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150 Cards in this Set
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- Back
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Neonate w/gradual cyanosis, in the beginning: parasternal murmur without cyanosis, RVH, R axis deviation, CXR: small heart w/pulmonary vessel sth!!? Dx? - TOGA - TOF - acyanotic heart disease |
TOGA The most common cyanotic heart disease presenting in newborn, more common in infant of diabetic mother. Aorta arise from RV, anterior and to the right of pulmonary artery. - 2 parallel circuits; need foramen ovale and PDA to mix - presentation: If no open: cyanosis severe once PDA close. No murmur and S2 single and loud. If VSD present: mixing. harsh murmur LL sternum. Pt present w/HF
- dx: Egg on string appearance :absence of main segment of pulmonary artery - tx: PGE1, Ballon atrial septostomy, arterial switch surgery in 2w.
TOF is most common cyanotic heart disease in childhood |
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4 m development milestone? - try to crawl - roll over from side to side - sit without support - complete fixation of head |
They answered C!! I think D At 4 month: - holds head steadily, support forearms in prone, roll from prone to supine - reaches w/both arms together and hands to midline - laughs and coos - likes to look around |
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Neonate w/bilious vomiting, seed stool diarrhea, passed meconium day 2. Cause? |
Allergy to formula milk * Cow's milk allergy (CMA) is the most common food allergy in young children * Tolerance is achieved by the majority of children with CMA. Non-IgE mediated CMA tends to resolve by early childhood, whereas IgE-mediated CMA may persist into adolescence and beyond. * Casein and whey proteins are the milk proteins responsible for the majority of IgE-mediated milk allergies * Manifestations of milk allergy include IgE mediated reactions, such as urticaria/angioedema and anaphylaxis, mixed IgE and non-IgE mediated reactions such as atopic dermatitis (eczema) and eosinophilic esophagitis, and non-IgE mediated forms of allergy that present with delayed gastrointestinal manifestations (enterocolitis). - enterocolitis: bloody diarrhea, malabsorption, FTT, vomiting, anemia, hypoproteinemia). Dx w/biopsy (villous blunting). - Diagnosis of IgE-mediated milk allergy is based upon careful history supported by skin prick tests and in vitro tests for specific IgE. An oral food challenge is warranted if the diagnosis of milk allergy is uncertain. Diagnostic testing for non-IgE mediated manifestations is limited |
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Child w/bronchiolitis, tx? |
Ribavirin Tx is primarily supportive, fluid and nebulizers if needed. Hospitalize if severe. Inpatient should be contact isolated, hydration, O2. Albuterol may be tried but corticosteroids not indicated. Ribavirin antiviral used in high risk pt: underlying heart, lung, or immune disease. RSV prophylaxis recommended in winter for high risk pr 2y of age. (Prematurity, chronic lung disease, CHD). |
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Initial management of JRA? |
NSAIDs / intra-articular corticosteroids - begins at or before age 16. Arthritis, fever, rash, adenopathy, splenomegaly and iridocyclitis are typical of some forms. Dx is clinical. Tx involves NSAIDs, intra-articular corticosteroids and disease modifying anti rheumatic drugs. - oligoarticular is most common form and usually affect girls. - polyarticular is second most common, Symmetric involve small joints. 2 types: RF+(adolescent girls) and RF- (young girls) - Enthesitis (painful inflammation of tendon and ligament insartion) older boys HLA-B27 - psoriatic (oligoarticular, Fhx of psoriasis, dactylitis, nail pits). - undifferentiated - systemic: fever occurs daily (quotidian) highest in afternoon
- JIA interfere w/growth and development. Micrognathia due to early closure of mandibular epiphyses or limb length inequality (affected limb is longer) - iridocyclitis typically asymptomatic but may cause blurring and miosis. Most common in oligoarticular JIA esp. + ANA - rash is transit appear w/fever diffuse and migratory (macular w/central clearing)
- remission in 50-70% of pt - slow disease progression w/methotrexate and biologic drugs (etanercept, anakinra) and tx sx w/iintra-articulat corticosteroid injection and NSAIDs - tx iridocyclitis w/ophthalmic corticosteroid drops and mydriatics. |
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Child w/red urine, constipation, urine analysis: increase RBCs, WBCs, protein: |
UTI? |
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Child w/arthritis, fever, epistaxis, gingival bleeding. Plt low, hgb low? Investigation? |
Bone marrow aspiration? |
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6y girl w/pansystolic murmur |
VSD |
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most causes of FTT:
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psychosocial
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8 month child presented with high fever 39.5 for 2 days examination is normal BP is 120\80 HR is 120 what is the organism:
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Streptococcus pneumonia
Tx: vancomycin and third generation cephalosporin |
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5y limping w/pain over 5m, no hx of trauma or fever. Dx? |
Slipped capital femoral epiphysis? Why not legg calve perthes disease? |
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Which situation the hepC positive mother should not breastfed her baby? |
Cracked nipples - breastfeeding not contraindicated w/: hepC (positive antibody or RNA positive blood). |
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when to give both heparine and FFP?
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DIC and thrombosis
- acquired syndrome characterized by hemorrhage and microvascular thrombosis. Endothelial tissue damage from a variety of underlying disorders (eg, sepsis, trauma, and malignancy) may lead to organ damage. - In the neonate, DIC is caused primarily by sepsis and perinatal complications (eg, birth asphyxia, respiratory distress syndrome (RDS), and necrotizing enterocolitis (NEC). - In mild cases, bleeding may only be noted at venipuncture sites, but in other cases there may be severe hemorrhage and thrombosis with end-organ damage to the kidney, liver, lung, central nervous system (CNS), and extremities. Hemorhage is the most common presentation followed by skin manifestations of purpura and acral gangrene (purpura fulminans) - labs: Thrombocytopenia, PT is prolonged in 50 to 75%, aPTT is prolonged in 50 to 60%, fibrinogen concentration is low (consistent with a diagnosis of DIC; Thrombin time is prolonged), Microangiopathic hemolytic anemia, Fibrin degradation products in 85-100%, D-diamr elevated in 90 percent of patients with DIC and is more specific than FDP. Both Factor V (common coagulation pathway) and factor VIII (intrinsic pathway) are decreased. Tx: 1) Replacement therapy is indicated in patients with significant bleeding symptoms (eg, melena or prolonged bleeding from venipuncture sites) or who are at high risk for bleeding because of an impending invasive procedure. Clotting factors can be replaced by either FFP or cryoprecipitate. 2) Anticoagulation: Heparin had been routinely used in patients with clinically overt thrombosis and potential end-organ failure. |
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pediatric with holosystolic murmer in left 3rd intercostal space , with hyper dynamic heart and loud S2 whats the dx
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VSD |
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3Y , UTI , febrile what to do
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US If I'm suspecting UTI from case senario >-- suprapupic aspiration and culture As treatment >-- antibiotics As other investigation to evaluate >---VCUG AND DEMSA for scaring detect |
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child with anemia a picture showed spherocytosis , what investigation you will do?
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osmotic fragility test
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young child presented with painful lesion in the back of her mouth and soft palate:
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herpangina
# Coxsackievirus : - Herpangina: group A coxsackieviruses, is a vesicular enanthem of the tonsillar fauces and soft palate that principally affects children 3 to 10 years of age during the summer and early fall may be accompanied by fever, sore throat, and pain with swallowing as the gray, pinhead-sized vesicles rupture to form large, fibrin-covered ulcers. - Hand, foot, mouth — The hand, foot, and mouth (HFM) syndrome, caused by a number of coxsackie A and B viruses, principally affects children younger than five years of age in the spring and early summer. characterized by fever, oral vesicles on the palate, tongue, and buccal mucosa, and peripherally distributed small, tender, cutaneous lesions on the hands, feet, buttocks and (less commonly) genitalia. The oral lesions begin as vesicles that rupture to form ulcers and are painful # Primary HSV infection may be a.w/ flu-like symptoms: fever, malaise, irritability, or sleeplessness. Lesions: red, edematous marginal gingivae that bleed easily, and clusters of small vesicles that become yellow after rupture. Cold sores= gingivostomatitis= HSV1 |
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newborn scrotal swelling tenderness , both testis what is the next investigation :
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illumination
A careful physical examination should include identification of the normal anatomic structures of the scrotum, and transillumination of any mass. |
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development child walk alone & build three cup ?
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18 months
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newborn with congenital adrenal hyperplasia present with:
Hirsutism Infantile acne Abdominal striae Dehydration |
If the newborn was male ANSWER D If the newborn is female then she may present in adolescence with hirsutism
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Child say few words what age?
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12 m |
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child after hx of URTI developed ascending muscle weakness ?
