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111 Cards in this Set

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A 6-day-old girl who was born at home is being evaluated for bruising and gastrointestinal bleeding. Laboratory findings include PT and PTT greater than 2 minutes; serum bilirubin, 4.7 mg/dL; alanine aminotransferase, 18 mg/dL; platelet count, 330,000/mm3; and hemoglobin, 16.3 g/dL

Hemorrhagic Disease of the Newborn

Tx: Vitamin K at birth
(now a standard)
A 7-year-old boy is brought to the clinic for a lifetime history of bedwetting. He has been completely healthy and has met all development milestones. His parents deny a history of trauma, and the history is not consistent with abuse. The patient has been wetting every night but not during the daytime. He has no incontinence.
What is the initial test?

(to rule-out infection or bleeding)
An inner city family has been using a neighbor to care for their 3-year-old child while the parents work. The neighbor is diagnosed with pulmonary tuberculosis. PPD test of the 3-year-old is negative. What is indicated for the 3-year-old?
Isoniazid chemoprophylaxis

(The chemotherapeutic dose is given for 6 to 9 months and is 300 mg/day for adults or 10/mg/kg/day for children)
A 5-month-old male infant has a urine output of less than 0.1 mL/kg/hr shortly after undergoing major surgery. On examination, he has generalized edema. His blood pressure is 94/48 mm Hg, pulse is 140/min, and respirations are 20/min. His blood urea nitrogen is 38 mg/dL, and serum creatinine is 1.4 mg/dL. Initial urinalysis shows a specific gravity of 1.018 and 2+ protein. Microscopic examination of the urine sample reveals 1 WBC per high-power field (HPF), 18 RBCs per HPF, and 5 granular casts per HPF. His fractional excretion of sodium is 3.2%

Next step?
Acute Renal Failure (ARF) in the immediate post-op period

(as manifested by the increase in blood urea nitrogen and serum creatinine and the decrease in urine output)

next step: Renal Ultrasound
A 6-year-old boy is brought to the pediatrician because of a 3-day history of skin lesions. On physical examination, he has multiple yellow, crusted erosions below the nares and on the cheeks, chin, and upper extremities. The rest of the examination is normal.

Bullous Impetigo

Tx: Cephalexin

(Cloxacillin, dicloxacillin, and azithromycin are good alteratives)
A 2 1/2-year-old child is evaluated by a neurologist because of difficulty walking. Neurological examination documents ataxia and mental retardation. The neurologist notes the presence of multiple telangiectasias involving the conjunctiva, ears, and antecubital fossae. The child also has a history of multiple respiratory tract infections.
Immunoglobulin studies on the child would most likely demonstrate what?

deficiency in IgA and IgE
A 15-year-old boy with Duchenne muscular dystrophy is brought to the emergency department with increasing respiratory distress and cyanosis. On examination, he is diaphoretic, with gasping respirations, poor air entry, and diminished responsiveness. He is tachycardic at 160 beats/min. His chest x-ray film shows a lingular pneumonia, and he is intubated. He improves over the next 10 days with antibiotics but is not extubated secondary to hypoventilation on weaning because of muscle weakness.
What would likely help wean him off the ventilator?

(This patient has irreversible muscle weakness, and his tidal volume is diminished, causing impaired alveolar ventilation. The tracheostomy will reduce the dead space and airway resistance. It may allow deep suctioning, helping effect ultimate weaning off the ventilator)
Why is postssium given to someone with DKA?
Hypokalemia will result as acidosis is corrected
A 7-year-old boy arrives at the ER in acute distress. Recent Hx of fatigue and mild, mid-abdominal pain that have become steadily worse. On physical examination he has a maculopapular non-blanching rash on his thighs and feet with some spread of the rash to his buttocks. He has N/V, fever, 10% dehydration and semi-soft dark stool, which is guaiac-positive.
Henoch-Schönlein Purpura

(Other characteristic findings of HSP include hematuria and joint pains. The illness may follow an upper respiratory infection or strep throat)
A 4-year-old boy presents with severe pains in both of his legs. On physical examination, his temperature is 37.7 C (99.8 F), blood pressure is 108/68 mm Hg, pulse is 96/min, and respirations are 17/min. He is noted to have marked pallor on his lips and palpebral conjunctiva. Numerous purpura and petechiae are noted on his skin. His spleen is palpable 3 cm below his left costal margin. Laboratory evaluation reveals a white blood cell count of 1600/mm3; hemoglobin, 6.1 g/dL; and platelets, 36,000/mm3.
Acute Lymphocytic Leukemia

