Usmle Step 2: Pediatrics Qbank

Front 1

child with recurrent intussusception

Back 1

meckel's diverticulum most common congenital anomaly of the GI tract and can be asymptomatic btw episodes of telescoping.

other risk factors include recent viral illness or rotavirus vaccination, henoch shonlein purpura, celiac dz, intestial tumor, or polyps

Front 2

howell jolly bodies

basophilic stippling

Back 2

nuclear remnants of the RBCs which are generally removed by a functional spleen; therefore, their presence ina peripheral smear suggests functional asplenia in sickle cell pts

basophilic stippling > thalassemias and lead/heavy metal poisoning

Front 3

waterhouse-friderichsen syndrome

Back 3

characterized by sudden vasomotor collapse and skin rash (LARGE PETECHIAE AND PURPURIC LESIONS) due to adrenal hemorrhage

occurs in infant with meningococcemia

Front 4

QID 4829 thymus silhoutte

Back 4

nl finding on frontal cxr in children less than 3 due to relatively large size compared to young child's thorax

Front 5

osteogenesis imperfecta

Back 5

caused by mutations in type 1 collagen. typical features include blue sclera and recurrent fx, hearing loss, and opalescent teeth. nl intelligence

high yield!

Front 6

growing pains

Back 6

bilateral!, lower extremity pains! that occur at night! in children age 2-12 yrs. no systemic sx, nl activity levels, and nl physical exams

tx consists of observation, parental reassurance, massage, and otc pain meds

Front 7

neonatal conjunctivitis tx

Back 7

chemical first 24 hrs: supportive mgmt

gonococcal: day 2-5: IV or intramuscular CTX or cefotaxime

chlamydial: day 5-14, oral erythromycin

Front 8

neuroblastoma

Back 8

third most common CA in ped popu

tumor arises from NEURAL CREST CELLS, which are also the precursor cells of the sympathatic chains and adrenal medulla. Most common site is the abdomen.

Calcifications and hemorrhages are seen on plan xray and ct scan.

levels of serum urine catecholamines and their metabolites (HVA adn VMA) are usually elevated

Front 9

anemia of prematurity

Back 9

most common anemia in premature and low birth weight infants.

pathology involves a combo of diminished RBC production, shortened RBC life span, and blood loss.

Iron supplementation does not prevent falling hemoglobin levels, and iron deficiency is not the cause of anemia of prematurity

Front 10

topical erythromycin

Back 10

not effective for chlamydial conjunctivitis. Effective only against gonococcal conjunctivitis.

chlamydia usually transmitted form motehr to neonate during passage through birth canal.

Front 11

klumpke palsy

Back 11

rare but potentially permanent complication of shoulder dystocia. Injury to the 8th cervical and 1st thoracic nerves results in hand paralysis and ipsilateral horner syndrome

Front 12

sweat chloride test aka ?

Back 12

quantitative pilocarpine iontophoresis gold standard

Front 13

Reye syndrome

Back 13

less than 15yo treated with salicylates for a viral infxn. most common presentation: vomiting, agitation, and irrational behavior, progressing to lethargy, stupor, and restlessness.

convulsions may occur.

treatment is supportive

Front 14

deficiency of 21-hydroxylase

Back 14

most common CAH. p/w virlization of female infants, salt-wasting, and increased 17-hydroxyprogesterone levels

Front 15

muscular dystrophies

Back 15

see qid 3544

duchenne muscular dystrophy (x linked recessive) suspected in boy < 5 with proximal muscle weakness, gower sign, and bilateral calf pseudohypertrophy. serum CPK and aldolase levels are elevated even before manifestation of weakness.

An absent dystrophin gene on genetic testing and undetectable dystrophin protein on muscle bx confirm the dx

Front 16

contraindications to breast feeding

Back 16

active untreated TB, maternal HIV, herpetic breast lesions, varicella infection, some meds, chemo or ongoing radiation, active abuse of street drugs or alcohol

infant has galactosemia

Front 17

celiac dz

Back 17

frequent cause of malabsorption and can lead to iron deficiency anemia. common include type 1dm and dermatitis herpetiformis

Front 18

tetrology of fallot

Back 18

p/w varying degrees of cyanosis depending on the degree of right ventricular outflow tract obstruction. squatting decreases R to L ventricular shunting, which improves cyanosis and increases the intensity of systolic murmur d/t increased blood flow across the right ventricular outflow tract.

clinical presentation depends on degree or right ventricular outflow obstruction.

