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44 Cards in this Set
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Physiologic herniation of bowel occurs at what maternal age?
a. 6-8 wks b. 8-12 wks c. 12-16 wks d. 16-20 wks e. 20-24 wks |
8-12 wks
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Plaque-like calcification in the abdomen of a neonate is most likely seen in which:
A. Neuroblastoma B. Intrauterine perforation of the bowel C. Multicystic dysplastic kidney D. Congenital megacalyces E. PCP |
. Intrauterine perforation of the bowel
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FALSE about vascular malformations?
a. Lymphocele (lymphangiomas) grow rapidly in first year b. Venous malformations enlarge during puberty c. (Capillary) hemangiomas involute rapidly during the first year d. AV malformation can grow with age |
Hemangiomas involute rapidly during the first year (FALSE)
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Hemangiomas of infancy always have a period of growth (proliferative phase) followed by a period of shrinkage (involutive phase). Most hemangiomas begin their proliferative (growth) phase shortly after birth. This phase usually lasts for 4 to 6 months, but can be longer or shorter. The involutive phase is much slower and can take up to ten years. It is difficult to predict how long this shrinkage process will last. Lesions that involute slowly, over a long period of time, are much less likely to shrink completely. In some children, even those hemangiomas that do shrink completely may leave residual fatty tissue and telangiectasias (tiny dilated blood vessels) of the skin.
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TRUE regarding venous malformation size:
a regresses in childhood b parallels the child’s growth c involutes at birth |
parallels the child’s growth
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9-year-old boy with intramuscular vascular malformation in his thigh mass containing phleboliths. This most likely reprsents:
A) Capillary hemangioma B) Venous malformation C) Arteriovenous malformation D) Lymphatic malformation CAVERNOUS hemangioma was an option in some years but not others |
Venous malformation
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Phleboliths are pathognomonic for venous malformation (emedicine, Vascular, Venous malformations). Venous malformations are congenital, but they may not become clinically apparent until late infancy or early childhood. Venous malformations do not regress or involute but rather grow with the child. Rapid enlargement may occur during puberty or pregnancy or with trauma. Potential complications include pain, compression or invasion of adjacent structures, decreased range of motion, bleeding, consumptive coagulopathy, and cosmetic deformity. Phleboliths are common.
Cavernous hemangiomas (more often seen in adults) can have punctate calcifications. Cavernous hemangiomas are larger and deeper and occur later in life. Often intramuscular. Do not spontaneously involute and therefore may require surgical intervention. Phleboliths are associated with cavernous hemangiomas in approximately 50% of cases. Capillary hemangiomas are one of the most common benign orbital tumors of infancy. Benign endothelial cell neoplasms typically absent at birth and characteristically have rapid growth in infancy with spontaneous involution later in life. Capillary hemangiomas are present in approximately 1-2% of neonates. All patients that eventually develop hemangiomas have them by age 6 months. Vascular malformations, such as lymphangiomas and arteriovenous malformations, are present at birth and are characterized by very slow growth with persistence into adult life. Females outnumber males with hemangiomas by ratio of 3:1. Arteriovenous hemangiomas are deep or superficial, are abnormal communication between arteries and veins, and cause a variable degree of shunting. Vascular malformations further differentiated into low-flow and high-flow lesions, which is an important distinction having clinical and therapeutic implications. The time-resolved contrast-enhanced 3-D MR angiography permits the most accurate classification of vascular malformations with visualization of the dynamic enhancement profile. Sclerotherapy is the treatment of choice for low-flow lesions. |
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Atresia of which portion of bowel is most associated with other congenital anomalies?
a. duodenal atresia b. jejunal atresia c. ileal atresia d. colonic atresia e. R colon atresia f. L colon atresia |
duodenal atresia
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Duodenal atresia has the highest association with other anomalies. 50% of patients with duodenal atresia will show other congenital anomalies. Common associations are Trisomy 21, malrotation, congenital heart disease, and VACTERL associated anomalies. Most sites of duodenal atresia are around the ampulla of Vater, either just proximal or just distal to it. The radiographic sign is the “double bubble” sign created by a dilated stomach and proximal duodenum. This can be seen as early as 24 weeks on ultrasound. The pylorus usually demonstrates hypertrophy secondary to the downstream obstruction. Emesis can be bilious or not, depending on whether the site of atresia is proximal or distal to the ampulla. Jejunal, ileal, and colonic atresias are rare and are secondary to in utero vascular accident.
