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Flashcards in UWorld - Peds Deck (272):
1

Wiskott-Aldrich syndrome:
- Mechanism
- Symptoms

- X-linked recessive defect in WAS protein, causing impaired cytoskeleton in leukocytes and platelets
- Eczema, thrombocytopenia, recurrent infections

2

Juvenile idiopathic arthritis:
Lab findings

- Anemia (Low HgB)
- High Ferritin
- Thrombocytosis (High platelets)
- High gammaglobulin
- High inflammatory markers (ESR, CRP)

3

Corkscrew pattern on barium swallow

Midgut volvulus

4

Most common cause of cyanosis in neonatal period:
Dx
Tx

Dx = Transposition of Great Vessels
Tx = Prostaglandins to keep ductus arteriosus patent

5

Most common cause of viral meningitis.

Enteroviruses (e.g. group B coxsackievirus)

6

Complete atrioventricular septal defect is most commonly associated with _________

Down syndrome

7

Patent ductus arteriosus is strongly associated with _____

Congenital Rubella Syndrome

8

DiGeorge is associated with what heart defect?

Tetralogy of Fallot

9

Acute unilateral lymphadenitis in a child

Staph aureus

10

Dx: Child with cervical paravertebral mass and Horner's syndrome (ptosis, anhydrosis, miosis)

Neuroblastoma of cervical paravertebral sympathetic chain

11

Dx: Positive acidified glycerol lysis test

The glycerol lysis test demonstrates cellular osmotic fragility. It is used to diagnose hereditary spherocytosis.

12

Dx: Newborn with X-ray showing fluid in the interlobar fissures
Tx?

Transient tachypnea of the newborn
Tx: self resolution in 1-3 days

13

Dx: genu varum

= bowlegged = rickets = vitD defi

14

Most common cause of acute bacterial rhinosinusitis and the treatment.

Cause: Streptococcus pneumoniae OR Haemophilus influenzae.
Tx: amoxicillin-clavulanic acid

15

Dx: Inspiratory stridor that worsens in the supine position and improves in the prone position

Laryngomalacia (Increased laxity of supraglottic structures)

16

When to use EDTA + Dimercaprol

When Pb levels are above 70. OR in lead poisoning accompanied by acute encephalopathy.

17

When to use succimer.

Chelation in Pb toxicity when Pb levels are between 45-69

18

When to use ferrous sulfate

Tx of iron defi

19

Henoch-Schonlein Purpura pathogenesis and symtpoms

Pathogenesis = IgA vasculitis
Symptoms = Lower extremity purpura, lower extremity arthralgia, abdominal pain / intrussusception, renal disease (hematuria)

20

Acute bacterial rhinosinusitis:
definition and Tx`

Definition = more than 10 days of symptoms
Tx = amoxiciliin +/- clavulinate

21

Medical abortion medication

Mifepristone and Misoprostol

22

Medication that prevents pregnancy by delaying ovulation. Effective within 72 hours after intercourse.

Levonorgestrel

23

Genotypical male (46 X,Y), but phenotypical female

Androgen insensitivity syndrome

24

Inactivated vaccines

Polio
HepA

25

Toxoid vaccines

Diphtheria
Tetanus

26

Live attenuated vaccines

Rotavirus
Measles
Mumps
Rubella
Varicella

27

Conjugated vaccines

HepB
Pertussis
Haemophilus influenzae type B
Pneumococcal
Meningococcal
Human papilomavirus
Influenza (injection)

28

Dx: Periosteal elevation of femur

Codman triangle, demonstrates osteosarcoma

29

Lytic lesion in bone of pediatric patient

Langerhans cell histiocytosis

30

Location of Osteosarcoma in bone

Metaphysis

31

Location of Langerhans cell histocytosis in bone

Skull, jaw, femur

32

Dx: Bone pain with hypernatremia

Central Diabetes insipidus caused by langerhans cell histocytosis

33

Dx: Blue sclerae

Osteogenesis imperfecta

34

What type of vaccine is the rubella vaccine?

Live attenuated

35

Congenital Rubella 3 clinical findings

- Sensorineural hearing loss
- Cataracts
- Patent ductus arteriosus

36

Congenital Toxoplasmosis 3 clinical findings

- Chorioretinitis
- Hydrocephalus
- Diffuse intracranial calcifications

37

Congenital Cytomegalovirus 2 clinical findings

- Chorioretinitis
- Periventricular calcifications

38

Congenital varicella syndrome 3 clinical findings

- Limb hypoplasia
- Cataracts
- Distinctive skin lesions (scarring)

39

Congenital syphilis 3 clinical findings

- Nasal discharge
- Hepatomegaly
- Osteoarticular destruction

40

Treatment of pertussis if individual is not vaccinated

Macrolides

41

Treatment for iron poisoning

Whole bowel irrigation
Deferoxamine (chelation therapy)

42

Symptoms of iron poisoning within 30 minutes to 4 days

- Abdominal pain
- Vomiting
- Diarrhea
- Hypotensive shock
- Metabolic acidosis

43

Dx when symptoms are dysphagia, drooling and respiratory distress

Epiglottitis associated with Haemophilus influenzae type b

44

Dx: Tympanic membrane with peripheral granulation and some skin debris

Cholesteatoma

45

How does Rubella present in unvaccinated adolescents (3 symptoms)?