(DDx: Aplastic Anemia, but they do not usually have bone pain, splenomegaly, and hepatomegaly)
An 8-month-old boy is diagnosed with obstructive hydrocephalus. He was born prematurely after a 26-week gestation to a 25-year-old primigravida and developed seizures and hypoxemia soon after birth.
Germinal Matrix hemorrhage

(Germinal matrix is a highly vascularized layer of neuroectodermal precursors lining the ventricles, developed b/t 22 and 30 weeks of intrauterine life. The vessels of the germinal matrix are vulnerable to hypoxic insults. Babies born prematurely are thus at high risk of hemorrhage in the germinal matrix region, as they often suffer from poor oxygenation)
Bug Dx:
A 4-week-old boy is brought to clinic by his mother because of a 1 day history of labored breathing. His birth was uneventful and immunizations have been up to date. His mother reports that the patient developed conjunctivitis on the sixth day of life. On physical examination, he is breathing rapidly at 40 breaths per minute and is afebrile. His chest reveals bilateral inspiratory crackles and a slight wheeze. On chest x-ray, bilateral pneumonia is evident. The leukocyte count is elevated at 15,000 with 40% eosinophils.
Chlamydia trachomatis

(This agent is transmitted from the mother's vaginal secretions to the neonate at birth. The conjunctivitis precedes the pneumonitis. Tachypnea, hypoxemia, crackles, wheezing and eosinophilia are seen)
Pneumonia and eosinophilia in child who has dogs and cats.
Ascaris lumbricoides

(produce visceral larva migrans and can cause pneumonia and eosinophilia and are passed-on by dogs and cats)
A 15-year-old girl with type 1 diabetes mellitus presents to her primary care doctor for a routine check up. Perusal of her blood sugar chart indicates that her recorded blood glucose levels are routinely between 120 and 150 mg/dL before breakfast, dinner and bedtime, with the normal being 116 mg/dL. She is on NPH and regular insulin.

What is the next appropriate step?
Obtain a glycosylated Hb test (HbA1c)

(She has near perfect glycemic control and compliance is often an issue in adolescents. Her near perfect glucose levels are a bit suspicious, and it is advisable to obtain a HbA1c)
A 4-year-old girl with sickle cell disease presents to the emergency department with a temperature of 39.6 C (103.2 F). Other than irritability, the physical examination is unremarkable. Laboratory evaluations reveal a white blood cell count of 18,200/mm3, with 88% polymorphonuclear neutrophils, 10% lymphocytes, and 2% monocytes, and a hemoglobin of 7.6 g/dL.

What is the most appropriate next step in management?
IV Ceftriaxone

(Children with sickle cell disease are at risk of serious bacterial infection and sepsis because they have impaired splenic function. Sepsis in these children is often caused by encapsulated organisms such as Streptococcus pneumoniae and HiB. IV ceftriaxone is the MC used antibiotic in a febrile child with sickle cell disease--it works against both of these bugs)
A 4-year-old boy, who has a ventriculoperitoneal shunt develops fever, headache, irritability, lethargy, photophobia, vomiting and nuchal rigidity.

What is the most likely pathogen?
Staph Epidermidis

Tx: Vancomycin
An infant with no genetic problems is noted to have a port-wine stain on the right side of her face that is 4 cm in length and 3 cm in width.

Pulsed Dye Laser
A 4-year-old, apparently healthy child is examined by a pediatrician. The pediatrician hears a loud systolic ejection murmur with a prominent systolic ejection click. He also hears a soft, early diastolic murmur. Both murmurs are heard best at the upper right sternal border. ECG shows left ventricular hypertrophy.
Aortic Stenosis

(Most cases are due to bicuspid aortic valves, and characteristically produce a systolic ejection murmur. An accompanying aortic insufficiency may produce an early diastolic murmur)
What is the most serious complication if a child with ALL is exposed to chickenpox (Varicella)?