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GBS |
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Child with severe rheumatic fever & cardiac involvement what to give for short period?
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large dose aspirin + Oral steroid
Treat residual GABHS pharyngitis if still present: - Oral (PO) penicillin V remains the drug of choice but ampicillin and amoxicillin are equally effective. - For patients who are allergic to penicillin, administer erythromycin or a first-generation cephalosporin. Treatment of the acute inflammatory manifestations of acute rheumatic fever consists of salicylates and steroids. Aspirin in anti-inflammatory doses effectively reduces all manifestations of the disease except chorea, and the response is typically dramatic. |
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Can Not take the object in 2 fingers .. How old is he?
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6 m: Raking grasp |
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2 months baby brought to hospital Parents complain that the baby is spitting what you will do?
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Reassure |
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infantile colic:
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Increased gases Etiology: - Gastrointestinal: cow's milk protein intolerance, sorbitol-containing fruit juice (eg, apple juice), incomplete absorption of carbohydrates in the small intestine, intestinal hypermobility, and alterations of fecal microflora. Lactose intolerance appears to play a minimal role. - Biologic: feeding techniques (eg, overfeeding, infrequent burping), immature motor regulation, increased serotonin, and tobacco smoke exposure. (See 'Biologic factors' above.)Psychosocial factors that may contribute to colic include infant temperament, increased sensitivity to environmental stimuli, family stress, and emotional tension during pregnancy |
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The most common drug used to treat juveniles rheumatoid arthritis is
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Penicillamine?!
I think NSAID |
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IDA in 2 year old child hg 9 what to give?
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Oral |
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complication of screening for down syndrome ?
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abortion
- Noninvasive screening tests for Down syndrome involve measurement of maternal serum analyte marker levels which are interpreted in the context of maternal age related risk. Upon the result, pt can make an informed choice about invasive diagnostic testing, which is costly and associated with a risk of pregnancy loss. - The first trimester combined test involves sonographic determination of nuchal translucency (NT) and gestational age (by crown-rump length) combined with the serum markers pregnancy-associated plasma protein-A (PAPP-A) and free or total beta human chorionic gonadotropin (beta-hCG). Screening can be performed at 9 to 13 weeks of gestation with free beta-hCG or at 11 to 13 weeks with total beta-hCG. Chorionic villus sampling (CVS) for definitive prenatal diagnosis must be available to women who undertake first trimester screening and are screen positive. - Patients who screen positive are offered fetal karyotype determination for definitive diagnosis. In the first trimester, karyotype is obtained by CVS. In the second trimester, amniocentesis is performed to obtain amniocytes for chromosomal analysis. |
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child come with severe symptom of croup, the doctor gave epinephrine then relive but after time again symptom? What will do?
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repeated epinephrine
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Adolescent with recurrent swelling of lips gene affected?
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Mutations in the SERPING1 gene cause hereditary angioedema type I and type II. The SERPING1 gene provides instructions for making the C1 inhibitor protein, which is important for controlling inflam-mation. C1 inhibitor blocks the activity of certain proteins that promote inflammation.
- AD - recurrent episodes of nonpitting edema - dx: clinical, skin tests, IgE ecific allergens - tx: avoid trigger and oral antihistamine - for severe: epinephrine, corticosteroids - chronic refractory: IVIG or plasmapheresis |
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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?! - Appearance: 2: no cyanosisbody and extremities pink 1: blue at extremitiesbody pink(acrocyanosis) 0: blue or pale all over - puls: 2: > 100 beats per minute 1: < 100 beats per minute 0: absent - Grimace: 2: cry on stimulation 1: grimace on suction or aggressive stimulation 0: no response to stimulation - Activity: 2: flexed arms and legs that resist extension 1: some flexion 0: none - respiration: 2: strong, lusty cry 1: weak, irregular, gasping 0: absent |
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mother wants to screen her fetus for thalassemia:
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amniotic fluid with something at 15 week DNA-based testing for sickle cell, and alpha and beta thalassemia can be performed during the first trimester of pregnancy on villi obtained by chorionic villus sampling (typically performed at 10 to 12 weeks of gestation), or on cultured amniotic fluid cells obtained by amniocentesis (typically performed after 15 weeks of gestation) |
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baby presented with abdominal bloating and constipation , inv shows increase ca+ . I forgot the choices!!
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- The 3 predominant sources of calcium and targets for regulation are the bones, renal filtration and reabsorption, and intestinal absorption. The major regulators of calcium levels are parathyroid hormone (PTH) and vitamin D, which target the bones, intestine, and kidney to increase serum calcium. Calcitonin, a more minor player in regulation, decreases serum calcium by its effects on bone and kidney. Cyclically, high levels of calcium suppress PTH and thereby decrease levels of the active form of vitamin D by decreasing the activity of renal 1 α -hydroxylase. - Hypercalcemia initially and predominantly affects the GI and nervous systems. - Stones, Bones, abdominal Moans, psycotic Grons. - bradycardia, hyporeflyxia, proximal muscle . - tx: Initial treatment of hypercalcemia involves hydration to improve urinary calcium output. Addition of a loop diuretic inhibits tubular reabsorption of calcium (furosemide). - Bisphosphonates IV serve to block bone resorption over the next 24-48 hours (dronate) - Calcitonin at subcutaneous (SC) or IM doses of 3-6 mcg/kg every 6 hours, works within hours to decrease skeletal reabsorption of calcium and inhibit renal reabsorption, but it lowers serum calcium concentration only for 2-3 days because of tachyphylaxis |
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4 years old boy was found on the floor of the kitchen , cyanosed , has peanut bean on his hand
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aspiration
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full term baby on breast milk and gaining weight, presented 10 days after birth with yellowish discoloration, indirect bilirubin 19.5, direct 2.7, what to do next :
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Phototherapy ●Breastfeeding failure occurs in infants with inadequate intake of breast milk because of difficulty in feeding or if the mother does not have an adequate milk supply. These infants lose a large amount of weight, thereby increasing bilirubin concentrations. Increasing the mother's milk supply, frequent feeding, and ensuring good sucking (latch) are the best treatments for inadequate intake jaundice. ●Breast milk jaundice is thought to be due to the infant's immature liver and intestines. It typically begins the first week after birth, peaks within two weeks after birth, and declines over the next few weeks. Breast milk jaundice is not a reason to stop breastfeeding as long as the baby is feed ing well, gaining weight, and otherwise thriving. Infants with breast milk jaundice rarely need treatment unless severe hyperbilirubinemia de velops. All infants with jaundice should be moni tored by a doctor or nurse. |
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Child DM1 w/frequent hypoglycemic attack at different time during day. Dx made 6m back and pt complained to diet and tx. Most likely cause of sx? |
Brittle diabetes (labile diabetes) is a hard to control type 1 DM. Pt experience frequent extreme swings in glucose levels. - cause disruption in persons life and prolong hospitalization - unpredictable episodes of hypoglycemia or ketoacidosis due to absolute insulin dependency (undetectable C peptide levels) = type 1 DM |
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Adolescent w/ fever, headache, meningism after swimming in river. Causative organism: |
Naegleria fowelri Primary amebic meningeoencephalitis PAM. Commonly found in warm freshwater (e.g. Lakes rivered and hot springs and soil). |
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7 d presented w/vomiting and fever, culture shows catalase positive, gram positive in chain, beta hemolytic. Mother had hx of infection before delivery. Tx: |
Ampicillin Combination of Ampicillin and gentamicin. |
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baby was jaundiced then become greenish
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Due to bilirubin oxidation |
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baby with unknown numbers of paracetamol pills ingestion presented after 10 or 4 hours what to do:
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Drug level
Serum paracetamol concentration at (or as soon as possible after) 4 hours post ingestion determines the need for N-acetyl cysteine (NAC) administration. ◦There is no benefit in measuring paracetamol concentration earlier than 4 hours post ingestion. ◦It is safe to wait for the paracetamol concentration to decide on the need for NAC in all cases that present within 8 hours of ingestion AND where a paracetamol concentration result will be available for interpre-tation within 8 hours of ingestion. ◦Patients who present 1 > hours after a toxic ingestion 122>( mg/kg) or after an ingestion in association with symptoms of toxicity (RUQ pain or tenderness, nausea, vomiting) should be commenced on NAC immediately. |
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baby with diarrhea , no vomiting , how to manage?
