6541 Final Exam Review

1) 7 month old RSV recommended treatment a. Supportive treatment; hydration, oxygen

2) Epiglottitis – what decreases the incidence of it? a. Caused by HIB. Drooling, insp & exp stridor, high fever, aphonia (muffled voice), shore throat, flaring nares, retractions, tripod position while sitting, extended neck as to make breathing easier b. Thumb sign- on lateral neck x-ray, epiglottis are looks like a thumb (google images has examples) c. Do not examine the throat d. Treatment: To surgery for exam w/otolaryngologist to establish airway, antibiotics, and can be follow by pulmonary edema so watch for that. e. 25% of cases are less than 1 year old. Otherwise common in 2 – 5 year olds. f. All household contacts get rifampin if there are unimmunized people that live there. g. VACCINES PREVENT THIS

3) Antibiotics or not? a. Asthma – No b. Epiglottitis – Yes c. Croup – No d. Bronchiolitis – No e. Foreign body aspiration – No. Only if secondary pneumonia develops.

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4) 12 year old female with fever & sore throat – possible differentials a. Strep, mono, apthous ulcers, peritonsillar abcess, epiglottitis, steven Johnson syndrome, measles

5) SGA infant – which type of chromosomal analysis? a. Testing would be chorionic villi sampling, amniocentesis, or fetal free DNA. b. Lots of detail in this answer, but we will likely need it later. Trisomy 18, Edwards syndrome. These kids are small, don’t typically live past one year with lots of issues. Didn’t look up much on this. Wasn’t in the book. c. Trisomy 13 – Patau Sundrome – 1 in 5,000. Microcephaly, with midline defects such as cyclopia, cleft lip, cleft palate. Sloping forehead, small easr, anopthalmia or micropthalmia, micrognathia, and pre-auricular tags. VSD, ASD, TOF and more hear defects. To test for this one, 17 week ultrasound is the best time to look for it. d. Turner syndrome – Short webbed neck, low hairline, posteriorly rotated ears, ptosis, short legs and 4th & 5th metacarpals, family is generally short in stature, hip dysplasia, hearing loss. Bicuspid aortic valve, CoA (35%), pulmonic stenosis. e. Holt-Oram Syndrome – “Heart Hand Syndrome” – Upper limb abnormailities, such as thumb, thenar and redial bone anomalies. Congenital heart lesions such as ASD, VSD, and/or conduction issues. Can occur spontaneously but is autosomal dominant. I have a feeling we are gonna have a question with a weird arm x-ray and this will be the answer. 1

6) 15 day old with Down syndrome, which cardiac disorders? a. AV septal defect, VSD, ASD, PDA, TOF (50%).

7) Basic info about Down syndrome. a. 50% have one of the cardiac issues in #6 answer. Echo is done in the first few weeks of life to rule it out. Prone to hirschprungs, imperforate anus, stenosis & bowel atresia, 10 times for likely to get leukemia, hypotonia in babies, 50-70% develop early onset alzheimers/dementia by age 60. b. Can be diagnosed by ultrasound at 14-24 weeks i. Nuchal fold thickness, amneiocentesis, & chorionic villi sampling.

8) Down syndrome and participating in sports a. 40% of them have instability at C1 & C2 (atlantoaxial instability). b. 61% have occipital hypermobility. c. Trauma would result in subluxation and spinal cord compression.

9) Basic info about: a. Fragile X – Long narrow face, high arched dental palate, dental crowding, prominent ears in teen years, short stature. Strabismus, recurrent OM, seizures, Macrochidism after puberty, joint hyperlaxity, OSA, increased risk for obesity, intellectual disability, language delays, autism, behavior problems, steropathies (hand flapping). As an infant, poor growth, GER, feeding problems, diarrhea. b. Kleinfelters (XXY) – Tall with long arms, dental decay, small penis, gynecomastia, skin striae, delayed puberty, autoimmune disorders, scoliosis, prone to malignancies (even male breast CA), shy/withdrawn, ADHD, immature for age. Cardiac – prone to PDA & ASD. c. Turner Syndrome – See question #5. d. XXX – “triple x syndrome” – 1 in 1,000 women. Early growth, longer legs. Problems with auditory disorders, language development, and trouble having stable relationships. Psych disorders. Often goes undiagnosed over all or until adulthood.

