be fine as long as no braces, teeth abnormalities, otherwise custom / dentist one.
112
Which bug associated with hemolytic uremic syndrome?
Escherichia coli O157:H7 or > Shigella dysenteriae
113
If fail car seat challenge, next step?
Rechallenge in car bed (no matter BW), NOT rechallenge in seat
114
Apt-Downey test?
On newborn (<8wk) hematemesis to see if maternal or fetal blood (if maternal, just bloody nipples, no further w/u)
115
5 week old, hematemesis (occult+). Next step?
Apt-Downey test on emesis. Tests if fetal or maternal blood. Can only do <8 week old. If maternal, just bloody nipples, no further testing. If fetal, US vs UGI, etc.
116
Craniopharyngioma, thirsty and peeing a bunch. Which lab direction: serum sodium, serum osmolality, urine osmolality?
serum sodium high, serum osmolality high, urine osmolality low. Central diabetes insipidus - pee a bunch because no ADH, thirst as compensatory mechanism. So pee a bunch (dilute urine, concentrated blood). If serum sodium and osm low, would be primary polydipsia.
117
mom painful genital lesions, HSV labs pending, neonate asymptomatic. What testing? HSV IgG at 24h, surface swab culture at 24h, wait for rash?
surface swab culture and HSV DNA PCR at 24h (IgG is mom's antibodies. Assume has ACTIVE HSV at delivery, inappropriate to wait for rash because not always cutaneous and can occur 2-4 weeks, need to know if infected)
118
Tooth avulsion tx including ABx?
Brief (10s) rinse water, transport in socket, between molar and cheek, or in milk, then replace, prophylactic doxycycline (or amoxicillin) x1 week
119
what lab diagnose infant botulism (flaccid paralysis)?
stool studies, NOT CSF
120
school age girl, 2 month skin toned ring with central clearing and firm edge on hand knuckle, tx?
No intervention (granuloma annulare, unknown cause, self resolve 2-4 years). Tinea has scale. Nummular eczema has crust and no central clearing.
121
7 yo pinworm. Had it 6 months ago. Tx? Albendazole for whole family, albendazole for him, ivermectin for whole family?
Albendazole for all. Tx whole family if re-infection. Can just treat him if 1st time.
122
teen with brain abscess on CT, lethargic, slow to follow commands. Best next step? Consult neurosurg, IV ABx, Blood Cx, LP?
Blood cx. Ideally get it first, then ABx, then neurosurg. No LP because herniation risk.
123
hospitalized with 2nd and 3rd degree burns. What most c/w burn infection? Fever, red tender skin around burn, positive bacterial swab cx, bacteria on burn biopsy?
Biopsy, or fungus on swab cx. Fever can just be hyperdynamic state, red skin from burn, often contaminated with skin flora so swab not helpful.
124
painful torticollis after trampoline. CT, MRI, neurosurg, PT?
CT. Atlantoaxial subluxation (want bone image, so CT better). Neurosurg if don't improve after PT/rest/nsaids few weeks, or signs myelopathy or focal neuro.
125
4 yo got BCG vaccine, CXR normal, but grandpa with active coughing TB at home. Next step? serum test and isoniazid if positive, serum test and isoniazid immediately, sputum stain and culture, TST skin test and isoniazid if positive
serum test and meds right away, <5 yo high risk severe disease so prophylaxis even if test negative! serum test better than skin especially if got vaccine and <10 yo (can have false positive)
126
complicated rhinosinusitis with periorbital cellulitis. which abx?
augmentin. not keflex.
127
nosebleeds, thrombocytopenia with small size, eczema, AOMs and pneumonia x1, who refer to?
Immunology (Wisckott-Aldrich syndrome, triad thrombocytopenia, eczema, and infections. immune deficiency). ITP has large platelets.
128
asymptomatic 9 months old with 6+ cafe au lait macules. next step? MRI or ophthalmology referral?
ophthalmology, (NF1), look for lisch nodules +- optic gliomas. MRI only if symptomatic.
129
Most likely bug to cause simultaneous AOM and bacterial conjunctivitis?
non typable H flu. (Moraxella, and strep pneumo also do both, but "less common")
130
neonate with bilateral pleural effusions, fluid is thin and milky. dx?
congenital chylothorax (most common type of neonatal PEs. empyema would be cloudy)
131
chronic kidney disease, growth failure. Ca, Phos, PTH levels?
Ca low, phos high, PTH high. (kidneys can't make active vit D, so don't absorb Ca from intestines, PTH compensatory rises)
132
conjunctivitis in 9 day old, no erythromycin. bug?
chlamydia (most common, gonorrhea possible but less common and usually <7 days)
133
asthma hx, hypertensive emergency, what med? IV hydralazine, po labetalol, po nifedipine, IV nitroprusside
IV nitroprusside (fast), IV>po, others slower, labetalol contraindicated in asthma
134
trisomy 21, 2 yo, persistent tachypnea, sats 96% nl, easily down to 80% with viral illness, NO murmur. What on echo? Large VSD with LtR flow, LVH with mitral regurg, normal, RVH with tricuspid regurg?
RVH with tricuspid regurg due to pulmonary hypertension due to pulmonary hypoplasia (in Down) and sleep hypoventilation (Down snoring).
135
8yo cancer, s/p stem cell, remission. Get HiB vaccine or not?
Yes even though older than 5! Naive immune system so redose 3 series. (this and HIV and immune deficiencies)
136
C diff tx?
oral metronidazole if mild, oral vanc if severe
137
parent wants to refuse vit K for their newborn. represents autonomy or nonmaleficence?
Nonmaleficence. (Only patients can claim autonomy for themselves. parents can't claim autonomy for children, claim authority. in peds, kids can claim own autonomy >12 yo)
138
HSP tx?
most of the time mild = supportive care. If severe abdominal pain or terrible kidney disease, maybe steroids.
139
5 day old, tire with feeds, cyanotic but comfortable 60%, clearly CCHD. tx? indomethacin, O2, prostaglandin, consult cards?
prostaglandin 1st! (reopen PDA, lifesaving, then O2 and cards)
140
ROP exam for who?
Infants born <30w or <1500g
141
gangrene bug?
Pseudomonas
142
home distilled alcohol poisoning, tx?
fomepizole (methanol poisoning)

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