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ORS |
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1 month old baby, has constipation science birth , best diagnostic investigation
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full thickness intestinal biopsy
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scenario about renal tubular acidosis in a child |
- metabolic acidosis w/normal AG and electrolyte disturbance due to impaired renal hydrogen ion excretion (type1, distal, PH7) or abnormal aldosterone production or response (type4, more common type, transtubular K gradiant). - type 2 a.w Rickets - type 1 a.w nephohrolithiasis - sx and signs of hypokalemia (muscle weakness, hyporeflexia, paralysis). - type 4 a.w hyperkalemia. -tx: alkali therapy, correct electrolytes. - faliure to tx slow growth in kids |
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monozygot twin presentation (twin A/twin B) will be dangerous in |
They answered: cephalic cephalic But I think breech cephalic - Vertex-vertex twins — This presentation accounts for approximately 42%. The general consensus is that a trial of labor with the goal of a vaginal delivery of vertex-vertex twins is appropriate at any gestational age. - A unique, potential complication of breech-vertex twin delivery, as opposed to breech singleton delivery, is the possibility of interlocking chins (ie, locked twins), but this is rare. |
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child parents Have TB- You read a PPD result after 48 hours. It showed 10 mm induration. What does that indicate?
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strongly positive
- Mantoux tuberculin skin test (TST) is the standard method of determining whether a person is infected with Mycobacterium tuberculosis. - >An induration of 15 or more millimeters is considered positive in any person, including persons with no known risk factors for TB. - An induration of 10 or more millimeters is considered positive in (Recent immigrants (< 5 years) from high-prevalence countries-Injection drug users-Residents and employees of high-risk congregate settings-Mycobacteriology laboratory personnel-Persons with clinical conditions that place them at high risk-Children < 4 years of age- Infants, children, and adolescents exposed to adults in high-risk categories). - An induration of 5 or more millimeters is considered positive in (-HIV-infected persons-A recent contact of a person with TB disease-Persons with fibrotic changes on chest radiograph consistent with prior TB-Patients with organ transplants-Persons who are immunosuppressed for other reasons (e.g., taking the equivalent of >15 mg/day of prednisone for 1 month or longer, taking TNF-a antagonists)). |
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(polio vaccine) IV & oral both do:
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Increase Intestinal IgA secretion
* Parenteral inactivated poliovirus vaccine (IPV) chiefly induces formation of serum antibody. Infection, with oral poliovirus vaccine ( OPV ) or wild poliovirus, also induces development of secretory IgA antibody. In addition, infection results in virus shedding and, hence, in possible spread of virus to contacts (more likely with wild than with vaccine virus). IPV induces a high level (90%-95%) of protection against disease, which presumably is mediated by serum antibody that prevents CNS invasion resulting from viremia. IPV induces little protection against infection but does modify the related virus shedding--chiefly that from the oropharynx |
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child with fever. Rash. Grysh macul in moth dx?
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Measels |
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baby brought by his parents to ER complaining of SOB & drooling saliva... diagnosis
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Epiglotitis |
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normal 10 y/o child , his parents worry about height of child? what the most thing to ask
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- |
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Child with nephrotic syndrome on steroid for 3-6wks or 6 months have vaccine ? |
- 3 month and give appointment
Corticosteroids used in greater than physiologic doses also may reduce the immune response to vaccines. Physicians should wait at least 3 months after discontinuation of therapy before administering a live-virus vaccine to patients who have received high-dose, systemic steroids for greater than or equal to 2 week
- nephrotic syndrome: >3g protein/day in urine w/edema and hypoalbuminemia. More prevalent in children 1 and half and 4y. Congenital in 1st y. Primary: minimal change, focal segmental, membranous.
- Complication: edema, infection esp.cellulitis, anemia, hypothyroidisim, hyper coagulability, protein undernutrition, hyperlipidemia, HTN (in adults), CKD. - sx: anorexia, malaise, frothy urine, arthralgia, dyspnea, abdominal pain. - dx: initial test: urine analysis Confirm: urine random spot (protein/creatinine ratio =/>3 OR proteinuria =>3g/24h). * cause is dx clinical, if not, serologic testing and renal biopsy. - UA (protein+cast+lipid=glomerular) * biopsy in children: pt fail to respond to corticosteroids.
- tx: First: tx causative disorder. 1) decrease proteinurea: ACEIs 2) Edema: Na restriction loop diuretics 3) hyperlipidemia: statin 4) hypercoagulability: anticoagulant to tx not prevent 5) pnemococcal vaccine 6) nephrectomy
#minimal change: renal function is normal, non nephritic urine sediment. Tx is corticosteroid, if not responding --> cyclophosphamide/cyclosporine. - biopsy (effacement of foot processes of podocytes). No complement or Ig deposit. - spontaneous remission in 40% - predinsone PO 60mg/m2 (4-6 wk and 2w maintenance and tapering after remission) 40-60% relapse. |
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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):
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Diphtheria Streptococcus pharyngitis?!
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What is the milestone of 4 year child ?
A. 40 - 60 word B.Count to 4 and C. tell story D. Say mama baba |
Tell a story |
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which vaccine is contraindicated in HIV pt?
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OPV
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Boy has a cat developed itching for a month with Red eye and watery with discharge No lymphad-enopathy and general exam normal:
Cat scratch Allergic conjunctivtis |
Allergic conjunctivtis Allergic conjunctivitis is an acute, intermittent, or chronic conjunctival inflammation usually caused by airborne allergens. Symptoms include itching, lacrimation, discharge, and conjunctival hyperemia. Diagnosis is clinical. Treatment is with topical antihistamines and mast cell stabilizers. - type I hypersensitivity reaction to a specific antigen. Symptoms tend to include itching, eyelid edema, stringy or watery discharge, and sometimes a history of seasonal recurrence.Diagnosis is usually clinical.Treatment includes tear supplements and topical drugs (usually antihistamines, vasoconstrictors, NSAIDs, mast cell stabilizers, or a combination). |
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Boy with elevated WBCs very high? Low hemoglobin Low MCV Low reticulocytes What is the di-agnosis?
A. Iron deficiency B. B Thalasemia trait C. Sickle D. Anemia of chronic disease |
Anemia of chronic disease?!
Nearst answer |
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7 year girl developed pubic hair And axillary hair and complain from acne and breast develop NOT enlargement of clitoris what dx?
a) central cause of puberty (something same this) b) gonadotropin releasing tumor |
- Precocious puberty is defined as the onset of pubertal development more than 2.5 to 3 standard deviations (SD) earlier than the average age. children presenting with signs of secondary sexual development younger than the age of eight years in girls or nine years in boys- The etiology of precocious puberty is classified by the underlying pathogenesis into three categories: (GDPP, central), (GIPP), and incomplete precocious puberty. - (GDPP) caused by early activation of normal pubertal development, central activation of HPG axis. more than 80 percent have idiopathic GDPP (a diagnosis of exclusion), others have CNS lesion .Thus all patients with GDPP should have brain imaging. Always appropriate to gender! In GDPP, basal LH levels are often elevated into the pubertal range and show a pubertal (heightened) response to GnRH stimulation.- (GIPP) caused by peripheral secretion of sex hormones from gonads or adrenal glands, ectopic hCG production by a germ cell tumor, or by exogenous sources of sex steroids, independent from HPG. Could be inappropriate to gender! LH level is low at baseline and fails to respond to GnRH stimulation.- Incomplete precocious puberty: isolated breast development (premature thelarche) or isolated characteristics such as pubic hair development mediated by androgens produced in the adrenal glands (premature adrenarche). Could be a variant of normal puberty and requires no intervention. close follow-up is recommended. |
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5 year old child present with odor of adult and pubic hair what investigation will do?
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investigation: initial screening tests: bone age, serum hormone levels (estradiol, testosterone, LH, FSH,TSH, free T4, DHEA-S, 17-OH-progesterone)secondary tests: MRI head, pelvic U/S, β-hCG, GnRH, and/or ACTH stimulation test
* Premature pubarche is the isolated appearance of sexual hair before the age of eight years in girls and nine years in boys. It is more common in girls. * Premature adrenarche is the most common cause of premature pubarche. It is the term applied to otherwise unexplained premature pubarche in association with a plasma steroid pattern indicative of adrenarche. Typically, the DHEA-S level is over 40 mcg/dl but no greater than normal for early puberty * Other causes of premature pubarche include nonclassic congenital adrenal hyperplasia, complete precocious puberty, and virilizing disorders. * Children presenting with premature pubarche should be carefully examined for testicular enlargement or breast development, the height and amount of pubic hair recorded for future comparison, and the bone age measured. * Children with an unusual amount of sexual hair, evidence of pubertal development, or advanced bone age should be further evaluated with hormonal measurements, including serum testosterone and DHEA-S. If the results are not consistent with premature adrenarche, further evaluation is indicated. |
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Breastfeeding mother treated with HCV by interferon more than one year what the risk of breast-feeding on infant ?
