Pretest Questions Flashcards
(364 cards)
1
Q
HSP also known as?
A
anaphylactoid purpura
2
Q
treatment for retentive encopresis
A
clear fecal impaction and use lots of stool softeners
3
Q
unilateral bowing of leg past 2 years of age =
A
blount disease aka idiopathic tibia vera. Abnormality in medial aspect of tibia
4
Q
What is legg-Calve perthes disease
A
avascular necrosis of the femoral head
5
Q
painless limp think
A
legg-calve perthes disease
6
Q
overweight patient with a limp think
A
slipped capital femoral epiphysis
7
Q
What are two types of breath holding spells
A
cyanotic - kid misbehaves and wants something
pallid - painful experience, kid stops breahting and passes out
8
Q
bedwetting and fat think
A
diabetes
9
Q
bitter almond odor think
A
poisoning w/ hydrogen cyanide
10
Q
treatment for hydrogen cyanide poisoning
A
high level oxygen, and hydroxocobalamin antidote
11
Q
headache, agitated and confused, works with plastics, gets dysrhythmia
A
cyanide poisoning
12
Q
rash that peaks at 2-4 weeks of life and is harmless
A
neonatal acne from mothers hormones
13
Q
white keratin plugs on nose, cheeks, chin
A
milia - benign
14
Q
treatment for scabies
A
permethrin cream
15
Q
how is scabies different in kids and adults
A
in kids it can occur on palms, soles,face, and head where as it is normally spared in adults
16
Q
pruritic papular rash that is in many family members
A
scabies
17
Q
diffuse infiltrates in newborn bilaterally, rapid onset, low WBC, left shift
A
group B strep
18
Q
Most common way that kids get orbital cellulitis
A
direct extension from nearby site like paranasal sinuses
19
Q
Common causes of orbital celluliits
A
MRSA, strep, Haemophilus
20
Q
orbital vs periorbital cellulitis
A
orbital has restriction of eye movement,. Periorbital can be managed as outpatient with oral antbioitcs
21
Q
general direction of motor development in kids?
A
cephalocaudal, trunk then arms then fingers
22
Q
How do you test for HIV in neonate and why?
A
use an antigen test like HIV PCR. Can’t do ELISA bc it will reflect maternal antibodies
23
Q
Where is eczema located when younger than 2
A
cheeks, wrists, scalp, arms and legs.Afterwards goes to the extensor surfaces
24
Q
Unique contraindication to DTaP
A
encephalopathy - coma, AMS, prolonged seizure within 7 days of administration of last dose
25
What is the problem with 1% lidane?
It can cause neurotoxicity from transdermal absorption. Especially when under 2 months?
26
3 weeks of progressive cognitive decline, listlessness, vomiting think
tuberculous meningitis
27
whitish polyp extending through TM in patient with recurrent OM
cholesteatoma - from recurrent infection or chronically draining ear
28
Once a child has low blood pressure how what percent dehydration has occurred?
10-15%
29
umbilical cord intact after 1 month think?
leukocyte adhesion deficiency type 1 - CBC with marked leukocytosis
30
How do you diagnose leukocyte adhesion deficiency type 1
measure surface CD11b with flow cytometry.
31
What can form after umbilical cord has separated
umbilical granulomas
32
how do you treat umbilical granulomas
silver nitrate
33
Most common cause of septic arthritis is?
S Aureus
34
Td 10 years ago what do you give now?
Tdap to help reduce pertussis
35
Mammalian bite how do you care for it?
Lots of irrigation. Unsure whether to do antibiotics. Definitely if monkey, less so if cat or dog
36
deferoxamine treats?
iron overdose
37
N acetylcysteine treats
acetaminophen ingestion
38
Dimercaptosuccinic acid treats
arsenic poisoning
39
CroFab treats
western diamond back rattlesnake
40
developmental delay, autism, abnormal temperament test for?
fragile X syndrome
41
long face, large ears, prominent jaw, macroorchidism, hypotonia, repetitive speech, hand flapping =
fragile X syndrome
42
What are normal transmitting males
guys with fragile X but they are normal and it doesn't show up on karyotypes. Pass it on to all daughters and then also to those grandchildren.
43
Genetics of fragile X syndrome
Dominant X-linked disorder with reduced penetrance
44
rocker bottom feet think
trisomy 18
45
erythematous macules with central yellow-white pustule,. What does fluid from lesions show?
This is erythema toxicum benign and found in newborns. Will show eosinophils
46
rash on neck and sometimes eyelid that gets worse with emotion and activity.
salmon patches or nevus simplex/nevus flammeus. The ones on face go away ones on nuchal and occcipital areas persist.
47
african america, present at birth, small pustules with hyperpigmented lesions encircled by a collarette of scale when u rupture the pustule
pustular melanosis- pustules first few days and then hyperpigmentation for weeks to months
48
Scalp area without hair and scaly yellow-orange lesions
sebaceous nevi. They can become malignant in adolescence
49
What are epstein pearls
epithelial cysts on the palage associated with milia
50
nonerythematous fine yellowish-white lesions on face of neonate think
milia
51
erythematous, ulcerative lesions on his fingertips. Painful and itchy - was in the snow all day
chillbain
52
girl with erythematous, firm, slightly swolen skin at edge of mouth extending to cheek in the summer
popsicle paniniculitis - destruction of fat cells by exposure to cold weather.