1) Fever
2) Rash (cephalocaudal spread of maculopapular rash)
4) Arthralgias

46

How does congenital Rubella (German Measles) present (3 findings)?

1) Sensorineural hearing loss
2) Cataracts
3) Paten ductus arteriosus

47

What is the difference between preseptal cellulitis and orbital cellulitis?

Orbital cellulitis is essentially a more severe form of preseptal cellulitis. Both preseptal cellulitis and orbital cellulitis involve eyelid erythema and swelling. However, patients with orbital cellulitis also present with pain with extraocular movements and diplopia. Preseptal cellulitis is treated with oral antibiotics. However, orbital cellulitis is treated with intravenous antibiotics and sometimes surgery.

48

Sandpaper rash. Dx?

Scarlet fever from streptococcus pyogenes.

49

Scarlet fever:Cause

Cause = Strep pyogenes

50

Scarlet fever: Symptoms

Symptoms = fever, pharyngitis, tonsillary erythema/exudates, strawberry tongue, tender anterior cervical lymph nodes, sandpaper rash

51

Scarlet fever: Lab test

- rapid strep antigen test
- throat culture

52

Scarlet fever: Tx

Tx = Penicillin

53

"slapped cheek." Dx and cause?

Dx = erythema infectiosum
Cause = parvovirus B19

54

Hand foot and moth disease cause.

Coxsackievirus

55

Criteria for diagnosis of Kawasaki

5 days of fever and more than 4 clinical criteria:
- >1.5 cm cervical node
- polymorphous rash
- edema of the hands/feet
- conjunctivitis
- mucosal changes (eg strawberry tongue, dry/cracked lips)

56

Superficial flaccid bullae on the skin of an infant. Dx?

Staphylococcal scalded skin, caused by Staph aureus

57

Symptoms of rubeola (measles) infection

Prodrom of cough, coryza, conjunctivitis, fever, Koplic spots)
Followed by maculopapular rash: cephalocaudal, sparing the palms and soles.

58

Treatment of rubeola infection for hospitalized patients

Supportive
and
Vitamin A

59

When and how to treat nasal discharge with antibiotics?

Acute bacterial rhinosinusiitis is treated with amoxicillin and clavulanate. Acute bacterial rhinosinusitis is differentiated from viral upper respiratory infection by worsening of symptoms with more than 10 days without improvement.

60

Treatment of acute otitis media.

Oral antibiotics:
Initial: amoxicillin
2nd-line: amoxicillin-clavulanic acid

61

Otitis externa. Tx?

Otic antibiotic drops

62

Most common cause of acute otitis media

Strep pneumoniae

63

Criteria for tympanostomy tube placement

More than 3 episodes in 6 months.
More than 4 episodes in 12 months.

64

Sticky stools with streaks of blood. Dx?

Intrussusception

65

What do you see on ultrasound for instrussusception?

Target sign

66

What is the purpose of the Technetium-99m scan?

To diagnose Meckel diverticulum

67

What is the purpose of Anorectal Manometry?

To diagnose Hirschsprung disease

68

Best test for pyloric stenosis

Abdominal ultrasound

69

Triple bubble sign. Dx?

Jejunal atresia

70

Treatment of children with severe dehydration

IV normal saline

71

1 side of body is larger than the other in a baby. Dx? Complications of this Dx? How to monitor for complications?

Dx = Beckwith-Wiedemenn syndrome
Complications = Wilms tumor, Hepatoblastoma
Monitor = Serum alpha fetoprotein (hepatoblastoma) and Abdominal ultrasound (Wilms tumor)

72

Rare but potentially fatal complication of infectious mononucleosis. Tx?

Acute airway obstruction.
Tx = corticosteroids

73

Acute rheumatic fever is a complication of ______

Group A streptococcal (GAS) pharyngitis
(aka Strep pyogenes)

74

Complication of Kawasaki disease.

Coronary artery aneurysm

75

Low B lymphocyte count. Dx?

X-linked (Bruton) agammaglobulinemia (XLA)

76

Defect in dynein. Dx?

Primary ciliary dyskinesia

77

When is varicella zoster vaccine given?

2 doses at ages 1 and 4

78

When is postexposure prophylaxis with VZV vaccine indicated?

For incompletely immunized child age >1 year who was exposed to chicken pox within the last 5 days.

79

When do you administer varicella immunoglobulin?