Varicella Pneumonia

Tx: IV Acyclovir
A 1 1/2 -year-old girl is sent to a children's hospital for evaluation following a nosebleed which was so severe as to require nasal packing and transfusion of platelet concentrates. The girl has the correct number of normal-sized platelets, all of which were individual, without clumping. Special platelet studies showed that the child's platelet's failed to aggregate with any physiologic aggregating agent.

what is the defect?

platelet membrane glycoprotein GPIIb-IIIa

(This protein normally can bind to fibrinogen, and in its absence, platelet aggregation and the resulting clot retraction can not occur)
Bleeding disorder that presents with chronic, severe mucosal bleeds and giant platelets on blood smear
Bernard-Soulier syndrome
A 6-year-old boy with mental retardation has recently been diagnosed with Fragile X syndrome. His 9-year-old sister appears to be of normal intelligence but has symptoms of attention deficit hyperactivity disorder (ADHD). What is the first test that is indicated in her work-up for ADHD?
Cytogenetic testing

(should be performed on all sisters of males with Fragile X. Heterozygous females frequently have developmental and behavioral problems such as ADHD. They may also have borderline or mild mental retardation)
A 5-yo boy has progressive fatigue, weakness, and nausea over the past few months. He was a model student but is now having trouble in school and displaying frequent outbursts; he then starts to have difficulty walking and speaking. His labs show a mild hypoglycemia, hyponatremia and hyperkalemia.
A 7-yo patient has a decreased growth velocity and hyprechloremic metabolic acidosis with a normal anion gap and urine pH of 5.0. What test is most useful in distinguishing the type of RTA she has?
Serum Potassium

(Type 4 RTA is the MC. Ammonia production is impaired by high serum potassium levels from hypoaldosteronism or pseudohypoaldosteronism)
Salter-Harris Type Fracture:

Fracture through the growth plate that extends into the epiphysis and into the joint space
SH type 3
Salter-Harris Type Fracture:

Fracture through the growth plate that extends into the metaphysis
SH type 2
Salter-Harris Type Fracture:

Fracture through both the metaphysis and epiphysis and into the joint space
SH type 4
Congenital infection with "blueberry muffin spots" and hearing loss
A 1-yo patient has blood-tinged nasal secretions, diffuse osteochondritis and saddle nose, including HSM, jaundice, anemia and rash. What congenital infection is suspected?

(blood-tinged nasal secretions are called "snuffles"; all Sx are considered 'Earlier' -less then 2yo- manifestations)
Patient is < 20 yo and has notching of the permanent upper 2 incisors, bone thickening and anterior bowing of the tibia.
Congenital Syphilis

('Later' manifestations)
What is the most significant serious complication arising from Kawasaki disease?
Coronary Aneurysms
Woman with a seizure disorder wants to have a child. Her risk of having a child with a neural tube defect is greatest with which medication? (2)
1. Carbamazepine

2. Valproic Acid
a newborn has intrauterine growth retardation and on PE you notice that she is below the 5th % for weight, length and head circumference; she has HSM, chorioretinitis and a head US shows periventricular calcifications.
Congenital CMV infection

(CMV can also have bluberry-muffin rash, differentiate it from Rubella w/ periventricular calcifications)
A 12-yo male adolescent presents with 1 month Hx of fever, weight loss, fatigue and pain and localized swelling of the midproximal femur
Ewing Sarcoma

(unlike osteosarcoma, Ewing has systemic symptoms such as fever, weight loss and fatigue; also pain at shaft versus epiphysis)
An afebrile 4-yo child with a limp has discomfort w/ rotation and flexion at the left hip joint. WBC count is 9,000 and ESR is 15. He has an antalgic gait (gait affected by pain) but does not refuse to walk

Transient (Toxic) Synovitis

(ability to bear weight and low ESR/WBC rule-out septic arthritis; since Sx localized to hip joint and no point tenderness over shaft, osteomyelitis is ruled-out)

Tx: Ibuprofen
What are the diagnostic blood test results for:
1. Osteomyelitis
2. Septic Arthritis
3. Toxic Synovitis
High C-reactive Protein;
High ESR; Normal WBC

Septic Arthritis:
High ESR; High WBC

Toxic Synovitis:
Low ESR; Low WBC
You Dx a patient with Rocky Mountain Spotted Fever and send blood cultures to confirm.
What is the next step?
Hospitalization for:
IV Doxycycline and Ceftriaxone

(Ceftriaxone must be added as meningococcemia prophylaxis)
Most likely cause of a pneumonia presenting with large pleural effusions
Staph Aureus
An 8-month-old presents with an itchy, erythematous, weeping papulovesicular rash on the face and the extensor surfaces of the arms and legs. The rash got better with hydrocortisone. There is a family Hx of allergies and asthma.

