Usmle 3 Pediatrics

Front 1

most common organisms in neonatal sepsis

Back 1

- GBS, E coli, klebsiella, enterobacter
- tx with amp and cefotaxime/CTX, or other antipseudomonal

Front 2

baby with jaundice, which abx to avoid?

Back 2

- CTX will worsen hyperbili

Front 3

meconium ileus

Back 3

- distal ileus filled with meconium --> can't pass stool

Front 4

duodenal atresia?

Back 4

- associated with down's syndrome and polyhydramnios

Front 5

fhx of severe constipation?

Back 5

- Hirschsprung's disease

Front 6

pyloric stenosis

Back 6

- typically in firstborn males

Front 7

what age do kids become fascinated with genitalia?

Back 7

- two years old
- 4-5 they are embarrassed if someone sees them nude and continues into teenage

Front 8

tall boy with long fingers and toes?

Back 8

- marfan's syndrome: connective tissue d/o
- develop aortic root dilation --> dissection of descending aorta --> ADVISE AGAINST STRENUOUS ACTIVITY
- get echo

Front 9

worry about intentional head trauma in 9 mo old

Back 9

- get CT head

Front 10

febrile seizures

Back 10

- common, do nothing

Front 11

tx of pyloric stenosis

Back 11

- correct electrolyte abnormalities
- surgical correction

Front 12

which abx causes increased risk pyloric stenosis?

Back 12

- erythromycin (given for pertussis)

Front 13

infant botulism

Back 13

- typically from soil
- supportive care: human derived botulinum antitoxin and supportive care
- most require 1-3 month hospitalization, may have lingering neurologic deficits if really bad, but otherwise complete recovery

Front 14

bronchiolitis

Back 14

- young age (<2 y), mild URI sx, mild to mod fevers, wheezing
- PEx: liver and spleen palpable b/c of hyperinflated lungs
- keep in respiratory isolation, supportive measure, O2, IV feeds, bronchodilators
- do rapid RSV nasal swab test
- common complication is ear infx
- increased risk of developing Asthma in future

Front 15

baby born with weak pee stream and distended bladder?

Back 15

- posterior urethral valves - most common cause of severe obstructive uropathy in kids
- get voiding cystourethrogram

Front 16

prune belly syndrome

Back 16

- multitude of renal, ureteral, urethral abnormalities
- underdeveloped abdominal musculature
- get imaging

Front 17

baby with developmental dysplasia of the hip

Back 17

- barlow test: attempt to dislocate the hip
- refer to orthopedic, put in pavlik harness

Front 18

bereavement in kids

Back 18

- 3-7y.o.: disbelief, think death is temporary
- >7: aware that deathaa is final

Front 19

malformations in down's

Back 19

- duodenal atresia, Hirschsprung's, atlanto-axial instability, hypoTH, endocardial cushion defect

Front 20

endocardial cushion defect

Back 20

- turns blue and short of breath when eating
- harsh holosystolic mumur over LLSB

Front 21

diaper rash

Back 21

- if very bad s/p abx use, clotrimazole cream, most likely fungal

Front 22

treatment of moderate lead poisoning? severe ? mild?

Back 22

- 45-70: IV EDTA or oral DMSA
- >70 severe: dimercaprol or EDTA
- <45: DMSA or d-penicillamine

Front 23

nocturnal enuresis

Back 23

- secondary: occurs 6 months after child was continent
- primary: resolves on its own by age 5-7
- if support doesn't work then try alarms or desmopressin

Front 24

rubella vs rubeola vs roseola

Back 24

- rubella: german measles, like measles but less sick; low grade fever, LAD, lymph nodes, maculopapular rash on face and spreads down
- rubeola: cough, conjunctivitis, coryza, koplik spots
- roseola: high fever rapidly resolves, rosy nonpruritic rash originating on trunk to extremities

Front 25

rocky mountain spotted fever

Back 25

- rash on palms and soles distal to central

Front 26

when to get a voiding cystourethrogram

Back 26

- < 5 y.o. w/ febrile UTI
- males of any age with UTI- females <3 with first UTI
- recurrent or no abx response

Front 27

baby with bilateral hip joint effusions?

Back 27

- transient synovitis from viral infx
- get U/S to evaluate effusion

Front 28

when is MMR vaccine c/i?

Back 28

- current mod or severe illness
- anaphylaxis to neomycin or gelatin
- severe immunodeficiency
- thrombocytopenia after first dose of MMR
- recent admin of Ig
- pregnancy

NOT C/I:
- TB or +PPD, breast feeding, Immundeficient household member, HIV w/out immunosuppression, anaphylaxis to eggs

Front 29

breast milk vs breast feeding jaundice?