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Most likely to cause cavitary/necrotizing PNA in a child?
a. Staphyloccocus aureus b. Streptococcus pneumoniae c. Chlamydia d. Mycoplasma e. Viral |
Most likely to cause cavitary/necrotizing PNA in a child?
a. Staphyloccocus aureus b. Streptococcus pneumoniae c. Chlamydia d. Mycoplasma e. Viral |
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Which is most characteristic of coxa valga deformity of the hips with dislocation?
a. Cerebral palsy b. Legg-Calve-Perthe disease c. Osteogenesis Imperfecta d. Metaphyseal dysplasia e. Tibial torsion |
a. Cerebral palsy
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Answer: Cerebral palsy
Coxa valga = increased angle between the head and neck of the femur and the shaft, > 140° in AP projection, neutral position. Reflects persistence of neonatal alignment of proximal femur, usually from weakness of abductor muscles and lack of normal weight-bearing forces. Most commonly associated with neuromuscular disorders such as cerebral palsy, spinal dysraphism, and poliomyelitis, but is also seen in some skeletal dysplasias and juvenile idiopathic arthritis. If severe, then there may be associated lateral subluxation or even dislocation of the femoral head. CP – coxa valga LCP – coxa magna and plana OI – coxa vara Metaphyseal chondrodysplasia – coxa vara Tibial torsion - coxa valga |
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Most commonly associated w/ microcolon:
a. meconium plug b. meconium peritonitis c. meconium ileus d. Hirschprung's e. anal atresia |
meconium ileus
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Meconium ileus causes 10-25% of bowel obstruction in newborns, and occurs in 6-20% of children with cystic fibrosis. Contrast enema shows a microcolon.
Hirschsprung's - absence of ganglion cells that innervate colon; usually focal segment. Meconium plug syndrome - functional immaturity of ganglion cells; it is a temporary phenomenon that resolves. |
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Microcolon is NOT associated with which of the following?
a. Meconium ileus b. Meconium plug c. Meconium peritonitis d. Hirshprung’s disease |
Meconium plug
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Meconium plug syndrome = functional colonic obstruction in the full-term neonate. Plug of thick meconium lodges in the distal colon, probably caused by poor peristalsis as a result of neuronal underdevelopment. Radiographs may reveal low obstruction with bowel distension. Contrast enemas usually reveal a normal-caliber left colon.
Meconium ileus occurs when meconium obstructs the distal ileum (microcolon always present, 99% a/w CF). Differential for microcolon is MI MCA: Meconium ileus/ peritonitis (cystic fibrosis), Ileal/ jejunal atresia, Megacystic-microcolon-hypoperistalsis syndrome, Colonic atresia, Aganglionosis (Hirschsprung dz). |
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A child presents with progressive lower extremity weakness, leg length discepancy, limp, scoliosis, sacral dimple/tuft of hair. Most likely associated with:
A. Tethered cord B. Sacrococcygeal teratoma C. Myelomeningocele D. Idiopathic scoliosis E. Chordoma |
tethered cord
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Tethered cord syndrome is associated with a variety of conditions: thickened filum terminale, intradural lipoma, myelomeningocele, diastematomyelia, lipomyelomeningocele, trauma, and infection. Presents with cutaneous findings: present in 80-100% of childhood tethered cord, and <50% of adult tethered cord, hypertrichosis (tuft of hair), subcutaneous lipoma, and/or dermal sinus. Difficulty with walking with lower limb weakness. Muscle atrophy, short limb. Foot deformity: common in children, not seen in adults. Sensory deficit (numbness).
