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170 Cards in this Set
- Front
- Back
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Baby came to the emergency with abnormal movement and teeth delay. Glucose is 5 (normal range from (5-10) Calcium is low Magnesium is low Phosphate is high What is the best management?
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Calcium |
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Child with septic arthritis came to er with kness pain , swelling . Management:
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Surgical drainage and iv antibiotic
* The goals of treatment include sterilization and decompression of the joint space and removal of inflammatory debris to relieve pain and prevent deformity or functional sequelae [1,3]. Surgical drainage and antimicrobial therapy are the cornerstones of therapy. - |
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Which syndrome is associated with coarctation of the aorta?
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Turner syndrome is associated with the following : *congenital heart defect particularly coarctation of aorta , bicuspid aortic valve *hypothyroidism *renal anomalies
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Kwashiorkor
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Low protein and high carbohydrate
Low protein and low carbohydrate. (marasmus) |
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7years girl presented with bilateral symmetrical lower limb weakness, emg showed ( i can't remember ) ,knee reflexes showed absolute bilateral knee reflex absence , she had hx one week ago of gi symptoms , what is the best treatment ?
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IVIG |
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Young , vesilce ,pastule on back like a band :
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Shingles
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Child admitted with sore throat and bilateral knee pain?
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JIA |
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Child eating a lot of milk but he does not eat meat, mcv hypochromic microcytic anemia , how will you manage this child?
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Oral vitamins + iron
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Child complain of unilateral scrotal swelling , does not transilluminate , what is your plan ?
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U/s and think about surgery
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Baby with 5 min after birth assessing ( hr 120 ,breath irregular and grasping , acrocynotic , cough and grimace , flexing all limbs not moving ) apgar score
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8 |
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. 8 years old girl, parent complains that she looks older than her classmates , wt and hight above the 95th percentile , otherwise normal :
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Life style modification
this is most likely due to obesity. Familial tall stature also known as constitutional tall stature is the most common cause of tall stature. The second most common cause is nutritional. The height as well as the weight are at higher percentile. Again the bone age is marginally to moderately advanced so final predicted height is not much. Nutritional tall stature is managed by life-style changes and avoidance of bad dietary practices. |
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Failure of obliteration of pharyngeal arch 2,3,4 leads to?
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Branchial fistula
* Defects in the development of pharyngeal cleft 1 can result in preauricular (i.e. in front of the pinna of the ear) cysts and/or fistulas * Anomalous development of the derivatives of pouches 3 and/or 4 can result in ectopic or absent parathyroid, thymic, or parafollicular thyroid tissue. The most common disorder in which this occurs is DiGeorge syndrome, caused by a deletion in the long (or "q") arm of chromosome 22, leading to a hypoplasia of 3rd and 4th pharyngeal pouch derivatives. Symptoms and signs of DiGeorge often include: - hypoplasia of the hyoidthymic hypoplasia (immunodeficiency due to a lack of T-cells) - hypoparathyroidism (missing or hypoplastic inferior parathyroid glands) - outflow tract defects (neural crest in this area also contributes to conotruncal cushions of the outflow tract) Interestingly, the hypoplasia of the 3rd and 4th arches can also disrupt the 1st and 2nd arches, leading to the following additional findings: micrognathia (reduced jaw) cleft palate hearing loss |
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Child football player on short acting β-agonist 5 time a week use + on zafirlukast
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Inhaled steroids child has uncontrolled asthma for which we should add steroids to his managemen Controlled: Daytime sx/reliver use of 2 times or less per w No : acute exacerbations/night sx/ limitation Pulmonary function normal or 80% predicted Partially controlled Daytime sx/reliver use of > 2 times per w night sx/ limitation of activity present Pulmonary function < 80% predicted acute exacerbations once or > per y Not controlled Daytime sx/reliver use of > 2 times per w night sx/ limitation of activity presentPulmonary function < 80% predictedacute exacerbations one in any week |
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Rheumatic heart dx prophylactic for 10 yrs old boy with no cardic involvement?
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10 y (Rheumatic fevere without cardaitis: 5 y or until age of 21 whichever is longer). |
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16 yr from aferica (ginia) with painless neck mass for 5 weeks developed cough , fever , urs:
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Burkitt lymphoma Burkitt lymphoma, or small noncleaved cell lymphoma, is a highly aggressive b-cell non-hodgkin lymphoma characterized by the translocation and deregulation of the c-myc gene on chromosome 8. - frequent bone marrow and central nervous system (CNS) involvement. Abdominal masses, which can cause abdominal pain and distention andascites. Painless lymphadenopathy (adults > children) - non HL: malignant proliferation of lymphocytes T cell, B cell, or intermideate origin cell - EBV has major role in Burkitt - predisposition w/congenital or aquired immunodeficiencies - T cell: mediastinal mass/lymphoblastic - B cll: small non cleaved cell |
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Tonsilitis case:
A. Amoxicillin / clavilonic B. Vancomycin C. Ciprofloxacillin D. Trimethoprime / sulpha |
To treat tonsillitis penicillin v or amoxicillin or erythromycin (if penicillin allergy) x 10 d are used
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5 years unwell with lower limb ecchymosis, positive cd10 (calla)?
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All
cd10 also called common acute lymphoblastic leukemia antigen (calla), one of first markers to identify leukemic cells in children (hence its name) found on all cells which derive from pre-b lymphocytes |
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Child with stridor, slightly relieved by epinephrine what will you do next?
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Steroids
a definitive treatment is treating the underlying disorder but emergency care involves: a mixture of helium and o2 (heliox), nebulized epinephrine, and dexamethasone (10 mg iv, then 4 mg iv q 6 h) may be helpful in patients in whom airway edema is the cause. |
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10 months, set without support, can't walk or crawl, say mom to hold him , grip pen what is the delay:
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Gross motor |
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Patient increase foot size 39 >> 41.5 and increase size of hand and joint which hormone?
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Somatotropin hormone “ known as growth hormone
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158. A child complains of bilateral knee swelling, fever and pharyngitis, “all at the same time i think”. His labs show high esr with no other abnormality. What is the most likely diagnosis?
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Acute rheumatic fever is diagnosed according to modified jones criteria: 2 major or 1 major 2 minor plus evidence of preceding step infection (history of scarlet fever, group a strep pharyngitis culture, positive rapid antigen detection test, anti-streptolysin o titers)
Minor: prolong PR, elevated CRP/ESR, arthralgia, fever |
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Child with barking cough and another sign indicate respiratory infection. What cause of this patient A. No croups or laryngotracheitis in answers B. Pertussis C. Epiglottitis D. ????
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Epiglotitis Barking cough is classic for croup which presents along with stridor. Pertussis presents with a whooping cough. In epiglottitis the patient look toxic, in sniffing position and drooling. Barking cough differential diagnosis includes epiglottitis. |
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Which one of these disease likely to exhibit cyanosis in later life?
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ASD reversal of the shunt occurs late in adulthood |
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Child with symptoms of dka abg ph 7.24 pco2 lower than normal hco3 lower than normal. What is it?
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Compensated metabolic acidosis
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Q about cerebral palsy with typical feature patient had spastic paralysis of all limbs except upper limbs had less paralysis. What type of cp the baby had:
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- Diplegia Remeber: Diplegia: all 4 limbs affected but legs more Quadriplegia:: all 4 limbs affected equally |
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Angular chelosis is due to deficiency in what vitamin?
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B2 B2 deficiency manifests as angular chelosis, stomatitis and glossitis. B12 deficiency manifests as megaloblastic anemia and peripheral neuropathy. B6 deficiency also manifests as peripheral neuropathy. |
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Attention deficit hyperactivity disorder ( they give me the symptom not the diagnosis ) child what is the manegment?