53
small, firm, white cold patches of skin after cold =
frostnip
54
cold exposure then stinging in tisseu followed by aching and then numb .Area becomes red, blotchy, and painful when you warm it back up
frostbite
55
scaling of lips with fissures at corners, glossitis, ocular problems, seborrheic dermatitis, poor growth, burning and itching of eyes =
riboflavin deficiency
56
seizure, peripheral neuritis, dermatitis, hypochromic anemia =
B6 deficiency
57
thiamine deficiency think besides korsakoff or wernicke
beriberi
58
NIacine deficiency think
dermatitis, diarrhea, dementia, death
59
Biotin deficiency think
dermatitis/seborrhea
60
High pitched cry, small for age, microcephalic
Cri du chat syndrome - abnormal larynx. delete short arm of 5
61
Deleted segment in angelman and prader willi
15q11-13
62
painful limp, WBC count and ESR are normal. Ruled out osteo and septic hip
transient synovitis
63
progressive neuro symptoms in kid in new house being redone think what and treat with what?
Lead poisoning, if symptomatic give dimeraprol and calcium EDTA assuming its severe. One or the other in a more mild form
64
When is N acetylcysteine ineffective?
after 36 hours of acetaminophen overdose
65
aspirin overdose what will help?
sodium bicarb helps in excretion
66
organophosphate poisoning treat with
washing, emesis, atropine followed by pralidoxime (2-PAM)
67
Megaloblastic anemia not from deficiency think?
infection with tapework diphyllobothrium latum - longest tapeworm. Treat with Praziquantel
68
Mother on lithium - kid gets
Ebstein anomaly - heart defect where tricuspid valve is in the right ventricle with attachment to wall instead of annulus
69
mother on ACE i - baby gets
renal sygenesis, oligohydramnios, skull ossification
70
mother on isoretinoin baby gets
teratogenic effects = hydrocephalus, CNS porb, microtia, smallor missing thymus, conotruncal heart defect, micrognathia
71
low leafy greens and stuff in mom, baby gets
neural tube defects like spina bifida
72
mom gets 3 day measles, baby gets
(mom got rubella) deafness, cataracts, mental retardation, heart defects
73
Guy at the beach gets intensely ithy lesion on feet that progresses up- raised, red, serpiginous.
called creeping eruption or cutaneous larva migrans. from dog and cat hookworms. Treat with ivermectin
74
what is ivermectin
anti-helminth medication
75
treatment for seborrheic dermatitis
topical steroids or selenium-sulfide compounds
76
people out at barbecue and they get photosensitive rash
can happen from lime juice
77
to cause heart block, SLE mothers must have antibodies to?
SSA/RO or SSB/La
78
Isoniazid therapy needs what vitamin
pyridoxine or B6 supplements
79
kids on pheytoin need?
folate supplementation
80
Kids with measles in developing countries need what vitamin
Vitamin A
81
Baby who is breast fed needs vitamin
D
82
Patients with sickle cell disease need supplementation wtih
folate
83
1 hour old newborn may need what supplement
Vitamin K to prevent hemorrhagic disease
84
Kid with repeated abscesses and a liver abscess think
chronic granulomatous disease - use NBT to assess
85
Kid with severe eczema and unusual infections think of?
Wiskott-Aldrich syndrome
86
Wha tis an easy way to rule out Wiskott aldrich syndrome in kid with severe eczema and unusual infection
check platelets. Wiskott-Aldrich syndrome unlikely if platelets are normal
87
How can you test for T cell deficiencies,
You could do an intradermal skin test using candida albicans, Won't get response
88
Kid with repeat meningitis from neisseria and then strep worry about?
asplenia - will see howell-Jolly bodies
89
children of diabetic mothers have what GI problem
small left colon
90
Baby becomes hypoxic when feeding but is ok when crying. What is happening
choanal atresia - need to stick an NG tube down
91
What is the CHARGE association with choanal atresia?
coloboma, heart disease, atresia of choanae, retarded grwoth, genital hypoplasia, ear abnormalities
92
How do you manage baby with mother who has VZV close to birth
VZV 5 days before delivery or within 2 days after need to give VZIG and isolation. If after 2 days you don't need to do anything
93
True contraindications to breastfeeding
active pulmonary TB, HIV, antineoplastic agents, malaria, typhoid fever, septicemia
94
What happens to second kid of a mother who had CMV during pregnancy
protected by mother IgG
95
What trimester is worst to get CMV infection
first
96
What is the apt-downey test and what is it used for?
Its a test that differentiates fetal from adult hemoglobin in bloody specimen since fetal hgb is alkali resistant. Used when baby has some blood stools bc if mothers blood then don't need to do anything
97
Safe medicine for breastfeeding
safe medicine for breastfeeding
98
Infants born to diabetic mothers have sugars that are initially?
hypoglycemic
99
What electrolyte abnormalities occur in neonates of diabetic mothers at 2-4 days?