Bladder dysfunction: dribbling, delayed toilet training, recurrent urinary infection and bed-wetting. Frequency, urgency, sensation of incomplete emptying, incontinence. Pain in the back, legs, or foot arches. Scoliosis or kyphosis: common in children, uncommon in adults (<5%). In children symptoms are aggravated by growth spurts. In adults symptoms are aggravated by trauma, maneuvers associated with stretching of the spine (flexion), disc herniation, spinal stenosis. Note that a meningomyelocele could cause similar symptoms but would present at birth. Idiopathic scoliosis (orthopedic problem) does not give rise to leg weakness, and is not associated with a sacral dimple. |
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Most specific finding in tethered cord:
a. Scoliosis b. Lower extremity paralysis c. Diarrhea d. Chronic UTI e. Limp |
scoliosis
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Diabetic mothers are more prone to have children with:
a) Caudal regression (syndrome) b) Syringohydromyelia c) Myelomeningocele d) Lymphoma e) Tethered cord f) Filum lipoma g) Sacral teratoma |
Caudal regression syndrome (sacral agenesis)
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Caudal regression syndrome is hypoplastic/absent distal spine, sacrum due to mesodermal insult during 4th week of gestation. Caudal regression syndrome = sacral agenesis. Infants of diabetic mothers are predisposed (16-22% of children with sacral agenesis have diabetic mothers). Also seen with greater incidence in infants of diabetic mothers:
meconium plug syndrome, subvalvular aortic stenosis (hypertrophic obstructive cardiomyopathy), hyaline membrane disease, adrenal hemorrhage, MCDK, renal vein thrombosis. |
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An 8 year-old develops fever, elevated WBC, flank pain, and positive UA. First imaging test?
a. cystogram to check for reflux b. kidney and bladder US c. CT abdomen/pelvis |
Kidney and baldder US
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3 month old baby with a solid renal mass. Most common neonatal renal mass?
a. Wilms tumor b. Mesoblastic nephroma c. RCC d. Neuroblastoma |
. Mesoblastic nephroma
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Mesoblastic nephroma is the most common solid renal tumor in children less than 6 months. It is a mesenchymal neoplasm consisting of connective tissue,islands of immature tubules and glomeruli,muscle,cartilage,cystic spaces. US demonstrates a large predominantly solid complex renal mass. Prognosis is good post-nephrectomy except for the more aggressive cellular histologies. On CT it appears as a large uniform mass of soft tissue attenuation, replacing the majority of the renal parenchyma. It may extend beyond the capsule but does not invade the renal vein. Post-contrast, tumor generally enhances less than the renal parenchyma, although focal areas of strong enhancement may present then becoming indistinguishable from a Wilms' tumor.
Wilms has it peak incidence at 3 ½. RCC is rare before age 5. |
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An 8 year-old develops fever, elevated WBC, flank pain, and positive UA. First imaging test?
a. cystogram to check for reflux b. kidney and bladder US c. CT abdomen/pelvis |
Kidney and baldder US
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3 month old baby with a solid renal mass. Most common neonatal renal mass?
a. Wilms tumor b. Mesoblastic nephroma c. RCC d. Neuroblastoma |
. Mesoblastic nephroma
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Mesoblastic nephroma is the most common solid renal tumor in children less than 6 months. It is a mesenchymal neoplasm consisting of connective tissue,islands of immature tubules and glomeruli,muscle,cartilage,cystic spaces. US demonstrates a large predominantly solid complex renal mass. Prognosis is good post-nephrectomy except for the more aggressive cellular histologies. On CT it appears as a large uniform mass of soft tissue attenuation, replacing the majority of the renal parenchyma. It may extend beyond the capsule but does not invade the renal vein. Post-contrast, tumor generally enhances less than the renal parenchyma, although focal areas of strong enhancement may present then becoming indistinguishable from a Wilms' tumor.