10) Diet of cystic fibrosis patients a. Tough finding this answer. This is what I found. b. Soy formula is bad for babies (causes increased FTT) c. Lipase supplements and vitamin A, D, E & K are necessary. Monitor weight and adjust plan accordingly. d. High energy diets as they require more energy to function than a person without CF 11) 6 week old boy: (not a ton of info on this. You guys are on your own if you want to read more.) a. RSV – can cause apnea b. Rhinovirus – a cold c. streptococcus pneumonia – Super rare in this age group d. listeria – Diarrhea and GI upset e. chlamydia trachomatis – Consider this as the diagnosis if symptomatic and there was no prenatal care as it usually comes from Mom during delivery. 2 12) 2-year-old with increased work of breathing, post-tussive emesis, fever, belly pain, no diarrhea. a. I didn’t even look this one up. Post-tussive emesis is a red flag for pertussis (whooping cough). I’m gonna hope this is a choice. 13) Which antibiotic is recommended for acute bacterial respiratory infection a. Amoxicillin if no allergies

14) 7 month old with 1 day hx of cough, yellow nasal drainage, and low grade temp a. Supportive measures, OTC such as Tylenol or ibuprofen, monitor

15) 3 year old with wheezing for the past 3 months – which tests are appropriate? a. Pulse ox, physical assessment, an x-ray is indicated when wheezing is occurring with no other pathology. b. If this patient were 4 or 5, peak exp flow measurements would be appropriate c. If 5 or older, spirometry testing is the gold standard to diagnosis, monitor and evaluate.

16) Symptoms of: a. Restrictive airway disease – Ex: pulmonary fibrosis, sarcoidosis, muscular dystrophy. (Asthma, COPD and bronchiolitis are consider “obstructive lung disease” so does not apply here.) Symptoms: shortness of breath with exertion depending on advancement of illness. Diminished lung sounds. b. Sinusitis – 4 – 12 weeks of symptoms. Headache, bad breath, fatigue, they get a little better and then get worse. Facial pain and facial fullness. c. Foreign body aspiration – Episode of coughing, choking, and/or gagging. Diminished lung sounds on obstructed side. Air trapping on x-ray (affected side), Mediastinum deviates toward affected side on x-ray. Wheezes, crackles, rhonchi on that side. d. Bronchiolitis – Upper respiratory symptoms. Coryza, mild conjunctivitis, pharyngitis, OM, SOB, retractions, exp wheeze, fine or corse crackles, palpable spleen and liver as they are pushed down by hyperinflation of lungs. Abdominal distention due to this. 17) 4-week-old; 3 days nasal congestion, cough, temp 101.5, contact with sick people. a. Mycoplasma pneumonia – no wheezing or stridor, which means it’s probably viral. b. Bronchitits – viral causes c. RSV – causes bronchiolitis. Transmitted from a mild adult URI; kids will have a low grade temp, which matches this patient. d. URI – caused by RSV. e. Didn’t put a ton of time into this one. I’m going with RSV. 18) Asthma meds; follow up care; when to admit a. Intermittent asthma is less than 2 days per week; Mild is greater than 2 days per week with mild activity problems; Moderate is daily and affects activity; Severe is throughout the day and limits physical activity. b. If acute exac. More than once every 4 – 6 weeks, re-evaluate the current treatment plan. c. Admit when in respiratory distress, meds aren’t effective, and oxygen is needed. Couldn’t find the exact rules for when to admit, but I came up with this. 3 19) Peritonsillar abscess and possible hospital admission a. Symptoms: Ill looking, febrile, usually unilateral pain, referred to ear, painful swallowing resulting in drooling, bad breath, torticollis as patient may tip head to affected side. Unilateral swelling in tonsillar area. May displace uvula. Cervical lymphadenopathy. b. Hospitalization for IV antibiotics and rehydration is warranted. The abscess may need to be surgically drained intraorally. c. Treatment will involve an ENT doc and a team of people. 20) Symptoms of pneumonia in a young child a. Infants have slower onset of symptoms; cough, fever, nasal flaring, retractions, hypoxia, fine crackles or rhonchi. Wheezing or stridor with less prominent fever is usually viral. b. Bacterial usually doesn’t have wheezing. 21) Asthma classifications: know them a. See #18 22) Diet for RSV, also treatment a. Treatment measures are supportive as it is self limiting. Most cases can be managed at home. If there is respiratory distress, poor feeding, dehydration, or the need for oxygen, consider admitting the patent. b. Diet would be to maintain hydration. c. No corticosteroids, use of albuterol is debatable, no antibiotics 23) Which child should not receive a TB skin test? a. I’ve looked this up before. I think it was on one of our quizzes. I’m hoping it comes to me when I see the choices because I couldn’t find it on the CDC site. 24) Which patient LEAST warrants a sweat chloride test? a. Asthma and Cystic fibrosis are a YES for this test. So, don’t pick those. 25) Wheezing; What does it sound like with: a. Asthma – it is common b. Foreign body – wheezing will be unilateral c. Croup -insp stridor, but if wheezing it indicates lower respiratory tract involvement d. Cystic fibrosis – Common. 