Varicella vaccine is made from a live virus, so it is contraindicated in pregnant women, immunocompromised hosts and neonates. In these populations varicella immunoglobulin is used instead (within 10 days of exposure to chicken pox).

80

Lateral neck X-ray demonstrates widened prevertebral space. Dx?

Retropharyngeal abcess (RPA)

81

What coagulation problem do patients with cystic fibrosis develop?

Vitamin K deficiency, due to CF patient's exocrine pancreas insufficiency, they cannot absorb the fat-soluble KADE vitamins.

82

What clotting factors are associated with Vitamin K?

Factors II, VII, IX, X, proteins C and S

83

Tinea corporis (ringworm). Tx?

Clotrimazole (topical antifungal)

84

Diaper dermatitis. Cause? Tx?

Cause = candida
Tx = topical nystatin

85

Teeth appear translucent and gray. Dx?

Dentinogenesis imperfecta, due to osteogenesis imperfecta

86

CBC in idiopathic juvenile arthritis

High WBC
High PLT
Low HgB

87

Limited upward gaze. Dx?

Parinaud (dorsal midbrain) syndrome, due to Pinealoma

88

Respiratory distress syndrome (RDS) in neonate.
Cause?
Risk factors?

Cause: immature lungs & lack of surfactant
Risk factors: Prematurity & Gestational Diabetes

89

Low platelets after a viral infections. Dx?

Immune Thrombocytopenia (ITP)

90

Cough with vomiting. Dx? Tx?

Dx = Bordetella pertussis
Tx = Macrolide (azithromycin, clarithromycin)

91

Dx? Newborn with left axis deviation on EKG and decreased pulmonary markings on chest radiograph.

Tricuspid valve atresia

92

What heart defect is diGeorge syndrome associated with?

Truncus arteriosus, where the aorta and pulmonary artery have a common outflow.

93

CD3+ is what cell type?

T cells

94

Diagnosis:
Child with abscess that is filled with neutrophils

Chronic granulomatous disease

95

Organisms associated with chronic granulomatous disease

Catalase Positive organisms:
Staphylococcus aureus
Aspergillus
Burkholderia
Serratia

96

What is the defect and chronic granulomatous disease?

Deficiency of oxidative burst (Hydrogen peroxide formation)

97

What lab testing is used for the diagnosis of chronic granulomatous disease?

Neutrophil function testing:
1) Nitroblue tetrazolium test
2) Dihydrorhodamine 123 test

98

Age of three finger grasp and age of two finger grasp.

Three finger grasp at nine months.
Two finger grasp at 12 months.

99

At what age should a baby be able to turn head to its name.

Six months

100

Yellow, oily scaling on face and scalp. Dx? Tx?

Dx = Seborrheic dermatitis, associated with colonization by Malassezia species
Tx primary = Emolient, non-medicated shampoo
Tx secondary = Topical antifungal or glucocorticoids

101

Recurrent severely pruritic rash not related to any contact, associated with family history of asthma or allergies. Dx?

Atopic dermatitis.

102

Recurrent severely pruritic rash that is related to some contact and may be associated with family history of asthma or allergies. Dx?

Contact dermatitis

103

Scaly lesions that form round or oval plaques typically on elbows and knees. Dx?

Psoriasis

104

Fine white scales on scalp only. Dx?

Tinea capitis

105

Painful, non-pruritic pustules with honey-crusted adherent coating. Dx? Organism?

Impetigo
- Staph aureus
- Strep pyogenes (Group A Strep)

106

Painful vescicular rash with "punched-out" erosions and hemorrhagic crusting. Dx? Organism?

Eczema herpeticum
- Herpes simplex type 1

107

Flesh-colored papules with central umbilication. Dx? Organism?

Molluscum contagiosum
- Poxvirus
(NOT chicken pox, which is caused by varicella zoster)

108

Pruritic circular patch on body with central clearing and raised, scaly border. Dx? Organism?

Tinea corporis
- Trichophyton rubrum

109

Fever, blisters, epidermal shedding with light pressure. But NO involvement of mucous membranes. Dx? Organism?

Staphylococcal Scalded Skin Syndrome
- Staph aureus

110

Pt with fever and well demarcated area of erythema, but NOT epidermal shedding. Dx? Organism?

Erisypelas
- Strep pyogenes (group A strep)

111

Pink sand-paper rash in a child that has recently had pharyngitis. Dx? Cause?

Scarlet fever
- Strep pyogenes (Group A Strep)

112

Skin blistering that covers >30% of body with involvement of mucous membranes, after starting a new medication. Dx?

Toxic epidermal necrolysis

113

Sharply defined perianal rash. Dx? Organism?

Streptococcal perianal dermatitis
- Group A Strep (Strep Pyogenes)

114

Perianal rash with satellite lesions. Dx?