Wilms has it peak incidence at 3 ½. RCC is rare before age 5. |
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Which disease does Down’s syndrome have the same incidence as in the general population? (Down's syndrome is NOT associated with:)
A Duodenal atresia B Pancreatic divisum C Obstructive sleep apnea D Hirschsprung's E Annular pancreas |
Pancreatic divisum
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Which disease does Down’s syndrome have the same incidence as in the general population? (Down's syndrome is NOT associated with:)
A Duodenal atresia B Pancreatic divisum C Obstructive sleep apnea D Hirschsprung's E Annular pancreas |
Pancreatic divisum
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Answer: Pancreatic divisum (NOT associated)
Bony changes: flattened acetabular angles, outward flaring of iliac wings, hypoplasia of ischial rami, increase in number of ossification centers of sternum, only 11 ribs, short in-curved fifth finger with a hypoplastic middle phalanx, atlantoaxial and atlantoccipital instability, clinodactyly. CV: AV canal defect, VSD, PDA. Pulmonary: Obstructive sleep apnea. GI: duodenal atresia, duodenal bands, annular pancreas, TEF, anorectal anomalies, Hirchsprung. Higher incidence of leukemia. |
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Down’s syndrome is NOT associated with:
a Increased atlanto-axial distance b Hypertrophic pyloric stenosis c Glossoptosis d Trident hands e Duodenal atresia f Echogenic bowel |
d Trident hands
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Trident hands are associated with achondroplasia - short, stubby fingers, separation between middle and ring fingers.
Abnormalities assosciated with Down’s syndrome include: Glossoptosis (abnormal downward or posterior placement of the tongue) Duodenal web or atresia Hirschprung Atlantoaxial instability Other ultrasonographic abnormalities include cystic hygroma, duodenal atresia or stenosis (double-bubble sign), cardiac defects (endocardial cushion defect, ASD, VSD, and abnormal MV,TV), and echogenic bowel and renal pyelectasis. |
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Down's syndrome is NOT associated with:
A. Scaphocephaly B. Duodenal atresia C. Clinodactyly D. Hypotelorism E. Flat acetabulum F. Under development of second tooth G. Echogenic bowel H. Multiple manubrial ossification centers I. Flattened acetabular roof |
Scaphocephaly
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Down's patients have brachycephaly - WIDE head in lat to medial direction (synostosis of coronal sutures). Scaphocephaly = dolichocephaly - LONG head in AP diameter (early closeure of sagittal sutures).
Down Syndrome also characterized by MR, hypotonia, characteristic facies, Simian crease. More common associations: Persistent metopic suture (40-79%) after age 10, atlantoaxial subluxation (25%) hypersegmentation of manubrium = 2-3 ossification centers (90%), 11 pairs of ribs (25%), clinodactyly (50%). Congenital heart disease (40%): endocardial cushion defect, VSD, tetralogy of Fallot Duodenal atresia (8-10%) – “double bubble sign” |
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Work up of UTI in a 8 yo female would be:
a. VCUG b. MRI of the pelvis c. Cystogram d. Ultrasound |
us
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In children > 3-4 yrs of age who have only signs of lower UTI, VCUG is not recommended if renal U/S is normal. However, if renal U/S is abnormal, then VCUG or radionuclide cytography is recommended.
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2 year old girl develops flank pain, burning micturation, fever and pyuria. What is the next most appropriate study?
a. Ultrasound of the kidneys and bladder b. Contrast-enhanced CT c. IVP d. VCUG e. excretory urogram |
VCUG
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All are associated with NEC EXCEPT:
A. Most commonly involves the right colon and ileum B. Late finding is right sided stricture C. Associated with bacterial infection |
Late finding is right sided stricture
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Necrotizing enterocolitis may occur secondary to hypoxia, stress, infection/endotoxin, or congenital heart disease. It usually develops 2-3 days after birth, and 90% of cases develop within first ten days of life. Predisposed by prematurity, low-birth-weight, Hirschsprung disease, and any type of bowel obstruction. Symptoms include abdominal distention, bilious emesis, diarrhea, bloody stools, and sepsis. On plain film, signs include small bowel distention, a disorganized bowel gas pattern, tubular bowel loops, thumbprinting (bowel wall edema), pneumatosis intestinalis/portal venous gas, pneumoperitoneum, and ascites. NEC usually involves the terminal ileum, cecum, and right colon. It rarely involves the stomach or proximal small bowel. Complications include bowel perforation in 10-30%, which is treated by surgical resection. If large amounts of bowel resected, short bowel syndrome (diarrhea, malnutrition) may result. Inflammatory strictures develop in 80% of patients, characteristically in the left colon.