Front 19

hemophilic arthropathy

Back 19

delayed consequence of recurrent hemarthrosis. associated with HEMOSIDERIN DEPOSITION leading to synovitis and fibrosis within the joint.

risk of hemophilic arthropathy can be significantly reduced by ppx with factor concentrates

Front 20

myotonic muscular dystrophy

Back 20

autosomal dominant! disorder characterized by grip myotonia (delayed muscle relaxation), facial weakness, foot drop, dysphagia, and cardiac conduction anoalies. other problems include cataracts, testicular atrophy,/infertility, and baldness

Front 21

local impetigo treatment

Back 21

topical mupirocin or oral erythromycin!

Front 22

HSP: see qid3554

Back 22

answer

Front 23

Rheumatic fever

Back 23

suspect in child with sore throat, fever, pericarditis, erythema marginatum, arthritis, chorea, and subcutaneous nodules.

condition caused by group A streptococcus

3443

Front 24

developmental milestones during first year of life 4199

Back 24

answer

Front 25

APGAR score interventions

Back 25

scores < 7 may require further evaluation and resuscitation. Maternal factors that increase risk for resuscitation include very young maternal age, h/o substance abuse, and h/o DM or HTN.

review!

if pulse below 60, chest compressions required

Front 26

friedreich ataxia

Back 26

autosomal recessive condition and genetic counseling is recommended for prenatal diagnosis for parents with one affected child

characterized by excessive trinucleotide repeats, resulting in abnormality of a tocopherol transfer protein.

disorder is progressive with poor prognosis. most wheelchair bound by 25, and death by 30-35.

Front 27

differential for t wave inversion

Back 27

mi, myocarditis, old pericarditis, myocardial contusion and digoxin toxicity

Front 28

according to qbank, should perform LP before starting antibiotics

Back 28

qid 3633

Front 29

most common cause of congenital hypothyroidism in the US

Back 29

thyroid dysgenesis

Front 30

young boy with increased ICP (headaches, vomiting), bitemporal hemianopsia, and a calcified lesion above the sella

Back 30

craniopharyngioma until proven otherwise.

Front 31

infertility a/w cystic fibrosis

Back 31

almost all have obstructive azoospermia from CONGENITAL BILATERAL ABSENCE OF VAS DEFERENS -> FAILS TO DEVELOP DUE TO ACCUMLUATIO OF INSPISSATED MUCUS IN THE FETAL GENITAL TRACT

Front 32

pt with apparent subcutaneous emphysiema 2/2 svevere coughing paroxysms. next step?

Back 32

cxr to r/o ptx

Front 33

conduct disorder vs oppositional defiant disorder

Back 33

conduct: disruptive behavioral patterns that violate basic social norms for at least one year in pts < 18yo. aggressive behavior towards others or animals, behaviors resulting in property damage, theft, or violations of societal rules.

antisocial if pt > 18yo

oppositional defiant seen more commonly in late childood and adolescence, but is characterized by disruptive behavior such as negativity, hostility and defiance

Front 34

screenign and dx of muscular dystrophies

Back 34

serum CK: screen

muscle bx: confirm

gold standard: genetic studies required in atypical cases

look for manifestations of duchennes: pseudohypertrophy of calves and positive gower's sign.

Front 35

developmental dysplasia screening and mgmt

Back 35

barlow and ortolani maneuvers. palpable clunk should prompt referral to an orthopedic surgeon

soft click, leg-length discrepancy, or asymmetric inguinal skin folds require diagnostic imaging with US 9age < 6mo) or xrays (age >4-6mo

tx of choice for less than 6mo is pavlik hip harness

Front 36

initial sx of HIV in infants

Back 36

oral thrust, lymphadenopathy, and hepatosplenomegaly. more severe sx subsequently develop such as intractable diarrhea, refractory infections and failure to thrive.

detected via pcr viral culture and p24 antigen testing since serologic testing not useful due to passage of maternal antibodies to fetal circulation through placenta

Front 37

duodenal vs jejunal atresia

Back 37

duodenal: 1/3 have chromosomal abnormalities, most commonly down syndrome. double bubble on radiography

jejunal: bilious vomiting and abdominal distention. abdominal xray shows "triple bubble" sign and gasless colon. risk factors include prenatal exposure to cocaine and other vasoconstrictive drugs

Front 38

when to give varicella vaccine vs varicella zoster IG

Back 38

if immunocompromised, give vaccine + immunoglobulin with exposure to symptomatic person

if immunocompetent, give just vaccine

Front 39

risk factors for vitd deficiency

exam findings?