(Atopic Dermatitis)
A 5-yo boy presents with fever and a new 3/6 systolic ejection murmur heard best at the right upper sternal border. There are splinter hemorrhages and petechiae on exam.

(Fever and new murmur is either endocarditis or rheumatic heart dz; splinter hemorrhages and petechiae are consistent w/ endocarditis)
A 12-yo child presents w/ an acute exacerbation of Crohn's Dz.

What is the best Tx?

What is the most commonly used "maintenance" med for IBD?
Acute: Corticosteroids

Maint: Sulfasalazine
What is the most appropriate Acute therapy for V-tach?

For long QT syndrome in a child?
V-tach: Lidocaine

Long QT: Nadolol (b-blocker)
What is the most common defect from a cryptorchism that leads to surgery?
Inguinal Hernia

(seen in 90% of cryptorchism cases)
A 3-mo-old has FTT and a pH=7.32, Na=134, K=4.5, Cl=106, Bicarb=10.

What is the Anion Gap equation/answer?

What is the Anion Gap normal range?

[Na - negatives]


Normal= 12 (+/-) 4
[8 - 16]

Dx: Inborn Errors of Metabolism
what are the (3) MCC in a child of Metabolic Acidosis (pH<7.4) with an increased Anion Gap?
1. DKA (inc acid production)

2. Renal Failure (dec acid excretion)

3. Inborn Errors of Metabolism
Why is there elevated BUN levels in DKA?

What is the acid/base status of a DKA patient?
BUN inc cause: Dehydration

DKA: Met Acidosis w/ Resp Alkalosis
An infant w/o any Hx of immunizations has a high fever, which goes away once a rash appears that starts on the trunk and spreads to the periphery

Underlying cause?

cause: Herpes virus 6
A child presents w/ dysuria, frequency, urgency and a Hx of a previous UTI. The UA is positive for nitrates and leukocyte esterase.

Next step? (3 together)
1. Give Amoxicillin

Schedule exams in next 6 weeks:

2. Renal US

3. Voiding Cystourethrogram
An infant 4 days after birth presents with bilateral purulent discharge from the eyes, eyelid edema and conjunctival swelling.

What is the cause?

What culture medium? (2)
N. Gonorrhea

(onset is 2-4 days, bilateral involvement, edema and conjunctival swelling)

1. Chocolate agar
2. Thayer-Martin agar
What are the (3) differences in conjunctivitis presentations b/t Chlamydia and Gonorrhea?
1. onset 4 - 10 days after birth
2. Unilateral or Bilateral
3. Conjunctival injections (red)

1. onset 2 - 4 days after birth
2. Bilateral only
3. Conjunctival swelling
(and eyelid swelling)
What is the difference in presentation with Metatarsus Adductus and Talpies Equinovarus?
Plantarflexion and Dorsiflexion are intact in MA

(MA responds to stretching exercises)
If a 5-yo patient has records of 3 DTaP doses, 3 Hib doses, 3 IPV doses, 3 PCV doses and 3 HepB doses, what should he get on this visit?
DTaP, IPV, MMR and Varicella

(since the risk of HiB is low at this age, it is not indicated; most pediatricians will not give a PCV at this time unless there is a specific health condition)
What is the Tx for Lead blood levels < 45?

for those b/t 45-69?

for those >70?
<45: oral Succimer or Penicillamine

45-69: Editic Acid (EDTA)

>70: BAL
A 3-yo presents for a well child visit. On the eye exam you cover one eye and when it is removed you notice the eye "drifts" back towards the center.