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XRT in children will more likely results in which when compared with XRT in adults:
a. scoliosis b. osteonecrosis c. sarcoma d. cartilage damage |
Scoliosis
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Best way to differentiate hyaline membrane disease (RDS) from meconium aspiration:
a. Lung volumes b. Pleural effusion c. Interstitial pattern d. Heart size e. Pneumothorax/pneumomediastinum |
Lung volumes
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Meconium aspiration is most common cause of respiratory distress in full term infants. It produces hyperinflation with areas of emphysema. Diffuse, bilateral patchy opacities are seen. Rapid clearing in 48 hours. Small pleural effusions are sometimes present (20%). Physical obstruction of small airways is associated with subsegmental collapse and compensatory hyperinflation. The coarse patchy infiltrates are due to atelectasis and inflammatory changes. Rupture of hyperinflated air spaces may lead to pneumothorax and pneumomediastinum in 25%.
Hyaline membrane disease (RDS of the premature newborn) is an acute disease with hypoinflation (stiff lungs), immature surfactant production, atelectasis, reticulogranular pattern, and prominent air bronchograms. Low lung volumes are seen (if not on ventilator). In severe cases, diffuse consolidation may reflect edema and hemorrhage. |
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Large mass between bladder and rectum on neonatal ultrasound is most likely:
A. Sacrococcygeal teratoma B. Rhabdomyosarcoma C. Neuroblastoma D. Hydrometrocolpos E. Duplicated rectum |
Sacrococcygeal teratoma
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Large mass between bladder and rectum on neonatal ultrasound is most likely:
A. Sacrococcygeal teratoma B. Rhabdomyosarcoma C. Neuroblastoma D. Hydrometrocolpos E. Duplicated rectum |
Sacrococcygeal teratoma
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Which is TRUE of Meckel's diverticulum?
A. urachal remnant B. omphalomesenteric remnant C. arises on the mesenteric side of the bowel D. cloacal remnant |
Omphalomesenteric remnant
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The diverticulum is a blind pouch that is a remnant of the omphalomesenteric duct or yolk sac that nourished the early embryo. It contains all layers of the intestine and may have ectopic tissue present from the pancreas or stomach.
50% ectopic gastric mucosa (this increases to 95% in pts presenting w/ GI bleed); located within 2 feet of ileocecal valve/2 % of population/ symptomatic before age of 2/ 2 inches in length; usually located on ANTImesenteric border. REMEMBER: in nucs study: pentagastrin stimulates uptake of pertechnetate & cimetidine inhibits its secretion. |
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All are associated with SCFE EXCEPT:
a. Obesity b. Hypothyroidism c. Growth hormone d. Spondyloepiphysealis dysplasia e. Renal osteodystrophy |
Spondyloepiphysealis dysplasia
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SCFE is associated with hypothyroidism, panhypopituitaryism, gonadal conditions, renal osteodystrophy, and during growth hormone therapy.
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MOST specific fracture for child abuse?
a. Skull b. Long bone c. Scapula d. Clavicle e. Vertebral body |
SCAPULA
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Primary defect in osteogenesis imperfecta?
A. Decreased mineralization B. Decreased conversion of woven to lamellated bone C. Decreased formation of matrix D. Increased resorption |
Decreased formation of matrix
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Osteogenesis imperfecta is characterized by low production and abnormal production of type I collagen. The primary defect is in the extracellular bone matrix. The clinical deficits of osteogenesis imperfecta involve tissues with high type I collagen content including bones, ligaments, tendons, fascia, sclera, and teeth.
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What is the most common cause for a limp in a child without history of trauma?
A. Osteomyelitis B. AVN C. Toxic synovitis D. Hip dislocation E. Malignancy |
Toxic synovitis
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Most common mediastinal mass in 6-12 year old child:
A Neuroblastoma B Lymphoma C Thymoma D Germ cell neoplasm E Bronchogenic cyst |
Lymphoma
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Neuroblastoma is most common in children two years of age or younger. Ganglioneuroblastoma is the second most common. Mediastinal masses in young infants are within the posterior mediastinum 50-60%, with neuroblastoma as the most common (*this age group is too old for neuroblastoma).
