Random Questions

Question 1

In the neonate, unequal thigh folds can indicate which of the following?

Answer 1

developmental hip dysplasia

(a dislocated hip displaces proximally in developmental hip dysplasia, causing a shortening of the leg that may present as unequal thigh folds)

Question 2

What is nursemaid’s elbow?

Answer 2

radial head dislocation (from grabbing the child by the wrist and pulling him up off the floor)

reduce–by supination and flexion of elbow (palpable click when successful)

Question 3

What if the first line treatment for Lyme disease in patients under 12 yo?

Answer 3

amoxicillin

(doxycycline for pts older than 12 yo due to harmful effects on teeth and bones)

Question 4

The most accurate way to determine the exact degree of spinal curvature with scoiliosis is to do what…

Answer 4

calculation of the cobb angle

(using AP and lateral Xray films of the entire length of the spine)

Question 5

10 yo male presents with pain in his leg worse at night. Aspirin relieves pain and pt denies trauma. PE reveals point tenderness over tibia and pt has a limp. Radiographs show a 1 cm radiolucent nidus surrounded by osteosclerosis.

What is the Dx?

Answer 5

osteoid osteoma

(osteoid sarcoma is a benign tumor in children 5 - 20 yo, presents with increasing pain, worse at night and relieved by aspirin)

Question 6

at a 4 wk old WCC, an infant with a history of breech birth, needs what to rule out developmental hip dysplasia?

Answer 6

physical exam is sufficient at this time (typically get a US at 6 wks)

risk factors for DDH: + FH, ligamentous laxity, breech presentation, female gender, large fetal size, first-born status

Question 7

A child has tried two courses of Abx therapy for otitis media (first amoxicillin and then augmentin). What is the next best step?

Answer 7

tympanocentesis

(the child has unresponsive acute OM having failed two courses of appropriate therapy. tympanocentesis is indicated to ID the organism and pick the best Abx)

Question 8

What is the first line agent for a child with acute otitis media?

Answer 8

amoxicillin

and then augmentin for resistant cases, not initial treatment

Question 9

What is the treatment of choice for streptococcal pharyngitis?

Answer 9

penicillin

(erythromycin is a good choice for someone who is PCN-allergic)

Question 10

A child presents with acute epiglottitis. What is the best step?

Answer 10

Epiglottitis requires endotracheal intubation to maintain the airway but should only be done in the OR or ER with a competent physician

Question 11

a 3 yr old presents with sore throat and fever. the child appears toxic and is having trouble handling oral secretions.

What is the next step in evaluating this patient?

Answer 11

order a lateral neck Xray study

classic “thumbprint” sign for epiglottitis

Question 12

treatment of choice for resistant bacterial sinusitis, especially in children with risk factors (daycare attendance, Abx treatment 1 - 3 months prior, age younger than 2 years)

Answer 12

Augmentin

Question 13

a 4 yo child presents with rapid onset high fever and extremely sore throat. what would be suggestive of the Dx of epiglottitis?

Answer 13

croupy cough and drooling in a patient who appears very ill

examining the throat is contraindicated unless the airway can be maintained

Question 14

A 2 wk old male newborn presents to the office for WCC. He is breastfed and the mother follows a vegan diet. What vitamin is the patient at the greatest risk for deficiency?

Answer 14

vitamin B12 (CYANOCOBALAMIN)

mainly found in animal products

Question 15

3 yo boy brought to the office by his parents for WCC. ht is in the 3rd percentile and wt is in the 1st percentile. he has constant sinus infections and pneumonia. he has stools that are generally loose, greasy, and mucousy. What is the most effective study to diagnose this patient?

Answer 15

sweat chloride test

(characteristic sx of CF: growth delay, multiple upper and lower respiratory tract infections and malabsorption)

Question 16

What is Wilms tumor?

Answer 16

nephroblastoma typically presenting with an asymptomatic abdominal mass or increasing size of the abdomem

mass feels smooth and firm, well defined and typically does not cross midline

gross hematuria can be present but rare

MC solid renal tumor of childhood – arises from the kidney and is usually seen in otherwise healthy children < 4 yo

associated conditions: WAGR syndrome

• Wilms tumor
• aniridia
• genitourinary anomalies
• retardation

Question 17

How do you diagnose a Wilms Tumor? And how do you manage it?

Answer 17

ultrasound and abdominal CT

followed by

biopsy or resection

Surgical resection and chemo for treatment; most cases are curable

Question 18

4 yo girl brought for WCC. parents say she’s healthy but they notice she tires more quickly than her peers. BP is 132/82 in R arm and 128/80 in L arm. What is the most appropriate next step?

Answer 18

measure BP in lower extremities

this component of PE can exclude coarctation of the aorta as a cause of secondary HTN in this child

Question 19

What does the diagnosis of sickle cell anemia require?

Answer 19

(+) HgbS on hemoglobin electrophoresis

Hb SS = disease

Hb SA = trait

treat with high flow O₂ and pain control during crisis

supportive transfusion when Hg < 6

Question 20

What should you administer to a neonate pt with sickle cell disease?

Answer 20

penicillin

(administration in children < 5 yo with sickle cell disease because it decreases the risk of serious bacterial infections such as pneumonia)

hydroxyurea is a medication used to treat sickle cell crises (chemo used to slow the growth of cells in cancer patients/prevent formation of sickle-shaped RBCs in sickle cell pts)