Back 39

risk factors: exclusive breasfeeding, increased skin pigmentation, and lack of sun exposure

exam findings: craniotabes, rachitic rosary (bony prominences of the costochondral junctions noted bilaterally), and genu varum.

xray findings include cupping and fraying of the metaphyses of the long bones

Front 40

Digeorge syndrome

Back 40

defective development of pharyngeal pouches

clinical features:

CATCH

conotrunctal cardiac defects, abnl facies, thymic aplasia/hypoplasia, cleft palate, hypocalcemia

Front 41

atlantoataxial instability

Back 41

seen in 10-15% of patients with DOWN SYNDROME, most commonly occurs due to excessive laxity in the posterior transverse ligament, which causes increased mobility between the atlas (C1) and the axis (C2).

presenting sx include behavioral changes, torticollis, urinary incontinence, and vertebrobasilar sx such as dizziness vertigo, and diplopia.

ON exam, UMN sx such as leg spasticity, hyperreflexia, a positive babinki sign, and clonus often present.

diagnosed with lateral radiographs of cervical spine.

tx consists of surgical fusion of the first cervical vertebrae to the second

Front 42

hyperIgM syndrome

Back 42

characterized by high levels of IgM with deficiency of IgG, Ig and poor specific antibody response to immunizations

Front 43

mongolian spots

Back 43

commonly found in african, asian, hispanic and native american infants and usually fade spontaneously during childhood.

Front 44

parinaud syndrome

Back 44

paralysis of vertical gaze that may be a/w pupillary disturbances and eyelid retraction (collier's sign)

involved lesion is on the rostral midbrain at the level of hte superior colliculus and CNIII.

most comonly caused by GERMINOMAS AND PINEALOMAS at this region.

endocrine syndrome results from interruption of hypothalamic inhibiting pathways, and sometimes beta-hcg secretion and consequent leydig's cell stimluation

3655

Front 45

lesch nyhan syndrome

Back 45

2/2 deficiency in HGPRT

sx include self-mutilation, neuro features (mental retardation, dystonea, choreoathetosis, spasticity), gouty arthritis, and tophus formation.

gout usually seen in pts above 50yo;

therefore, suspect lesch0nyhan syndrom eif you see a boy with gout

x-linked recessive disorder

Front 46

metatarsus adductus

Back 46

congenital foot deformity most frequent in first born infants, attributable to molding effect of primigravid uterus

about 10% also have hip dysplasia!

spontaneous resolution in 95%!

xray findings;mild adduction of metatrsals at hte tarsometatarsal articulation and an increased angle between the first and second metatarsals.

Front 47

neonatal displaced clavicular fx. next step?

Back 47

reassurance and gentle handling

classic finding includes crepitus over clavicle, asymmetric moro reflex, and pain with passive motion of the affected extremity.

Front 48

guthrie test

Back 48

urine test that is qualitative (coloration) that can detec tht epresence of metabolic products of phenylalanine in the urine

phenylketonuria signs?

Hint 48

autosomal recessive, can produce mental retardation nd seizures, fair complexion, blue eyes, eczema and musty body odor.

low phenylalanine diet. high protein foods avoided. can have nl development and nl life span.

Front 49

review tumors 3658

Back 49

review

Front 50

edwards syndrome

Back 50

commonly p/w microcephaly, prominent occiput, micrognathia, closed fists with index finger overlapping the 3rd and 5th overlapping hte 4th and rocker bottom feet

2488

Front 51

marfan's syndrome

Back 51

autosomal dominant disorder that results form mutations of the fibrillin-1 (FBN1) gene.

p/w tall stature, long and emaciated extremities, arachnodactyly, hypermobility of the joints, upward lens dislocation, and aortic root dilation

Front 52

homocystinuria

Back 52

marfan's features + mental retardation + thromboembolic events + downward dislocation of lens

autosomal recessive

3687

Front 53

nursemaid elbow

Back 53

occurs when infants/children are lifted or pulled by the hand or arm.

mechanism involves radial head subluxation. child typically keeps hand in a pronated position, and refuses attempted forearm supination)

Front 54

vitamin that reduces morbidity and mortality of measles

Back 54

vitA

helps through immune enhancement and also helps GI and respiratory epithelium regenerate

Front 55

3192

Back 55

???