(misalignment of the eyes, which leads to Amblydopia - reduced vision in the affected eye)
What is the typical sequence of pubertal events in the female?
"The Hairy Pubic Mons":

1. Thelarche (breast budding)

2. Height growth

3. Pubic hair

4. Menarche
(3) uses of Epinepherine in cardiac pathology
1. Asystole

2. Bradycardia

3. Ventricular Fibrillation
(2) common problems caused by Varicella
1. Chicken pox

2. Shingles
How is the HOURLY maintenance fluid calculated in a 22kg child?
4-2-1 method:

(4mL/kg/hr for first 10kg) +
(2ml/kg/hr for second 10kg) +
(1ml/kg/hr for each additional kg) =

How do you calculate the initial replacement fluid in a severely dehydrated child?
replace w/ bolus of 20ml/kg initially

(then subtract that number from the amount given to replace the deficit in the first 8 hours)
what type of dehydration is a child most likely to have?

(from water or juice replacing electrolytes lost in stool)
What is the amount of fluid given per hour (in the first 8 hours) in a 18kg child who has lost 2000mL?
(5 steps)
1. 18kg x 20ml/kg = 360ml

2. 2000ml/2 = 1000ml in first 8 hrs

3. 1000ml-360ml = 640ml
640ml/8hrs = 80ml/hr

4. maint fluid= (4x10)+(2x8)= 56ml/hr

5. 80ml + 56ml = 136ml/hr
What is the amount of fluid given per hour (after the first 8 hours) in a 18kg child who has lost 2000mL?
(3 steps)
1. the second half (1000ml) is replaced over 16 hrs:
1000ml/16 hrs = 63ml/hr

2. maint fluid= (4x10)+(2x8)= 56ml/hr

3. 63ml + 56ml = 119ml/hr
Another name for Croup (Parainfluenza)?
Acute Laryngotracheobronchitis
autosomal-recessive disorder that manifests as hypokalemia, hypochloremia, and high renin and aldosterone levels
Bartter syndrome
infant or young child with hypertension, polyuria, polydipsia, and hypokalemic metabolic alkalosis. The serum concentration of aldosterone is low.

(also known as the Liddle syndrome; in primary hyperaldosteronism (Conn syndrome) Aldosterone is high)
Difference in presentation between Psoriasis and Diaper rash dermatitis?
Psoriasis is seen in the skin folds
(and are silvery patches, not erythematous patches)
Infant with salmon-colored, scaly, oily plaques that commonly involve the scalp and face.
Seborrheic dermatitis
In the summer, a vomiting infant is brought to the emergency room. The blood work results reveal a normal blood count except for a hyponatremic, hypochloremic, metabolic alkalosis.

What genetic-based disease should be included in the differential Diagnosis?
Cystic Fibrosis

(Although metabolic alkalosis is an uncommon presentation for cystic fibrosis, in the summer time with excess sweating, infants with cystic fibrosis may present with dehydration and this electrolyte pattern)
A 5-year-old boy develops a headache, cough, myalgia and a fever. He has been a healthy child with all immunizations up to date. He is given a decongestant and an aspirin for his symptoms with some relief. However, 4 days later he is brought back by his parents because of persistent vomiting and irritability. On physical examination, he is found to be semicomatose, becoming combative on stimulation.

What should be measured to aid in the diagnosis of this patient?

Tx? (2 together)
Reye syndrome

(an acute encephalopathy, hepatomegaly and delirium. It most commonly occurs in young children after a viral illness)

Lab: CBC for High Ammonia Levels
(for encephalopathy)
(also large increase in LFT)

1. Mannitol (Inc ICP is MCC of death)
2. Glucose (glycogen stores depleted)
A 5-year-old boy is brought to his pediatrician's office after he falls from his bicycle and strikes his head against the sidewalk. There were no witnesses to this incident, which occurred 8 hours ago. The child is otherwise healthy, up-to-date on his immunizations, and not taking any medications. On physical examination, his vital signs are stable. He has a 5 × 4 cm abrasion on his forehead. He is alert and oriented to date, place and self. His motor and sensory examinations are normal and reflexes are normal.