26) X-ray findings of Croup: a. Perihylar lymphadenopathy – No. TB or sarcoidosis. b. Thumb sign – This is present with epiglottitis c. Steeple sign – Yes. The trachea looks like a steeple on posteroanterior view x-ray with croup d. Hyperinflation – Yes. 27) Mild to moderate acute asthma and albuterol a. Mild asthma gets albuterol but it should be accompanied by a low dose inhaled corticosteroid (ICS). b. Next step is to add a LABA. c. As symptoms advance, finally consider omalizumab and if necessary, can add an oral steroid. 28) Most common congenital heart defect in kids a. VSD 4 29) Chest pain in young children a. Most common in adolescents. b. Almost always musculoskeletal. If there are cardiac or pulmonary issues, rule out with assessment, x-ray, PFTs, etc. 30) Innocent murmurs; Where are they found; What grade are they? a. Usually grade I to III/IV in intensity and localized. b. They change with position changes (standing to laying) c. They vary in loudness visit to visit. d. Fever, anemia, exercise, and anxiety make them louder. e. They are musical or vibratory in quality, sometimes blowing f. Systolic in timing g. May disappear with jugular pressure, Valsalva, or positioning h. EKG and VS are good i. ALL MURMURS GET A CARDIAC REFERRAL 31) Basic info: a. Rheumatic Fever – a complication following a GAS laryngeal infection. i. It results in an autoimmune process that attacks joints, the heart, CNS, and sub-Q tissue. Sydenham chorea can happen (random, jerky body movements). Most effects are minimal in the long term except scarring and fibrosis on heart valves. ii. In the acute phase it will cause fever and arthralgias. b. Kawasaki Disease – Childhood vasculitis i. Symptoms: bilateral conjunctival injections, changes in lips and oral cavity, cervical lymphadenopathy, polymorphous exanthema, changes in extremities (swelling of hands, feet and perianal area). ii. Acute phase with fever. Subacute they are doing better and can last up to one month. Convalescent shows lab value improvements. c. Sickle Cell Anemia – A group of complex disorders. i. Sickle shaped hemoglobin. People of African descent. ii. Multitude of Symptoms: Fatigue, anemia, pain crises, swelling of hands and feet, arthritis, lung and heart injury, leg ulcers, splenic sequestration, liver pooling, bone infarcts, eye damage, and abdominal pain. 32) Useful test for evaluation of acute rheumatic fever? a. Originally a positive strep test. Later – ESR, WBC, CRP, long PR on EKG, echo that shows mitral regurge or prolapsed valve. 33) Testing about high cholesterol in children a. First test is once between ages 9 & 11 (before puberty) b. Second one is once between 17 and 21 (after puberty) c. Every 4-6 years in adulthood. 34) Who is most commonly diagnosed with Kawasaki’s a. Japanese 35) What is the essential test for managing Kawasaki’s a. Baseline echocardiogram and then repeat them at 2 and 8 weeks from diagnosis. 5 36) Physical findings in newborns with Down syndrome a. Flat occiput, flattened facial appearance, epicanthal folds, flat nasal bridge, upward slanting palpebral fissures, brushfields spots, small nose and mouth, protruding tongue. 37) Which labs should be done yearly with Down syndrome a. Thyroid labs 38) Physical signs of fragile X in adolescence. a. See #9. Macrochidism happens after puberty. 39) When is it important to refer to genetics for further evaluation? I’m not sure what she meant here. Not enough info. 40) DM type I & II. a. You’re monitoring a type I with AiC of 14.9, what does that indicate i. Non-compliance or ineffective treatment plan. A1C of 14.9 equals an average glucose at approximately 355 or higher for the past three months. b. A 5-year-old type I & management of insulin requirement i. For 0-5-year olds, 0.6-0.7 units/kg/day; 25-30% of it as basal dose. ii. Their baseline glucose levels should be 90-130 before meals and 90-150 at bedtime/overnight. c. Physical findings of a teen who might have type II DM i. BMI>85th %ile or wt is greater than 120% of ideal weight and they have two of these risk factors: family hx DM, race (Native American, latino, pacific islander, African American, Asian American) acanthosis nigrans, polycystic ovarian syndrome, hypertension, dyslipidemia, maternal history of DM or gestation DM. ii. Other signs – vaginal yeast infections, thrush, or other recurrent infections. 41) What does left shift in a WBC count mean? a. There are a lot of immature WBCs. The bone marrow is producing more WBCs and they are young. 