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nipple crickeld
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treatment of streptococcus glomerulonephritis in children with edema and HT ? |
- follow infection w/Group A beta hemolytic strep in throat or skin. 5-12y old, range from microscopic hematuria to ARF - lumpy pumpy deposits of Ig and complement. - Triad: Edema, HTN, hematuria - screen: urinalysis--> RBC, casts, protein, PMN cells - Low C3 (autoimmune) - anti-DNase antigen is single best to prove previous infection - tx: penicillin for 10d * na restriction, diuresis * fluid and electrolyte management * HTN: CCB, vasodilators, ACEIs 95% complete recovery. |
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fluid required to give for neonate 10 KG, loss 5% of his body fluid?
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1500
we have to calculate the fluid deficit and maintenance. fluid deficit = wt x percentage of loss x 10 ml of fluid. maintenance = first 10 of child wt = 100 ml/kg second 10 = 50 ml/kg addition kg = 20 ml/kg so in this case: fluid deficit = 10 x 5 x 10 = 500 ml and the maintenance = 10 x 100 = 1000 . so total fluid required is 1500 ml/day |
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child with pain when chewing and headache, he complain loss of weight and decrease appetite ? (Temporomandibular joint dysfunction) ? what is the complain ?
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Hearing loss?! |
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High height low weight dm1 child, what to check next?
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GF |
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mother bring her first & only infant was fatigute not move or gaze from light direct on his eye what the Dx?
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Infantile botulism |
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6y old boy fever, sore throat, developed pink maculopapular rash all over and pericarditis , what's the Dx?
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Kawasaki Disease
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what is the condition that baby will have bone age more than chronological age?
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congenital adrenal hyperplasia
BA>=CA : Normal velocity: familial tall stature or obesity Abnormal velocity: 1) genatic syndrome 2) endocrine: precocious puberty, CAH, hyperthyroidism 3) CNS lesion |
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milestone baby can hold his head and when he looks at his flying hand he laughs and coos
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- they say 2 I think 4 |
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milestone said baba and walk holding furniture and a lot of other features
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10 m |
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One month boy came for vaccine. His older sister (6 years old) had renal transplant and now is on immunosuppressive medication. Which vaccine is contraindicated? (Doesn't say for the baby or for the girl)
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OPV?! VAPP "vaccine associated paralytic poliomyelitis" usually occurs among young infant OPV recipients and among direct contacts of OPV recipients. The overall risk is about 1 case per 900,000 first dose OPV. Adults may be at higher risk than young infants and children. Persons with B cell immunodefi-ciency carry the highest risk with an estimated VAPP rate of 2 per 1000 vaccines Which means immunocompromised direct contacts carry the highest risk for OPV complications |
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Most common intra-abdominal tumor in infants?
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Neuroblastoma neuroblastoma is the most common intra-abdominal malignancy of infancy. Wilms tumor is the most common childhood abdominal malignancy with a median age of 3.5 years - neuroblastoma from neural crest cells. Occur at any site, most are adrenal, retroperitoneal sympathetic ganglia, cervical, thorasic or pelvic ganglia. - firm, painful mass, w/calcifications and Hemorhage. - initial presentation usually metastasis: skull, orbital most. Long bone, lymph nodes, liver skin. Never lung. (Wilms-->lung) - dx: MRI is best - Elevated HVA and VMA in 95% (homovanillic acid, venillylmandleic acid). |
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pediatric pat k/c of Asthma since age 2 years he is now asymptomatic with rare uses of albuterol inhalers, he came for counseling, he had contact sport participation, what is best question to ask to know his response:
A- “Are keeping up with your friends B- “How frequent do use inhaler” C- “ presence night symptoms (cough)” |
“ presence night symptoms (cough)”
Symptom assessment — Symptoms over the past two to four weeks should be assessed at each visit. Assessment should address daytime symptoms, nighttime symptoms, use of short acting inhaled beta agonists to relieve symptoms, and difficulty in performing normal activities and exer-cise. Several quick and validated questionnaires, like the Asthma Control Test, have been published Both B and C can be correct according to the above , but B is not specific for SABA , it could be steroid and it's not one of the routine question you ask to asses response , so the most probable answer is C. |
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long term treatment of sickle cell is:
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Folic acid - According to the uptodate , pencilline is recommended daily up to the age of 5. Hydroxyurea only used for a short time to avoid complications "Folic acid supplementation is well established in the treatment of chronic hemolytic anemia. Although it is proposed that folate in anemia raises hemoglobin levels and helps provide a healthy reticulocyte re-sponse, the use of folic acid in patients with SCD is not well supported by the primary literature." Both folic and penicillin are used as long term but folic acid use can go until adulthood even though data is not clear weather folic acid is required for management |
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12-hour newborn developed jaundice. Which investigation will you order?
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- G6PD?! Infants who have TB values ≥95th percentile or suspicion of hemolytic disease require subsequent measurement(s) of TB and further evaluation to determine the etiology of jaundice Initial tests that should be obtained are [8]:Blood type and direct Coombs testComplete blood count and smearReticulocyte countGlucose-6-phosphate dehydrogenase (G6PD) measurement, if clinically appropriateDirect or conjugated bilirubinETCOc (if available) |
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Sanrio about baby when birth weight was 3.5 kg after one week 3.1 kg A. Give Abotics B. Oral replacement therapy C. Reassurance D. Do routine investigation and send home
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Term neonates may lose up to 10 percent of their birth weight in the first few days of life and typically regain their birth weight by 10 to 14 days". So normally is weight after birth can reach to 3.15 kg. Source: uptodate: normal growth patterns in infants and prepubertal children
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Asthmatic boy on muntelukast present to ER, he has symptoms everyday exacerbated by exercise What to give for maintenance
A. oral steroid daily with long acting when needed B. inhaled steroid twice with short acting when needed C. Muntelukast with long acting |
inhaled steroid twice with short acting when needed
- Etiolgy: (Th1 and Th2), IgE, interleukins, granulocyte-monocyte colony-stimulating factor (GM-CSF), TNF-α, and the ADAM33 gene, which stimulate airway smooth muscle and fibroblast proliferation or regulate cytokine production. - status asthmaticus describes severe, intense, prolonged bronchospasm that is resistant to treatment. - asymptomatic between exacerbations. Patients experience dyspnea, chest tightness, audible wheezing, and coughing. - Signs include wheezing, pulsus paradoxus (ie, a fall of systolic BP > 10 mm Hg during inspiration—see Pulsus paradoxus), tachypnea, tachycardia, and visible efforts to breathe (use of neck and suprasternal [accessory] muscles, upright posture, pursed lips, inability to speak). The expiratory phase of respiration is prolonged, with an inspiratory:expiratory ratio of at least 1:3. Wheezes can be present through both phases or just on expiration, but patients with severe bronchoconstriction may have no audible wheezing because of markedly limited airflow - severe exacerbation and impending respiratory failure typically have some combination of altered consciousness, cyanosis, pulsus paradoxus > 15 mm Hg, SaO2< 90%, Paco2> 45 mm Hg, or hyperinflation - Diagnosis is based on history and physical examination and is confirmed with pulmonary function tests. * spirometry during forced expiration before and after bronchodilators ^ decrease FEV1--> FEV1>12% ^ decrease FEV1/FVC ratio >0.8 Medication: -short acting beta 2 agonist: betrol (not maintenance) drug of choice for relieving acute bronchoconstriction and preventing exercise-induced asthma. SE: tachycardia and tremor, hypokalemia - long acting beta 2 agonist: metrol (not used as monotherapy) : with inhaled corticosteroids and permit lower dosing of corticosteroids - Anticholinergics (tropium) not used as first line have an additive effect when combined with short-acting β2-agonists. Adverse effects include pupillary dilation, blurred vision, and dry mouth Controler: - inhaled steroids: first line controller, Inhaled corticosteroids have no role in acute exacerbations but are indicated for long-term suppression, control, and reversal of inflammation and symptoms. SE: dysphonia, oral candida - systemic steroid (predinsone and its derivatives) SE: suppression of the adrenal-pituitary axis, osteoporosis, cataracts, skin atrophy, hyperphagia, and easy bruisability. Growth suppression - Mast cell stabilizer: Cromolyn should be taken before exercise or allergen exposure. - leukotrine inhibitor: Montelukast, may cause liver enzyme elevations - The methylxanthine theophylline is used for long-term control as an adjunct to β2-agonists. Extended-release theophylline helps manage nocturnal asthma. many adverse effects and interactions with other drugs, include headache, vomiting, cardiac arrhythmias, and seizures. - Immunomodulators include omalizumab, an anti-IgE antibody developed for use in severely allergic patients with asthma who have elevated IgE levels. SE: anaphylaxis |
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amenorrhea ,Short stature ,HTN,broad neck ,Also parent short stature dx:
A- Familial B- Turner |
Turner Familial short stature usually occur in healthy children with no delay in bone age and normal growth velocity that correlates with their parents. - The mentioned features are typical for turner, which is a result of a chromosomal defect; the presence of a short stature in one of the parent might be coincidental. - If the short stature runs in the family that is always due to short stature of one of the parents with no other complains think of the autosomal dominant ( achondroplasia : Dwarfism ) |
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young boy presented with diarrhea some time bloody, Wight loos, arthritis, anemia the diagnosis
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Both UC, and CD can present with the above features. Since CD is more common than UC. + some of the the extra-intestinal manifestations are more common in CD, it would be the probable diagnosis Quoting from uptodate " CD tends to present In late childhood or adolescence and it's the predominant form of IBD after the age of 8" " arthritis is twice as common in CD as compared to UC"
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8 year child come with 30 BMI what can you do for him?