Candida dermatitis

115

Treatment of Lyme in child vs. adult

Child under 8 = amoxicillin
Over 8 = doxycycline

116

Child with maculopapular rash that spares the palms and soles. Dx? Tx?

Dx = measles (rubeola)
Tx= Vit A + Supportive

117

Koplik spots. Dx?

Dx = measles (rubeola)

118

What test to perform if child has psychosis but also proteinuria and hematuria?

Test for antinuclear antibodies
BECAUSE child may have
Systemic Lupus Erythematosus

119

Mnemonic and list of findings in SLE

RASH OR PAIN:
Rash (malar or discoid)
Arthritis
Serositis (pleuritis, pericarditis)
Hematologic disorders (cytopenias)
Oral/nasopharyngeal ulcers
Renal disease
Photosensitivity
Antinuclear antibodies
Immunologic disorder (anti-dsDNA, anti-Sm, antiphospholipid)
Neurologic disorder (seizures, psychosis)

120

What type of kidney injury is associated with Sickle Cell Trait?

Acute Papillary Necrosis

121

Children aged ________ must receive a renal and bladder ultrasound after a UTI to assess for anatomic abnormalities.

< 2 yrs

122

The clinical manifestations of Henoch-Schonlein purpura.

- Palpable purpura
- Arthritis/arthralgia
- Abdominal pain - intrussusception
- IgA nephropathy

123

At what age do symptoms of pyloric stenosis usually present?

3-5 wks

124

Keratomalacia.
Definition?
Dx?

Keratomalacia = wrinkling, cloudiness of cornea
Dx = Vit A deficiency

125

Pancreatic pseudocyst is a complication of _________.

Pancreatitis

126

Biliary cysts present at what age?

< 10 yrs old

127

Classic Triad of symptoms for Biliary cysts.

1) RUQ pain
2) Jaundice
3) Palpable mass

128

Anti-tissue tranglutaminase antibody assay.
- Used for diagnosis of what?

Celiac disease

129

How to diagnose baby colic.

Baby colic is a type of pain that starts and stops abruptly, often occurs at the same time every day. Diagnostic features: Crying for more than three hours per day, more than three days per week, more than three months.

130

Hematochezia and eczema in a one month old infant. Diagnosis?

Milk or soy protein induced enterocolitis.

131

Three reasons for physiological jaundice in a newborn.

1) Low hepatic UGT activity
2) Low red blood cell lifespan
3) high enterohepatic recycling of bilirubin

132

If an infant has tracheoesophageal fistula, what other conditions are associated with this?

Mn* VACTERL
Vertebral
Anal atresia
Cardiac
Tracheoesophageal fistula
Renal Limb

133

Next step in management, if you suspect UTI in an infant that wears diapers.

1) BUN/CR
2) Catheterization
3) Urinanalysis
4) Urine culture

134

Newborn with flattened facies, abdominal distension, clubfeet and decreased aeration of lungs. Dx? Mechanism of disease?

Potter Sequence
Urinary tract anomaly (most often posterior urethral valves) cause oliguria (small urine production) in utero, which causes oligohydramnios (deficiency of amniotic fluid), which causes the 3 findings:
1) Pulmonary hypoplasia
2) Flat facies
3) Limb deformities

135

define: Hypospadias

A congenital abnormality where the penile urethra opens on the ventral side of the penis rather than the tip.

136

Most common cause of urinary tract obstruction in newborn boys

Posterior urethral valves

137

Normal Urine pH

4.5 - 8

138

Normal specific gravity of urine

1.01 - 1.03

139

define:Hyposthenuria

Inability of the kidneys to concentrate urine, causing low urine specific gravity.

140

Normal Serum Sodium
Low Urine Specific Gravity
Dx?

Sickle cell trait
- response to poor renal perfusion is hyposthenuria, but intact ADH results in normal serum sodium.

141

High Serum Sodium
Low Urine Specific Gravity
Dx?

Diabetes Inspidus,
- due to insufficient ADH production (central) or poor ADH response (nephrogenic).

142

How to diagnose the type of Diabetes Insipidus. Central vs. Nephrogenic?

Water deprivation test
- hold water, administer ADH
- measure urine osmolarity in response to ADH

143

After pediatric UTI -- what are the indications to perform a renal and bladder ultrasound?

If the first UTI is at age 2-24 months
OR
If this is the second or more -- UTI

144

Urinary test for Cystinuria

Cyanide-Nitroprusside test

145

Severe periodontal infections. What is the immunodeficiecy?

Leukocyte Adhesion Deficiency

146

What conditions are associated with cafe-au-lait macules?

Neurofibromatosis Type 1
McCune-Albright

147

Symptoms of McCune-Albright syndrome

Cafe-au-lait spots (unilateral)
Polyostotic fibrous dysplasia
Precocious puberty
Multiple endocrine abnormalities

148

Solitary hyperpigmented lesion with density of overlying dark, coarse hairs. Dx?