Front 56

Fragile X

Back 56

low to nl IQ with learning disabilities, generalized language disability, short attention span, autism, large head, prominent jaw, large low set ears and macroorchidism

Front 57

infantile colic

Back 57

presents by 3 wks of age with excessive crying for more than 3 hours a day, more than 3 days a week, and more than 3 weeks a mo, usually resolving by four mo

Front 58

supracondylar fracture

Back 58

brachial artery can be compromised, resultin gin the loss of the radial artery pulse; therefore, radial artery pulse must be assessed when fx is reduced

boy who falls on outstretched hand

Front 59

midgut volvulus

Back 59

presents in child less than one month of age as bilious vomiting, abdominal distension and passage of bloodstained stools

Front 60

mccune albright syndrome

Back 60

3Ps: precocious puberty, pigmentation (cafe au lait spots), and polyostotic fibrous dysplasia.

Front 61

cyclic vomiting

Back 61

recurrent self-limiting episodes of vomiting and nausea in children, in the absence of any apparent cause

Front 62

leukocyte adhesion defect type 1

Back 62

suffer from delayed separation of the umbilical cord, recurrent bacterial infections of hte skin and mucosal surfaces, and necrotic periodontal infetions. Additional findings include leukocytosis with a neutrophil predominance and the complete absence of neutrophil sin inflamed or infected tissues

Front 63

kartagener's syndrome

Back 63

triad of recurrent sinusitis, bronchiectasis, and dextrocardia (aka situs inversus)

cause is primary ciliary dysplasia.

Front 64

chronic pyelonephritis

uretopelvic obstruction

Back 64

characterized by focal parenchymal scarring and blunting of calices on IVP

uretopelvic obstruction would lead to hydronephrotic changes in the kidney with IVP showing the level of obstriction as a constricitoni n the flow of the dye

Front 65

phenytoin use in pregnancy

Back 65

craniofacial abnl, fingernail hypoplasia, growth deficiency, developmental delay, cardiac defects and facial clefts

Front 66

biliary atresia

Back 66

neonatal cholestasis --> look for h/o jaundice in a/w light colored stools, hepatomegaly, and direct conjugated hyperbili (remember that gilbert and crigler-najjar are unconjugated).

either by extrahepatic obstruction or liver cell injury.

Front 67

nephrotic syndrome with hepB

Back 67

often leads to dvlpt of membranous glomerulonephritis.

although minimal change dz still the most common cause of nephrotic syndrome in children

Front 68

breastfeeding failure jaundice

Back 68

exaggerated unconjugated hyperbili in the FIRST WEEK OF LIFE that is caused by lactation failure!

can be caused by both maternal (inadequate milk supply, cracked/clogged nipples, engorgement, INFREQUENT FEEDING), and infant (POOR LATCH, ineffective suck, falling asleep) factors

nl infants pass dark, sticky meconium during the first 2 days of life, after which they should transition to yellowish or green stool if ingesting adequate milk.

inadequate stooling results in decreased bili elimination and increased enterohepatic circulation of bili

appropriate amt = breastfeeding 15min per side every 2-3 hours

Front 69

orbital cellulitis: most common predisposing factor?

Back 69

bacterial sinusitis

sx include proptosis, ophthalmoplegia and diplopia

Front 70

tetrology of fallot

Back 70

right ventricular outflow tract obstruction (pulmonary stenosis or atresia)

right ventricular hypertrophy

overriding aorta

VSD

Front 71

tricuspid atresia

Back 71

left axis deviation, decreased pulmonary markings on cxr due to hypoplasia of the right ventricle and pulmonary outflow tract

Front 72

rules with vaccines with premature infants

Back 72

premies are at especially high risk of dangerous complications from vaccine-preventable diseases.

vaccines for MEDICALLY STABLE preterm infants should be administered by CHRONOLOGICAL age not by gestational age.

Vaccination of premies is safe and antibody productio is adequate to confer immunity.

exception is that weight should be greater than 2 kg before first hepB vaccine

Front 73

when would imaging studies be performed to identify any underlying structural abnl predisposing to UTIs?