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Reassure and Life style
- For patients in the initial stages of obesity treatment (stages 1 and 2 above), we suggest that the provider of primary care perform a brief clinical intervention, using the behavioral strategies, nutri-tional goals, and exercise goals. Source uptodate: management of childhood obesity in primary care sitting Anti-obesity drugs can be useful adjuncts to diet and exercise for obese adults with a BMI greater than 30 kg/m2, who have failed to achieve weight loss goals through diet and exercise alone. Source uptodate : drug therapy of obesity |
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4 years old SCD w/ recurrent VOC what is best management for future improvement ?
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Hydroxyurea
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Fragile x syndrome associated with:
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Large protruding ear, long face, high arched palate, hyperextensible finger joint, double joint thumbs, flat feet, soft skin, post pubescent macroorchidism , hypotonia, language deficit, autism, ADHA, strabismus, seizures, fertility.
- more in males - learning deficulties IQ mean 50 - Autistic feature and hyperactivity - maco-orchafisim after puberty usually Dx: cytogenetic analysis or DNA analysis |
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child come with case of immunodeficiency with presented with lump in the groin and lap was given what is the diagnosis ?? there's CH50 in Q
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severe combined immune deficiency
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child presented with something in the eye with lab result of incense of WBC what is the diagnosis
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Not clear Q But :- - According leukemia we will have high WBC and may papilledema in case of CNS involvement . - Regard-ing neuroblastoma may we have low WBC (Anemia or other cytopenias suggest bone marrow involvement.) + eye manifestation will be Opsoclonus or Horner syndrome ) + Abdominal mass .
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2 y child had mass in flank lead to displace the collection system Dx? A. wilms B. neuroblastoma
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neuroblastoma
-neuroblastoma abdominal mass which CROSS MID LINE + other S&S - wilms tumor usually we have Asymptomatic abdominal mass which Does Not CROSS MID LINE |
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hemangioma in the lift eye in an infant and it needs to be resected so it doesn't affect the vision, when will u do that?
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Immediatly |
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child 9 y ..Rx of severe avascular necrosis? Answer: ??! |
Medical and surgical. - legg calve perthes disease: Idiopathic AVN of femoral head, present 4-8y of age. If <6y: better prognosis. * A.w ADHD in 33% of cases and delay bone age in 89%. * most common in adolescent athletes, esp. Jumping/spring - child w/antalgic limp, intermitting pain of knee, hip, groin or thigh. Flexion contracture (stiff hip) decrease internal rotation and abduction. - collapse of femoral hip is diagnostic - tx: physiotgerapy, femoral/pelvic osteotomy if >8y or severe. - complication: early OA and decrease ROM |
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child e recurrent UTI investigation ?
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US usually start by US then Voiding cystourethrography (VCUG)) Ref :- Nelson Ultrasonography of the bladder and kidneys is recommended for infants with febrile UTIs to exclude structural abnormalities or detect hydronephrosis. Voiding cystourethrogram (VCUG) is indicated if the ultrasound is abnormal (hydronephrosis, scarring, or other findings to suggest obstruction or congenital abnormality). Vesicoureteral reflux is the most common abnormality found and is ranked from grade I (ureter only) to grade V (complete gross dilation of the ureter and obliteration of caliceal and pelvic anatomy) (see Chapter 167). A technetium-99m DMSA scan can identify acute pyelonephritis and is most useful to define renal scarring as a late effect of UTI |
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A child present with s&s of Leukemia with CALLA +ve? Dx?
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ALL * common acute lymphocytic leukemia antigin |
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child with Painful limping, Dx?
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12 Y +OBESE+ Cannot bear weight + hip externally rotated>>slipped capital femoral epiphysis
- Children with septic arthritis of the hip typically are febrile and ill-appearing, although occasionally the presentation is more subtle [7]. Neonates and infants with septic arthritis of the hip may present with irritability and pseudoparalysis of the affected limb, with or without fever. Weight-bearing and motion of the affected hip are quite painful and strongly resisted in all patients. Other joints typically are spared, although up to 8 percent of septic arthritis in children is multifocal - Osteomyelitis — Osteomyelitis is an infection of bone that occurs most commonly in children younger than five years of age. - Osgood-Schlatter disease, also known as apophysitis (formerly osteochondritis) of the tibial tuberosity, is an overuse syndrome that occurs in active individuals. most common chief complaint is anterior knee pain that increases gradually over the course of time. Pain may be exacerbated by direct trauma, running, jumping, or kneeling, and is relieved by rest. localized tenderness and, often, a prominence of the tibial tuberosity with soft tissue swelling are present; occasionally a palpable bony mass is found - Legg-Calvé-Perthes (LCP) disease is a syndrome of idiopathic avascular necrosis of the hip that occurs in children between the ages of 3 and 12 years. present with limp of insidious onset and a Trendelenburg gait. Pain, if present, is mild and often referred to the anteromedial thigh or knee. On examination, patients may have limited internal rotation and abduction of the hip. Pain may lead to disuse, which may result in atrophy of the thighs and buttocks. - Children with unilateral DDH usually present with a Trendelenburg gait, decreased hip abduc tion, and pistoning of the thigh (eg, sliding along the pelvis) during gait. The child may walk on the toes of the affected side to compensate for the shortened thigh. Patients with DDH have a posi tive Trendelenburg test (inability to maintain the pelvis horizontally while standing on the ipsilat eral leg) because of weakness of the hip abduc tors on the affected side. Patients also have a positive Galeazzi test (asymmetry of the knee heights when the child is supine with the hips and knees flexed so the ankles are brought to the buttocks); the height of the knee is shorter on the affected side [4]. In addition, there may be extra skin folds on the affected limb. Children with bilateral DDH typically have a lordotic, sway ing, "drunken sailor" gait, which is pathogno monic. - Slipped capital femoral epiphysis (SCFE) occurs between the ages of 8 and 15 years, predominantly in obese males. In SCFE, the femoral epiphysis slips posteriorly, resulting in a limp and impaired internal rotation of the hip. Patients may present with acute hip pain and inability to walk, often after minor trauma, but more commonly they come to attention after months of ill-defined hip or knee symptoms and antalgic or Trendelenburg limp with or without an acute exacerbation. The pain is increased by physical activity and may be chronic or intermittent. The absence of pain, or pain localized to the knee or thigh instead of the hip, can lead physicians to overlook the diagnosis [62,63]. Simultaneous external rotation and abduction of the hip during hip flexion is a useful, though variably present, |
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child with blue dot in testis and painful mass in inguinal area?
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testicular appendix torsion
* Torsion of testicular appendages can result in the clinical presentation of acute scrotum. Two such appendages are the appendix testis, a remnant of the paramesonephric (müllerian) duct 92%, and the appendix epididymis, a remnant of the mesonephric (wolffian) duct 23%. * Pain may be present. Onset is usually acute, but pain may develop over time. Typically, it has a more gradual onset than testicular torsion. Intensity ranges from mild to severe. Patients may endure pain for several days before seeking medical attention. The pain is located in the superior pole of the testicle. This is a key distinguishing factor from testicular torsion. A focal point of pain on the testicle is uncommon in complete testicular torsion. * Systemic symptoms are absent. Nausea and vomiting * Urinary symptoms are absent. Dysuria and pyuria are not associated with torsion of the testicular appendages. Their presence is more indicative of epididymitis. * The presence of a paratesticular nodule at the superior aspect of the testicle, with its characteristic blue-dot appearance, is pathognomonic for this condition. A blue-dot sign is present in only 21% of cases.The combination of a blue-dot sign with clear palpation of an underlying normal, nontender testes allows for the exclusion of testicular torsion on clinical grounds alone.Vertical orientation of the testes is preserved. - dx: color dopler - tx: conservative |
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HUS vs TTP?