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Atomoxetine
- Attention-deficit/hyperactivity disorder (ADHD) is a syndrome of inattention, hyperactivity, and impulsivity. The 3 types of ADHD are predominantly inattentive, predominantly hyperactive-impulsive, and combined. Diagnosis is made by clinical criteria. Treatment usually includes drug therapy with stimulant drugs, behavioral therapy, and educational interventions.ADHD has been classified as a developmental disorder, although some experts consider it a disruptive behavior disorder. ADHD affects an estimated 5 to 15% of school-aged children - The predominantly hyperactive-impulsive type occurs 2 to 9 times more frequently in boys; the predominantly inattentive type occurs with about equal frequency in both sexes. ADHD tends to run in families. - Some risk factors include birth weight < 1500 g, head trauma, and lead exposure, as well as prenatal exposure to alcohol, tobacco, and cocaine. - dx: sx for 6 m, in 2 or more settings (home and school), impair function - sx: 1) inattention: eaisly distracted, not persist w/tasks 2) hyperactivity: excess movement, fidgeting, restlessness, interference w/normal social functioning. 3) impulsive: acting without reflection (erratically - signs; look for Development delay, clumsiness, learning dificulty, dysmorphic features, hearing/vision 50% have co morbid psychiatric disorder - tx: behavior modifing and educational approach is mainstay. - SE of stimulant: HTN and slow growth - Drug therapy, typically with stimulants such as methylphenidate or dextroamphetamine (stimulants) - Atomoxetine, a selective norepinephrine reuptake inhibitor, is also used. |
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During otoscopy examination of a child, pulling the ear at which direction is going to help to see tympanic membrane?
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Posterior and inferior
Straighten the patient's ear canal by pulling the pinna up and back in children 3 years of age and older and down and back in children younger than 3 years of age. In general: in children, the auricle should be pulled downward and backward. |
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What is the daily fluid requirement for 15kg baby?
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1250 |
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12 year boy came to the clinic complaining that he is short comparing to his colleagues, his height was 155 and his weight is similar to 10 years boys. His mother height is 145, father is 178, what is the expected height of the pt.
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160_175
To calculate mid-parental height: For boys: [paternal height + (maternal height + 5 inches or 13 centimeters)] / 2 178 + (145+13) /2 = 336/2=168 +- 8 = 160-176 cm (range) For girls: [maternal height + (paternal height – 5 inches or 13 centimeters)] / 2 |
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Infant with mother for routine checkup, when the mother put the baby he was laughing and when he saw the doctor he tried to reach his mother what is most likely his age
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6?! Why not 9 stranger anxiety! |
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2year old child got otitis media after urti. Treatment:
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Amoxicillin 90 mg/ kg/ day for 10 days
OM: acute suppurative OM, accompanied w/HL 20-30 db - cause is bacterial in 75% (S.pneumonia mostly. Nontypeable H.influenza, moraxella). - if viral: RSV - RF: 1st 2y, boy, poverty, tobacco smoke, exposure to other children, cold weather, conganital anomalies: palatal cleft, Down, craniofacial anomalies. - breast milk is protective - sx: ear pain, purulent otorrhea, fever, irritability - pneumatic otoscpoe: bulging, fullness, retraction, erythema, some opacity (most important sign is no movement to be effusion) - tx: high dose Amoxicillin is first line, for 10 d - if penicillin allergic: azithromycin - if pt cant take oral: IM ceftriaxon - second line: pain continue after 2-3 d: amoxicillin- clavulinic acid - if no responce: myringotomy or tympanocentesis * tympnostomy tube: at 6-12 m if continued bilateral OME or at 4 m w/bilateral hearing loss. Usually you should assess hearing if effusion >3 m. - prophylaxis not recommended |
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Absence of moro reflex in right side of infant is due to.
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Erbs palsy Erbs palsy causes asymmetrical moro reflex. Intracranial hemorrhage causes poor moro reflex. |
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13 years old with enteric fever. Allergic or resistant to chloramphenicol (i forgot). Treatment is
A. Double chloramphenicol. B. Add ciprofloxacin. C. Ciprofloxacin alone (orally) D. Im ceftriaxone |
Im ceftriaxone
Antibiotic resistance is common and increasing, particularly in endemic areas, so susceptibility testing should guide drug selection. In general, preferred antibiotics include ceftriaxone 1 g im or iv q 12 h (25 to 37.5 mg/kg in children) for 14 days |
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Child woke up screaming, nightmare and crying parents asked the child he doesn't remember anything what sleep stage?
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3 They answered 4 too! In the current rules, nrem stage 3 and nrem stage 4 are combined as stage n3 Confusional arousals, sleep terrors, and sleepwalking are the most significant parasomnias associated with nrem sleep. They are also termed disorders of partial arousal as they result from incomplete arousal from nrem sleep. Typically, they occur at the transition from deep nrem (stage n3) sleep into the lighter stages of nrem sleep (n1 or n2) or into the awake state. |
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Blood film for girls came abdominal pain cough splenomegaly dx; A. P.malaria B. P.falcifom C. P. Oval D. Mp. Something
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- - Uncomplicated malaria: tachycardia, tachypnea, chills, malaise, fatigue, diaphoresis, headache, cough, anorexia, nausea, vomiting, abdominal pain, diarrhea, arthralgias, and myalgias Physical findings may include mild anemia and a palpable spleen. * Mild jaundice may also develop in patients with otherwise uncomplicated falciparum malaria. * falciparum malaria is the most virulent. * Laboratory evaluation may demonstrate: parasitemia (usually <5000 parasites/microL of blood, <0.1 percent parasitized RBCs), anemia, thrombocytopenia, elevated transaminases, mild coagulopathy, and elevated BUN and creatinine. - Complicated malaria — Patients with complicated or severe malaria may have hyperparasitemia [≥100,000 parasites/microL of blood (≥5 to 10 percent of parasitized RBCs)] Sx: Altered consciousness, ARDS, metabolic acidosis, Circulatory collapse, hepatic/ Renal failure, hemoglobinuria ("blackwater fever"), Coagulopathy, anemia, Hypoglycemia. * most severe and complicated malaria is usually due to P. falciparum - To establish the diagnosis of malaria, blood smears or a rapid diagnostic test (RDT) should be performed. If the RDT is positive, a smear is important for speciation and to determine degree of parasitemia. If the initial diagnostic evaluation is negative, follow up testing should be done each day for two more days. - Chloroquine, quinine, quinidine, halofantrine, and artemisinin compounds are the rapidly acting drugs that can terminate an acute malaria attack. While chloroquine acts rapidly, resistance is widespread, and an accurate travel history should be obtained before choosing the antimalarial drug - Febrile paroxysms may occur every other day for P. vivax, P. ovale, and P. falciparum and every third day for P. malariae. Paroxysms occurring at regular intervals are more common in the setting of infection due to P. vivax or P. ovale than P. falciparum. - Relapse may occur in the setting of infection due to P. vivax and P. ovale infection, since the life cycle of these two species includes hypnozoites, a quiescent stage in the liver. presumptive antirelapse therapy with primaquine - Primaquine is contraindicated in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency and in pregnant women. - Chloroquine is highly effective against P. malariae and P. ovale and is effective for most cases of P vivax. Hydroxychloroquine is a second-line alternative to chloroquine - falciparum: affect RBC of all ages, diameter of RBC normal. No ameboid trophozoites or Bands. 16-20 merozoits - vivax/ovale: affect reticulocytes, diameter of RBC large. Has ameboid trophozoites but no Bands. Ovale--> 8 merozoits - malaria: affect old RBC, diameter of RBC small. No ameboid trophozoites but form Bands. 8-10 merozoits |
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Newborn in endemic area of cretinism suspect to have cretinism what's your action:
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Thyroxine |
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Treatment of EBV (in scenario there patient with tonsillar exudates, lymphadenopathy, splenomegaly)
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Supportive |
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Most common cause of precocious puberty in girls
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Idiopathic |
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2 weeks neonate passed unformed stool. What will you do?
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Give oral rehydration solution?!