Back 29

- feeding: first week of life --> dehydration or reduced caloric intake
- milk: something in milk increases bilirubin ciruclation, after first week into 2nd and 3rd
; tx interrupt breast feeding temporarily

Front 30

when do you get worried about hyperbili?

Back 30

- total bili >12 mg/dl or serum bili increases >5 in 24 hours
- do phototherapy

Front 31

How long to treat TB meningitis, miliary, osteo?

Back 31

- 12 months antiTB therapy

Front 32

when are TB patients considered noninfectious?

Back 32

- 3 negative sputums

Front 33

NF1, NF2, tuberous sclerosis, sturge weber, osler-rendu-weber

Back 33

- NF1: acoustic neuroma (unilatera), cutaneous neurofibromas, hyperpigmentation cafe au lait, axillary freckling
- NF2: AD, cafe-au lait spots (hypopigmentation), bilateral acoustic neuromas
- tuberous: congenital hypopigmented maculae (Ash-leaf spots), glial prolif, organ hamartomas/cysts
- sturge weber: facial port-wine stain, leptomeningeal angiomatosis
- oslter: multiple telangiectasias, vascular lesions of CNS

Front 34

18 month old with breasts and single pubic hair

Back 34

- benign premature thelarche
- just breasts without other signs of precocious puberty

Front 35

McCune-Albright

Back 35

- cafe au lait spots, fibrous dysplasia of bone, precocious puberty
- estrogen from ovarian cysts

Front 36

Sydenham's chorea

Back 36

- Saint Vitus dance, classic manifestations of rheumatic fever
- usually girls 5-13y.o.: emotional lability (cry or laugh), school performance drops, distal hand movements, facial jerking, grimacing
- heart murmur-- carditis, mitral regurg
- cultures neg
- hypotonia, decreased reflexes
- tx penicillin x 10 days or erythromycin
- ppx into adulthood

Front 37

most common complication of tick bite?

Back 37

- local infection or inflammation
- lyme disease risk is <1.5%
- if tick isn't engorged with blood then no risk of lyme/RMSF/ehrlichiosis b/c must be on at least 24 hours

Front 38

which is the only vaccine that pregnant woman should avoid in those that get it?

Back 38

- small pox for 28 days

Front 39

which vaccine not to give to pregnant women?

Back 39

- MMR

Front 40

most common symptoms of sickle cell disease?

Back 40

- dactylitis: inflammation of fingers/toes
- splenic sequestration: blood pools in spleen, swells

Front 41

parents don't want treatment of child b/c of religion

Back 41

- don't even have to go to court, just treat the kid

Front 42

kid with cat bite?

Back 42

- give amp/sulbactam (broad)
- follow with amox/clavulanate 3-5 days

Front 43

currant jelly stool

Back 43

- intussusception - get U/S first
- then tx: air or water soluble contrast enema

Front 44

heinz bodies, target cells

Back 44

- heinz: G6PD
- target: thalassemias

Front 45

anemia in 8month old that only breast feeds

Back 45

- anemia due to diet of only breast milk
- start eating at 6 months

Front 46

malnourished kid

Back 46

- always try oral rehydration first because IV causes HF
- if oral ulcers or to sedated then put in dobhoff
- don't initially give excess protein or calories b/c gut can't handle it

Front 47

most common cause of viral meningitis?

Back 47

- arbovirus, eeg. EEE, WEE esp in rural areas

Front 48

21 hydroxylase deficiency

Back 48

- mineralocorticoids and glucocorticoid deficiency
- ambigous genitalia, virilization in females, precocious puberty in males
- salt wasting in first 2-4 weeks with emesis, dehydration, shock
- hypona, hyperk (lack of aldo), hypoglyc (lack or cortisol)

Front 49

11-hydroxylase

Back 49

- decreased aldo and cortisone
- increased androgens and deoxycortisone
- HTN, hyperNa, hypoK

Front 50

3-beta hydroxysteroid

Back 50

- low testosterone, MC, GC, increase DHEA-S
- females are masculinized, males don't have normal external genitalia

Front 51

how do you dx 21 hydroxylase def?

Back 51

- elevated 17-alpha-hydroxyprosterone
- elevated corticotropin and renin
- low aldo for renin levels

Front 52

best abx tx for CF PNA?