42) Which labs for microcytic hypochromic anemia a. CBC, TIBC (total iron binding capacity), Fe to differentiate iron deficiency anemia from others 43) MMR – What type of immunity would their mom have? Or not? a. This is a weird question. Prior to 1987, people only received one dose of MMR, so it is possible that some Moms have less immunity than younger people. That’s all I can come up with. 44) 6-month-old with new sickle cell. At the WCC… what should you do at this visit? a. Do a CBC and reticulocyte count now and every few month. b. The HIB/meningococcal combo vaccine is recommended at 2,4,6 & between 12 and 15 months. I need to make sure the parents know the importance of staying on schedule with the child’s vaccines in general. c. Prescribe Penincillin V 125 mg bid indefinitely as these kids are prone to bacterial infections and they can be life threatening. d. General parental education about importance of hydration and prompt medical care for any exaccerbations. Provide information about supportive care and services available to them. e. Refer to hematologist. 6 45) 9-month-old with palpable right supraclavicular node. What does this possibly indicate? a. It could mean sarcoid, TB abdominal or pulmonary CA, lymphomas, or a bacterial infection. We need more info. 46) 5-year-old with ALL – what might they be at risk for developing? a. Other malignancies – Lymphoma and AML. b. Long term issues with cognition, neuropsychological and growth deficiencies. c. Other late effects are CHF, avascular necrosis, and osteoporosis. 47) When to start screening infants for anemia a. Screen for IDA at 9-12 months, 6 months later and annually from 2 – 5 years for children at high risk of developing it. 48) What snacks to a teen with type I DM? a. Healthy balanced diet snacks. Not many details in the book. Limit sugary snacks and artificial sweeteners. 49) Male with breast tissue enlargement. How to treat? a. 65% of male adolescents experience gynecomastia within a year of PHV. It’s transient and usually lasts 12 to 18 months. b. It is usually benign and can also be caused by anabolic steroid use or illicit drugs. When this symptom is accompanied by acne, a care provider could screen for drug abuse or steroid use. 50) Gynecomastia – what should you also assess for? a. See #49 B. 51) What does low TSH indicate? a. Hyperthyroidism – this happens with Graves disease or the first 18 months Hashimotos. It can carry over from Mom for 3 months after delivery, but dissipates. Almost 100% of the time, the child will have a goiter. Underweight for height. We already know this stuff. 52) Cushings. Symptoms and what would they present with? a. Weight gain, easy bruising, acne, flushing, poor wound healing, fatigue, lower limb edema, impaired glucose tolerance, hyperpigmented skin, amenorrhea, hirtsuism, freq infections. 53) UTI in a 2-year-old – treatment. a. Bactrim 8-12 mg/kg divided into twice daily doses. If an allergy, amoxicillin 25- 50 mg.kg divided into twice daily doses. 54) Sickle cell anemia and prophylactic penicillin a. Prophylactic Penicillin V 125 mg bid is indicated at 2 months of age. When the child turns 3, increase dose to 250 mg bid. Continue this until they are 5 years old or the child has received 2 doses of PPSV23 vaccine (23-valent pneumococcal polysaccharide). 55) Basic info: a. Osteosarcoma – Most common bone malignancy. Mets to lungs commonly. 13% survival rate at 5 years. Femur is most common starting point. b. Wilms tumor – Most common urinary system CA. Presents as a mass on the child’s flank or upper lateral edge of the abdomen. Most occur between ages 2-5. i. It is typically accompanied by congenital anomalies such as hypospadias, cryptorchidism, duplication of the collecting system, ambiguous genitalia, 7 hemihypertrophy, aniridia, Beckwith Weideman, Denys-Dash, and Pearlman syndromes. And cardiac abnormalities. ii. Increased frequency in African American kids c. ALL – In leukemias, bone marrow is replaced with blast cells. ALL is the most common childhood cancer. i. Peak between 2 & 6 years. 90% cure rate. ii. Patient will have hx of infections, fever, weight loss, bleeding episodes, lymphadenopathy, hepatosplenomegaly, bone and joint pain. 56) Peak incidence of osteosarcoma is what age group? a. 5 years to adulthood. 57) Features of DiGeorge syndrome. (Also known as velocardiofacial or 22q11.) a. Palate abnormalities, long tubular nose, crumpled ears, hypertelorism, malar hypoplasia, hypotonia, early feeding problems, constipation, chronic OM/sinusitis, polydactyly, vertebral abnormalities, strabismus, developmental disabilities, delayed speech and hypernasality, psych disorders. b. This syndrome should make care providers question the administration of live vaccines. Don’t know why. Didn’t look into it. 58) 4-year-old immunizations and chemo treatment. a. The CDC has ACIP guidelines for immune compromise and vaccines. i. Defer live vaccines until immune system has improved. ii. Overall, if inactivated vaccines are given at this time, they may be ineffective due to the lack of immune response. So they may end up having to repeat them later. iii. The best thing to do would be to get as many of them in prior to the start of treatment, as they are more prone to infection during their treatment time, and it will help them stay healthy. iv. Household contacts of these kids need to immunized and up to date. 59) 11-year-old weight loss, polyuria, and polydipsia. What to rule out? a. Diabetes mellitus. Didn’t bother looking this one up. 60) Congenital adrenal hyperplasia. a. Impaired cortisol synthesis = increased ACTH = overstimulation of adreal cortex resulting in hyperplasia and oversecretion of enzymes. b. Females with this will have varying degrees of external male type genitalia, though the internal reproductive organs will develop normally. c. If not treated appropriately and promptly, genitalia will continue to progress toward male anatomy and infertility could be an issue. 