Functional diarrhea is defined as the painless passage of three or more large, unformed stools during waking hours for four or more weeks, with onset in infancy or the preschool years, and without failure to thrive or a specific definable cause [15]. This common, benign disorder has also been termed chronic nonspecific diarrhea of childhood or toddler's diarrhea.Children with functional diarrhea usually pass stools only during waking hours. Early morning stools typically are large and semi-formed, then stools become progressively looser as the day progresses [16]. Virtually all children develop normal bowel patterns by four years of age. In some cases, the diarrhea is associated with excessive intake of fruit juice, sorbitol, or other osmotically active carbohydrates, and will improve when the intake of these foods is moderated. Other than this precaution, restrictions to the diet or other interventions are not necessary or helpful. In particular, restriction of dietary fat may be counter-productive [16,17].If the evaluation suggests functional diarrhea, we suggest trials of the following dietary changes:Reduce or eliminate fruit juice or other osmotically active carbohydrates. Apple, prune, and pear juice contain sorbitol and have a particularly high osmotic load.Liberalize the fat content of the diet to 35 to 50 percent of total calories.Other than these two measures, alterations in diet are not helpful and are sometimes counter-productive. |
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A 6 years child of positive HBV mother not taken any vaccine except BCG after delivery. What will you give him:
A. MMR,OPV,HBV,Varicella B. HIB, MMR,OPV,HBV,PCV C. HIB, MMR,OPV,HBV,…. |
I think A HIB and PCV not givin after age of 5 Varicella given up to 12y |
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A case of a child with delayed developmental milestones flat nasal bridge wide forehead short hand and feet what is the cause
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Genatic |
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Child abused sexually, in vaginal examination hymen rupture in which of the following indicate rape?
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6 o'clock
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Medical director discovered cretinism in 90% of children in his village, when he analyzed the water he found that it is deficient in iodine. The director wants to prevent and manage (the question was asking about how to treat them) cretinism. What he is going to do initially?
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Thyroxin supplement (levothyroxine)
initial management should be supplementation of thyroxin, if the question was asking about a definitive solution then we may choose to supplement water sources with iodine, however they are asking about initial management. |
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What is the most common cause of hearing loss in children?
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Otitis media with secretion
genetic defects are the most common cause of hearing impairment in newborns. Ear infections, including secretory otitis media , and accumulation of earwax are the most common causes of hearing impairment in infants and older children. |
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Baby with rash in diaper area was going to different private hospitals which they gave him 3 different steroid with no improvement, when you examine him you noticed that he has sattallite spots in the thigh and buttucks .what you will give
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Antifungal if candidiasis is suspected or proven by potassium hydroxide (koh) preparation or culture, an antifungal agent effective against yeast is indicated. The author has good experience in using hydrocortisone cream (1%) twice daily and antifungal (nystatin cream, powder, or ointment; clotrimazole 1% cream; econazole nitrate cream; miconazole 2% ointment; or amphotericin cream or ointment) cream after every diaper change or at least 4 times per day. |
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2 weeks infant came with history of sob , sweating in forehead, what cardiac anomaly he has?
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VSD most probably moderate vsds Babies may have excessive sweating as a consequence of increased sympathetic tone. This sweating is especially notable during feeds. An important symptom is fatigue with feeding. Because feeding results in a need for increased cardiac output, this activity may unmask exercise intolerance in a baby. Rapid breathing (tachypnea) at rest or with feedings is usually present. |
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Baby born full term flax-....enlarge labia the cause is :
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Estrogen
Newborn girls temporary changes in the vaginal area: -the labia, may look puffy as a result of estrogen exposure in neonate. -there may be a white fluid (discharge) from the vagina. This is called physiologic leukorrhea. -there may also be a small amount of bleeding from the vagina. -these changes are common and should slowly go away over the first 2 months of life. |
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Rx of neonate with apgar score 3
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ventilation.
Explanation: resuscitation should be started with room air or a blend of o2 and air and titrated to achieve o2 saturations within the target range, which increases over the first 10 min of life. 1) PPV 2) <60 HR: intubate. Chest compressions 3) epinephrine |
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Child with eye itching for one month (no other symptoms in scenario), and have hx of asthma, what's the d?
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Venral conjunctivitis
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Child had bee sting. No symptoms other than edema and erythema at the site of the bee sting. Management will be
A. Oral steroid B. Antihistamine C. Admission and observation |
Oral steroid a typical local reaction to a sting (1 to 5 cm) may be treated with cold compresses. Large local reactions (5 to 10 cm) treatment is based upon symptoms: Oral prednisone 40 to 60 mg to reduce significant swelling. (nsaids) can reduce pain. Pruritus can be treated with oral antihistamines and high potency topical corticosteroids until the itching subsides. They answered antihistamine in another similar question!!! |
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Long history (case of meningitis) child receive iv penicillin g, lp showed gram –ve diplococcal, family concerned about his young brother:
A. Admitted him to the hospital + observation B. Give him iv penicillin C. Oral rifampicin |
Oral rifampicin - Rifampin 600 mg (for children > 1 mo, 10 mg/kg; for children < 1 mo, 5 mg/kg) po q 12 h for 4 doses - Ceftriaxone 250 mg (for children < 15 yr, 125 mg) im for 1 dose - In adults, a fluoroquinolone (ciprofloxacin or levofloxacin 500 mg or ofloxacin 400 mg) po for 1 dose |
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New born totally healthy with left thigh bruise all examination normal. Prolonged pt, ptt Your dx: A. Hemophilia
B. Factor 10 deficiency C. Idiopathic thrombocytopenic purpura |
Factor 10 deficiency |
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Child with dental caries, what u will advise him?
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Diet modification
Caries management with restorative therapy (eg, fillings) is the preferred therapeutic approach in many countries. However, restorative therapy must be combined with preventive measures, since restorations have relatively short durability and new caries may form at the margins of restorations if the causes of the disease persist. The key for the prevention and control of dental caries and advanced periodontitis is the active promotion of oral hygiene. The components of such a regimen include: ●regular brushing with a fluoridated toothpaste and dental flossing after each meal ●dietary counseling to reduce the ingestion of sugar-rich foods or beverages ●use of topical fluorides and oral antimicrobial rinses, such as chlorhexidine for high-risk patients ●modification of risk factors, such as smoking cessation ●overcoming the reluctance for regular visits to dental professionals |
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Pediatric patient is always fatigued, he sleeps well at night with no orthopnea or pnd. What is deficient enzyme?
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Pyruvate kinase
- one of the most common enzymatic defects of the erythrocyte, manifests clinically as a hemolytic anemia that can range from mild to severe. - patient’s family history will be consistent with autosomal recessive inheritance. Patients may become symptomatic during times of physiologic stress, including during acute illness (particularly viral disorders) and pregnancy.The following are evident in pyruvate kinase deficiency:Mild to severe anemiaSymmetrical growth delayFailure to thriveCholecystolithiasis: Usually after the first decade of life but possibly in childhoodFrontal bossingIcteric scleraMild to moderate splenomegalyUpper-right-quadrant tendernessMurphy signChronic leg ulcers |
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Asthmatic patient on inhaled corticosteroid and prn short acting beta 2 agonist which he use 3 times daily. What is next step in the management?
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Long acting beta 2 agonist
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Sign of fetal distress
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Late decelerations A late deceleration is a reflex fetal response to transient hypoxemia during a uterine contraction |
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45 days old child k/c of g6pd deficiency. Presented with jaundice and bilirubin=25 and his weight at 10th percentile. What is the cause of jaundice?
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Hemolysis Gucose-6-phosphate dehydrogenase (g6pd) deficiency is an x-linked enzymatic defect common in blacks that can result in hemolysis after acute illnesses or intake of oxidant drugs (including salicylates and sulfonamides |
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Child with vomiting + diarrhea after meal... Had similar attack one month ago after he came from camping with school. What is the most important thing help you in diagnosis?
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Lactose breath test.
- chronic watery diarrhea and abdominal pain, bloating a.w diatery intake - primary: older child, crampy abdominal pain and loos stool. - secondary: infant, persistent diarrhea (post viral/bacterial infection, celiac, IBD). Dx: trial of lactose free diet, watery stool acid PH, positive reducing sugar, positive breath hydrogen if >6y. Tx: lactose free diet, lactose containing tablets |
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Thalidomide in pregnancy, what does it cause {ob/gyn?}
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No bone or ear or eye
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Gingival hypertrophy side effect
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Phenytoin : Hairsutisim, gingival hypertrophy, arrythmia Lamatrogen: aspetic meningitis Valproate: wt gain, thrombocytopenea, alopecia, tremor Carbamazepine: rash, neutropenia, blood dyscraisis, osteoporosis Topiramate: cognitive slowing, kidney stone, close angle glucoma, hyperhidrosis Levetriacetam: irretability |
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Neonate 2 week old with umbilical hernia and jaundice, what will you do?