Hypocalcemia and hypomagnesemia bc delayed PTH synthesis
100
Which is more severe Rh incompatibility or major blood group incompatibility
Rh is more severe
101
how is direct coombs test different in Rh and ABO incompatibility
in Rh its strongly positive. In ABO it can be weakly positive or not at all
102
Describe why babies get cold easily and how they respond
Going to colder environment, wet, with large surface area, no fat. To bring up temp start increasing metabolic rate, ventilate faster, they DON"T sweat, and often build up lactic acid
103
In premature infants what is the cause of apnea
icnompletely developed respiratory center
104
What defines an apneic episode
absence of respirations for more than 20 seconds
105
Mass on the right neck at 1 week of age
borken clavicle that is only now apparent with callus formation
106
Erbe-Duchene paralysis which nerves are affected and how do they present
cervical 5,6. Present with pronated forearm that is extended. With arm that is internally rotated and at side. CAN"T abduct or externally rotate at shoulder
107
Klumpke paralaysis which nerves are affected and presentation
cervical 7,8, T1. palsy of hand and can produce horner syndrome.
108
When there is paralysis of upper extremity from brachial plexus also worry about?
phrenic nerve damage. Will see elevated diaphragm on CXR
109
newborn with enlarging head and fluid wave in the skull worry about
subgaleal or subaponeurotic hemorrhage - need to observe in ICU.
LIke a cephalohematoma that crosses midline
110
Elevated hematocrit in premature baby can cause?
seizure from hyperviscosity syndrome
111
Complication of erythromycin in newborn?
increased incidence of hypertrophic pyloric stenosis
112
What do you give to infants of HIV mothers
Ziduvodine
113
Two things always given to neonates at birth
Hep B vaccine and Vitamin K supplements
114
congenital cystic adenomatoid malformation vs diaphragmatic hernia
in diaphragmatic hernia the ng tube will go into chest, whereas normal location in CCAM
115
Baby born to Hep B ag positive mother what do you do
give vaccine and immunoglobulins
116
Why are beta blockers dangerous at pregnancy
When throughout pregnancy cause growth retardation
| but near birth they prevent baby from increasing heart rate if asphyxiated. Can also get hypoglycemia and apnea
117
If there is bilious fluid in a neonates vomit you know that the GI anomaly is not?
Esophageal atresia or pyloric stenosis
118
Cleft lip and palate predisposes you to?
recurrent otitis media and hearing loss and speech deficits
119
How do you make prenatal diagnosis of neural tube defects?
detection of elevated alpha feto-protein in the amniotic fluid
120
CXR in newborn showing pulmonary gascular markings with fluid in fissures and hyperexpansion of lungs - has difficulty breathing and grunting. Csection
transient tachypnea of the newborn
121
How do you evaluate a fifth-finger polydactyly in whites and blacks
In black its common and familial
in whites need to do a cardiac exam.
thumb sided polydactyly is always bad!
122
What is harlequin syndrome?
transient change in skin color of asymptomatic newborn. dependent side turns red and upper side remains pale
123
Two wtins have hematorcrit that differ by more than 15 what happened/
twin-to-twin transfusions that happens in monochorionic
124
What happens to donor in twin-to-twin transfusions? recepient?
donor gets oligohydramnios, anemia, hypovolemia
| recipient gets polyhydraminios, larger, hyperviscosity syndrome if hematocrit goes over 65%
125
What do you do with natal tooth that is loose
have to remove it because worried about aspiration
126
longitduinal striations in the metaphysis charactersitic of
congenital rubella
127
osteochondritis or periostitis indicates
congenital syphilis
128
Triad of toxo congenital infection
hydrocephalus, chorioretinitis, intracranial calcifications
129
Which is most common TORCH infection
CMV
130
Cardiac defects make which TORCH infection more likely?
congenital rubella
131
Stable pneumothorax in a neonate can be treated with?
100% oxygen to cause a "nitrogen washout"
132
widely spaced eyes, low set ears, broad nose, bilateral renal agenesis and you get?
Potter sequence with pulmonary hypoplasia
133
What proteins do you care about in maple urine syrup disease
leucine, isoleucine, valine
134
hemihypertrophy and aniridia think
Wilms tumor
135
lateral displacement of medial canthi, broad nasal bridge, single eyebrow, partial albinism (white forelock or heterochromia, deafness
Waardenburg syndrome - AD inheritance
136
flat vascular malformation in distribution of Cn III think
| What else do you get?
Sturge-Webber syndrome
| malformation involves meninges, get atrophy of cerebral cortex, seizures, mental deficiency, hemiparesis, hemianopsia
137
tuberous sclerosis - can get them in brain and also have seizures
138
What brain abnormalitiy do you get with shaken baby syndrome?
subdural hematoma
139
What is caput succedaneum
soft-tissue swellin go fscalp where the baby was delivered. Can be ecchymotic and cross sutures. Resolves in first few days
140
preterm infant with enlarging head and lethargy worry about?
intraventricular hemorrhage aka germinal matrix hemorrhage. - in gelatinous subependymal germinal matrix
141
cephalohematomas vs caput succedaneum
cephalohematomas never cross the suture line.
142
Treatment for tricyclic antidepressant overdose when you have prolonged QT =
sodium bicarbonate to alkanize the blood.
143
Jones major criteria for ARF
carditis, polyarthritis, erythema marginatum, chorea, subcutaneous nodules
144
What one symptoms is enough to make diagnosis of rheumatic fever
Syndenham chorea
145
What is most common symptom of acute rheumatic fever
polyarthritis
146
Medical treatment for tet spells
propranolol and morphine to calm kid down and improve blood flow into the lungs
147
What do you do with child with FH of early heart disease
Test for lipid levels after 2 years of age to see if there are any lipid lowering therapy that you will need to do
148
swelling in feet and hands for a few days in kid with other family members with similar problem =
Hereditary angioedema - AD
Can get abdominal pain, vomiting, diarrhea if the edema happens in the GI tract. Can also get in larynx and cause problems breathing
149
What is wrong in hereditary angioedema
deficiency of C1-esterase inhibitor - get excessive vasoactive kinin
150
Common cardiac defect in turner's syndrome
coarctation of the aorta
151
Risk in kid with another child in family with congenital heart disease?