Back 73

pt under 10, male, or a prepubertal nonsexually active female

most common identified structural abnormality in the pediatric range is vesico-ureteral reflux

Front 74

seborrheic dermatitis

Back 74

common pediatric skin condition. papular, scaly rash tends to affect eyebrows, nasolabial folds and scalp. tx consists of moisturizers, antifungals and topical steroids

Front 75

mgmt of erb-duchenne palsy

Back 75

most infants recover arm function spontaneously within a few months -> affects c5-c6

surgical intervention in infants with no improvement by age 3-6mo but is not necessarily curative

Front 76

congenital syphilis

Back 76

may also include hsm, cutaneous lesions, jaundice, anemia, ad rhinorrhea

metaphyseal dystrophy and periostitis may be seen on radiography

Front 77

neonatal respiratory distress syndrome

Back 77

suspected when a premie presents with grunting, flaring, adn tretractions immediatley after birth. cxr includes characteristic fine reticular granularity of the lungs.

tx includes early continuous PPV

Front 78

Reye syndrome

Back 78

can lead to fulminant hepatic failure. elevation of ammonia levels and transaminases, vomiting, and mental status changes arethe more common manifestations of the syndrome

characterized by diffuse mitochondrial injury that leads to N/V, HA, excitabilility, combativeness, hypoglycemia, liver failure, and progressive cns damage

histologically, extensive fatty vacuolization of the liver without inflammation is present.

tx?

Hint 78

administration of glucose with FFP and mannitol to decrease cerebral edema

Front 79

acute iron poisoning

Back 79

IRON IS RADIOOPAQUE ON CXR

commonly occurs in children of pregnant women taking prenatal vitamins bc children often confuse brightly colored iron pills for candy.

tx involves deferoximine, which binds ferric iron, allowing urinary excreion

causes systemic manifestations such as abdominal pain, hematemesis!, shock, and metabolic acidosis!

Front 80

concerning sexual behaviors

Back 80

extensive sexual knowledge, preoccupation with masturbation, touching other's genitals, excessive talk about sexuality, and simulating foreplay or intercourse

Front 81

reservoirs for rabies

Back 81

bats, wild carnivores (raccoons, skunks, foxes), should receive post exposure ppx for rabies

Front 82

type hypersensitivity

Back 82

type 1: immediate IgE mediated -> atopy, urticaria and anaphylaxis

type 2: antibody mediated, cytotoxic reactions involving specific reactions of IgG or IgM to cell-bound antigens. -> immune hemolytic anemia nad Rh hemolytic dz in the newborn

type 3: immune complex mediated. serum sickness and arthrus reaction

type 4:delayed cell-mediated, allergic contact dermatitis

Front 83

acute otitis media vs otitis media with effusion vs otitis externa

Back 83

acute otitis media: middle ear effusion PLUS acute eardrum inflammation (bulging eardrum, fever)

otitis media with effusion: middle ear effusion w/o acute inflammation

otitis externa: pain with tragal traction, erythematous and swollen external auditory canal +/- otorrhea

Front 84

diagnostic features of acute bacterial rhinosinusitis

Back 84

1) persistent sx > 10d w/o improvement

2) severe sx, fever > 39, purulent nasal d/c, or face pain > 3d

3) worsening sx >5d after initially improving viral upper respiratory infxn

Front 85

osgood sclatter dz

vs patellar tendonitis

Back 85

traction apophysitis of the tibial tubercle.

radiographic findings include anterior soft tissue swelling, liftingo f tubercle from the shaft, and irregularity or fragmentation of the tubercle

tx: activity restriction, stretching exercises, and NSAIDs

patellar tendonitis: overuse from repetitive jumping or kicking. point tenderness at inferior pole of the patella

Front 86

presenting sx of type 1 DM in kids

Back 86

nocturnal enuresis, also diaper candidiasis (erythematous plaques and pustules) commonly seen in toddlers with new-onset disease

Front 87

risk factors for necrotizing enterocolitis

Back 87

prematurity, hypotension, and congenital heart dz

Front 88

esophageal coin treatmetn

Back 88

in asymptomatic pts can be observed for up to 24 hrs after ingestion. if pt is symptomatic or time of ingestion is unknown, the coin should be removed promptly by flexible endoscopy.

Front 89

partial vs complex partial vs partial seizures with secondary generalization

Back 89

partial: no loss of consciousness, feeling of familiarity (deja vu), can have aura, patient may remember event well

partial seizures with generalization: loss of consciousness, tonic-clonic activity

complex partial: loss of consciousness, can have aura, motor autoamatisms!!! (chewing, swallowing, sucking), sometimes have bl motor findings

Front 90

measles vs rubella

Back 90

measles tends to be more svere than rubella, with fevers up to 40C, coryza, and malaise. in addition, rash spreads more gradually and appears darker (reddish brown) in comparison to rublela

rubella: low grade fever, tender lymphadenopathy, adn a maculopapular rash that spreads cephalocaudally.