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HUS: Thrombocytopenea, MAHA, renal involvement Usually in children Diarrhea (shiga toxins) TTP: Thrombocytopenea, MAHA, renal involvement, fever and CNS involvement Usually in Adults ADAMTS 13 abnormalities |
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pedia case neonat has jaundice admitted due to physiological jaundice then discharge , still appear jaundiced what is case ?
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Duodenal atresia * Prolonged physiological jaundice associated with hypothyroidism and GIT obstruction A) in 24h: This is not normal!The commonest cause is due to haemolysis usually due to either ABO incompatibility, Rhesus disease of the newborn or Hereditary Spherocytosis.However can be caused by infection either from the mothers genital tract or in the amniotic fluid, therefore a TORCH screen should be used. B) day 2-week2: Although other causes must be excluded, the most common causes in this time period are ;Physiological Jaundice is very common, usually appearing around day 2-4, peaking at 7 days and then regressing. It is caused by a combination of the following two factors:Foetal haemoglobin has a shorter life span than adult haemoglobin and is constantly being broken down at a high rate.The newborn liver cannot cope with all of this bilirubin, and so it builds up in the blood.Breastfeeding Jaundice is thought to result from increased enterohepatic bilirubin. C) Prolonged: Congenital hypothyroidism can cause jaundice in this time period, however you would expect this condition to be picked up on the Guthrie heel prick test.Biliary atresia is a rare condition in which all or parts of the biliary tree fail to develop, preventing bile from flowing into the gut. This leads to a high concentration of conjugated bilirubin level in the blood. An important question to ask when taking a jaundice history is the colour of the stools. In biliary atresia the stools are often pale or ‘chalky white’. Ultrasound or radionuclide scans can identify the defect and surgery is needed to create a functional biliary tree. |
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baby has sickle cell anemia and receive blood transfusion , what about vaccination ?
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Take vaccine |
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pediatric case croup , from where take swap ?
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Nasopharyngial swab |
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child in the hospital play and come to his parents say stories , draw head and hands and legs what is the age of this child:
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5y - skips alternating feet, jump over obstacles. - copy triangle, ties shoes, spread w/knife - print first name - tell story, knows alphabet - play pretend, play cooperative games - ask wh a word mean - like to help in house |
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Child after trauma in perineum region showed urine extravasation
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Penial urethra?! - The membranous urethra is prone to injury from pelvic fracture because the puboprostatic ligaments fix the apex of the prostate gland to the bony pelvis and thus cause shearin of the urethra when the pelvis is displaced - The bulbar urethra is susceptible to blunt force injuries because of its path along the perineum. Straddle- injuries from falls or kicks to the perineal area result in bulbar trauma. - the penile urethra is less likely to be injured from external violence because of its mobility, but iatrogenic injury from catheterization or manipulation can occur, which is also possible in the fossa navicularis. |
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12 years old girl has type 1 DM , her weight 40 kg ( below 50th percentile ) and his height 150 cm ( below 95th percentile ) , she has no signs of secondary sexual characteristics of puberty, you want to perform annual screening in clinic for :
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GH?! |
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baby on antibiotic developed watery diarrhea , what is most likely organism :
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C.difficil |
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parent brought their baby to your clinic , you noticed testicular asymmetry and was tender on palpation , the testes were palpable in scrotum bilaterally , next step :
A. transillumination B. surgery C. watch it while the baby is crying and coughing |
- c?! http://cursoenarm.net/UPTODATE/contents/mobipreview.htm?32/6/32878?view=print# |
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baby came to u with sore throat , u obtain culture and send the baby home , the culture grows meningococcus , u call the parents and they say their baby is asymptomatic , what will u do :
A. 10 days oral ampicillin B. one dose IM ceftriaxone sorry I forgot the rest of choices |
- uptodate: Although testing for nasopharyngeal carriage is not typically performed, the meningococcus is occasionally detected on throat culture obtained for some other reason. The most common indication is pharyngitis, which is not caused by N. meningitidis.There are no recommendations for eradicating nasopharyngeal carriage in the community outside of an outbreak or a patient with invasive meningococcal disease. There are three problems with attempting to eliminate nasopharyngeal carriage in the community: |
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Roles of Calcium :
- Contraction of skeletal, cardiac and smooth muscle - Blood clotting - Control of nerve impulses * Increases in the level of calcium cause depression of the nervous system * Decreases in the level of calcium causes excita tion of the nervous system * Levels of calcium are controlled by PTH. PTH causes:Increased osteoclast activity Decreased excretion of calcium by the kidneys |
Dx of hypercalcemia: 1) Ca corrected to alb or ionized Ca: total corrected serum Ca2+ >10.5 mg/dL (2.6 mmol/L) OR ionized Ca2+ >5.4 mg/dL (1.35 mmol/L) * For every decrease in albumin by 10, increase in Ca2+ by 0.2 * OR: measured Ca+ 0.02 x (40 – albumin) 2) if PTH is high: 2ddx (measure Ca in urine) - if >200: primary hyper parathyroidisim (adenoma) - if <100: FHH 3) if PTH is low, - PTHrP is high: malignancy - if 1,25D is high: lymphoma, TB, sarcidosis, granuloma - if 25D is high: meds, vitamins, minerals 4) if all normal: think of endocrinopathies like thyrotoxicosis, addissions, acromegaly Sx: “Bones, stones, groans and psychic moans”Depressed nervous system – this can lead to slow reflexes.Poly uria / polydipsiaDecreased QT intervalLack of appetite and constipation and vomiting – probably due to decreased contractility of the muscle walls of the GIt.Decreased contractility and decreased neuron activityFormation of calcium phosphate crystals at very high levels of Ca2+ in the bloodDecreased QT interval on ECG Tx: Volume expansion (e.g. NS IV 300-500 cc/h): initial therapy • Calcitonin [Increase Urinary Ca2+ Excretion]: transient, partial response • Bisphosphonate [Diminish Bone Resorption]: treatment of choice, Tachyphylaxis may occur, Dangerous – hematotoxic and hepatotoxic. • Corticosteroid [Decrease GI Ca2+ Absorption]: most useful in vit D toxicity, granulomatous disease, some malignancies (hematologic)• Saline diuresis + loop diuretic (for volume overload): temporary measure* Dialysis Treatment of last resort • Indication: severe malignancy-associated hypercalcemia and renal insufficiency or heart failure |
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child admitted with sore throat and bilateral knee pain?
A. Juvenile rheumatoid arthritis B. Rheumatoid arthritis |
??? Maybe rheumatic fever |
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Osgood schlatter disease |
- Osgood-Schlatter disease is osteochondrosis of the tibial tubercle.Osgood-Schlatter disease occurs between ages 10 yr and 15 yr and is usually unilateral. Although the disease is more common among boys, this status is changing as girls become more active in sports programs. Etiology is thought to be trauma due to excessive traction by the patellar tendon on its immature epiphyseal insertion, leading to microavulsion fractures. Characteristic symptoms are - tender lump over tibial tuberosity, pain on resisted leg extension, anterior knee pain exacerbated by jumping or kneeling, relieved by rest.
- dx: clinical, sometimes X-ray (fragmentation of the tibial tubercle). - tx: rest, analgesic Resolution is usually spontaneous within weeks or months. Usually, taking analgesics and avoiding excessive exercise, especially deep knee bending, are the only necessary measures. Complete avoidance of sports is unnecessary. Resolve when growth halts.
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- child eating a lot of milk but he does not meat, MCV hypochromic microcytic anemia , How will you manage this child? |
- Iron Exclusive milk can cause Iron deficiency anemia , the treatment is by iron of not receiving fortified cere-als/meat - more efficient iron absorption in proximal intestine in breast milk. Introducing iron rich food is effective in prevention. - caused by consumption of large amount of cow milk and foods not enriched w/fe - lead to leakeage of blood from GI and further decrease in absorption. - adolecent has growth spurt, dietary deficincy and menstruation. - first decrease in hemosiderin--> decrease in serum ferritin--> decrease in serum iron and transferrin saturation--> increase TIBC - poikilocytosis - tx: Oral Ferrous Salts, continue for 8w after values normalize. |
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Child can walk without support ,crawling ,build 3 cubes point to something he interested in , so what is the age of the child ?
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15 m - creeps up stairs, walk backwards - scribbles and build tower of 2 blocks - 4-6w, follow one step command without gesture - use cups, spoons - points and hugs |
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Child came by his parents , they said that their son have recurrent lip swelling(angioedema)so deficiency of which ?
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Deficincy in C1 inhibitor |
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Parent came to your clinic with their obese child with BMI 33 ,So they are afraid of having their child a disease , they wanted you to do lipid profile , after taking history you decided to do a lipid profile but why ?