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Baby's tsh and t4 levels
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Child presented with erythematous pharynx, with cervical lymph nodes and rapid strplysin test negative and low grade fever with positive ebv. It next step
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Give antipyretic and fluids
Supportive: rest, hydration, saline gargle, analgesic for sore throat 2-avoid contact sports if splenic enlargement for 6-8 wks. If there is airway obstruction (due to tonsillar enlargement): admit + steroid Acyclovir doesn't reduce duration of sx and nor result in earlier return to school/work |
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About an adolescent who missed or didn't receive vaccine? Can't remember exact choices
A. 3 times 2 weeks apart B. 3 times 4 weeks apart C. 3 times 6 months apart |
Answer: (it depends on the vaccine type and the dose interval between doses) Example: between 1st and 2nd doses it's often a minimum of 4 weeks apart except for hepatitis a (6 months apart) and meningococcal (8 weeks apart) and varicella (3 months apart in younger than 13 years old)
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Commonest sexual anomaly in boys
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Cryptorchidism Hypospadias affecting 1 in every 250 children, 1 in every 125 live bir |
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A case of absence seizure. Epidural fentanyl causes A. Demyelination. B. Neurotoxic metabolite. C. Something to gamma receptors
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Neurotoxic metabolite.
Systemic opioid may cause neurotoxicity at higher doses Clear case of absence seizure, what happens if we give fentanyl? Answer: fentanyl-induced epileptiform activity on the electrocorticogram |
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Child with generalized tonic clonic 5min, fever 38 , what is best mang?!
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Control fever
* (simple febrile seizure less than 5 min treat symptomatically) if it recur or >5 min administer iv diazepam Febrile seizures are the most common neurologic disorder of infants and young children, simple febrile seizures, defined as generalized seizures lasting less than 15 minutes and not recurring during a 24-hour period, represent the majority of febrile seizures. The most common seizure type is generalized clonic, but atonic and tonic spells are also seen. |
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Child develop glove and stock numbness in foot and hand . Which is the best management: A. Plasma exchange B. Immunoglobulin C. Steroid
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Plasma exchange The main modalities of therapy for gbs are intravenous immune globulin (ivig) and plasma exchange (also called plasmapheresis). Ivig is preferred to plasma exchange in children because of the relative safety and ease of administration, although there are no reliable data suggesting that one or the other is superior. |
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Child presented with runny nose.. Sore throat. . Feel of fullness of ears with no fever.. On examination nose congested and erythematous tonsils.. Diagnosis
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-otitis media there is usually triad of otalgia, fever, and conductive hearing loss
- croup presented with characteristic barking cough and fever - urti could present with different non specific signs and symptoms and according to etiology it could be viral with low grade fever or no fever. |
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5 years old girl with uncomplicated cystitis. What is the management :
A. Oral amoxicillin B. Iv cephalosporin C. Im ceftriaxone D. sodium something |
Oral amoxicillin (patient >2y with uncomplicated cystitis , afebrile , no anomalies or underlying medical problem empirically can be given: orally 2nd generation or 3rd generation cephalo and if we suspect gram +ve enterococcus give amoxicillin ) uptodate "treat lower-urinary tact infection (cystitis) with amoxicillin, trimethoprim-sulfamethoxazole, or nitrofurantoin (if no fever)" (kaplan pediatrics) |
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Fever, abdominal pain, watery diarrhea, vomiting ,12 y child:
A. Rotavirus B. Adenovirus C. Norovirus |
a is the most common, if there was urt symptoms go with b. If adult or the case is epidemic chose norovirus
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12-old boy came to the clinic with his parents , they are complaining that he is obese and has strong appetite, all his milestones were 2-3 months later than normal , pe / small hands and feed compared to rest of body , the cause of his problem is :
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Genetic Prader-willi syndrome H3O - Hypotonia and weakness - Hypogonadisim - Hyperphagia (Obsessive) binge eating - Obesity from 6m to 6y Short stature, almond eyes, small hands and feet w/tapering of fingers, development delay, hypopigmentation, type 2 DM. Mental retardation - deletion at 15q11-q13, paternal chromosome - hypothalamic-pitutiry dysfunction (growth, thyroid, adrenal). - decrease life expectancy due to morbid obesity |
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2 weeks baby had uti and sensitivity was +ve for amoxicillen, what investigation you should order before starting rx
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All children under age of 5 and all male children should have a renal us to identify anatomical abnormalities including hydronephrosis , dilatation of the distal ureter , or bladder hypertrophy and to rule out pyelonephritis
vcug indication : Female <5 y with uti Female > 5y presenting with second uti All males Febrile uti |
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Child fall on his abdomen and felt a severe right abdominal pain and tenderness, what is the diagnosis:
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Liver contusion
The mechanism indicates a liver injury which happens commonly after blunt injuries (spleen injury is more common with blunt trauma than liver injury). And the severe pain might have resulted after bleeding into the peritoneal space causing peritonism. |
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Child present with signs of meningitis, what complication will suspected if patient not treated?
A. Seizures B. Somatization symptoms C. At least 2 gi symptom |
seizures
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How to prevent infection for small baby during examination!
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Hand wash |
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A neonate has eye infection gm -ve diplococci ? A. Iv ciprofloxacin
B. Im something C. Local antibx |
ceftriaxone 25–50 mg/kg iv/im, single dose (max 125 mg) alt: cefotaxime, single dose
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Boy has a cat developed itching for a month with red eye and watery with discharge no lymphadenopathy and general exam normal:
A. Cat scratch B. Dermtitis allergic C. Conjunctivitis |
Dermatitis allergic |
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Baby with vomiting and abdominal distension examination gush of stool history of decrease feeding and constipation, history of barium enema what next?
A. Colectomy B. Hydrostatic reduction C. Leveling colostomy |
- hirschsprung disease I think clostomy Treatment in the neonate typically involved a colostomy proximal to the aganglionic segment to decompress the colon and allow the neonate to grow before the 2nd stage of the procedure. Later resection of the entire aganglionic portion of the colon and a pull-through procedure is done. However, a number of centers now do a 1-stage procedure in the neonatal period. Results using laparoscopic technique are similar to those of the open method and are associated with shorter hospitalizations, earlier initiation of feeding, and less pain. |
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Lactating mother with active hepatitis b.
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Encourage breast feeding
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Parent brought their baby to your clinic , u noticed testicular asymmetry and was tender on palpation , the testes where palpable in scrotum bilaterally , next step :
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Surgery
in the pediatric population, there is a higher likelihood for testicular torsion if the testis is high riding compared with the other side. While abnormal lie can help in diagnosis, fewer than 50% of cases demonstrate horizontal lie. In an older patient, a physical examination may reveal a swollen, tender, high-riding testis with abnormal transverse lie and loss of the cremasteric reflex. Surgical exploration is mandatory unless torsion can be excluded. |
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Child with arthritis , fever, epistaxis, gingival bleeding, results put is low , hgb is low.. Appropriate investigation?
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Bone marrow aspiration
The causes of pancytopenia are: aplastic anemia, mds , myelofibrosis ,leukemia,tb,amyloidosis, sarcoidosis or drugs (e.g. Chemotherapy). |
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Child e elective oral surgery ,all lab within normal, on examination there is murmur 2/6 best hear in left sternum or ( suprasternal ) not sure , this murmur appear in sitting disappear in supine . Otherwise normal: what the appropriate initial step: A. Give antibiotics before surgery B. Postpone surgery C. Reassurance D. Some thing
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Reassurance |
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Q about truncus arteriosus & bulbous cordis, cause? A. Vsd B. Asd C. Tetralogy of fallot
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if there is toga choose it, if not choose tof
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Neonate with gradual cyanosis, in the beginning there is parasternal murmur without cyanosis, there is right ventricular hypertrophy , right axis deviation, on x-ray there is small heart with pulmonary vessel (something i didn't recall) what is the diagnosis ?
