Pediatrics

Front 1

What is Intraventricular hemorrhage (IVH)? What is biggest risk factor?

Back 1

newborn with pallor, cyanosis, hypotension, seizures, focal neuro signs, bulging or tense fontanel, apena and bradycardia
RF: premature and LBW infants
Dx: transfontanel US for all newborns with predisposing RF because can be asymptomatic

Front 2

What is Tinea versicolor present as? How do you Dx? How do you treat?

Back 2

pale, velvety pink or whitish, hypopigmented macules that do NOT tan and do not appear scaly, but scale on scraping.
Dx: skin scrapings after KOH preparation -> large, blunt hyphae and thick-walled budding spores "spaghetti and meatballs"
Tx: selenium sulfide lotion or ketoconazole shampoo

Front 3

When would you screen for lead poisoning in a child?

Back 3

- RF's + = minority race, low SES, pre-1950s housing, occupational exposure from parents, recent immigration
- or symptomatic (microcytic anemia and neuro damage)

Front 4

Vision screening for kids when?

Back 4

children aged 0-5 -> look for strabismus, amblyopia and refractive errors

Front 5

When give meningococcal vaccination?

Back 5

11-12 years
if asplenic or high risk can give at 2 years

Front 6

When do you give rotavirus vaccine?

Back 6

Between 2-8 months
First dose 6-14weeks (not after 15weeks)
Last dose before 8 months

Front 7

Hows does Transposition of the great vessels present? What is treatment?

Back 7

presents in first few hours of life; commonly in diabetic moms and in males
- cyanosis and tachypnea + single loud S2, with no murmur
CXR: shows increased pulmonary markings (increased flow) ECHO confirms
Tx: PGE1 IV to stabilize neonate by maintaining PDA - impt for survival - need surgery

Front 8

Disorder of the spinal nerve roots?

Back 8

Cauda Equina syndrome (CES)

Front 9

Presents w/ recurrent infections early in life especially with catalase + organisms (s. aureus, E.coli, klebsiella, aspergillus, candidia), pneumonia and suppurative adenitis
Gram stain: PMNs filled with bacteria ?

Back 9

Chronic granulomatous disease (CGD)

Front 10

What is the defect in CGD? What is inheritance? How do you dx? What is Tx?

Back 10

-impaired oxidative metabolism within phagocytes (intracellular killing is ONLY thing deficient) - lack of NADPH oxidase activity
-X-linked AR
Dx: Negative nitroblue tetrazolium test (cannot turn it blue)
Tx: daily TMP-SMX (IFN-alpha can reduce incidence of serious infections)

Front 11

Child with recurrent infections (S. pyogenes, S. aureus, Pseduomonas), oculocutaneous/partial albinism, neuropathy and neutropenia
Gram stain: giant cytoplasmic granules in PMNS ?

Back 11

Chediak-Higashi Syndrome
- defective LYST gene (phagocyte lysosomal transport)
Tx: bone marrow transplant

Front 12

What happens in the adipose tissue to make estrogen?

Back 12

peripheral conversion of adrenal androgens by aromatase enzyme (which is present in the adipose tissue) to estrogen (estrone)
-> lessens sx of menopause

Front 13

At what age do physicians give dexamethasone w/ or prior to first dose of antibiotics in bacterial meninigits and why?

Back 13

>/= 6 months - to prevent neurological sequelae (hearing loss) in kids and decrease mortality in adults

Front 14

At what age do physicians give dexamethasone w/ or prior to first dose of antibiotics in bacterial meninigits and why?

Back 14

>/= 6 months - to prevent neurological sequelae (hearing loss) in kids and decrease mortality in adults

Front 15

For the past 2 weeks, a 6 year-old boy has had agressive edema of various sites - puffy cheeks and eyes on awakening and swelling of feet + abdomen as day progress. His hx includes URT infection and being stung by YELLOW jacket.

Back 15

Serum Sickness - venom (type III hypersensitivity)

Front 16

A 4 YO girl presents with severe pneumonia, hypoxia, FTT and thrush.
CXR shows diffuse bilateral infiltrates.

Back 16

HIV/AIDS (PCP pneumonia)
- DDX: SCID (they are usually dead btw 6 mo + 4yrs and NO lymphadenopathy)

Front 17

A 2 month-old infant with congenital heart disease is hospitalized with a cough and tachypnea.
CXR shows diffuse infiltrates and NO thymic shadow. Serum Ca2+ is 6.5mg/dL

Back 17

DiGeorge's Syndrome

Front 18

10 mo old boy had 5 episodes of otitis media. PE eczema
CBC: thrombocytopenia
His uncle died in infancy of infection

Back 18

Wiskott-Aldrich (X-linked Waiter)

Front 19

10mo old male presents with subcutaneous abscess. At age of 5 mo he had staph cervical lymphadenitis that required drainage. His uncle also had recurrent abscesses.