2-6%
152
right ventricular systolic lift. Fixed S2 think
atrial septal defect
153
conjunctivitis in someone with rash, arthritis, and other constitutional symptoms think
Kawasaki's disease - conjunctivitis is more unique to Kawasaki than ARF or other things
154
Treatment for Kawasaki disease
IVIG and high dose aspirin
| aspirin stays until the thrombocytosis comes down
155
Most common causes of myocarditis in babies
coxsackievirus B and adenovirus
156
3 groups most at risk of endocarditis
unrepaired cyanotic heart disease
prosthetic material
prior endocarditis
157
Organisms that cause endocarditis in children
Most are strep viridians and staph aureus
| also think about HACEK group, strep pneumo, coag neg staph,
158
first line treatment for SVT in infant
carotid massage, face in cold water, voluntary straining
159
Verapamil or adenosine for SVT treatment in infant
Can't use verapamil bc causes hypotension cardiac arrest
160
quadruple heart sounds with right atrial enlargement, right conduction defect with systolic murmur and diastolic rumble =
ebstein's anomaly
161
girl becomes pale while running and then returns to normal after 30 minutes. No evidence of structural heart disease
WPW
162
spiking fevers, spindle shaped swelling of fingers and joints. Salmon colored rash that develops with fever
Systemic juvenile idiopathic arthritis
163
Cyanotic newborn with LVH and LAD. holosystolic murmur
tricuspid atresia - have hypoplastic right ventricle so shows LVH
164
Transposition of the great arteries
Transposition of the great vessels with an intact ventricular septum presents with early cyanosis, a normal-sized heart (classic “egg on a string”
radiographic pattern in one-third of cases), normal or slightly increased pulmonary vascular markings, and an ECG showing right-axis deviation and
right ventricular hypertrophy. In tetralogy of Fallot, cyanosis is often not seen in the first few days of life. Tricuspid atresia, a cause of early
cyanosis, causes diminished pulmonary arterial blood flow; the pulmonary fields on x-ray demonstrate a diminution of pulmonary vascularity, and
left-axis and LVH are shown by ECG. Total anomalous pulmonary venous return below the diaphragm is associated with obstruction to pulmonary
venous return and a classic radiographic finding of marked, fluffy-appearing venous congestion (“snowman”). In pulmonic atresia with an intact
ventricular septum, cyanosis appears early, the lung markings are normal to diminished, and the heart is large.
165
Cyanotic patient hours after birth and not responding to oxygen. Give them?
prostaglandin E1
166
Thrombocytopenia-absent radius has what heart defects
TOF and ASD
167
Male with turner syndrome like stuff has what disease and what cardiac symptoms
Noonan syndrome think right sided heart stuff like pulmonic stenosis
168
Ehlers-Danlos syndrome associated with what heart defect
Mitral valve prolapse is seen in patients with Ehlers-Danlos syndrome. Patients with Ehlers-Danlos syndrome have hyperextensibility and easy
bruising, joint hypermobility (leading to joint dislocations and sprains), skin that is velvety to touch, and tissue fragility. Six different kinds are
described with “classic” and “hypermobility” forms predominating.
169
Adolescent with syncopal episodes and deafness
QT elongation and deafness = Jervell-Lange-Nielsen syndrome
170
child with difficulty breathing, right arm palsy, but normal CXR. What do you do next
Do a chest ultrasound to look for hemidiaphragm paralysis
171
1 year old runny nose and sneezing then with worsening cough and wheezing on exam? What is it and what to do
Bronchiolitis - monitor oxygen and fluid status. Most things don't really help
172
ingestion of gasoline, kerosene, or furniture polish, what do you do?
symptomatic management. Don't want NG, charcoal etc
173
At what age does a PPD become effective
3 months. Before that treat a child empirically if you are worried about exposures.
174
Repeat pneumonia with hemoptysis. Rapid resolution each time. think about?
Idiopathic pulmonary hemosiderosis
175
What are typical findings in idiopathic pulmonary hemosiderosis
recurrent infections w hemoptysis. Microcytic, hypochromic anemia, low serum iron levels, occult blood in stool (swallowing pulmonary secretions)
176
How do you diagnoise idiopathic pulmonary hemosiderosis
bronchalveolar lavage showing hemisoderin laden macrophages.
177
Some people with pulmonary hemosiderosis have what other hypersensitivity
hypersensitivity to cows milk. called Heiner syndrome.
178
Staph pneumonia with acutely worsening respiratory symptoms worry about?
Tension pneumothorax. Need large bore needle and chest tube aspiration kit
179
Biphasic stridor following a few days of URI. Looks toxic and has difficulty breathing. Normal epiglottis
bacterial tracheitis
180
Kid who eats a lot of dirt with first episode of pneumonia. Found to have a lot of eos
Infection from dog parasite toxocara canis. Need to test with ELISA bc the larvae go from gut to organs but don't return to gut
181
Pus in middle meatus suggests what source?
| Superior meatus
Middle meatus - maxillary, frontal, anterior ethmoid
| Superior meatus - sphenoid or posterior ethmoid
182
How do sinuses change over time in terms of infectio
From birth maxillary and ethmoid can have infection
sphenoid large enough at 3-5 years
frontal large enough at 6-10 years
183
Which organism causing pneumonia can also cause a number other upper respiratory infections?