61) 14-year-old without menstrual cycle. a. Check for pubertal changes (thelarche, etc). If no pubertal signs yet, then look into the issue. If pubertal signs are present, no concerns until they are 16. Also consider female athlete eating disorder tract. Is their BMI healthy? 62) What could primary dysmenorrhea be caused by a. Typical there is no pelvic pathology. Exaggerated production of prostaglandins causes uterine contractions and ischemia and this is what causes the pain. 63) Signs and symptoms of congenital hypothyroidism a. More common in females. Abnormal fetal development of thyroid gland. 8 b. Most common cause of preventable mental retardation. Untreated it leads to brain damage, growth failure, deafness, and neurologic abnormalities. c. Newborn screening and aggressive treatment can prevent all this. 64) Adolescent with untreated Graves disease. a. 50% will have exophthalmos. Underweight for height, goiter, possible audible thyroid bruit, warm moist skin, tachycardia, tremor, and hyperreflexia. 65) Signs and symptoms; clinical features… a. Turner syndrome – see #5. b. Marfan syndrome – Normal developmental cues. Tall with long limbs. Aortic root dilation, mitral valve prolapse/regurge. Ectopia lentis (partial dislocation of lens in the eye), myopia, retinal detachement, extropia/strabismus. Prone to spontaneous pneumothorax. Connective tissue issues (pectus deformities), hyperextensibility. c. Kleinfelters – See #9. d. Beckwith Weideman – Normal development. They will have macroglossia, omphalocele or umbilical hernia, facial port wine stain, hypoglycemia, cardiomegaly, dental malocclusion with maxillary underdevelopment. 66) Primary amenorrhea a. Defined as absence of menarche by 16 year with normal pubertal growth or no pubertal growth by age 14. i. First thing to do is rule out pregnancy regardless of reported history. ii. Test TSH, FSH, and prolactin. iii. Ask maternal and siblings age of menarche. A ton of stuff to consider with this and there is an algorithm to follow. 67) Which age is most common for adolescent gynecomastia? a. Within one year of PHV during puberty. Can last 18 months. Transient. 68) List most likely etiology… a. Malrotation with intermittent volvulus – this is a congenital 270-degree rotation of the midgut around the mesenteric artery. b. Pyloric stenosis – hypertrophied pyloric muscle causes narrowing of pyloric sphincter. First born males are most commonly diagnosed with this one. c. Esophageal foreign body – A kid swallowed something. It gets stuck at the thoracic inlet of esophagus. d. Intussusception – A section of intestine gets pulled antegrade into adjacent intestine. Usually proximal to ileocecal valve and is usually ileocolic. Most common obstruction in kids. 80% of the time they are less than 2 years old. It is Idiopathic. i. Medical predisposition: Meckels diverticulum, polyps, Henoch schonlein purpura, constipation, lymphomas, lipomas, parasites, rotavirus, adenovirus, foreign bodies. It could also be a complication of CF. 69) 3-week-old male infant; projectile vomiting and constant feeding. a. Pyloric stenosis (See #80) – I didn’t look this up, because I know it. Info on it in the last question. Around two or three weeks of age, projectile vomiting will start. There will not be blood in it. The kid will be constantly wanting to eat. 9 70) Positive stool for salmonella a. Will last 1-3 days. Self-limiting. Supportive care. Consider antibiotics if less than 3 months of age, have chronic illness, CA, HIV or other immune suppressive issues. 71) Most common presentation of Hirschsprung’s disease a. Failure to pass meconium within 48 hours of birth b. FTT, poor feeding, other various GI symptoms. 72) Treat healthy 8-month-old with diarrhea a. Diarrhea at this age is defined as 5 or 6 stools per day. Restore and maintain hydration and nutrition. Stool cultures if bloody or prolonged diarrhea. Suggest a probiotic. 73) When to suspect crohns disease in an adolescent a. Crohns peaks in late adolescence. b. Unexplained low grade fever, delayed growth, perianal skin tags, fissures or fistulas. RLQ tenderness, wt loss, anorexia, diarrhea with possible blood and mucous, oral apthous ulcers, and tobacco use. 74) 9-year-old with dyspepsia, no occult blood. Which steps to take? a. Didn’t take the time to look this one up. I would suggest stopping milk products or starting lactaid drops when trying to do dairy. Basically diet modification, follow up in two weeks to see if the dairy thing helps. 