Back 52

- must do two therapy coverage for pseudomonas b/c high resistance
- toramycin and antipseudomonal semisynthetic PCN (ticarcillin-clavulanate or piperacillin-clavulanate; or cefepime, ceftazidime or carbapenem)
- must also cover for most common: staph and H flu

Front 53

petechiae and low plts

Back 53

- ITP after infx
- give corticosteroids

Front 54

what's the first to response in iron therapy in anemia

Back 54

- retic count

Front 55

complication of bacterial conjunctivitis?

Back 55

- keratitis - urgent ophthalmologic referral

Front 56

treatment of choice for bacterial conjunct?

Back 56

- erythromycin , sulfa
- contact lens wearers: fluoroquinolones to cover pseudo
- return to school 24 hours later, but still infectious until no discharge

Front 57

tx of choice for strep pneumo?

Back 57

- amox

Front 58

which abx to avoid in kids?

Back 58

- cipro: tendon rupture

Front 59

when to admit anorexia to hospital?

Back 59

- obvious things: abnormalites, vitals, etc
- weight is < 75% average for her age, height and sex (e.g. if she should be 120 lbs, then admit if 120*.75 is more than her weight)

Front 60

tx of inpt anorexia?

Back 60

- olanzapine?? and special diet

Front 61

refeeding syndrome

Back 61

- edema, trouble breathing from HF
- low phosphate
- delirium and cardiac arrest

Front 62

pt dx with turner, next step?

Back 62

- get echo: coarctation, bicuspid aortic valve, MVP, hypoplastic heart
- visual, hearing, renal U/S, TSH
- horseshoe shaped kidney, hypoTH

Front 63

recurrence of turner syndrome?

Back 63

- same as population, doesn't increase with age
- note: do buccal smear test: no barr body b/c only XO

Front 64

young girl with freckles, hypoNa, hyperK and decreased ax and pub hair

Back 64

- addisons

Front 65

high TSH and low T4 of foot pad draw after birth?

Back 65

- repeat on regular draw to confirm

Front 66

most common causes of acute otitis media?

Back 66

- strep pneumo, h flu (NON TYPEABLE STRAIN), moraxella catarrhalis

Front 67

when to start HPV vaccination?

Back 67

- 11-12 years old
- don't need to restart from beginning if schedule is interrupted
- no need to test if pregnant

Front 68

baby with small head

Back 68

- toxo from undercooked meat

Front 69

non-neurologic complication of myelomeningocele

Back 69

- bladder dysfunction (remember that patient with finger in urethra)

Front 70

baby with fast growing strawbery hemangioma?

Back 70

- benign, let it go

Front 71

peristaltic waves seen on baby's abdomen?

Back 71

- pyloric stenosis

Front 72

diastolic murmur and thin fingers?

Back 72

- think marfans w/ aortic regurg
- risk of dissection
- also have MVP that develops into mitral insufficiency --> pulm edema

Front 73

barking cough

Back 73

- croup, parainfluenza
- steeple sign
- give corticosteroids

Front 74

NO C/I IN GIVING ABX UNLESS AT THE KID'S DEATH BED

Back 74

OK

Front 75

if you think a kid has CF?

Back 75

- order sweat chloride test, don't do genetic test b/c test only identifies 10% of CF b/c so many mutations

Front 76

kid w/ cellulitis, why won't lidocaine patches work?

Back 76

- acidic environment from skin neurtalizes basic lidocaine --> ineffective

Front 77

which are the only PCN with activity against pseudomonas? which of the cephalosporins?

Back 77

- piperacillin-tazobactam and ticarcillin-clavulanic acid
- cefepime and ceftazidine

Front 78

kid swallows a coin

Back 78

- no intervention

Front 79

tx of GERD in baby?

Back 79

- thickening of formula with cereal
- don't suggest prone position b/c of SIDS

Front 80

Dx criteria for NF1?

Back 80

- 1st degree relative with NF
- 6+ cafe au lait spots 5mm or greater
-or-
- 2+ neurofibromas, Lisch nodules, optic glioma, bone dysplasia, or axillary freckling

- IMMEDAITE REFERAL TO OPHTHO to look for optic nerve gliomas

Front 81

suspect botulism in baby

Back 81

- do gag reflex, usually impaired, may aspirate

Front 82

dx of pubertal delay?

Back 82

- no testicular enlargement by 14 y.o. or 2.5cm less in diameter or delay in development of 5 years or more
- GET WRIST XRAY, if bones are older or match age then BAD, get genetic and endocrine testing
- if bones are younger then constitutional and its ok

Front 83

tx of polycythemia in baby?