Mycoplasma pneumonia
184
reversed heart, chronic sinuopulmonary infections
Kartagener syndrome - have primary ciliary dyskinesia
185
When and what causes congenital cystic adenomatoid malformation
embryonic disruption before 35th day - improper bronchiole development
186
Fluctuant mass on the posterior wall of pharynx after few days of low grade fever and sore throat
retropharyngeal abscess
187
2-12 week old who had conjunctivitis earlier now with afebrile pneumonia think
chlamydia trachomatis
188
Young child with decreased breath sounds on one side where you hear normal inspiration but don't hear expiration
Think of foreign body causing air trapping
189
stool filled rectal vault with poor anal sphincter tone
functional constipation
| Hirschrung disease would have normal or excess sphincter tone
190
systemic signs of eosinophilic esophagitis
peripheral eosinophilia or elevated IgE levels
| will see food allergies and eczema etc.
191
When do children start getting intussuception?
After 6 months of age
192
echogenic bowel on prenatal ultrasound hints at
CF meconium ileus developing
193
What is sandifer syndrome
Bending or arching of neck caused by reflux - can be confused for infantile spasm
194
Triad of crohns disease
diarrhea, abdominal pain, weight loss
195
What do you do with a child who regurgitates food and then swallows some of it agtain
behavioral modification. its rumination and related to an attention seeking behavior
196
How do you diagnose meckel's diverticulum
technetium 99m
197
diagnostic test for lactose intolerance
breath hydrogen or acidic stool pH in the presence of a reducing substance
198
When do you consider it to be direct obstructive jaundice?
When dbili is more than 20% of the increase
199
When can ABO and Rh incompatibility lead to direct hyperbilirubinemia
if there is significant hemolysis at birth that causes inspissated bile syndrome
200
How is hypertonic dehydration different in presentation
skin can be doughy and you get less tachycardia and hypotension bc the high sodium means a lot of the fluid loss is from intracellular compartment rather than the extracellular compartment
201
Maxillary frontal teeth decay but normal mandibular frontal teeth
bottle feeding esp with things with high concentration of sugar
202
If you break your teeth how should you transport them?
In saliva or milk
203
Management after ingestion of drain cleaner
Don't try to vomit bc re-expose esophagus again. Just do endoscopic exam in 12-24 hours
204
What are some drugs that charcoal is actually useful for
pnenobarbital and tricyclic antidepressants. sustained release theophylline
205
How do you diagnose EHEC?
Need special sorbitol-MacConkey agar to isolate. Or you can now look for shiga toxin
206
What laboratory test can show vitamin C deficiency
plasma ascorbate level <.2mg/dl
207
CXR with generalized bone atrophy and epiphyseal separation?
Vitamin C deficiency
208
how do you treat labial adhesions?
can just observe and wait for estrogen to kick in during puberty or put topical estrogen cream. Then need petroleum after separation to ensure it doesn't stick together again
209
gray and bloody vaginal discharge since birth with normal exam?
physiologic trauma related to estrogen withdrawal
210
lax, wrinkled abdominal wall, dilated urinary tract, inta-abdominal testicular tissuse. Oligohydramnios, pulmonary problems, other renal problems. Could have club feet
prune belly syndrome
| get lack of abdominal wall muscles, cryptorchidism, and urinary tract abnormalities
211
Baby who is always thirsty and peeing all the time
congenital nephrogenic diabetes insipidus
212
Review fanconi syndrome
Fanconi
syndrome can be hereditary or acquired; hereditary forms are usually secondary to a genetic abnormality such as cystinosis, galactosemia,
Wilson disease, and some mitochondrial abnormalities. A number of agents can cause Fanconi syndrome, including gentamicin (or other
aminoglyco-sides), outdated tetracycline, cephalothin, cidofovir, valproic acid, strepto-zocin, 6-mercaptopurine, azathioprine, cisplatin, ifosfamide,
heavy metals (eg, lead, mercury, cadmium, uranium, platinum), paraquat, maleic acid, and toluene (from sniffing glue). The mechanism of action
of these agents is through acute tubular necrosis, alteration of renal blood flow, intratubu-lar obstruction, or allergic reactions within the kidney
itself. Many of these toxic effects are reduced or eliminated with removal of the offending agent.
213
Asian boy with pain radiating from his abdomen down to his groin
urolithiasis
214
large bladder, large kidneys, weak urinary stream in a male
posterior urethral valve - an obstructing membrane in the posterior urethra
215
what is a pyelonephritis that is taking longer to respond to antibiotics and a wedge shaped focal enlargement of one lobe that has minimal contrast enhancement
acute lobar nephronia - need to do prolonged IV and PO antibiotics
On CT has no cortical rim sign just an area of decreased blood flow
216
Fixing an undescended testis only helps with what potential complication
can help prevent testicular torsion through orchiopexy
217
3 day old infant with blood found in diaper, new abdominal mass. Baby was large for gestational age when born
renal vein thrombosis - kid could also be dehydrated and have polycythemia making it more likely
218
how are rheumatic strains and nephritogenic strains of strep different?