In older children, mediastinal lymphadenopathy is most commonly due to lymphoma. Hodgkin's disease has been reported to cause 33-56% of pediatric mediastinal lymphomas. 80%-90% are nodular sclerosing. Neurogenic tumors are reported to be the second most common pediatric mediastinal malignancy seen in 21%-44%. |
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CXR of non-symptomatic child with HIV shows reticulonodular infiltrates. Most likely cause of these findings?
a. PCP b. LIP (Lymphocytic interstitial pneumonia) c. Parainfluenza |
LIP (Lymphocytic interstitial pneumonia)
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Answer: Lymphocytic interstitial pneumonia (LIP)
Lymphoid interstitial pneumonitis (LIP) is the second most common AIDS-defining illness in children. Typically occurs in children with relatively high CD4 counts. CXR demonstrates reticulonodular opacities +/- hilar lymphadenopathy that persists for two months despite adequate treatment. Patients are usually asymptomatic initially, but may develop cough and shortness of breath as the disease progresses. LIP increases susceptibility to bacterial pneumonia pathogens, especially Haemophilus influenzae and pneumococcus. PCP is most common opportunistic infection in children before universal prophylaxis. Pneumocystis carinii pneumonia typically presents with fever and tachypnea. CXR may show reticulonodular infiltrates or may be normal. Diagnosis is made by sputum or BAL antigen detection. Infants between 6 weeks and 1 year of age require prophylaxis regardless of CD4 count; otherwise, recommendations for prophylaxis are based on CD4 count and history of prior PCP infection. |
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Infant presents with peribronchial infiltrates, FTT, and diarrhea (symptoms of CF) may have all of following EXCEPT:
a sterility b intussusceptions c pansinusitis d intestinal polyposis e meconium ileus equivalent |
Intestinal polyposis (NOT associated)
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Cystic fibrosis is associated with pulmonary conditions such as recurrent pulmonary infections (staph/pseudomonas), progressive respiratory failure, finger clubbing (hypertrophic osteoarthropathy from hypoxemia); GI tract conditions such as pancreatic insufficiency, steatorrhea, malabsorption, liver cirrhosis, rectal prolapse, meconium ileus [meconium ileus equivalent in older children], meconium peritonitis, intussusception, and other conditions such as hypoplastic frontal sinus, opacification of other sinuses, infertility in males. Radiographic features include bronchiectasis, mucus plugging reticular, cystic pattern of lung fibrosis, prominent hila (pulmonary hypertension, adenopathy), recurrent pneumonias. Early complications include lobar atelectasis (especially RUL), pneumonia. Late complications include respiratory insufficiency, hypertrophic osteoarthropathy, recurrent pneumothorax (rupture of bullae and blebs), cor pulmonale and PAH, hemoptysis, aspergillus superinfection. Cystic fibrosis correct answer on 2002 exam (nonvisualization of gallbladder on HIDA scan). |
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Afebrile 2 month old child presents with stridor. AP and lateral XRs demonstrate eccentric narrowing of the trachea. Which of the following is most likely?
a. Thyroglossal duct cyst b. Papilloma c. Subglottic hemangioma d. Rhabdomyosarcoma |
Subglottic hemangioma
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Subglottic hemangiomas (= infantile laryngeal hemangiomas) are most common subglottic soft-tissue mass causing upper respiratory tract obstruction and croup-like symptoms in neonates (age < 6 months). Radiographic finding: eccentric thickening of subglottic portion of trachea (AP view), these arise from the posterior wall below true cords (on lateral). Epiglottis is a supraglottic mass.