A. Transposition of great vessels B. Tetralogy of fault C. Other acyanotic heart disease |
TOF |
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Case senario the result was (high lactic acid ) : defecincy of
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Pyruvate carboxylase
Pyruvate carboxylase (PC) deficiency is a rare disorder that can cause developmental delay and failure to thrive starting in the neonatal or early infantile period. All patients who develop symptoms in the first weeks and months of life have lactic acidosis. - Metabolic acidosis caused by abnormal lactate production is associated with nonspecific symptoms such as severe lethargy, poor feeding, vomiting, and seizures, especially during periods of illness and metabolic stress. In the most severe form, pyruvate carboxylase deficiency results in progressive neurologic symptoms, starting in the neonatal or early infantile period, including developmental delay, poor muscle tone, abnormal eye movements, and seizures |
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Yellowish discoloration and caries on occlusal surface of a child teeth, what will u do? A. Oral antibiotics B. Hexidine mouth wash C. Improve diet |
Improve diet |
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Mother changes her baby diaper many times a day. Labs all within the normal except (na) was low. What is diagnosis?
A. Acute proximal renal tubules acidosis B. Acute distal renal tubules acidosis C. Congenital chloride diarrhea |
Congenital chloride diarrhea
Congenital chloride diarrhea: serum electrolyte levels may be within the reference range, especially in neonates and treated patients. However, typical findings include low concentrations of serum chloride, sodium, and potassium. Renal tubular acidosis: serum sodium expect to be within normal ranges |
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10 years old baby boy diagnosed with type 1 diabetes , presented to emergency department with 3 days history of not feeling well and losing weight. Investigations showed high blood sugar and ketone in the urine. What is best initial thing to do?
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Fluid replacement
Step (1): always start with iv fluid then insulin Step (2): correct potassium and bicarbonate - Step (3): monitoring therapy: should continue until resolution of dka. Criteria for resolution are: - Plasma glucose <11.1 mmol/l (<200 mg/dl) (at this point, insulin can be decreased by 50%) - Serum bicarbonate >18 mmol/l (>18 meq/l) - Venous ph >7.3 - Anion gap <10 |
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Girl after eating seafood developed rash with severe itching and diarrhea, the mechanism of reaction:
A. Complement B. Cell mediated C. Immediate |
Immediate Food-induced anaphylaxis: type i hypersensitivity reaction is mediated by food proteins binding to food-specific ige, leading to mast-cell degranulation. Mast cells release mediators such as tryptase and histamine, which give rise to the symptoms of anaphylaxis. - Typical symptoms include urticaria, angio-oedema, throat tightness, hoarseness, pruritus, vomiting, nausea, diarrhoea, wheezing, respiratory distress, and hypotension, usually within 2 hours of ingestion of the inciting food. - The most common food allergens in adults are peanuts, tree nuts, shellfish, and fish. In children, milk, eggs, soya, wheat, peanuts, and tree nuts |
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Baby can walk when he held by one hand and good pincer grips but he cannot put things in the bottle. What is his age?
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9 m |
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. 2 month old with ida what is the route of treatment? A. Oral ferrous sulfate B. Prenatal iron C. Transfusion of packed erythrocyte
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Transfusion of packed erythrocyte (sure answer from canadian bank
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Case senario about child fall on his toys and twisted his ankle , they mention that he couldn't walk and want to be held by his parents:
A. Soft tissue swelling of the ankle B. Spiral fracture of tibia C. Dislocation of fibula |
A?! |
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Boy fall on his mandibular, which muscle forceful close the jaw
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Temporalis?! |
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6 year old with duchene muscular dystrophy what to see?
A. Atrophied muscles of lower limbs B. Fasiculation C. Gower sign'climb on him self |
The gower sign is a classic physical examination finding in md and results from weakness in the child's proximal hip muscles. Although the gower sign is a classic physical examination finding in duchenne md, it is by no means pathognomonic; other types of md and disorders with proximal weakness may also cause this sign.
- only in boys, X linked recessive - primary myopathy w/ genetic basis, progressive and result in death of fibers. - sx: poor head control, hip girdle weakness, gower sign, hip waddle gait and lordotic posturing, calf pseudohypertrophy, scoliois - cardiomyopathy - intellectual impairment - death by 18y from respiratory failure, HF, pnemonia, aspiration - dx: screen by CPK high, initial test by molecular genetic dx. Accurate test is muscle biopsy - tx: physiotherapy, nutritoin Ca, digoxin, orthostatic devices. |
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. 4 yo girl came with her father for bilateral esotropia what is management ?
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Glasses
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Pediatric case of broncheactitis whats the most important ? A. Physiotherapy B. Home oxygen C. Steroid
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Physiotherapy! In addition to the treatment of an identified underlying disorder in patients with bronchiectasis, therapy is guided at reducing the airway secretions and facilitating their removal through cough. Antibiotics can be used to prevent and treat recurrent infections, usually based on the findings at bronchoalveolar lavage. Secretions can be mobilized with chest physiotherapy and mucolytic agents. Inhaled corticosteroids may have a role in regulating the host response and halting inflammatory damage to the lung. |
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12 yo bilateral lower lung infiltration treatment (ttt)?
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Azithromycin Tx of atypical pneumonia (bilateral infiltration). Typical causes lobar pneumonia and ttt is amoxicillin or 2 nd – 3 rd gene. Cephalosporin* chlamedya or mycoplasma: erythromycin or other macroloids |
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Child hgb is low, rbc show spherocytes…..what type of anemia?
A. Microcytic hypochromic B. Microcytic hyperchromic C. Macrocytic anemia |
non of above - normocytic normochromic Explanation: rbc show spherocytes = hereditary spherocytosis (type of hemolytic anemia)
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Behcet's disease
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Behçet disease is a rare vasculitic disorder that is characterized by a triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis.
- an autoimmune etiology. - inflammatory tissue infiltration with both T cells and neutrophils - interplay between infectious-agent exposure and genetic factors may have a role. - Age of 25-35 years at onset - Pseudofolliculitis and acneiform lesions, found more commonly in males with Behçet disease, primarily affect the trunk and extremities.Erythema nodosum, which is more common in females with the disease, are occasionally differentiated from alternate etiologies based on ulceration, which is a characteristic more unique to Behçet disease. - For ocular disease, azathioprine is widely accepted as the initial agent - For oral and genital ulcerations, topical steroids or sucralfate solution are first-line therapy for mild isolated ulcerations. |
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Radiosensitive tumor ?
A. Seminomas B. Yolk sac C. Embryonal carcinoma |
Seminomas
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14 years old child known case of scd present to the er due to abdominal pain , pale he had a urti few days back , vital : Hgb 34 (normal 110-120) Wbcs : high Fever Reticulocyte =8 Splenomegaly What your initial management:
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Splenectomy |
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What is the reliable method to diagnose all:
A. Lymph node involvement B. Anemia and thrombocytopenia C. Bone marrow blast cell |
Blast cells bone marrow aspiration and biopsy (definitive for confirming leukemia) |
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. 4 y/o boy thumb sucking
A. Observation B. Palatal crib C. Reward ++ |
Reward. Use positive reinforcement. Identify triggers. Offer gentle reminders
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18 month-old female child presents with anemia. What is the most likely diagnosis?
A. Homozygous β-thalassemia B. Homozygous α-thalassemia C. Carrier α-thalassemia |
Homozygous β-thalassemia
Β-thalassemia major manifests by age 1-2 years old with symptoms of severe anemia. |
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Case of thalassemia >> splenomegaly + frontal protrusion Labs: hb electrophoresis, hb a2, hb f high
A. B thalassemia major B. B thalassemia minor C. Alpha thalassemia |
B thalassemia major
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A woman has +ve hep b surface antigen delivered a baby in a hospital and received immunogloben and b vaccine within the first 12 hour ,, what are the recommendation for breast feeding ??
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Breast feeding after 12 hours
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Most common cause of epistaxis in children ?
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Self induced |
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Patient with lower limb weakness and sensation also angular stomatitis?