Rheumatic disease only comes from group A strep of pharynx
| post strep nephritis can come from pharyngeal or skin infection (impetigo)
219
coombs test in HUS?
negative
220
Epididymitis is different than testicular torsion how?
Normal cremasteric reflex, pain reduces when you elevated testicle, posterior pain
221
rash on buttocks and extensor surfaces, with renal failure, and abdominal pain - not on face, soles, trunk, and palms
HSP
222
HSP is what type of disease
An IgA mediated systemic vasculitis
223
Unilateral lymphadenopahty is part of what disease?
Kawasaki's disease
224
Initial management of varicocele
Education and wait
225
Management for hydrocele found in first year of life
Just observe
226
Asymptomatic microscopic hematuria - that becomes gross hematuria after respiratory infections is what? and what else is it associated with
Alport syndrome - also get ocular abnormalities and hearing abnormalities
227
What is inheritance of Alport syndrome?
X linked dominant - so guys get it worse
228
Idiopathic hypercalciuria initially presents as?
hematuria, often persistent. dysuria, abdominal pain, don't always get stones formed early
229
What do you have to worry about with acute glomerulonephritis?
Get oliguria (looking like dark,cola urine). Need to sometimes restrict fluids to make sure you don't get volume overload
230
Where do you normally get edema in nephrotic syndrome
periorbital and scrotal in boys
231
Berger nephropathy associated with?
HSP
232
prevention/treatment for malignant hyperthermia is
dantrolene
233
How to identify patients at risk for malignant hyperthermia?
caffeine contracture test
234
Headache, seizure, atazia, fatigue 2 weeks after infection with multiple white lesions on MRI think
ADEM - acute disseminated encephalomyelitis
235
What do you use instead of edrophonium to test for MS in young kids
neostigmine. Avoid bc can cause cardiac arrhythmias in kids
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hemisyndrome with eyes looking away from the paralyzed side makes you think of?
infantile hemiplegia
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developmental deterioration, macular cherry-red spots, sensitivity to sound is what disease and what mutation
Absence of Beta hexosaminidase A activity in WBCs and is Tay Sach's disease
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Fabry disease - absence of alpha galactosidase
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myotonic muscular dystrophy is different than most other muscular dystrophies in that it?
affects distal muscles more than proximal
240
What is common problem that occurs alongside myotonic muscular dystrophy?
cataracts
241
Tuberculous meningitis findings on CT scan with contrast
exudate on basal cisterns that enhances
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tuberous sclerosis sometimes treated with?
rapamycin
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cranial nerve abnormalities, long-tract signs, unsteady gate and behavioral changes
pontine glioma
244
Patient with tetrology of fallot and an infection suddenly has neuro symptoms why?
He has a brain abscess bc tetralogy of fallot allows for right to left shunts
245
unilateral pupillary defect, hemiplegia, seizures after a fall worry about
an epidural hematoma causing downward herniation of temporal lobe compressing ipsilateral CN III and brainstem
246
triplet repeat expansion on chromosome 9
Friederich's Ataxia
247
What is more common infratentorial or supratentorial tumors in kids
Until 1 year of life supratentorial more common
1-10 get more infratentorial tumors
>10 supratentorial tumors become more common again
248
constipation is presenting first symptom of?
Botulism
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CNS degeneration, liver/spleen elargement, macroglossia, coares facial features, cherry-red spot on eye at birth
GM1 gangliosidosis type 1 with complete absence of acid Beta galactosidase activity
250
Normal children at birth with rapid decline in motor and cognitive function, btwn 16-18 mo. In girls lose control of their hands and get social withdrawal
Rett's syndrome
251
How long do febrile seizures normally last?
Only 2-5 minutes. Longer and you should be worried
252
peroneal and intrinsic foot muscle atrophy, then intrinsic hand muscle atrophy, then legs?
Charcot-Marie-Tooth disease
253
Periventricular calcifications classic for
congenital CMV infection
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scattered and soft appearing calcifications in cortex classic for?
congenital toxo infection
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achromic skin patches and infantile spasms
tuberous sclerosis
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decreased fetal movement, general hypotonia and arefelxia with fasciculations
degeneration of anterior horn cells in SMA type 1
| Normally you have selective degeneration bc functional gene
257
When does duchenne's muscular dystrophy usually start to present itself?
Kid reaches normal milestones but starts showing the weakness around 2 years. by 7-12 years in a wheel chair
258
Syndeham chorea triggered by?
An infection with Group A beta hemolytic strep
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unilateral facial lesion and blindness suggests
Sturge-Webber syndrome or PHACE syndrome
260
What does PHACE syndrome involve?
posterior fossa malform, hemangioma, arterial anomalies, coarctation of the aorta, cardiac defects, eye abnormality
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large, irregular unilateral cafe-au lait spots and fibrous dysplasia of bones in precocious puberty in girls, goiter
McCune Albright syndrome
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coryza, conjunctivitis, widespread maculopapular rash with white pinpoint lesions on mucosa
measles
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maculopapular rash for 3 days, enlargement of posterior cervical and occipital lymph nodes
german measles or rubella
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sore throat that progresses to adherent membrane covering tonsils, uvula, palate, posterior oropharynx etc.