Front 91

constipation in toddlers

Back 91

common due to transition to solid food and cow's milk, toilet trainign, and school entry.

complications include anal fissures, encopresis (stool holding) and enuresis (bedwetting)

laxative therapy should be initiated promptly to soften stools

Front 92

CF bacterial pneumonia -> what bugs to think of?

Back 92

staph A most common cause in young children with CF, especially with coexisting influenza infection. IV vanc is drug of choice for severe pna in this setting


once pt is 20 yo, pseudomonas is more common

Front 93

pellagra

Back 93

4Ds! diarrhea, dementia, dermatitis, and possibly death

Front 94

children age < 24mo with first UTI. next step?

Back 94

7-14 course of oral antibiotics and should undergo a renal and bladder US to evaluate for structural abnormalities that could predispose them to UTIs.

Voiding cystourethrogram not indicated for first febrile UTI. instead, wait for renal and bladder us to determine if necessary, also for first UTI with family hx or with non Ecoli

indications listed on 3692

Front 95

pneumatosis intestinalis

Back 95

aka intramural air and portal venous air

"abdominal xray with air in the bowel wall and portal veins"

Front 96

atopic dermatitis

Back 96

in infancy presents with pruritis and skin lesions typically distributed symmetrically over the face, scalp, chest, and extensor surfaces of the extremities

diaper region typically spared

Front 97

evaluation of primary amenorrhea

Back 97

first with pelvic exam or US

if uterus present, perform serum FSH

if absent, perform karyotype

9566

Front 98

Turner syndrome

Back 98

complete or partial deletion of X chromsome. --> gold standard is karyotype analysis

if nl, but suspicion still high, FISH analysis can detect mosaicism (45,XO/46,XX) that is beyond the resolution of standard karyotyping.

Front 99

central vs peripheral precocious puberty

Back 99

4239

Front 100

clinical manifestations of late onset CAH

Back 100

signs of androgen excess -> premature adrenarche/pubarche, severe cystic acne resistant to tx, accelerated linear growth, and advanced bone age

NORMAL ELECTROLYTES

Front 101

measuring lead toxicity in children

Back 101

use venous blood draw

false positives on capillary draw!

Front 102

most common cause of acute bacterial sinusitis

Back 102

strep (30%), nontypeable H. influenzae (30%), and moraxella catarrhalis 10%)

use augmentin

Front 103

kawasaki disease

Back 103

vasculitis characterized by fever for > 5 d, nonexudative conjunctivitis, extremity changes (erythema, edema, desquamation of the hands and feet), cervical lymphadenopathy, oral mucosal changes (erythema, fissured lips, strawberry tongue), and polymorphous rash

at risk for developing coronary artery aneurysms and thrombosis. Tx with ASA and IVIG critical in decreasing cardiovascular morbidity and mortality within 10d of fever onset. (USE ASA EVEN THOUGH RISK OF REYE SYNDROME)

Front 104

distinguishing between preseptal (periorbital) and postseptal (orbital) edema,

Back 104

look for ophthalmoplegia, pain with EOM, proptosis, and vision impairment

Front 105

benign cardiac murmur

Back 105

not a/w structural heart dz

typically grade II/VI or less intensity, early or mid-systolic, decrease with standing and Valsalva, have a nl associated S2, and occur in otherwise healthy, asymptomatic children. Benign murmurs are managed with observation and reassurance.

Front 106

pubertal gynecomastia

Back 106

seen in up to 2/3 of adolescent boys during mid to late puberty.

can be unilateral, bilateral or painful

no specific mgmt necessary and usually resolves in a few mo to 2 years

Front 107

lyme dz according to stage

Back 107

early: erythema migrans, myalgias, arthralgias

early disseminated (weeks to months): carditis, cranial nerve deffects (usually VII), meningitis, encephalitis), muscular, conjunctivitis, lymphadenopathy

late or chronic (mo to years): neurologic: encephalomyelitis, peripheral neuropathy, arthritis

Front 108

milk or soy protein proctocolitis

Back 108

should be suspected when a well-appearing neonate p/w painless bloody stools. rectal bleeding should stop within 2 weeks of elimination of dietary dairy and soy products

meckel's diverticulum not observed in neonates

Front 109

workup of simple febrile seizures?