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Vit B12 Vitamin B12 deficiency can present with lower limb weakness and loss of sensation with angular stomatitis. Vitamin B2 and B3 can present with angular stomatitis but usually not with lower limb weakness. Vitamin B1 deficiency causes beriberi which causes mainly lower limb weakness and paresthesia or cardiac diseases (wet beriberi). |
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2 Years child with neck mass, has has ptosis , miosis , anhidrosis and Heterochromia. What is your diagnosis (case of Horner's syndrome):
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Neuroblastoma
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What is the commonest cause of htn in adolescent :
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Idiopathic disease or renal artery stenosi (secondary to renal involvement) .. Most childhood hypertension, particularly in preadolescents, is secondary to an underlying disorder (table 27). Renal parenchymal disease is the most common (60 to 70 percent) cause of hypertension.23 Adolescents usually have primary or essential hypertension, making up 85 to 95 percent of cases.23 table 323–25 shows causes of childhood hypertension according to age. |
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Girl came with upper arm bone pain investigation was given with anemia and high bilirubin and high reticulocyte count what most appropriate next step:
A. Hb electrophoresis B. Arm x-ray |
Hb electrophoresis e are suspecting sickle cell anemia in this patient due to anemia (from sickle shaped rbc rupture), high bilirubin (from rbc hemolysis) and high reticulocytes (young rbc trying to compensate rbc loss), and most importantly bone pains that can be explained by the occurrence of a vaso-occlusive crisis known to happen to sicklers. |
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An infant came with cyanosis during feeding and crying (there was many thing in scenario) what is the management:
A. Prostaglandin B. Surgical repair |
depend in the full history with which cyanotic congenital heart disease Tetralogy of fallot (most likely the scenario about it and the treatment is surgical)
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4 months on breastfeeding, came with 2 days hx of lethargy constipation, fever, response weak when light directed to his eyes (long scenario), cause?
A. Hypothyroidism B. Infantile botulism |
Infantile botulism Infants typically present with constipation and poor feeding. This presentation is followed by progressive hypotonia, and weakness. Loss of deep tendon reflexes appears to occur more commonly in type b infection [37]. Cranial nerve dysfunction is manifested by decreased gag and suck, diminished range of eye movement, pupillary paralysis, and ptosis. Autonomic signs include decreased tearing and salivation, fluctuating heart rate and blood pressure, and flushed skin |
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Developmental milestone expected in a 3 year old? A. Climbs stairs B. Catches ball with foot
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- climb stairs Mature gait in walkingRides a tricycle Favors using one hand over the other Copies a circle Dresses well except for buttons and lacesCounts to 10 and uses plurals Recognizes at least 3 colors Questions constantly Feeds self well Can take care of toilet needs (in about half of children) |
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Mother with gbs and had a baby who has irritability and agitation and fever. What will you do? A. Give antibiotics B. Do cultures ✅
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Best next step do cultures (spinal and blood) then treat with iv abx (penicillin or ampicillin)
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. 7 year girl pupic hair growing, what is best investigation:
A. Fsh B. Ct scan |
CT best investigation for definitive imaging of adrenals if high suspicion of tumor |
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Physician in the clinic tell the child to bend forward and hang his both hands freely. This test is used in detection of ?Physician in the clinic tell the child to bend forward and hang his both hands freely. This test is used in detection of ?
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Scoliois Adams forward bend test Patient has to bend forward, starting at the waist until the back come in horizontal plane,with feet together , arms hanging and the knee in extention, the palms are hold together , th examiner stand at the back of the patient and look along the horizental plane of the supine. |
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Croup in details if recurrent after half hour of treatment what next mangement ? What is the second line tx after epinephrine A. Epinephrine can be repeated every 15-20min with monitoring the heart B. O2 supplement and consider intubation if there is danger of airway compression |
- Nebulized epinephrine can be repeated every 15 to 20 minutes. The administration of three or more doses within a two- to three-hour time period should prompt initiation of close cardiac monitoring if this is not already underway. |
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Supra renal mass with mets to lung in child
A. Neuroblastoma B. Wilms tumor |
Wilms Neuroblastoma >> rarely metastasize to the lung |
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Boy medically free complaint of hematuria on urine analysis next step:
A. Repeat urine analysis. B. Bladder scop |
This is a case of microscopic hematuria which mean : > 3 rbcs on urinalysis of at least two separate sample Limited to these two choices bladder scop is not indicated in the investigation for hematuria. The most common cause of hematuria in children is uti
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Newborn with red lump on left shoulder .. It is
A. Lipoma B. Hemangioma |
B |
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Child with hairless spot, mother noted she was pulling her hair when stressed, what to give her? A. Lithium
B. Lorazepam |
ssri :citalopram, fluvoxamine, escitalopram, paroxetine, sertraline, fluoxetine (uptodate) trichotillomania is an intriguing psychosomatic entity in which there is an irresistible desire to pull out the hair from the scalp, eyelashes, eyebrows and other parts of the body. The process results in an instant release of tension, a sense of relief and security. However, non-scaring alopecia is its clinical presentation. The development of trichobezoar following ingestion of the pulled hair is its salient complication in a few cases. Subsequently, it may cause symptoms pertaining to the gastrointestinal tract culminating in intestinal obstruction, perforation, pancreatitis and obstructive jaundice. The rapunzel syndrome
trichobezoar) may occur when gastrointestinal obstruction is produced by a rare manifestation of a trichobezoar with a long tail that extends to or beyond the ileocecal valve. In most cases in children, trichotillomania +/- trichobezoar is a habit disorder and thus has a better prognosis. However, in adults the psychopathology is usually deeper and thus entails a poor prognosis. The diagnosis is made after taking a thorough history, noting the clinical features and evaluating a hair-root examination, where telogen hair is (almost) completely lacking, which distinguish trichotillomania from other hair disorders. Treatment modalities vary in childhood and adult varieties. Apart from psychotherapy, the drug treatment involves several agents including selective serotonin reuptake inhibitors (ssris) and domipramine. Trichobezoar/rapunzel syndrome requires surgical intervention. |
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Child with itchy scalp and scales, other classmates are affected, what is the most likely diagnosis?
A. Tinea capitis B. Scabies |
Tinea capitis Tinea capitis is a highly contagious disease caused by superficial fungal infection of the skin of the scalp, eyebrows and eyelashes. Pruritus usually is minimal but may be intense at times. Alopecia is common in infected areas. |
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2 year child didn't complete his vaccination ( 10 months is the last one ) present with fever bilateral swelling pediauricular , unable to swallow , dysphasia , enlarged tonsils and spleen and lymph nodes...( no infectious mononucliosis nor mump in the choices):
A. Diphtheria B. Streptococcus pharyngitis |
Diphtheria pharyngitis will cause all the prementioned signs and symptoms in addition to a pathognomic grayish membrane.
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Baby with blood jelly stool ( was case of intussusption ) what will u do :
A. Us B. Barium enema |
I think US They answered enema |
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What is the features that seen in patient with congenital adrenal hyperplasia?
A. Hirsutism B. Dehydration |
depends on which enzyme in cortisol synthesis pathway is defective. Presentation of 21-oh deficiency (most common). Divided into classic deficiency with salt wasting and dehydration (50%): inadequate aldosterone resulting in failure to thrive, hyperkalemia, hyponatremia, hypoglycemia, acidosis (most male presentations) Classic deficiency without salt wasting: simple virilizing, female ambiguous genitalia Non-classic: androgen excess (e.g. Amenorrhea, precocious puberty, hirsutism, etc.)
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Child with mild intermittent asthma, he is using short acting b agonist 1 time\ week. Nowadays, he is using it 4 times \ week without any benefit, what will you add : A. Long acting b agonist B. Short acting inhaled steroid
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B |
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Neonate + white eye reflex. Posterior segment information not available ?
A. Congenital cataract B. Congenital glucoma |
A |
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Child with om take amoxicillin and follow up now with opd on examination there is fluid behind t.m? A. Amoxicillin B. Wait and watch
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I think B |
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2 days old baby with urine smelling like burned sugar. What's the diagnosis?
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Maple syrup disease
- Maple syrup urine disease and phenylketonuria are both inborn errors in the metabolism of amino acids. - Phenylketonuria accumulation of phenylalanine in body fluids, leading to intellectual disability and “mousy odor”. - Maple syrup urine disease accumulation of leucine, isoleucine and valine and their corresponding keto-acids leading to encephalopathy, progressive neurodegeneration, and “maple syrup or burned sugar smelling urine” |
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Child with earache and fever ? A. Otitis media B. Otitis externa
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I think A The key physical finding of oe is pain upon palpation of the tragus (anterior to ear canal) or application of traction to the pinna (the hallmark of oe). |
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African teen with jaw mass histopathology showed starry sky appearance (case of burkitt's lymphoma) what's that pathophysiology?