Diphtheria
265
What do you do in infant born to HIV mother before confirm HIV status
PCP prophylaxis
266
aspirin + viral infection =
Reye syndrome an acquired mitochondrial hepatopathy
267
Common cause of death in Reye's syndrome
cerebral edema
268
Seizures and bloody diarrhea
Shigella
269
Kawasaki disease treatment?
apsirin gama globulin
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What cause of tinea capitis fluoresces under wood lamp
microsporum canis
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Exposure to animals fever, rash, meningismus
leptospirosis - most are mild
272
Age range for kawasaki's disease
under 5 years
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Any general infection like otitis media with a new change in AMS in young infant
LP to check for meningitis
274
Newborn with sibling who developed pertussis
Give newborn erythromycin
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CBC findings in EBV mononucleosis
predominance of lymphocytes with at least 10% being atypical
276
How long does it take to get finding on Xray for osteomyelitis
Can take days to get soft tissue changes and up to 12 days to see actual changes in bone
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16 day old infant with meningitis from gram positive rod
Late onset Listeria monocytogenes
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well appearing infant with sudden elevated fever and and left shift in WBC and markedly elevated WBC
pneumococcal bacteremia - can also consider H flu and meningococcus
279
When does rubella really harm the fetus?
at the first 2 months
280
What is dacrocystitis
infection of nasolacrimal sac
281
posterior and occipital lymphadenopathy with 3 days of fever
rubella
282
What is a possible worrisome complication of mumps
CNS meningitis that can occur during mumps or 10 days after
283
prophylaxis for bat bite?
wound cleaning + rabies immunoglobulin + five injection rabies vaccine
284
RMSF treatment options
have to use doxy. Amox doesn't work like it does in lyme
285
thrombocytopenia + eczema + increased susceptibility to infection
Wiskott-Aldrich syndrome = X linked recessive combined immunodeficiency
286
2 weeks of diarrhea in kid who is at daycare with people getting diarrhea
Crypto - even though immunocompetent can get it. Can pick it up on microscopy
287
erythema multiforme + vesicular, ulcerated lesions of mucous membranes
stevens-johnson syndrome
288
DRESS stands for? and associated with?
Drug rash, eosinophilia, systemic symptoms
| associated with anticonvulsants
289
weakness, facial swelling, muscle pain, fever eos on CBC. GI symptoms earlier. from rural central america
ate improperly cooked T spiralis
290
How do you treat trichanella spiralis
mebendazole or albendazole
291
contraindications to LP
severe ICP without an open fontanelle
skin infection at puncture site
uncontrolled bleeding disorder
too unstable
292
Most common cause of croup
parainfluenza virus
293
Digeorge syndrome has hypoplasia of what?
Thymus and parathyroid glands bc defective embryologic development of third and fourth pharyngeal pouches
294
Immunoglobulins in Wiskott-Aldrich syndrome
diminished IgM. Elevated IgA and IgE
| Also have thrombocytopenia
295
hypergammaglobulin E, eczema like rash, recurrent severe staph infections
Job-Buckley syndrome - disorder of phagocytic chemotaxis
296
How is wound through a tennis shoe vs on bare foot different?
Through tennis shoe can get pseudomonas bc warm wet conditions
Through bare foot get outdoor stuff like staph
297
Bartonella Henselae causes
catch-scratch disease
298
young child with few days of high fever that quickly goes away and followed by an evanescent maculopapular rash
Roseola - mostly caused by HHV-6
299
infant with interstitial infiltrates, eosinophilia. No fever. Mom had?
Chlamydia trachomatis infection
300
Under 1 year old with URI for a few days that suddenly becomes bad fever with severe respiratory symptoms?
Staph pneumonia
301
Learn the fungal causes of pneumonia
learn fungal causes of pneumonia
302
What is the concern with prednisone for treating suspected ITP
Would want to do a bone marrow biopsy first to rule out leukemia.
303
When are levels of erythrocyte protoporphyrin elevated?
lead poisoning or when iron levels are severely limited
304
Sickle cell patient with stroke. What is first thing you do
blood transfusion to dilute out sickled cells
305
sickle cell daily treatment?
folate and penicillin
306
What is kasabach-Meritt phenomenon
large vascular anomalies cause sequestration at birth getting thrombocytopenia, coagulopathy and MAHA
307
infantile fibrosarcoma in an infant often mistaken for a
infantile hemangioma - think this when the hemangioma is not resolving
308
rash, fever, lymphadenopathy wtih associated pneumonia or sepsis every 3 weeks. Treat with?
cyclic neutropenia - treat with recom human granulocyte colony-stimulating factor
309
When does hgb reach physiologic nadir
6-8 weeks
310
pale baby who is otherwise normal with good retic coung and no ABO incompatability what happened?
fetomaternal transfusion
311
Why do you get a reading of atypical lymphocytes on smear in leukemia
Actually blasts but read as atypical lymphocytes
312
aniridia in an infant, check for?
Wilm's tumor aka nephroblastoma
| Both associated with chromosome 11 mutation
313
Eosinophilia in a healthy newborn likely caused by?
helminth infestation
314
What can cause spherocytosis other than hereditary spherocytosis
ABO incompatibility (not Rh), G6PD, hyperthermia,
315
PT in hemophilia A and B?
Not prolonged
316
thrombin time test for
conversion of fibrinogen to fibrin
317
VWF type 1, with some acute bleeding
Give desmopressin
318
Ewing sarcoma rarely occurs in?
Blacks
319
Bone pain that occurs in the middle of the night is concerning or not concerning?
very concerning
320
lymphadenopathy of cervical and inguinal areas with cough and nightly fevers what should you do first?