Laryngeal papillomatosis is the most common benign tumor of the larynx, and might present with similar symptoms (inspiratory stridor, cough, respiratory distress). But the age of onset is older (1-54 years). Laryngomalacia (immaturity of cartilage) is most common cause of stridor in neonate + young infant, and is only cause of stridor to get worse at rest. This involves the supraglottic portion of the larynx. |
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Most common cause of round pneumonia in children is:
a. Staphylococcus aureus b. Streptococcus c. Psudomonas d. Klebsiella |
Streptococcus
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Two brothers with pneumonia, liver abscesses, and other infections. Which of the following do they have?
a. DiGeorge syndrome b. Chronic granulomatous disease c. Agammaglobulinemia d. Cystic fibrosis |
Chronic granulomatous disease
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Chronic granulomatous disease of childhood is a recessive X-linked (60%) / autosomal (40%) immunodeficiency disorder resulting in purulent infections and granuloma formation primarily involving lymph nodes, skin and lungs. Onset of symptoms is at childhood with recurrent chronic infections. Hepatic abscess is the most common abdominal process associated with this disease. Caused by abnormal leukocyte function.
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6 year old with a pustule on the hand, then develops swollen, painful epitrochlear and axillary nodes as well as forearm swelling. What is the most likely diagnosis?
a. Lyme disease b. Cat-scratch disease c. Mycosis fungoides d. Lymphoma e. RMSF f. Kawasaki dz. g. Eosinophilic fascitis |
Cat-scratch disease
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60% of cases of cat scratch disease occurs in kids. 3-5 days after a cat scratch, clinical symptoms include a localized papule progressing to a pustule that crusts over. Tender regional adenopathy develops within 1-2 weeks. Scratches are most often sustained over the hands or face producing epitrochlear, axillary, pectoral and cervical adenopathy.
Rocky Mountain Spotted Fever is caused by Rickettsia ricketsii. The classic clinical triad includes fever, rash and history of tick exposure. Macules first appear on the wrist and ankles and progress to involve the trunk. More severe sequelae include CNS involvement, renal failure, hepatic injury and bleeding. I found no mention of adenopathy. Kawasaki’s disease is an acute febrile multisystem disease of children. It is characterized by nonsuppurative cervical adenitis and changes in the skin and mucous membrane (congested conjunctivae, erythema of the oral cavity, lips and palms), and desquamation of the palms and soles. |
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Which places a pediatric patient at high risk for latex hypersensitivity?
a. Tetrology of Fallot b. Bladder exstrophy c. Unilateral renal agensis d. Allergy to PCN |
Bladder exstrophy
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Patients with spina bifida have a high risk of clinical latex hypersensitivity. Since exposure appears to increase the probability of latex hypersensitivity, children with other conditions requiring frequent surgery may also be at risk. These conditions include bladder exstrophy, cerebral palsy, myelomeningocele, and spinal cord injury. |
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Most common type of esophageal atresia:
a. EA with proximal TEF b. EA without TEF c. EA with proximal and distal TEF d. EA with distal TEF |
EA with distal TEF
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6-week-old afebrile infant with hyperinflated lung and peribronchial cuffing and peri-hillar infiltrates, what is the most likely cause?
a. Chlamydia b. Parainfluenza c. RSV d. E. coli e. Kleisbella f. Streptococcus g. Staphylococcus h. Mycoplasma |
parainfluenza
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Viral pneumonia (parainfluenza) tends to present with hyperinflation, atelectasis and perihilar peribronchial cuffing.
Chlamydia pneumonia - average age of onset is 6 weeks. Presents with cough, rhinitis, and conjunctivitis (30%). The findings on chest radiographs are far worse than would be predicted on physical exam. Radiographic findings can vary from perihilar/interstitial process to a focal alveolar infiltrate with generalized hyperinflation. Effusions may occur; consolidation is rare. Mycoplasma causes bronchopneumonia. |
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Membranous croup is caused by:
a. Staphyloccocus aureus b. Haemophilus flu c. Parainfluenza d. Streptococcus e. Ecoli |
. Staphyloccocus aureus
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Answer: Staphyloccocus aureus
Membranous croup (exudative tracheitis) is caused by a bacterial infection, most commonly Staphylococcus. Donnelly CXR shows irregularity fo the tracheal walls due to membranes in the subglottic airway. (Kirks 3e p.654) Noncontagious croup is caused by diphtheria. Viral croup, AKA croup or laryngeotracheobronchitis, is caused by a virus, commonly parainfluenza. Donnelly p. 5 |