Congenital Melanocytic Nevus

149

Newborn with gray-blue patches that are poorly circumscribed. Dx?

Congenital dermal melanocytosis (Mongolian spots)
- these fade with time

150

What is nevus flammeus?

Port-wine-stain

151

Scaly erythematous patch with hair loss on scalp. Also pt has tender lymphadenopathy. Dx? Tx?

Dx = Tinea capitis (dermatophyte infection)
Tx = Griseofulvin or Terbinafine

152

What kind of rash presents with acute rheumatic fever?

Erythema marginatum

153

Describe the rash in that occurs in Scarlet Fever.

"Sandpaper" rash

154

What kind of imaging is performed to diagnose hip dysplasia?

Age < 4 mo = Hip ultrasound
Age > 4 mo = Hip radiograph

155

X-ray of femur demonstrates cortical layering and a "moth eaten" appearance. Dx?

"onion skinning" and "moth eaten" bone = Ewing Sarcoma

156

Where does Ewing Sarcoma present?

Diaphyses of long bone

157

A lytic lesion in bone surrounded by concentric layers of new bone. Dx?

"Onion Skinning" = Ewing Sarcoma

158

Tumor in the epiphysis with "soap bubble" appearance. Dx?

Giant Cell Tumor

159

Most common cause of pneumonia in otherwise healthy patients.

Strep pneumoniae

160

Nocturnal perianal pruritis. Dx? Test? Tx?

Dx = Helminth infection (Enterobius vermicularis)
Test = Tape test
Tx = Albendazole or Pyrantel Pamoate

161

Suspect this diagnosis if individual develops a maculopapular rash after amoxicillin.

Infectious mononucleosis (Epstein-Barr virus)

162

What type of rash occurs in acute rheumatic fever?

Erythema marginatum

163

Describe the rash of Erythema Infectiosum

Erythema infectiosum = rash initially involving the face (slapped cheek) progressing to entire body

164

How to diagnose Acute Lymphoblastic Leukemia.

Bone marrow biopsy with >25% lymphoblasts

165

Pediatric patient with fever and mediastinal mass on X-ray. Dx?

Hodgkin lymphoma

166

Rouleaux formation on blood smear. Dx?

Multiple Myeloma

167

Lymphadenopathy, tenderness of bones, splenomegaly, petichiae. Dx?

Acute Lymphoblastic Leukemia

168

Franconi Anemia. Mechanism? Symptoms?

Mechanism = Inherited DNA repair defect
Symptoms:
- Short stature
- Hypo/hyper-pigmented macules
- Abnormal thumbs
- Genitourinary malformations

169

Lab findings for Fanconi Anemia

- Pancytopenia
- Diagnosis of Fancioni Anemia is made by exposing DNA to interstrand crosslinking agents, demonstrating chromosomal breakage

170

Until what age is it normal to see the thymus on X-Ray?

< 3 yrs old

171

When to use Palivizumab?

Palivizumab is a monoclonal antibody against RSV, used for prophylaxis of children under 2 years old who are at exceptionally high risk. High risk individuals:
- Preterm <29 wks gestation
- Chronic lung disease of prematurity
- Hemodynamically significant congenital heart disease

172

If an infant < 2 months has bronchiolitis -- then what complication is the infant at greatest risk for?

Apnea (temporary cessation of breathing)

173

First step in management of a newborn with suspected congenital diaphragmatic hernia.

Endotracheal intubation to stabilize breathing.

174

Congenital absence of bilateral vas deferens is associated with what condition?

Cystic fibrosis

175

Opacification of ocular lens is associated with what condition?

Intrauterine rubella infection
OR
Galactosemia

176

Which pediatric tumor crosses the midline and which one does NOT?

Neuroblastoma may cross the midline
Wilms tumor does not

177

Neuroblastoma stymptoms

Abdominal mass that may cross the midline
Periorbital ecchymosis
Opsoclonus-myoclonus

178

"Owl eyes" on lymph node biopsy.

Hogkin lymphoma

179

Bone pain and pancytopenia in Pediatric pt. Dx?

Acute Lymphoblastic Leukemia

180

What drug to avoid in G6PD deficiency if trying to treat UTI.

Nitrofurantoin

181

Ear canal is red and swollen. Diagnosis? Mechanism?

Diagnosis = Otitis externa
Mechanism = infection with Pseudomonas aeruginos OR Staph aureus, most commonly due to water exposure ("swimmer's ear")

182

Treatment of Epiglottitis

Infection with Haemophilus influenzae type b.
Tx = ceftriaxone (against haemophilius influenzae type b and streptococcus species) and vancomycin (against MRSA)

183

What antibiotic to use to treat whooping cough?

To treat Bordetella pertussis, use Azithromycin

184

Empiric therapy for neonatal sepsis

Ampicillin and gentamycin

185

Tx for atypical pneumonia.