What constitutes reasonable management?
Instruct parents to observe neurological status for 24 hours

(The patient has no findings on history or examination. An intracranial bleed or severe brain injury is not likely. If present, symptoms should have become manifest within several hours of the injury. Thus the parents should be advised to monitor for somnolence, vomiting, seizures and severe headaches, and to return if these occur)
A 1400-g infant, born at 35 weeks' gestation, is 42 cm in length and has a head circumference of 28cm. One day after birth, she becomes very irritable, tremulous, and inconsolable. Her cry is high-pitched. Her pulse is 174/min. There are no dysmorphic facial features.

What substance was this newborn most likely exposed in utero?

What CNS lesion is a child at increase risk of obtaining with this exposure?

(Infants are usually small for gestational age (SGA) and sometimes have microcephaly and neurodevelopmental abnormalities. Exposed infants are very irritable and inconsolable in the withdrawal period. Their cries are often high-pitched. They are also at increased risk of sudden infant death syndrome [SIDS])

Periventricular Leukomalacia
(a CNS ischemic lesion associated with cocaine exposure)
Drug newborn exposed to in utero:

Infant presents with failure to thrive, cardiac defects, facial dysmorphic features (such as narrow forehead, microphthalmia, short palpebral fissures, and micrognathia), and neurologic abnormalities

(Fetal Alcohol Syndrome)

(will also see smooth filtrum of lip)
Drug newborn exposed to in utero:

Infant presents with limb anomalies, mental retardation, nail hypoplasia, and some dysmorphic features, such as a short nose and a low nasal bridge.

(It is not usually associated with low birth weight and microcephaly)
Drug newborn exposed to in utero:

pregnancy is associated with a high incidence of obstetric complications, such as placental abruption, preterm labor, and fetal growth restriction. Tremors, irritability, vomiting, and diarrhea present in the neonatal period
Infant presents with coarse, gargoyle-like facies (large tongue, flat nasal bridge, and short neck), mental retardation, hepatosplenomegaly, umbilical hernia, corneal clouding, and severe heart disease.
Hurler syndrome

(Autosomal Recessive)
Child born with low-set ears, excess nuchal skin, broad chest, lymphedema of hands and feet, and congenital heart disease
Turner's syndrome
A 6-month-old infant presents to the emergency department with the new onset of weak cry, decreased activity, and poor feeding. The mother also states that the infant has been constipated for the past 2 days. On physical examination, the infant has a very weak cry, poor muscle tone, and absent deep tendon reflexes.
Infant Botulism

(results from the production of toxin after colonization of the GI tract by Clostridium botulinum in young children aged 1-9 months. The most common source of the organism is the soil or, less frequently, honey)
a pure motor syndrome characterized by weakness and fatigue, particularly of the extraocular, pharyngeal, facial, cervical, proximal limb, and respiratory musculature
Myasthenia gravis

(Fifteen percent of infants born to myasthenic mothers have neonatal myasthenia gravis because of the transplacental passage of acetylcholine receptor antibodies; the condition
completely resolves in weeks to months)
A 15-year-old girl presents with diplopia after prolonged reading and ptosis that worsens in the afternoon. On examination, she is noted to have bilateral ptosis, impaired extraocular muscle movements, facial weakness, and generalized hypotonia and weakness increasing with repetition.

What is the best diagnostic test for this disorder?
Myasthenia Gravis

(It usually first affects the ocular muscles, with ptosis and diplopia as early signs. Muscle weakness progresses throughout the day and improves with rest. Respiratory involvement may be life-threatening)

Dx test: Electromyography (EMG)
A 4-year-old girl is brought to the physician by her mother who is concerned because her child has a vaginal discharge. Starting 2 days ago, the child began scratching her vulva and complaining of burning with urination. The child is otherwise healthy and has never had a similar problem. Examination reveals normal structural anatomy for a 4-year-old girl. There is no evidence of atrophy. There is an inflammatory erythema on the medial aspects of the labia majora and excoriations. There is a mucous discharge with a few flecks of blood intermixed.

What is the most likely cause of a vaginal discharge in this patient?
Foreign bodies

(often stool or toilet paper, are the most common cause of vaginitis in a 4-year-old girl. These objects can cause a bloody discharge that may be associated with few other symptoms. However, a vaginitis may develop secondary to the foreign object and this is often characterized by inflammation and erythema of the labia majora)
A 14-year-old male presents with a complaint of soreness, and weakness in his legs for the past day that has slowly spread from his calves to his thighs. He now complains of weakness in his trunk and arms. On examination he appears tired and lays on the examining table. His temperature is 37 C (98.6 F), pulse is 48/min, and respirations are 22/min. Both of his legs are diffusely tender. Deep tendon reflexes are absent in the lower extremities, and sensation is greatly diminished.