Back 109

no required workup

can be discharged from emergency department with reassurance about a good prognosis

Front 110

erythema toxicum neonatorum

Back 110

benign neonatal rash characterized by blanching erythematous papules and/or pustules. Resolves spontaneously within 2 weeks after birth.

Front 111

laryngomalacia

Back 111

p/w inspiratory stridor that worsens in the supine position and with crying and peaks at age 4-8mo. dx confirmed with flexible LARYNGOSCOPY, which shows collapse of the supraglottic structures during inspiration.

Usually self resolves! by age 18mo

Front 112

asthma: when to endotracheal intubation?

Back 112

unresponsive to meds who have fatigue, AMS, CO2 retention, worsening hypoxemia, and poor air movmt on exam

Front 113

cryptorchidism

Back 113

most common congenital anomaly of the GI tract d/t failure of testicular descent. Orchipexy is performed in infancy preferentially to prevent testicular torsion, improve fertility, and decrese risk of testicular marlignancy.

greatest risk of sperm count being substandard.

risk of testicular torsion removed as testis is surgically affixed to scrotal wall.

does not eliminate testicular CA risk!

Front 114

contraindications to rotavirus vaccines

Back 114

anaphylaxis to vaccine ingredients

h/o intussusception

h/o uncorrected congenital malformation of the GI tract (meckel's diverticulum)

SCID

Front 115

infant botulism

Back 115

caused by ingestion of Clostridium botulinum spores, which colonize the gut and lead to production and release of a neurotoxin responsible for life-threatening, descending flaccid paralysis.

The dx should be considered when a previously healthy infant p/w bulbar palsies, constipation, and hypotonia, even if hte infant has not been fed honey.

Human derived botulism immune globulin is the treatment of choice

Front 116

rehydration therapy

Back 116

mild: p/w h/o decreased intake or increased fluid loss with minimal or no clinical sx

moderate: p/w decreased skin turgor, dry mucous membranes, tachy, irritabilty, delayed cap refill, and decreased UOP

severe: cool, clammy skin, a delayed cap refill > 3sec, cracked lips, dry mucous membranes, sunken eyes, sunken fontanelle (if still present), tachy, lethargy, and minimal or no UOP). hypotension and severe shock possible

oral rehydration should be initial tx for mild to moderate dehydration

children with moderate to severe dehydration should be immediately resuscitated with IV fluids to restore perfusion -> use only isotonic saline (no D5, though this can be utilized as maintenance fluid)

Front 117

cerebral palsy

Back 117

etiology often multifactorial, but PREMATURITY is leading risk factor

affected pts have uncoordinated and limited voluntary movmts

spastic diplegio is the form most commonly seen in preterm infants. it presents as hypertonia and hyperreflexia that involve predominantly the lower extremities with both feet pointing down and inward (equinovarus deformity). Resistance to passive muscle movement increases with more rapid movement of the affected extremity (clasp-knife)


many pts with CP suffer from vision, hearing, speech, or other impairments. Approx 50% of pts also have intellectual disability.

Front 118

complex partial seizure vs atypical absence seizure

Back 118

complex partial seizure: brief episodes of impaired consciousness, failure to respond to various stimuli during the episode, staring spells, automatisms, and post-ictal confusion. EEG pattern usually nl

atypical absence seizure lasts longer and has characteristic EEG pattern that is slow spike-and-wave activity with frequency less than 2.5Hz

Front 119

bedwetting nl until what age?

Back 119

5

Front 120

positives of breastfed babies

Back 120

decreased risk of otitis media, respiratory, GI, and UTI, and necrotizing enterocolitis

also have lower rates of DM1 and childhood CA

absolute contraindications?

Hint 120

galactosemia

Front 121

fetal alcohol syndrome

Back 121

pathognomonic facial features are small palpebral fissures (horizontal distance of eyes), smooth philtrum, and thin vermilion border (top lip)

also microcephaly

Front 122

when to take out a battery in a child

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esophagus -> remove immediately under endoscopic guidance to prevent mucosal damage and esophageal laceration

distal to esophagus: pass uneventfully in most cases and need only be observed with stool exam and/or follow up xrays to confirm excretion.