A. Because his parents wish or need this test to be done B. Because the child eating French fries daily C. Because there is early family history of cardiac disease |
Because there is early family history of cardiac disease - Clinical clues that suggest a hormonal etiology for childhood obesity include the following:Weight gain out of character for the familyObesity in a short child Progressive weight gain without a comparable increase in linear growh Dry skin, constipation, intolerance to cold, and fatigability History of central nervous system (CNS) damage (eg, trauma, hemorrhage, infection, radiation, seizures) Accumulation of fat in the neck and trunk but not in the arms or legs Purple striae (stretch marks) Hypertension Inappropriate sexual development at an early age Excess facial hair, acne, and/or irregular menses in a teenage girl Headaches, vomiting, visual disturbances, or excessive urination and drinking Treatment with certain drugs or medications - |
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2 month old has diarrhea and his mother is worried from dehydration what will you advise the mother:
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Oral hydration solution |
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A child presented with diaper rash with satellite lesion he was given local creams and steroid but didn't work:
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Local antifungal due to candida infection , they use sertaconazole cream (new alternative for diaper derma-titis candidiasis treatment & ciclopirox more safe and effective |
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child has itching and all student in his class got the same infection:
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Scabies , it's skin infection caused by mite sarcoptes scabiei contagious condition , transmitted through person to person by direct contact
- Scabies is a very itchy rash caused by a parasitic mite that burrows in the skin surface. The human scabies mite's scientific name is Sarcoptes scabiei var. hominis - Scabies causes a very itchy rash. It’s important to search for burrows carefully in a patient with severe itch, especially if the rash is mild. Contacts should be examined for burrows, whether or not they are itchy. (Spare scalp) - burrows appear as 0.5–1.5 cm grey irregular tracks in the web spaces between the fingers, on the palms and wrists. - dx: Dermatoscopy: the mite at the end of a burrow has characteristic jet-plane or hang-glider appearanceMicroscopic examination of the contents of a burrow * Crusted scabies reveals numerous mites on dermatoscopy or microscopy, raised immunoglobulin E (IgE) and eosinophilia. - tx: The chemical insecticides used to treat scabies are called scabicides. The scabicide is applied to the whole body from the scalp to soles. The usual topical treatment is 5% permethrin cream, left on the entire skin for 8–10 hours. It should be applied under fingernails using a soft brush. |
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What is the most common cause of facial cellulitis in pediatrics?
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- Facial cellulitis in pediatric practice is now largely due to (1) trauma/loss of skin integrity with secondary infection, (2) dental problems, or (3) severe sinusitis. |
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- child c/o unilateral nasal foul smelling discharge for two weeks ,what is your treatment? |
x-ray of the head
to determine the kind of the foreign body , if appear as radiopaque that's mean it's metal object Then you assess how to remove it. The role of plain x-ray is very limited as the condition need to and only can be confirmed under direct visualisation with endoscope It may be very helpful in primary care setting as this bony concretion will demonstrate some degree of opacity thus aid the working diagnosis And demonstrate the exact lesion |
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hydrops fetalis in thalassemia case :
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Normal 2 beta abnormal 4 alpha
It's alpha thalassemia major ,absent of 4 alpha Because there is no alpha globin chain production, affected fetuses have great difficulty in synthesizing a functional hemoglobin molecule. Gamma chains accumulate and form gamma-4 tetramers (hemoglobin Bart's); hemoglobin Bart's binds oxygen, but cannot release it to tissues because its affinity for oxygen is much greater than that of hemoglobin A. Hemoglobin electrophoresis will show greater than 80 percent hemoglobin Barts while the remaining hemoglobin will be of embryonic origin, with a small component of hemoglobin H (beta-4 tetramers) |
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most sexual differentiation in male :
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hypospadias
Hypospadias is a condition where the meatus isn't at the tip of the penis. Instead, the hole may be any place along the underside of the penis. The meatus (hole) is most often found near the end of the penis ("distal" position). But it may also be found from the middle of the penile shaft to the base of the penis, or even within the scrotum ("proximal" positions). Over 80% of boys with this health issue have distal hypospadias. In 15% of those cases, the penis also curves downward slightly, a condition called "chordee." When the meatus opens further down the shaft, curvature occurs in more than 50% of patients. Hypospadias is a common birth defect found in up to 1 in every 200 boys.In most cases, hypospadias is the only developmental problem in these infants and doesn't imply there are other flaws in the urinary system or other organs. |
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11 months old infant , dark foul smell stool mixed with blood and mucus , what will u do investi-gation :
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US Intussusception |
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newborn with umbilical hernia.what should tell the mother ?
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Reassure Should treat it before school
Umbilical hernia: |
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baby with vomiting and diarrhea , looks ill , cries with tears , capillary refill 3 sec , vital signs were normal almost :
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Severe dehydration, give IV fluid?! |
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years old baby presented with severe lower limb pain , growth parameters under the 5th percen-tile , low Hg :
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Vaso Occlusive crisis
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baby with blood jelly stool ( was case of intussusception ) what will u do
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US Barium enema can be used for treatment as well |
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8 years old girl , parent complains that she looks older than her classmates , wt and height above the 95th percentile , otherwise normal :
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reevaluate after 12 months
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newborn after 2weeks c/o bilateral conjunctivitis ,chest infiltration , lung crepitation, what is or-ganism ??
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chlamydia
Conjunctivits: Initially the disease presents as watery discharge that becomes purulent.This can (but does not always) progress to marked swelling of eyelids with red and thickened conjunctiva (chemosis).A pseudomembrane may form over the conjunctiva, which can become friable, resulting in bloody discharge.A membrane of granulation tissue may form after about two weeks if the condition is left untreated.Untrested infection may last for months and cause corneal and conjunctival scarring. Pnemonia : - 5 to 30% of infected neonates will develop pneumonia. Approximately half of these infants will have a history of C. Trachomatis conjunctivitis. - Onset is insidious and characteristic features include a staccato cough, tachypnea. Rales is common upon auscultation, but wheezing is not. The liver and spleen may be palpable secondary to hyperinflated lungs. - WBC normal but eosinophilia |
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what is the features that seen in pt with congenital adrenal hyperplasia? A. hirsutism, B. Dehydration
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Hirsutism?! |
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child ate honey then he develop flaccid paralysis :
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clostridium botulinum
* Constipation is the usual presenting symptom, often preceding motor function symptoms by several days or weeks. * Gag reflexes are frequently impaired, which can lead to aspiration if the airway is unprotected * Infants with botulism are afebrile, suck poorly, and are lethargic and listless. They often are described as being floppy * Constipation is almost always the first sign of infant botulism.[27] Constipation, poor feeding, ptosis, facial and generalized weakness are considered to be the classical signs of infant botulism * descending weakness and paralysis, hypoventlation. * Breastfeeding may protect infants from lethal fulminant infant botulism, but exclusive breastfeeding is a risk factor for the disease, presumably because the relatively pristine bowel flora of the exclusively breastfed infant is more permissive for spore germination and toxin production * For infant botulism detecting botulism toxins or spores in stool is the best way to confirm the diagnosis. * Human Botulism Immune Globulin Intravenous (BabyBig) should be administered for infant botulism. It is effective if given within 7 days of onset of symptoms. Abx is contraindicated, antitoxin maybe used. |
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child his height and weight below normal besides growth hormone what you will order: A. somatomedin C B. aldosterone C. insulin D. testosterone
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Insulin?! |
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Say few words at the age of which ?
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12m |
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what u will seen on physical examination of pt with croup ??
presence of inspiratory sounds presence of expiratory wheeze |
Inspiratory sounds |
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newborn girl ( i did not remember the complain but there is enlargement of clitoris ( I think this is congenital adrenal hyperplasia ) ask about treatment ?
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it's CAH and the treatment is long-term glucocorticoid or aldosterone replacement
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Boy 10 yrs BMI 30 , wt &ht above 95 percentile what is the best managem ?
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Lifestyle modification
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18 months old girl delivered premature her wt was 2.6kg .she is healthy but last 2 days c/o irrita-bility and fatigue .mother shift feeding from breast feed to cow milk feeding at age of 9 month , she has hypochromic microcytic anemia , this patient complain due to ?
A. premature B. cow milk feeding C. bone marrow defect |
Cow milk feeding |
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viral gastroenteritis prevented by which vaccine :
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Rotta |
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25 kg child maintenance 24h
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The Maintenance is 1600 ml Half 800 ml given in 1st 8 h ..the rest is given in 2nd 16 h
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child develop petechiae in leg hx of URTI LAB : normal CBC expect plt was low next management?
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Its ITP 1st choice in treatment is corticosteroids then immunoglobulin
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child complains of abdominal pain since 2 weeks , diarrhea occasionally bloody. malaise. what is the most appropriate test for the diagnosis?