A. Overexpression of c-myc B. Overexpression of n-myc |
C-myc All types of burkitt lymphoma are characterized by dysregulation of the c-myc gene by one of three chromosomal translocations t(8:14), the most common. Or less commonly t(8:2) and t(8:22). Overproduction of the c-myc product may also change the lymphocytes into cancer cells. |
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Years old girl failed in math exam. Then she had palpitations, tachypnea and paresthesia. This is ? (age missing) A. Hyperventilation syndrome B. Conversion
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hyperventilation syndrome (hvs): is a condition in which minute ventilation exceeds metabolic demands, resulting in hemodynamic and chemical changes that produce characteristic dysphoric symptoms. Cause of hvs is unknown, but some persons who are affected appear to have an abnormal respiratory response to stress, sodium, lactate, and other chemical and emotional triggers, which results in excess minute ventilation and hypocarbia.
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Child come with watery diarrhea during the stool microscope you found a flagellated parasite. What is the mechanics of the diarrhea: A. A/ secretions a lot of fluid B. B/ decrease the absorption of fluid
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B. Decrease absorption Giardiasis Giardia induces programmed cell death (apoptosis) in infected cells.[REF 27] [REF 28] This causes malabsorption of sodium, water and glucose and reduced disaccharidase activity due to loss of absorptive surface area of the epithelium. |
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Child present with abdominal mass and some urinary symptoms but i can not remember after ct the report say that there is a large mass involved the renal collecting system what your next step :
A. 24 h collection of catecholamine B. MRI |
I think the pt has wilms tumor and next step should be evaluation of lung metastasis by Ct/CXR - Primary tumors arising from the kidney, usually Wilms, rapidly growing vascular abdominal tumors; fragile gelatin capsule. - Peak age at 2-3; rare in kids >5 - associated with aniridia, hemihypertrophy, GU malforms - Beckwith-Wiedemann: Omphalocele, Macroglossia , Gigantism , Exophthalmos ,Hypoglycemia - sx: Asymptomatic abdominal mass found by family or on routine PE, Pain, malaise, hematuria in 20-30%; 25% with HTN. Mets to lungs, liver, regional nodes - dx: US to determine size and shape, vessel involvement, thrombi in major vessels; chest film/CT to check for mets Neuroblastoma: - Malignancy in neural crest cells in sympathetic ganglia, adrenal medulla, chest, abdomen; small round blue tumor cells - Most common cancer in infants - Metastatic to lymph nodes, bone, BM, liver - Fever and malaise; catecholamine secretion: HTN, sweats, irritability; diarrhea; opsoclonus-myoclonus; cerebellar ataxia. - signs: preorbital ecchymosis, cutaneous nodules; abd mass; weakness/paralysis, horner syndrome - CT/MRI to locate tumor; bone scan;MIBG; PET. Labs (urinary catecholamines) |
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Safe vaccine you can give it to immunocompromised patient
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safe: pneumococcal, meningococcal, hib,
Contraindicated: all live vaccines. Oral polio, rota , mmr, smallpox , bcg , varicella , opv |
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Pediatric patient is complaining of red eye and fever, later he develops pink rash on the face which spreads to upper and lower limbs, there is also white papule in the mouth, what is the diagnosis?
A. Rubella B. Meningococcal rash |
They answered Rubella I think it is Measels Measles: 1) 3 C: coryza, conjungtivitis, cough 2) fever 3) kopolic spots 4) maculopapular rash: Rash beginning on the head and spreading to the trunk and extremities over a few days. |
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16 y/o female presented with history of irregular period, that came every 5 weeks then, 6 weeks?
A. Normal changes or physiological changes B. Uterian fibroids |
A Long cycles most often occur in the first 3 years postmenarche, the overall trend is toward shorter and more regular cycles with increasing age. By the third year after menarche, 60% to 80% of menstrual cycles are 21 to 34 days long, as is typical of adults. An individual's normal cycle length is established around the sixth gynecologic year, at a chronologic age of approximately 19 or 20 years. |
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. Child with sever rheumatic fever &cardiac involvement what to give for short period? A. Im penicillin monthly B. Large does aspirin + ... Orally steroid
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?? A? confirmed rheumatic fever: antibiotic therapy - with arthritis: salicylate therapy or NSAIDs - with heart failure: diuretic/ACE inhibitors, glucocorticoids - with atrial fibrillation: digoxin - with valve leaflet or chordae tendinae rupture: assessment for emergency valve replacement - with severe or disabling chorea: anticonvul sants. all patients following acute treatment: secondary prophylaxis |
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Patient with barking cough and 38 C temp which of the following symptoms is associated with this disease? A. Cyanosis B. Wheezing
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Cyanosis |
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Child take overdose of isoniazid and toxicity symptoms?
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seizure include status epilepticus
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10 years old girl presented with fatigability, diarrhea and glossitis. What is the diagnosis?
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Vit B12 deficiency Periphral neuropathies and dementia, ataxia, vitiligo - angular stomatitis, spoon nail, irretable/apathy: iron - cleft lip, shild chest wide nipples: diamond blackfan syndrome - absent kidney or nephromegaly, abscent thumb, short, microophthalmia, microcephaly, hyperpigmentation, cafe au let: fanconi anemia - retinopathy: SC - frontal bossing: thalassemia major |
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A. 6 years old boy presented with gingivitis, petechiae and rash. What is the diagnosis? a. Vitamin c deficiency B. A boy with rickets (picture was provided). What is the deficient vitamin? |
A: vit C deficiency B: . Vit d Deficincy clues: - reduced wt for ht: calories - pallor: anemia - edema: protein, thiamine (B1) - parotid swelling: protein - follicular hyperkeratosis, adaptation to dark, color discrimination: vit A - bleeding gum, purpura: vit C/K - dermatitis: riboflavin (B2) - Alopecia: Zinc, protein - moon faces: kwashiorkor, simian faces: marasmus - angular stomatitis: iron, riboflavin - chielosis: B 2,3,6 - smooth tougne: iron - caries: floride - goiter: iodine - cranial bossing, wide fontanelle, craniotabes, beading, epiphysial enlargement: vit D - retardation: niacine (B3), iodine - sensory/motor neuropathy, ataxia, areflexia, ophthalmoplasia, dementia: vit E |
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Child sucking his thumb what to do?
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Reward we he doesn't do it
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8 years old girl presented with fever, numerous bruises over the entire body and pain in both legs. Physical examination reveals pallor and ecchymosis and petechiae on the face,trunk and extremities. Findings on complete blood count includes a haemoglobin of 6.3 g/dl, white cell count of2800/mm3 and platelet count of 29,000/mm3. Which of the following would be the most appropriate treatment?
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dx>> acute lymphoblastic leukemia
1) induction: complete remission (no blast, normal hematopoiesis) 2) consolidation/ intensification: eliminate subclinical leukemic cells/ eliminate resistant cells 3) maintenance : intermittent low dose 2-3 y prevent relapse (not done in AML) 4)prophylaxis: methotrexate intrathecal or CNS radiation (not done in AML) AML vs. ALL (Big vs. Small) - AML: big people, big blast, high mortality, lots of cytoplasm, lots of neucliolo :3-5, lots of granules and Aur rods, maturation defect beyond myeloblast or promyelocyte. - ALL: small people, small blast, low mortality, less of cytoplasm, few of neucliolo :1-3, No granules and Aur rods, maturation defect beyond lymphoblast. |
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Child came to the clinic with his mother was having ball, the doctor asked him to throw the ball to him , he through it to the doctor and he went away to take the ball back what is the developmental milestone of this child ?
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2 years = 24 month?!
Stands on tiptoe Kicks a ball Begins to run Climbs onto and down from furniture without help Walks up and down stairs holding on Throws ball overhand Makes or copies straight lines and circles |
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Treatment of de queverian syndrome?