Confirmatory Dx test?
Guillain-Barré syndrome (GBS)

(a postinfectious polyneuropathy that causes demyelination of BOTH motor and occasionally, sensory nerves. It is classically an ascending paralysis)

Dx test: CSF studies
(essential for diagnosis and reveal a protein level usually twice normal values but with normal amounts of white blood cells, normal glucose level and an absence of pleocytosis [elevated lymphocytes])
A 7-year-old girl complains of increased urinary frequency, dysuria and itching on urination. Her urinalysis is consistent with a urinary tract infection. This is her 20th infection in the past year, despite adequate antibiotic coverage. Further imaging of her bladder, kidneys and ureter is consistent with vesicoureteral reflux.

What is the next appropriate step?
Antireflux surgery
A 17-year-old boy comes to medical attention because of recurrent sinusitis and pneumonia, and persistent watery diarrhea due to Giardia lamblia. His parents and a sister are in excellent health. Physical examination reveals enlarged lymph nodes in cervical, axillary and inguinal regions. A lymph node biopsy shows hyperplastic follicles with an absence of plasma cells. Laboratory investigations show depressed levels of serum IgG, IgM and IgA, and normal B-cells.

What (3) cancers does the patient have an increased risk for?
Common Variable Immunodeficiency Syndrome

(Important clues to the diagnosis are onset in late adolescence/young adulthood, hypogammaglobulinemia with markedly decreased IgM, recurrent pyogenic infections of the upper respiratory tract and intestinal giardiasis, and failure of lymphocytes to differentiate into plasma cells)


1. B-cell Lymphomas
2. Gastric CA
3. Skin CA
What are the (3) "C"s of Measles?
1. Cough

2. Coryza (a cold)

3. Conjunctivitis
To Dx Kawaski's disease, you need a fever > 5 days and 4 of 5 of what criteria?

1. Conjunctivitis;
2. Rash (truncal);
3. Aneurysms of coronary arteries;
4. Strawberry tongue (or crusting lips);
5. Hands and feet erythema

(child will not want to walk b/c it is painful on swollen feet)
(2) Gold standard Dx test for Osteomyelitis?
1. MRI

2. Technetium Bone scan
(better test)
What is the Dx test of Transient Synovitis?

Technetium scan

results: Increased uptake at Epiphysis
A child with high, spiking fevers that return to normal daily, generalized lymphadenopathy, and a rash of small, pale pink macules w/ central pallor on trunk and proximal extremities w/ possible involvement of palms and soles; joint pain weeks to months after fever
Systemic Still's Disease

(type of juvenile RA)

A child < 5-yo presenting with skull lesions, diabetes insipidus and exophthalmus
Hand-Schuller-Christian dz

(a form of Histiocytosis X)

[HSC: Huge eyes, Skull lesions, Continuous urination]
MC malformation of the head and neck

Cleft Lip

cause: failure of fusion of Maxillary prominences

(no interference with feeding)
What is the difference in pathology b/t an Anterior and Posterior Cleft Palate?
failure of Palantine shelf to fuse with:

Anterior - Primary palate

Posterior - Nasal septum

(both interfere with feeding and require a special nipple for the baby)
a boy is born with a long face, prominent jaw, large ears, enlarged testes (postpubertal), developmental delay and mental retardation
Fragile X syndrome

(X-linked Dominant; #1 cause of MR in boys)
(2) toxic ingestions that can cause Hypotension with bradycardia
1. Organophosphates

2. Beta-blockers
(2) toxic ingestions that can cause Hyperthermia
1. Salicylates

2. Anticholinergics
A 9-year-old boy is brought to the pediatrician's office for bed-wetting. His mother states that he has never been dry at night. Occasionally, he has problems controlling his bladder during the day. On physical examination, his blood pressure is 98/56 mm Hg. Both his weight and height are below the 5th percentile for his age. His bladder is enlarged and palpable above the symphysis pubis.