A.abdominal CT B.barium enema C.abdominal US |
- Acute infectious gastroenteritis due to viruses accounts for most bouts of diarrhea.
- life threatening: 1) Intussusception: 6-12 m, the classically described triad of pain, a palpable sausage-shaped abdominal mass, and currant-jelly stool. 2) HUS: triade: Microangiopathic hemolytic anemia,Thrombocytopenia, Acute renal failure. Children typically have a prodromal illness with abdominal pain, vomiting, and diarrhea that precedes the development of HUS by a few days, enterohemorrhagic E. coli infections with the 0157:H7 strain. 3) Pseudomembranous colitis: an overgrowth of toxin-producing clostridial organisms in the bowel, acute watery diarrhea, lower abdominal pain, low-grade fever, and leukocytosis, starting during or shortly after antibiotic administration I think pt has IBD. In addition to endoscopy, imaging of the upper gastrointestinal tract (esophagus, stomach, and small intestine) is recommended, primarily to distinguish between UC and CD. UGI/SBFT is the best established imaging technique to evaluate the small bowel for suspected CD |
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3 years old came to the ER with dry cough, he was crying and hoarseness of voice was present, what is your management?
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nebulized cool mist
Cool mist administered by face mask may help prevent drying of the secretions around the larynx. - Children receiving aerosol treatment should be hos-pitalized or observed for at least 2 to 3 hours because of the risk of rebound airway obstruction. - The most common complication of croup is viral pneumonia, |
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child presented to the emergency room with non productive cough and inspiratory stridor. what is the worst sign we should worry about?
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bluish lip color
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child vaginal bleeding + breast +mass in pelvic? A-ovarian teratoma B-granulosa theca C-yolk sac tumour |
Granulosa theca: Patients usually present with precocious pseudopuberty (70-80%) and have secondary sex characteristics at a very early age. These may include increased linear growth, breast enlargement, clitoral enlargement, pubic hair development, increased vaginal secretions, and vaginal bleeding. - manifestations of hyperestrogenism. mass related complications - |
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baby diagnosed with Cystic fibrosis. ..he has + sweat chloride test his brother is normal, to confirm diagnosis of cystic fibrosis?
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CTRF gen in parent
Cystic fibrosis is a recessive disorder, which means that both parents must pass on the defective gene for any of their children to get the disease. If a child inherits only one copy of the faulty gene, he or she will be a carrier. Carriers don't actually have the disease, but they can pass it on to their children. |
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Purulent discharge from newborn's eye, what's the organism?
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gonorrhea ( by student get 100% in OPH )!
Most likely Dx. is neonatal conjunctivitis Could be Gonococcal infection neisseria gonorrhoeae .( within first 48h of life ) Or could be chlamydia trachomatis eye infection ( at 1-2 weeks of age ) |
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3 years child with UTI . What investigation should done before Tx?
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US “urine sample
- children <3m: US sent for urgent micrscopy and culture --> initiate tx - children 3m to 3y: * specific urinary sx: start abx and send urine sample for urgent micrscopy and culture * sx not specific for UTI: depends on - is pt high risk? start abx and send urine sample for urgent micrscopy and culture - is pt low risk? US sent for urgent micrscopy and culture --> initiate tx if positive |
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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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Diplegic
- hemiplegic: affect one side of the body, arms more affected than legs - Diplegic: affect all four limbs, legs are affected more than legs - quadriplegic: affect all four limbs - monoplagia: affect one limb, usually an arm - triplagia: affect 3 limbs 2 arms and one leg. - pentaplagia: all limbs and head and neck Types: - Spastic: most common 80%, increased muscle tone ( Involuntary movements, stiffness, mobility impairment). - Ataxic: 20%, damage to cerebellum, result in hypotonia, tremor, motor impairment, imbalance, visual and hearing problems. - Athetoid/dyskinetic: 5% mixed muscle tone, hypertonia and hypotonia. Postural impairment, fine motor function problems and poor physical control. - Mixed: 5% have 2 or more types |
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young boy presented with diarrhea sometimes bloody , Weight loss , arthritis ,anemia the diagno-sis is :
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UC? Ulcerative colitis is a recurrent, inflammatory and ulcerating disease involving the mucosa of the colon. Characteristically, the disease presents with rectal bleeding, diarrhoea and colicky pain. Weight loss and growth failure may occur, although this is less frequent than in Crohn disease. Extraintestinal complications include erythema nodosum and arthritis. |
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child young present with his family (pic of baby his age is months head tilted to one side) he was normal on birth with normal not complicated delivery ,when you try stretch sternocleidomastoid he was crying all reflexes and movement normal?
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Infant Torticollis
- Torticollis is a result of unilateral tightness and shortening of one sternocleidomastoid muscle. - The mass is generally 1-3 cm in diameter. It is a painless swelling in the substance of the sternocleidomastoid muscle and develops in neonates aged 2-3 weeks. In infants, the tumor is hard, and the patient's head is tilted and flexed to the side of the fibrosis. - Older children compensate for the head tilt by elevating their shoulder to maintain a horizontal plane of vision - Management for torticollis is primarily nonoperative, generally consisting of parental physiotherapy. The rare indications for surgical management include the following: * Persistent sternocleidomastoid contracture limiting head movement * Persistent sternocleidomastoid contracture accompanied by progressive facial hemihypoplasia * Torticollis in children older than 12 months |
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child mild persistent asthma visit ER once every month he is on ventolin what to add to his medi-cation?
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10% |
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deceleration in fetal assessment?
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Deceleration means decreased HR in Fetal
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baby recently 6 months ago diagnosed w/ DM type 1 compliant to medication and diet start to have episodes of hypoglycemia not in particular time what is the cause ?
A- honeymoon period B- Dawn phenomenon C- Sigmoid phenomena |
???! |
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baby can sit roll from prone to supine and back play handle object but can't pick things b/ 2 fingers age
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6 m |
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baby after operation has loss of gag reflex in left side, normal uveal movement what nerve injured ?
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Glossopharyngeal nerve lesions produce difficulty swallowing; impairment of taste over the posterior one-third of the tongue and palate; impaired sensation over the posterior one-third of the tongue, palate, and pharynx; an absent gag reflex; and dysfunction of the parotid gland.
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What is more present in Cow milk than breast milk
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Proteins. |
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non pruritic pink eruption of the right foot no scales no history of infection
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Granuloma annulare
- a common skin condition in which there are smooth discoloured plaques. They are usually thickened and ring-shaped or annular in shape. Granuloma annulare is more correctly known as necrobiotic papulosis. There are several clinical patterns. - children, teenagers or young adults (or older adults, less commonly). - Granuloma annulare is a delayed hypersensitivity reaction to some component of the dermis. Inflammation is mediated by tumour necrosis factor alpha (TNFα). The reason that this occurs is unknown. - Localised granuloma annulare is sometimes associated with autoimmune thyroiditis but it does not clear up with thyroid replacement. Extensive granuloma annulare is sometimes associated with diabetes mellitus, hyperlipidaemia, and rarely with lymphoma, HIV infection and solid tumours. - dx: clinical, biopsy - tx: no need |
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newborn presented with vomiting and enlarged clitoris ,lab was included showing hypokalemia and hyponatremia. what is the most likely diagnosis
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congenital adrenal hyperplasia
if it's hyperkalemia not hypo. In CAH Genitalia are ambiguous in girls , boy do not initially exhibit any abnormality but begin to loss their finding sexual futures as they age . Inappropriate facial hair , fertilization and menstrual abnormalities are seen . Hyponatremia , hypochloremia , hypoglycemia and hyperkalemia are seen. |
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viral hemorrhagic disease
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Viral hemorrhagic fevers (VHFs) are a group of febrile illnesses caused by RNA viruses from several viral families. These highly infectious viruses lead to a potentially lethal disease syndrome characterized by fever, malaise, vomiting, mucosal and gastrointestinal (GI) bleeding, edema, and hypotension.
- sx: High fever, Headache, Fatigue, Abdominal pain, Myalgias, Hematemesis and bloody diar rhea, Generalized mucous membrane hemor rhage, Rash, Altered mental status and cardio vascular collapse (preterminal events). - A complete blood count often indicates leukopenia and thrombocytopenia - Elevated hepatic transaminases are observed in viral hemorrhagic fever (VHF) and are predictive of high mortality in Lassa fever infection - Prothrombin time, activated partial thromboplastin time, international normalized ratio, and clotting times are prolonged. - A disseminated intravascular coagulation profile including fibrinogen level, fibrin degradation products, and platelet count may be useful - tx: Supportive care is based on the patient's physiologic condition and infection control. |