Back 19

chronic granulomatous dz (abnormal nitro blue test - neutrophil oxidation test)
- staph dz = phagocytic

Front 20

6 yo boy from Indiana develops fever, chest pain and cough. He was playing in a barn 10 days ago.
CXR - diffuse bilateral reticulonodular infiltrates + hilar lymph node

Back 20

Histoplasmosis

Front 21

13 YO girl develops fever (102.5F) + chest pain and left lower lobe pneumonia. She was visiting family in Arizona where they were out in the desert a lot.
PE - tender, red, shiny induration on both shins

Back 21

Coccodiomycosis
(erythema nodosum)

Front 22

16 yo male presents with fever, arthralgia, cough, abdominal pain and rash of 5 days duration. He went to Puerto Rico for a river rafting trip 3 weeks ago.
PE: T 102F, splenomegaly, urticaria, WBC-7.6 with 23% Eosinophils

Back 22

Schistosmiosis (fresh water parasitic worm infection, freshwater snails) - multisystem and splenomegaly
- can lead to bladder cancer

Front 23

A 4 YO boy presents with fever and cough of 10 days duration. 101.8F, hepatomegaly.
Norm WBC with 45% eosinophils.
He likes to play with his puppy in a sandbox.

Back 23

Toxocara canis - can lead to visceralis larva migrans and ocularis larva migrans

Front 24

8 YO boy returns from Africa and 1 week later develops fever that gets higher in the next 4 days. He has HA, abdominal pain and refuses to eat. His last bowel movement was normal prior to onset of fever.

Back 24

Malaria OR typhoid fever

Front 25

6 YO boy develops swelling pain + decreased ROM in the right knee. NO fever. 2 months ago he was hiking in Wisconsin.
PE: swelling + decreased ROM in the R knee, rest of exam normal.

Back 25

Lyme Disease
(arthritis)

Front 26

11 YO girl presents with enlarging erythematous NON-itching spot on her left shoulder. She was camping in upstate NY 2 weeks ago.
PE: 100.3F, flat annular lesion 7cm diameter.

Back 26

Lyme disease
(Erythema migrans)
spiorcete (cousin of syphillis)
TX: >8/9yo = doxycycline
less than 8/9yo = ampicillin

Front 27

8 YO girl from N. Carolina present with fever of 102.6F, severe HA and myalgia over 3 days in june
PE: macular rash on wrists, palms, ankles and soles.
Labs: Platelets are low and serum Na+ low

Back 27

RMSF
TX: doxycycline ONLY

Front 28

11 month old boy has fever of 103-104F for 4 days and was seen for a single episode of febrile seizure.
3 days later, the child's fever has resolved but NOW he has a maculopapular (pink) rash

Back 28

Roseola (HHV-6)

Front 29

6 YO girl has 1 day history of rash. It started on her face and then spread down to the trunk. Prior to developing the rash she had a 4 day hx of running nose, pink eyes with crusting, barking cough and high fever. She was recently adopted from Poland.
PE: 103F, maculopapular rash mostly on trunk. 3 tiny whitish round spots on buccal mucosa

Back 29

Measles (Rubeola)
Koplik spots

Front 30

7 YO boy has sore throat, fever and rash. His classmate had similar sx 1 week ago.
PE = 102F, red tonsils, swollen tender anterior cervical lymphatic nodes, and confulent red rash that feels "SAND-PAPER-like". He has circumoral pallor.

Back 30

Scarlet Fever - from GAS (pyogenes)
DDX: Kawasaki Dz (fever >5 days and unique swelling/peeling of hands and feet)

Front 31

8 YO girl has 4 day hx of fever and bright red cheeks. Now she has a rash everywhere.
PE: 100.8F, "slapped"-looking cheeks, and discrete macular rash on trunk and extremities that looks LACY

Back 31

Parvo B19 virus

Front 32

3 YO develops a rash. She was recently adopted from Romania, and her immunization hx is unknown
PE - 100.4F, confulent maculopapular rash on face and discrete rash on the trunk; Suboccipital + posterior cervical lymph nodes palpable + arthritis

Back 32

Rubella (togavirus)

Front 33

5 YO boy has a very and pruritic rash for 3 days. He is a recent immigrant from overseas.
PE - 101.8F; crops of papules, vesicles, pustules and crusts on the face, trunk and extremities.

Back 33

Varicella (chix pox)

Front 34

5 YO boy presents with sudden onset of high fever and reddish-purple palpable NON-blanching spots, mostly on lower extremities and buttocks. He is rapidly progressing to SHOCK.

Back 34

meningococcal menigitis
(NON-blanching = papule VS. a palpable purpura seen in HSP - and they would be walking)

Front 35

9 YO girl has fever, pink eyes and rash for 3 days. She refuses to eat.
PE = 101.8F, red conjuctival w/ yellow discharge, swollen lips and oral ulcers. On the trunk and palms there are round flat lesions with central darkening. Upon slight stroking, her epidermis sloughs.
Last week she was treated with Penicillin.

Back 35

Scaled Skin syndrome (staph aureus)
target lesions (erythema multiforme)
Nikolsky's sign + = pemphigus vulgaris, TEN, scaled skin syndrome