Organisms of atypical pneumonia = Mycoplasma pneumoniae, Clamydia pneumoniae)
Tx = Azithromycin

186

How to treat pulmonary infection in cystic fibrosis.

CF patients are susceptable to Pseudomona aerguinosa.
Tx = Piperacillin-tazobactam

187

Osteosarcoma
vs
Ewing sarcoma
on X-ray

Osteosarcoma = "sunburst" periosteal reaction and Codman triangle
Ewing sarcoma = "onion-skin" appearance

188

Newborn patient demonstrates a preference to tilt hear head to the left while rotating the chin to the right. Dx?

Dx = Congenital torticolis
This is a postural deformity of the neck in which the sternecleidomastoid muscle is tight and contracted, likely due to intrauterine crowding.

189

Cystic hygroma

A congenital lymphatic malformation located in the posterior triangle of the neck

190

Craniosynostosis

Premature closure of cranial sutures, which results in skull deformity

191

Treatment of child with UTI

3rd gen cephalosporin
- Ceftriaxone
- Cefotaxime
- Cefpodoxime
- Ceftazidime
- Cefixime

192

Age milestone: Babbling

6 months (language development)

193

Age milestone: Pincer grasp

12 months (motor development)

194

Age milestone: hops and balance on one foot

4 years

195

Age milestone: jumps with 2 feet

2 years

196

How to treat E Coli O157:H7?
What medications to avoid? Why?

Treat with supportive care.
Avoid: Antibiotics and Antimotility meds (loperamide), because they increase the chance of developing Hemolytic Uremic Syndrome

197

Complication of giardia infection.

Lactose intolerance

198

Giardia treatment

Metronidazole

199

Tx for beta thalassemia major.

Transfusion + Chelation

200

What are the key unique features of Rubella infection in children and what are the key features of Measles infection in children?

Rubella (German Measles) = Lymphadenopathy, specifically suboccipital, posterior auricular and posterior cervical.
Measles (Rubeola) = 3 Cs = Cough, Coryza, Conjunctivitis. Higher fever (40 C).

201

Which one is a Torches infection -- Measles OR Rubella? What are the manifestations?

Rubella
Manifestations = Cataracts, Deafness, Patent Ductus Aretriosus

202

If pt has UTI. What is the indication for an ultrasound? What is the indication for a voiding cystourethrogram?

Ultrasound = IF fever does not improve with 2 days of antibiotics
Voiding Cystourethrogram = IF 1 of the following is met:
(1) Ultrasound shows abnormality (e.g. hydronephrosis)
(2) Unusual pathogen (Not E. coli)
(3) Chronic kidney injury (Hypertension, Poor growth)
(4) 2 or more febrile UTIs

203

Abdominal pain, diarrhea, seizures in a child.

Shigella gastroenteritis

204

What are the values of the pleural fluid analysis that tells you whether the parapneumonic effusion is uncomplicated or complicated? What is the Tx of uncomplicated vs complicated?

Uncomplicated = pH >7.2, Glucose>60, WBC<50k
Complicated = pH<7.2, Glucose<60, WBC>50k
Uncomplicated Tx = Antibiotics
Complicated Tx = Antibiotics + drainage

205

Criteria to place ear tubes for patients with Acute Otitis Media.

- 3 or more AOM episodes in 4 months
- 4 or more AOM episodes in 12 months

206

Criteria to give antibiotics to patients with Acute Otitis Media.

- Bilateral AOM
- High Fever
- Severe pain

207

Compare the skin findings of Neurofibromatosis type 1, Tuberous Sclerosis and Sturge-Weber

Neurofibromatosis type 1 = Neurofibromas, cafe-au-lait spots, axillary freckling
Tuberous Sclerosis = Angiofibromas, Shagreen patches, Ash-leaf spots
Sturge-Weber = port wine stain (along trigeminal nerve distribution)

208

Dimercaprol treats...

Lead poisoning

209

Fomepizole treats...

Methanol or ethylyne glycol poisoning

210

Glucagone treats...

Beta blocker or Ca2+ channel blocker poisoning

211

Methylene blue treats...

Methemoglobinemia (exposure to dapsone, nitrates, topical anesthetics)

212

Pralidoxime treats...

Organophosphate poisoning
(use pralidoxime together w/ atropine)

213

Perianal pruritis at night. Dx?

Pinworm = Enterobius vermicularis

214

Ivermectin treats...

- Strongyloides (intestine and lung)
- Onchocerca (river blindness)

215

Metronidazole treats...

- Trichomoniasis and bacterial vagenosis (Vagina)
- Giardia (GI)
- Entamoeba (GI --> liver abscess)

216

Praziquantel treats...