Get a CXR. suspecting hodgkins. Get CXR before lymph node biopsy
321
Child starts having jaundice, hepatomegaly, seizures after starting to drink fruit juice.
hereditary fructose intolerance
| Will have reducing substance on urine test
322
Gaucher disease characterized by? What do you see in Xray
Beta glucocerebrosidase deficiency
| - get erlenmyer flask appearing long bones
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Child born to mother with hyperthyroidism gets
heart failure, thrombocytopenia, microcephaly etc.
| All low things because the body is overdoing it
324
What penile length and testicular volume indicates that some pubertal development has occured
penis longer than 2.5cm, Testicular volume greater than 3 cubic centimeters
325
unilateral or bilateral deafness, heterochromia irides, white forelock
Waardenburg syndrome
326
Most common cause of goiter in western child
lymphocytic thyroiditis
327
10 year old very overweight, short, has osteopenia on xray, hypertension has?
If this was an infant?
congenital adrenal hyperplasia
if infant its adrenal carcinoma
328
patients with galactosemia at increased risk of?
E. Coli sepsis
329
elevated blood or urine succinylacetone
tyrosinemia
330
elevated leucine, isoleucine, valine, depression of alanine
maple syrup urine disease
331
In achondroplasia what ratios are off
the limbs are short and head is large
332
prolonged jaundice and constipation
hypothyroidism
333
macrosomic w/ macroglossia, abdominal wall defects, organomegaly, linear ear creases. Hypoglycemia as newborn
Beckwith- Wiedemann syndrome
| have increased incidence of cancer
334
constitutional short stature have what bone age and height age
bone age and height age that are younger than chronologic age. So although shorter will have time to grow and reach a good height
335
neuro complication of achondroplasia
hydrocephalus bc boney overgrowth at foramen magnum
336
first step in evaluating solitary thyroid nodule found on exam
serum thyroid function tests
337
long term complication of patients with bilateral retinoblastoma
Some other primary tumor - most commonly an osteosarcoma
338
short, delayed bone age, mental retardation, increased bone density, brachydactyly, obesity, subcapsular cataracts, lots of calcifications
pseudohypoparathyroidism or Albright hereditary osteodystrophy
body doesn't respond to PTH so look hypoparathyroid but have high PTH
339
Immobilized following fracture of weight bearing bone can get
hypercalcemia
340
In 21 hydroxylase deficiency what do you find on labs
elevated 17 hydroxyprogesterone deficiency beyond 3 days of life
341
urine turns black on exposure to oxygen
alkaptonuria - deficiency of homogenistic acid oxidase
342
What do you get in the kidneys with wilson syndrome
Fanconi syndrome - renal tubular dysfunction. RTA type 2 with lots of other absorption problems
343
Menkes syndrome vs wilsons disease
In menkes have low ceruloplasmin and low copper
344
hypothermia, hypotonia, myoclonic seizures in first months of life
Menkes syndrome
345
What are the renal findings in vitamin D deficiency
phosphaturia and hypocalciuria bc low calcium and phosphate stimulates PTH which triggers release of phosphate and reabsorprtion of calcium
346
tetany and convulsions in first 72 hours of life likely
idiopathic hypocalecmia - from maternal problems, resp distress, low birth weight, hypomagnesemia
347
lab findings in patients with vitamin-D resistant ricketts
genetic abnormality in reabsorption of phosphate in kidneys
| get hypophosphatemia with usually normal calcium
348
blue sclera, easily broken bones what is it and what are lab ca and phos
osteogenisis imperfecta - have normal Ca and Phos
349
obesity, mental retardation, hypogonadism, polydactyly, retinitis pigmentosa with night blindness
Laurence - Moon- Biedl syndrome also called Bardet-Biedl
| Think moon is fat and at night.
350
what abnormality do you see on lab values of G6PD deficiency
patients are hyperlipidemic. Increased TG levels cause factitiously low electrolyte values
351
newborn with low sloping shoulders, hand attached at elbow, agenesis of forearm, missing chest wall musculature, birid thumb
Holt-Oram syndrome
352
Mitochondrial disease mainly involves what organs?
Neuro and muscle
353
hypopigmented whorls on upper extremities
hypomelanosis of Ito
354
isoretinoin problems?
teratogenic
liver abnormalities. Messes with your lipids
can cause muscle pain
355
treatment of trunk acne
benzoyl peroxide with some added retinoic acid if you want
356
first hint of hypertrophic cardiomyopathy can be?
passes out during practice or at a game
357
What defines a grade 1 concussion?
no loss of consciousness and gets back to normal under 15 minutes
358
small papules on genitals that become pustular, erode, ulcerate with concomitant painful inguinal lymphadenopathy
chancroid
359
painless papule on genital that resolved. now has unilateral draining inguinal lymphadenitis
lymphogranuloma venereum - serotype of C trachomatis
360
How to differentiate chancroid and lymphogranuloma venereum
chancroid has lymphadenopathy at same time as ulcer or ulcers.
361
Mostly shoulder injuries including rotator cuff tendinitis think
swimming
362
osgood schlatter seen in what sports
basketball and volleyball
363
Most common injury in skiiers
skiers thumb - abductiona nd hyperextension of thumb spraining of ulnar collateral ligament
364
Diseases that involve triplet repeats
Fragile X, DMD, Huntington chorea, Friedreich ataxia