Back 83

- IV hydration and partial exchange transfusion
- due to hyperviscosity decreasing blood flow to organs -- hypoglycemia, apnea

Front 84

baby born with erb's palsy

Back 84

- good recovery

Front 85

hyperbili

Back 85

- unconjugated is common
- conjugated is physiologic
- start phototherapy if >18

Front 86

ppx monotherapy for cat bite

Back 86

- amoxicillin/clavulanic acid in kids
- if more ill then amp-sulbactam
- if not a kid then doxy

Front 87

african MALE baby BORN IMMEDIATELY with unconjugated jaundice-- #1 cause?

Back 87

- G6PD
- coomb's negative = hemolysis
- no triggering even needed
- also think in mediterranean or asian
- PHYSIOLOGIC JAUNDICE IS 24 HOURS AFTER BIRTH
- THALASSEMIAS AND SICKLE CELL APPEAR LATER

Front 88

3 week old with conjunctivitis and pulmonary infection?

Back 88

- chlamydia from vaginal canal
- develops days to weeks after birth
- mother should have been treated
- tx baby with erythromycin

Front 89

tx suspected bacterial pharyngitis with amox and develop rash?

Back 89

- then it's mono
- no sports

Front 90

recommended calcium in girls?

Back 90

-1300
- > 18 then it's 1000
- >51 then it's 1200

Front 91

toddler that never walked?

Back 91

- check CK for possible muscular dystrophy

Front 92

WINTER TIME and baby with URI + APNEA-

Back 92

- RSV
- apnea is key

Front 93

failure to thrive

Back 93

- <2 years old that is <5th percentile for age but otherwise normal
- usually b/c lack of calories
- encourage increased feeding

Front 94

febrile seizure

Back 94

- if simple (nothing focal) then slight increased risk of epilepsy
- if complex (i.e. focal and post ictal) then no increased risk of epilepsy
- both have HIGH risk of recurrence

Front 95

diarrhea but ok?

Back 95

dont rec BRAT diet, just normal--- low fat/sugar

Front 96

baby with diaphragmatic paralysis

Back 96

- from phrenic nerve injury most likely w/ hx of Erb's palsy/shoulder distocia

Front 97

blood lead levels

Back 97

- >44: chelation
- >70: IV chelation
- otherwise environmental/behavioral interventions

Front 98

flexible kyphosis vs scheuermann's disease

Back 98

- flexible kyphosis: kid can correct with effort, do nothing
- scheuermann: no corrected by effort, sharp angulation on forward bending; use brace and spinal muscle exercises

Front 99

kallman's syndrome

Back 99

- anosmia, hypogonadotropic hypogonadism
- midline faical defects
- defective GnRH secreting olfactory neurons

Front 100

constituational delay

Back 100

- watchful waiting
- if very severe psychological issues then can give testosterone (no GH)

Front 101

s/p sore throat now with swollen mouth and tongue?

Back 101

- epiglottitis from H. Flu
- CS and epi doesn't help
- get thee to emergency room for possible intubation

Front 102

meckel's diverticulum

Back 102

- RLQ paina, 5-10 y.o.

Front 103

cleft lip reconstruction

Back 103

- reconstruction occurs at 10lbs, 10 weeks, and 10g of hb

Front 104

baby with PNA but no fever

Back 104

- afebrile PNA syndrome
- chlamydia trachomatis, mycoplasma, CMV, RSV, etc
- if hx of conjunct then chlamydia, ages 2-19 weeks

Front 105

how many words should s 2 year old know?

Back 105

50

Front 106

how often should newborns be fed?

Back 106

- q222

Front 107

LOC after hit in sports-

Back 107

- head CT even with normal exam

Front 108

HIV and diffuse bilateral ground glass opacities

Back 108

- Bactrim
CD < 200

Front 109

URI followed by maculopapular rash

Back 109

- HSP

Front 110

HSP vs HUS vs TTP

Back 110

- HSP: URI
- HUS: abd pain and diarrhea
- TTP: pentad of thrombocytopenia (normal PT, PTT), microangiopathi hemolytic anemia, neuro signs, renal failure, fever

Front 111

babies born to mothers with GBS

Back 111

- severe disease in babies, bacteremia, meningitis, ventriculitis, osteomyelitis
- chemoppx with PCN G or amp 4 hrs before delivery

Front 112

rabies in a sleeping kid's room

Back 112

- give Ig and five doses of vaccine

Front 113

undescended testes

Back 113

- wait until 6 months, if undescended then surgery

Front 114

slipped capital femoral epiphysis

Back 114

- if unstalbe (unable to ambulate then surgical with internal fixation

Front 115

diaper versus candida rash?

Back 115

- if it involves the folds or not
- zinc oxide vs nystatin

Front 116

kid toilet training with constipation

Back 116

- given mg hydroxide (milk of mg)