75) Normal appendicitis findings. a. RLQ pain that started near the umbilicus, nausea and vomiting, difficulty walking due to pain, rebound tenderness at McBurney’s point, and pain with movement. Patient will usually be most comfortable on their side. 76) What is recent history in child with C-Diff? a. Antibiotics. Didn’t look this up. Just know it. 77) Most common presenting symptom in inflammatory bowel disease? a. Couldn’t find this one in the book. Based on reading about it, my guess is diarrhea or weight loss. 78) Most accurate way to determine dehydration in a child a. Cap refill time. This along with skin turgor and tachypnea considered together. 79) Most likely pathogen – 9-month-old with gastroenteritis that goes to daycare. a. Rotavirus or norovirus. I’m going with rotavirus. 80) Signs and symptoms o pyloric stenosis a. Regurge or non-projectile vomiting in first few weeks (no blood, non-bilious); Projectile vomiting starts at 2-3 weeks of age, insatiable appetite with weight loss, dehydration and constipation. A palpable olive shared mass just to the right side of the epigastrum. 81) Pinworms cause what? a. Perirectal or vaginal pruritis; Nervous irritability, hyperactivity, insomnia, urethritis, vaginitis. 82) Bloody diarrhea – what would NOT be the appropriate first action? a. I am not taking the time to figure this one out. I would guess palpation. 83) Food poisoning with family who eats out 4 to 5 times per week. a. Educated guess – E. coli 10 84) Labs for IBD – pick one out of the list that is not helpful. a. There are the labs that ARE helpful… ESR, CRP, CBC with diff (WBC), AST, ALT, Total billi, GGT, albumin, total protein, iron binding capacity, zinc, calcium, folate, B12, Stool culture w/O&P, C-diff, fecal alpha 1 antitripsin. 85) IBD – finding most consistent with ulcerative colitis. a. Rectal inflammation in 95% of cases. 86) Child with 2nd perirectal abscess in 6 months. a. Didn’t read up on this, but I’m going with diabetes or crohns. 87) Foods for kids with celiac disease a. No wheat gluten, barley or rye. 88) Signs and symptoms in teens: a. Appendicitis – See # 75 b. DKA – c. Gastroenteritis – d. Pelvic inflammatory disease – 89) Generalized absence seizures. Common in which age group? a. Childhood onset is 5-6 years old with remission at 10-12 years. b. Juvenile starts at 10-12 years and last through the lifetime. 90) Long term outcomes with open spina bifida a. Neurogenic bladder with cathing, seizures (15%), learning difficulties, ADHD, higher spinal defects can have mobility issues 91) Conditions most responsible for developmental delays in children a. This is so vague. Use all the stuff you already know and take a guess. Can you tell its late right now? Lol. 92) Compulsive eating and bulimia. Differentiate between the two. a. Bulimia includes purging. Didn’t look this one up. 93) Male adolescent and you suspect anorexia. a. I might come back to this one. If I don’t, sorry. 94) 5-year-old with encopresis a. Alleviate blame. Explain to the parents how it works so they know that their child wasn’t pooping his pants out of laziness. It is a form of incontinence. It is necessary to get parents cooperation for a treatment plan. 95) 12-year-old who injured spine while diving. Know spinal levels based on symptoms. a. I just looked up the dermatomes. Cervical spine is the neck. T4 is nipple level. T10 is umbilicus. L1 is hips and genitalia. Arms are C5, C6, C7 and C8. Hopefully these will help us take a good guess. 96) Most common CNS side effect of mumps a. Meningoencephalitis 97) Growth plates; Know Salter Harris classifications. a. On page 1045 in Burns. b. Fracture along the growth plate is V. 98) Common cause of in-toeing in childhood is… a. Medial tibial torsion (MTT). A result of in utero positioning 99) Treatment for Osgood-Schlatter a. Self-limiting. Symptoms management. Modify activities. Ice. Stretching. NSAIDS. Neoprene sleeve. 11 100) Sprained ankle treatment. a. Rest, ice, compression, elevation. Pain management. Range of motion exercises. 101) Sports physicals – what is important to include routinely? a. Comprehensive head to toe assessment with focus on musculoskeletal, cardiovascular, and neurological systems. A genital exam. A complete history or previous injuries, respiratory and cardiovascular health hx. Family history of sudden cardiac death. 102) Child who walks on their toes. Your response… a. This is normal in the first 6 months of walking until they learn heel to toe walking. b. Persistent toe walking occurs with cerebral palsy, muscular dystrophy kids that have autism, tight heel cords. It can just be a bad habit and usually resolves on its own by age 3. 103) Difference between a sprain and a strain. a. A sprain is injury to the ligament that connects two bones. b. A strain is injury to the connective tissue that connects muscle to a bone. 104) 6-year-old with a painful hip. Which labs do you order? a. To rule out a septic joint… CBC to see WBCs, ESR needs to be less than 40 to rule it out. Maybe a CRP too. 105) 18-month-old who stopped walking a. I vaguely remember reading about this, but can’t remember the details. If any of you know the answer, please share with me. I am losing the motivation for these vague questions. 