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rest, warm soaks, and nsaids may help in very mild cases. Local corticosteroid injections and a thumb spica splint help 70 to 80% of cases. Surgical release of the first extensor compartment is very effective when conservative therapy fails. - The tendons of the abductor pollicis longus and the extensor pollicis brevis are tightly secured against the radial styloid by the overlying extensor retinaculum. Any thickening of the tendons from acute or repetitive trauma restrains gliding of the tendons through the sheath. Efforts at thumb motion, especially when combined with radial or ulnar deviation of the wrist, cause pain and perpetuate the inflammation and swelling. - Patients frequently are mothers of infants aged 6-12 months, and symptoms are often noted in both wrists. Repetitive lifting of the baby as it grows heavier is responsible for friction tendinitis - note pain resulting from thumb and wrist motion, along with tenderness and thickening at the radial styloid. - The Finkelstein test (consisting of flexion of the thumb across the palm and then ulnar deviation of the wrist) causes sharp pain at the first dorsal compartment - Splinting of the thumb and wrist relieves symptoms, but most patients find the loss of the thumb for functional activities too restrictive and do not consistently wear the splints. Injection of corticosteroid into the sheath of the first dorsal compartment reduces tendon thickening and inflammation. - If injection therapy fails, surgical release of the first dorsal compartment relieves the entrapment. |
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5 m milestone |
Holds head steady when upright Sits with support Rolls over, usually from stomach to back Reaches for objects Recognizes people at a distance Listens intently to human voices Smiles spontaneously Squeals in delight Babbles to toys |
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Which babies should not get rotavirus vaccine or should wait?
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o Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
o Severe combined immunodeficiency (scid) o History of intussusception |
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. Boy return from africa and got meningitis. Cause?
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meningococcal meningitis
The largest burden of meningococcal disease occurs in an area of sub-saharan africa known as the meningitis belt, which stretches from senegal in the west to ethiopia in the east. |
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6 month infant turns bluish when feeding. Auscultation shows holosystolic murmur with single s2. Diagnosis:
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Tga present with single s2 but with no murmur. (unless there's vsd) Answer: tof Tof: most common cyanotic heart disease in children, cyanosis usually absent at birth but develop over first 2 year of life, infant are often asymptomatic until 4-6 month Auscultation: single s2 with systolic murmur on upper and left sternal border Tga: most common cyanotic heart in infant cyanosis usually within few hours after birth. Auscultation: loud single s2. They may not be a murmur if no svd present |
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Child who has repeated infections in chronic granulomatous disease:
Chronic granulmatous disease child what is the defect: What is the most common pathogen in patient with chronic granulomatous disease? |
They are most likely caused by staph and strept defective phagocyte napdh oxidase Chronic granulomatous disease (cgd) is a rare (∼1:250,000 births) disease caused by mutations in any one of the five components of the nicotinamide adenine dinucleotide phosphate (nadph) oxidase in phagocytes. This enzyme generates superoxide and is essential for intracellular killing of pathogens by phagocytes. Staphylococcus arues Unusual infections with catalase-positive organisms:s. Aureus (most) |
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Tx of 13 y o with hypertension ? |
Salt and thiazide
- Nonpharmacologic therapy (ie, lifestyle changes) includes weight reduction for children who are overweight, a regular aerobic exercise regimen, dietary measures (eg, salt restriction), and avoidance of excess alcohol consumption and smoking - Pharmacologic agents used frequently in children that are efficacious and safe include thiazide diuretics, angiotensin converting enzyme (ACE) inhibitors, beta blockers, and calcium channel blockers
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. 11 years child previously normal, presented with cyanosis, echo showed ventricular hypertrophy i cant remember rt or left, what is the diagnosis
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it is important to know which ventricle coz the diagnosis will change Rvh>> fallots tetralogy Lvh>> tricuspid atresia , pulmonary atresia According to the patient age it most likely fallots tetralogy ( it is the most common cyanotic congenital heart disease in children )
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Parents had a child with cleft palate and they are asking about recurrence rate of cleft palate i their children:
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4%
While if the q was about spina bifida the chance to have another baby is 1% 4% ( source: medscape) and 9% if two children were affected previously) |
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description of scarlet fever rash
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* 24-48 h after pharyngitis , rash begins in the groin ,axillae , neck ,antecubital fossa:pastias lines may be accentuated in flexural area .
*within 24 h , sandpaper rash becomes generalized with perioral sparing , non-pruritic , non-painful,blanchable *rash fades after 3-4d may be followed by desquamation Scarlet fever : Prodrome: sore throat, exudative pharyngitis, strawberry tougne. Fine maculopapular rash feels like sand paper, esp in inguinal and anticubitus. Pastia lines - complications: acure rheumatic fever, Glomerulonephritis |
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Milestone > baby healthy run to the doctor play a role model as his father can't complete a sentence can't eat with spoon
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18 m |
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Child is doing fine, his brother died while heading to work. What we should investigate for?
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Hypertropic cardiomyopathy - obstructive left CHD (decrease filling) - present w/: weakness, fatiuge, dyspnea on exertion, palpitations, angina, syncope, sudden death - no systolic ejection click, left ventricular lift, SEM - ECG: LVH - CXR: cardiomegaly - tx: BBs and CCBs no sternois exercise, digoxin and diuresis are contraindicated |
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Vaccine of hep. A missed second dose what to do?
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have it as soon as possible but you don't need to start with the first dose again
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Boy with hypopigmented lesion in back and extremity becomes lighter with sun exposure treatment topical steroid antibiotic ...
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A fungal infction called pityriasis versicolor. The organism is called malassezia furfur. A common, benign, superficial cutaneous fungal infection usually characterized by hypopigmented or hyperpigmented macules and patches on the chest and the back. And it usually recur. Treated with topical antifungal
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Diabetic or (gdm) pregnant in her 40 or 42 ga nvd on examination there was an absent moro reflex on the lt. Side of the baby dx?
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Erbs palsy birth-related (obstetrical) brachial plexus injuries” the mother is diabetic so big baby is a risk factor” Causes of absent infant moro reflex: Cerebral palsy Damage to spinal cord and brain Clavicle fracture Broken shoulder bone Erb's palsy Erb-duchenne paralysis involves the 5 th & 6 th cervical nerves & is the most common & usually mildest injury. The infant cannot abduct the arm at the shoulder, externally rotate the arm or supinate the forearm. The usual picture is one of painless adduction, internal rotation of the arm, and pronation of the forearm. The moro reflex is absent on the involved side,& the hand grasp is intact. |
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Child with decrease uop, tea colored urine , generalized swelling next investigation :
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The investigations include(in order): ua,cbc,bun,esr and complement . Streptozyme testing may be useful. Imaging studies are helpful in some patients, for assessment of clinical signs suggesting extrarenal involvement.
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Patient with a family history of multiple sudden cardiac death. This patient has marfan's syndrome features. What might be the cause of death?
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Ruptured aortic aneurysm
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Intranasal influenza vaccine (the name of the vaccine)
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Flumist quadrivalent (laiv4)
Indicated for active immunization to prevent influenza a and b viruses in healthy children, adolescents, and adults aged 2 to 49 years. - Se (children): runny nose/nasal congestion (46-50%), cough (36-40%), irritability (16-20%), headache (16-20%) - Contraindications: Hypersensitivity to eggs, sulfites Iv/im administration Children/adolescents receiving aspirin Asthma, reactive airway disease Diabetes, renal dysfunction Hemoglobinopathies Immunodeficiency diseases Patients on immunosuppressants Any chronic pulmonary/cardivascular disorder |
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Child eat many tablet of paracetamol tablet, which of the following increase risk of poisoning
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glutathione depletion
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Child with vasoocclusive crises last week now came for hep a vaccine , what to do ?
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Hepatitis a and hepatitis b vaccines are indicated for those who require repeat transfusions, such as sickle cell anemia
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- Von will brand disease >>>> pathophysiology - Bcl bcr gene associated with: |
- The aptt is mildly prolonged in approximately 50% of patients with vwd. The prolongation is secondary to low levels of fviii because one of the normal functions of vwf is to protect fviii from degradation. - Chronic myelogenous leukemia (cml) The diagnosis of cml is based on the following: histopathologic findings in the peripheral blood and philadelphia (ph) chromosome in bone marrow cells. |
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Multiple fractures in child?
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Osteogenesis imperfecta, (oi) is a group of genetic disorders that mainly affect the bones. The term "osteogenesis imperfecta" means imperfect bone formation. People with this condition have bones that break easily, often from mild trauma or with no apparent cause. Multiple fractures are common, and in severe cases, can occur even before birth. Milder cases may involve only a few fractures over a person's lifetime.
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Child with red bulging tympanic membrane, ear pushed down and forward, what is the dx?
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- mastoiditis |