Dx test?
Bladder Outlet obstruction

(MCC of urethral obstruction in males is posterior urethral valves. It typically results in urinary obstruction and vesicoureteral reflux)

Dx test: Voiding cystourethrogram
An 11-year-old boy presents with fever and sore throat. A rapid-strep test confirms streptococcal pharyngitis. He is leaving for a summer camp in 2 days. In the past, he has had problem finishing the whole course of antibiotic treatment.

What is the best treatment for his streptococcal pharyngitis?
A single dose of Benzathine Penicillin G intramuscularly
At what stage is some contour separation of the areola is noted?
Tanner stage 4
A 5-week-old infant is brought to the clinic for a 4-week history of noisy breathing that has not improved. She has otherwise been healthy except for a current upper respiratory infection for the past 4 days, which according to the parents, has worsened the noisy breathing. On examination, she has inspiratory stridor. The noisy breathing improves when the infant is asleep.

(MCC of stridor in children)
What is the equation for calculating water deficit?
(3 steps)
1. Body H20 = 60% total body weight

2. (dehydrated Na) x (dehydrated body H20)
= (normal Na) x (normal body H20)

3. Free Water Deficit = (Normal body H20) -
(Dehydrated body H20)
On admission a child is dehydrated and weighing 10kg. His serum sodium is 175 (normal is 140).
What is the child's free water deficit?
1. Body H20 = 60% total body weight
Body H20 = 10kg x 60% = 6kg

2. (dehydrated Na)x(dehydrated body H20) = (normal Na)x(normal body H20)
Nml body H20 = (175 x 6)/140 = 7.5L

3. Free Water Deficit = (Normal body H20)-
(Dehydrated body H20)
FWD = 7.5L - 6L = 1.5L
a 3-yo child presents with a follow-up of Hepatitis A from a Dx 5 days ago. Mother is concerned about 1-yo brother becomming ill.
What is correct post-exposure prophylaxis in brother?

what if brother was > 2-yo (and received vaccine)?
in child < 2-yo:
Immunoglobulin only

in child > 2-yo:
both Hepatitis A vaccine and Immunoglobulin
A 1-yo child presents with N/V and severe abdominal pain. PE shows diffuse abdominal tenderness and labs show amylase of 1400 and lipase of 3000.
Pancreatitis caused by Trauma

(usually unexplained causes of pancreatitis in children lead to suspicion of Abuse)
What lab test helps rule-out HIV infection in an infant who is on AZT prophylaxis from mother that has HIV?
HIV DNA qualitative PCR

(HIV can be excluded in a child with two separate negative assays)

HIV RNA qualitative PCR - to measure number of copies of active virus (not to rule-out)
MC side effect of AZT?

(due to bone marrow suppression)
A child presents with bloody diarrhea and new seizures.


A child is admitted with bacterial meningitis and treated. Eight hours later he begins to have convulsions.

Next step?

(possible complication of bacterial meningitis; important to monitor child for two days to insure that it does not develop)

next step: Check Electrolytes
A 4-month-old boy presents with slow growth and poor motor development. On PE the baby appears hypotonic and weak; no DTRs; visible atrophy and fasciculations of the tongue.
Spinal Muscular Atrophy
A 5-mo baby presents with a fever and history of a chronic draining ear. There is also severe diaper rash, cradle cap and a scaling, purpuric, papular rash appearing over the trunk. Sample of cells resemble tennis rackets
Langerhans Cell Histiocytosis

(80% also has skeletal involvement; tennis racket cells = Birbeck granules)
While watching a soccer game you see a 9-yo child collapse. The child is not breathing and is pulseless.

What is the first step?
Call 911

(in a witnessed collapse where the child is pulseless, the probability of an arrhythmia is higher, thereore getting a Defibrillator to the patient quickly is best for resuscitation. "Witnessed pulseless collapse = Phone first, not fast")
What lab is elevated in all types of Rickets?
Alkaline Phosphatase
A child is found lying unconscious under a tree with a ladder proped against it. The child is cyanotic and not breathing.

Next step?
Perform a Jaw thrust to open airway and give two rescue breaths

(this will help stabilize the cervial spine; establishing an airway and 1 minutes of CPR before activating EMS is indicated in infants and children - "phone fast, not phone first")