- Cestodes (tapeworms) like Taenia solium from pork or Diphyllobothrium from fresh fish
- Tematodes (flukes) like Schistosoma (which can lead to bladder cancer) from fresh water or Chlonorchis sinesis (which can lead to gallbladder cancer)

217

Permethrin treats...

Scabes

218

Pyrantel pamoate treats...

Enterobius vermicularis (pinworm) that causes anal pruritis

219

When is MMR vaccine given?

1 year
and
4 years old

220

What rheumatological comorbidity is associated with Down's syndrome?

Atlantoaxial instability (laxity between C1 and C2)

221

Treatment for lead poisoning depending on lead level.

Less than 45 = remove from environment
45 - 70 = Succimer (Dimercaptosuccinic acid
> 70 or sings of encephalopathy = EDTA + Dimercaprol (British anti-Lewisite)

222

Hamartomas on the iris --> what is the genetic condition?

Lisch nodules = NF1

223

White-grey spots on periphery of the iris - what is the genetic condition?

Brushfield spots = Down's

224

Renal angiomyolipoma - what is the genetic condition?

Tuberous sclerosis

225

Retinal hemangioblastoma - what is the genetic condition?

von Hippel-Lindau

226

What are the 3 conditions that have cafe-au-lait spots? What symptoms help to differentiate between the two?

NF1 (iris hamartoma - Lisch nodules, cutaneous neurofibromas)
and
McCune-Albright (multiple endocrine abnormalities, precocious puberty)
and
Fanconi anemia (thumb defect, anemia)

227

Skin condition associated with Celiac disease

Dermatitis herpetiformis

228

What is the difference between the location,symptoms and treatment of preseptal cellulitis and orbital cellulitis?

Preseptal cellulitis is anterior to the orbital septum, while orbital cellulitis is posterior.
Symptoms that point to orbital cellulitis are extraocularr muscle defect like painful or weak eye movements AND proptosis (bulging eyes).
Treat preseptal with oral antibiotics, treat orbital with IV antibiotics and possible surgery.

229

What can cause megaloblastic anemia other than B12/Folate deficiency? What other symptoms to look for and mechanism of disease.

Fanconi anemia (DNA repair defect leads to PANcytopenia, not just anemia; Also look for thumb defect, cafe-au-lait spots)
AND
Orotic aciduria (UMP synthase defect, which leads to orotic acid in urine)

230

Anal fissure in a toddler. Dx? Tx?

Dx = pediatric constipation
Tx = laxative (e.g. polyethylene glycol, mineral oil)

231

Most common complication for patients with Sickle Cell Trait.

Humaturia
and
Hyposthenuria (impairment in urine concentrating ability, which can present as nocturia and polyuria)

232

Glomerular basement membrane thickening. Dx? Symptoms?

Dx = Membranous nephropathy
Symptoms = Edema, proteinuria

233

Glomerular basement membrane thining. Dx? Symptoms?

Dx = Alport Syndrome
Symptoms = Hearing, Vision problems

234

Linear deposition of IgG on basement membrane. Dx? Symptoms?

Dx = Goodpasture syndrome
Symptoms = Pulmonary hemorrhage, glomerulonephritis

235

Localized areas of mesangial sclerosis. Dx? Symptoms?

Dx = Focal Segmental Glomerulosclerosis (FSGS)
Symptoms = Edema, proteinuria

236

Mesangial deposition of IgA. Dx? Symptoms?

Dx = Henoch-Schonlein Purpura
Symptoms = Abdominal pain (intrususeption), Renal disease, Arthralgias, Lower extremity rash

237

Podocyte fusion. Dx? Symptoms?

Dx = Minimal Change Disease
Symptoms = Edema, proteinuria

238

Limited upward gaze. Where is the tumor?

Pinealoma

239

Special organisms associated with Chronic Granulomatous disease.

Serratia
Burkholderia
Aspergillus

240

Tests used to diagnose Chronic Granulomatous Disease

Dihydrhodamine 123 Test
Nitbroblue Tetrazolium Test
(These are tests for neutrophil function)

241

Medications for Tourette Disorder

Alpha-2 agonists (Guanafacine, Clonidine)
Dopamine depleter (Tetrabenazine)
Antipsychotic (Risperidone, Haloperidol)

242

Common causes of anion gap metabolic acidosis

Mn* MUDPILES
Methanol
Uremia
Diabetic Ketoacidosis
Propylene glycol/paraldehide
Isoniazid / Iron
Lactic Acidosis
Ethylene glycol (antifreeze)
Salicylates (aspirin)

243

Most common cause of pneumonia in healthy patients vs Cystic Fibrosis patients.

Healthy patients = Strep pneumoniae
CF before 20 months of age = Staph aureus
CF after 20 months of age = Pseudomonas

244

Until what age is bed wetting OK?

5 years. After 5 years old start enuresis alarm therapy.

245

Until what age is genu varum normal?

Age 2

246

Percent Fetal Hemoglobin in Sickle Cell Disease.