106) 2-year-old. Fever, poor feeding, tachy, appears ill, temp 101, x-ray of left hip shows widened joint space without fracures. What do you do? a. Rule out septic joint. See #104 for labs to order. Do ultrasound of the hip to check for effusion. There are criteria to indicate septic joint that leads to an aspiration of the joint fluid. 107) Increased headache, blurred vision, and personality changes. What would you do? a. It’s possible that the headache and blurred vision are because the patent needs glasses. That doesn’t account for the personality change. Head CT to rule out brain lesion. This is an educated guess. 108) 14-month-old with lower extremity bowing. The question will give lab values and you pick the most likely diagnosis. a. Malabsorption of vitamin D – will show hypocalcemia before bone loss starts. i. Labs – Calciciol < 20, Phosphorus less than 7 (normal phosphate levels in infants is 7, whereas in adults the low end of the scale is 2.5), Vitamin D < 20 is low. Less than 5 is severe. b. Phosphate malabsorption – Usually asymptomatic and found by accident c. Renal osteodystrophy – A collective term that describes skeletal effects of CKD. Hypocalcemia ad hyperphosphatemia don’t usually occur until GFR is down 25- 40% of normal. Low vitamin D levels contribute. Measure Ca+, phosphorus, and PTH levels once GFR is less than 60. d. Genetic primary hypophosphatemia – Hypophosphatemia rickets starts in kids. Bone pain, bow legs or knock knees. Just remember that normal phosphate levels 12 for infants is 7. This patient is 14 months, so it may be a little lower, but not much, as it transitions to normal numbers by adulthood. 109) 8-month-old spiral fracture. Response? a. Skeletal survey and contact child protective services as you suspect abuse. 110) 5-year-old with mild leg bowing. Lab values. Most likely diagnosis? a. Refer back to #108 for this one. 111) What is NOT characteristic of a life-threatening event? a. Good luck. This is too vague to answer. Don’t pick epiglottitis. That for sure is life-threatening. I would think an acute asthma exacerbation and anaphylaxis are too. 112) Common trigger for acute asthma? a. Allergens Up to video at 25:06 113) Chronic abdominal pain in children a. GERD 114) What would be a common symptom of GERD? a. Most common complaint is “heartburn” b. Infants – regurge, FTT, irritability, feeding aversion c. Child/adolescent – regurge during school years, abdominal and chest pain, asthma, sinusitis, laryngitis, and halitosis. 115) Children at daycare are at greatest risk for which infections? a. Didn’t look this one us, but going with RSV, rotavirus, and norovirus. 116) Vaccines prevent against the common types of what? a. Preventable diseases? This was a hard one to find. 117) What is the appropriate threatment for influenza A? a. Supportive; bedrest, fluids, OTC antipyretics, cough meds in children old enough 118) Common S & S and factors of Fifth disease (Erythema infectiosum) a. It is spread mother to fetus, by respiratory secretions, and blood exposure. b. Most common in ages 5 – 15. Symptoms show up 2 to 3 weeks after exposure c. 2 phases: i. Prodrome – mild fever in 15-30% of cases, myalgia, headache, malaise, and/or URI. ii. Rash – 7 to 10 days after prodrome phase and occurs in three stages 1. Face – slapped cheek appearance. Lasts 1-4 days. 2. Lacy macropapular rash on trunk 3. Spreads to arms, legs, and buttocks. Rash can last up to 1 month 119) Slipped Capital Femoral Epiphysis (SCFE) a. This is a salter harris type I fracture through the proximal femoral physis, caused by a shearing force. b. Puts kids at risk of avascular necrosis c. Happens at beginning of puberty in overweight boys most often. Especially those with delayed puberty. 13 d. When it happens before age 10, it is associated with other conditions. e. Patient will limp, possibly have one leg shorter than the other. External rotation of the leg. Limited abduction and extension. When it is unstable, weight bearing is not possible. 120) Skin lesions in Lyme disease a. A red annular macule or papule at the bite site. A clearing and then another larger erythematous outer ring. “Bullseye” rash. Called erythema migrans and has to be 5 cm to reach diagnostic criteria. b. The rash can show up 1 to 31 days from bite. It can show up on other parts of the body later and is warm and pruritic but not painful. 121) Becoming wheelchair dependent with Duchene Muscular Dystrophy a. Not much on this in the book. Not sure what they want. 122) What is important in evaluation of seizure disorder? a. A good assessment in office with description of the “spell” and to determine if there were any other seizure type episodes that happened in the past. b. If this isn’t an option, choose EEG. 123) What is a common symptom of absence seizures? a. Person stares off into space for a few seconds 124) What type of scale for testing childhood intelligence? a. I googled it. All options had Wechsler Intelligence Scale on it. 125) Head injury: a. Concussion – Can have any combo of the following: Headache, off balance, vision changes, dizzy, light or sound sensitive, paresthesias, confusion, altered concentration, altered memory, forgetfulness, mental stupor, irritability, emotional, drowsy, difficulty sleeping. b. Hematoma – Could have loss of consciousness, neurologic focal deficits are likely, glascow coma scale 9-12, could be seizures, vomiting, headache, symptoms can last several months. 126) Adolescent male with scrotal pain… a. Acute epididymitis – Infection of the epididymis. Gradual onset of painful scrotal swelling, dysuria, fever, possible nausea and vomiting. Assessment shows present cremasteric reflex and elevation of testes relieves pain. b. Orchitis – Scrotal pain and fever. Gradual onset of symptoms. UTI symptoms. Normal anatomic position. c. Testicular torsion – Twisting of spermaticord and obstruction of blood supply to a testicle. Most common in adolescence. Sudden onset of pain, nausea, vomiting, no fever, affected testis is elevated. Absent cremasteric reflex on affected side. A surgical emergency. d. Hydrocele – Painless intermittent scrotal swelling. Can be associated with a hernia. 127) Most common cause of UTI in peds a. E. coli 128) Info to give a 17-year-old male regarding sex and condoms. a. Condom info – must use it every time! i. Leave a ½ inch at the tip, be sure to remove the air ii. Remove correctly after intercourse, after taking it out of the vagina 14 iii. Do not use petroleum lube iv. Check package and exp date v. Only use it once vi. Keep a back up prescription for emergency contraception b. Didn’t look up the sex stuff 129) What is the best treatment for testicular torsion? a. Surgery 130) Treatments for phimosis a. Normal cleansing with gentle stretching of foreskin until resistance is met. Most are retractable by 5 or 6 years of age. Circumcision if it interferes with urination. Persistent phimosis can be treated with topical corticosteroids tid for one month. 131) Signs of congenital hypothyroidism a. See #63 132) Chronic adrenal insufficiency. What do they often have? a. Hyper pigmented skin. 133) Most common cause of primary amenorrhea? a. Pregnancy 134) Red reflex is only present in one eye. What are you worried about? a. Retinoblastoma. Requires immediate Ophthalmology referral. 135) Common treatment for dog and cat bites? a. Tetanus booster, consult local animal control or health department about whether rabies prophylaxis is necessary, administer analgesia and irrigate, but if just puncture wounds, soak in tap water and betadine mixture for 15 minutes. b. 3-5 day course of augmentin. If PCN allergy, 10 day course of cephalosporin or Bactrim 136) Diffuse petechial rash. Common diagnosis. a. Can mean invasive meningococcal disease, but more common option would be fifth disease. 137) Signs and symptoms: a. Eczema – Also called atopic dermatitis. Chronic pruritic inflammatory skin disorder of childhood. The “itch that rashes”. Protective barrier in impaired so there is dry skin, cracking, lichenification, and susceptibility to infections. b. Pityriasis rosea – “rose colored flaking”. Self-limiting. No known cause. 50% of the time it affects people less than 20 years old. c. Psoriasis – Chronic papulosquamous skin disorder with remission and exacerbations. Patient has thick silvery scales with varied distribution patterns. Genetic and immune mediated and 30% of cases start in childhood. d. Pityriasis Alba – A pale, fine scale that affects children and adolescents. May be minor atopic dermatitis. On face, cheeks, arms, and upper trunk. Sun exposure accentuates them. They show up more on dark skinned people. 138) Treatment for Pityriasis rosea a. It is self-limiting. So supportive treatment. Calamine lotion, antihistamines, tepid baths, emollients for itching. Minimize sun exposure. b. Oral erythromycin 250 mg QID for 2 weeks may speed up healing. 139) Seborrheic dermatitis a. Cause: Overproduction of sebum or overgrowth of Malassezia orelis. 15 i. Infants – thick flaky yellow crusts on scalp. Can also be behind ears, neck, on trunk and diaper area. ii. Adolescents – Mild flakes with some erythema; On scalp, forehead, bridge of nose, eyebrows, behind ears, and intertriginous places. iii. It is not pruritic. 140) Common causes of folliculitis and treatment a. Caused by S. aureus. b. Treatment: Warm compresses, topical keratolytic, topical antibiotic, or antistaph antibiotic if severe. 141) Acne. What is common for this condition? a. People are self-conscious about it and it can affect confidence. b. Not sure. Treatment would include keratolytics, comedolytics, topical antibiotics, or/and PO antibiotics such as doxy, minocycline, tetracycline, or erythromycin. 142) Which of the following is NOT true about stings from Bees, wasps, and fire ants? a. Couldn’t find this answer. 143) Basic info: a. Traction alopecia – When a hairstyle causes a pulling force on hair roots causing hair loss. Common in African American women. Preventable with a different hairstyle. Lol. b. Tinea corporis – “ringworm”. Spread by direct contact. It’s pruritic, erythematous circular lesion with raised border and central clearing. Well demarcated. Treatment: Topical antifungals. c. Allopecia Areata – Complete hair loss in frontal and parietal areas. Thought to be autoimmune and hereditary. They will also have nail ridging or pitting. THE END