SCD pts = 5-15% HgF
SCD pts on Hydroxyurea = > 15%

247

What therapy should be used in strabismus and at what age?

Until 4 months strabismus is OK. Afterwards need therapy such as eye patch on the good eye

248

What medications are used as emergency contraceptives to prevent pregnancy by delaying ovulation? Timeline to take.

Levonorgestrel (Plan B) - within 72 hrs of unprotected intercourse
Ulipristal - within 5 days

249

Most common cause of meningitis depending on age.

Before 6 months = Group B Strep
After 6 months - to old age/death = Strep pneumoniae

250

Longitudinal splitting of glomerular basement membrane. Dx?

Alport syndrome

251

Why does bruising and epistaxis occur in cystic fibrosis patients?

Cystic fibrosis patients have pancreatic insufficiency. This leads to decrease absorption of fat soluble vitamins K A D E. Lack of vit K increases PTT, which increases bruising and epistaxis.

252

Retinal hemorrhages on fundoscopy. Dx?

Dx = shaken baby syndrome (Subdural venous shearing)

253

Cystinuria. What type of crystal in nephrolythiasis? What is the diagnostic test?

Crystals = hexagonal
Diagnostic test = Cyanide-nitroprusside

254

Tourette syndrome often presents with what 2 other comorbid conditions?

1) ADHD
2) Obsessive-compulsive disorder

255

Treatment of UTI in pediatric patient.

Third gen cephalosporin.
(Cefixime, Ceftriaxone, Cefotaxime, Cefpodoxime, Ceftazidime)

256

What are the two conditions that cause cherry-red macula? What is their mechanism? What symptoms help you to differentiate between the 2 conditions?

Niemann-Pick and Tay-Sachs have cherry-red macula.
Niemann Pick is Sphingomyelinase deficiency.
Tay-Sachs is beta-hexosaminidase A deficiency.
Niemann Pick symptoms = Heptosplenomegaly and Arreflexia
Tay-Sachs symptoms = NO hepatosplenomagaly and Hyperreflexia.

257

Patient with hip pain after a mild viral illness. CBC is normal. Patient can bear weight on the affected leg. Dx? Prognosis?

Transient synovitis
Prognosis = Full recovery in up to 4 weeks

258

Timing of IgA nephropathy vs Poststreptococcal glomerulonephritis.

IgA nephropathy = 1-2 days after URI
Poststrep Glomerulonephritis = 1-4 wks after URI

259

Another name for "Eczema"

Atopic Dermatitis

260

An antibiotic that will cover both pseudomonas and MSSA.

Cefipime (4th gen cephalosporin)

261

Mechanism of Reye syndrome

Aspirin is a mitochondrial toxin. Causes liver damage. Results in microvesicular steatosis on liver biopsy.

262

Aspirin is usually contracindicated in children except in the treatment of what?

Kawasaki Disease
Rheumatologic disease (e.g. juvenile idiopathic arthritis)

263

Complications of infectious mononucleosis

Splenic rupture
Acute airway obstruction
Autoimmune hemolytic anemia and thrombocytopenia

264

Criteria to diagnose Acute Rheumatic Fever

JONES (major) + (minor)
Joints (mygratory arthritis)
O Carditis
Nodules (subcutaneous)
Erythema marginatum
Sydenham chorea
+ High CRP/ESR
+ High PR interval
+ Fever
+ Arthralgia

265

Turner syndrome: Estrogen, FSH and LH (high or low?)

Low Estrogen, High FSH, High LH

266

Kallman syndrome: Estrogen, FSH and LH (high or low?)

Normal Estrogen, Low FSH, Low LH (due to Low GnRH)

267

Androgen Insensitivity syndrome: FSH and LH (high or low?)

Normal to high FSH and LH

268

5 alphar reductase insufficiency: FSH and LH (high or low)

Normal to high FSH and LH

269

How to tel Androgen Insensitivity Syndrome from 5 alpha reductase, since they are both 46XY?

Androgen Insensitivity Syndrome will have breast development. 5-alpha reductase deficiency will NOT have breast development. 5-alpha reductase deficiency will have Virilization.

270

APGAR scoring system

Appearance: - +2 pink; +1 blue extremities; 0 all blue
Pulse: +2 >100; +1 <100; 0 absent
Grimace: +2 crying; +1 to grimace; 0 absent
Activity: +2 active; +1 some flexion; 0 limp
Respiratory: +2 good dry; +1 weak cry; 0 absent

271

When infant is crying or eating cyanosis appears. Dx?

This is a "tet spell" of Tetralogy of Fallot

272

The tetralogy of Tetralogy of Fallot

1) Ventricular septal defect (VSD)
2) Overriding aorta
3) Right Ventricle Hypertrophy
4) Right Ventricle Outflow Obstruction (pulmonary stenosis)