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respiratory distress in infant

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caused by surfactant deficiency -> more common in premies and infants of diabetic mothers

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dactylitis

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earlies manifestation of vaso-occlusion in sickle cell anemia

pts usually present at age of 6mo to 2yrs with an acute onset of pain and symmetric swelling of the hands and feet. Although only soft tissue swelling is initially seen, fever is sometimes present.

the pathophys of dactylitis involves vascular necrosis of the metacarpals and metatarsals, which may be seen on plain radiographs as osteolytic lesions

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vitA deficiency

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impaired adaptation to darkness, photophobia, dry scaly skin, xerosis conjunctiva, xerosis (dry) cornea, keratomalacia, Bitot spots and follicular hyperkeratosis of the shoulders, buttocks and extensor surfaces

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most likely cause of edema in neonate with Turner's syndrome

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dysgenesis of the lymphatic network

edema that is due to lymphedema is generally nonpitting on PE as opposed to the pitting edema seen with CHF, liver failure, or nephrotic syndrome

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transient synovisitis

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if xrays negative for hip pain.

typically follows a viral infxn, sx should resolve within 1-4wks.

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clubfoot (talipes equinovarus)

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patient who p/w equinus and varus of the calcaneum and talus, varus of the midfoot, and adduction of the forefoot.

(think tommy pickles)

tx?

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stretching and manipulation of the foot, followed by serial plaster casts, malleable splints, or taping

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most common cardiac defects in Down syndrome

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in order of decreasing frequency

1) complete atrioventricular septal defect -> failure of endocardial cushion fusion results in atrioventricular septal defects.
2) VSD
3) ASD

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unilateral cervical adenitis. tx?

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usually caused by streptococcal or staph infxn

tx is I&D plus an antibiotic like CLINDA (which can also battle MRSA)

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congenital diaphragmatic hernia

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rare but lifethreatening

if in respiratory distress, must perform endotracheal intubation. bag-and-mask ventilation can exacerbate respiratory decline.

A gastric tube should be placed immediately to decompress the stomach and bowel

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neurofibrimatosis 1 vs 2

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1: cafe-au-lait spots, macrocephaly, feeding problems, short stature, and learning disabilities. patients may later develop fibromas, neurofibromas or different tumors

2) bilateral acoustic neuromas and cataracts

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Lyme disease: tx

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children < 8: amoxicillin

otherwise, doxy!

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trachoma

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p/w follicular conjucntivitis and pannus (neovascularization) formation in the cornea

repeated infections can lead to scarring of the cornea

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major Jones criteria

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syndham chorea, migratory polyarthritis, carditis, subcutaneous nodules, and erythema marginatum

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ezcema herpeticum

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form of primary herpes infection a/w atopic dermatitis.

can be life threatening so treat with acylovir asap!

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RSV infection predisposes infant to what later in life?

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bronchiolitis -> higher risk of getting asthma

tx: supportive care with humidified oxygen and bronchodilators

ribavirin in high risk children

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serum sickness-like reaction

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may occur one to two weeks after administration of certain drugs in the setting of a viral illness

prominent sx include fever, urticarial rash, polyarthralgia, and lymphadenopathy

does not represent a true drug allergy

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when to suspect pertussis

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anyone with a cough lasting greater than 2 weeks w/o a clear cause and one of the following sx: inspiratory whoop, paroxysmal cough, and posttussive emesis

in first four weeks, obtain nasopharngeal sampling for viral culture or PCR for confirmation of dx

start azithro before obtaining final dx

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proper sunscreen usage

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15-30 min before sun exposure 15-30 proof or higher

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small for gestational age babies are at risk of developing what complications?

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hypoglycemia, hypothermia, hypocalcemia, polycythemia, and hypoxia

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Fibromuscular dysplasia

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can present as new onset hypertension in young patients.
(most common cause of secondary hypertension)

bruits or venous hum may be heart at the costovertebral angle

angiogram reveals a "string of beads" sign

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SCID

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life-threatening condition marked by recurrent bacterial, viral and fungal infxn

diagnostic features: absent lymph nodes and tonsils, lymphopenia, absent thymic shadow on xrays, and abnl T, B, NK cells enumerated by flow cytometry

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transient synovitis

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commonly due to a virus

synovial inflammation leads to pain, decreased ROM and limping.

pt may have hip partially flexed, abducted and externally rotated to maximize joint space (less painful)

tx: NSAIDs and rest, though an xray may be taken to exclude leg calve perthes, bony lesions, or fx

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development of secondary sexual characteristics

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generally considered premature in girls age < 8 and boys age >9.

Obese children of all ethnicities are at higher risk for precocious development as increased adiposity can stimulate sexual hormone production centrally and peripherally.

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heroine baby

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aka neonatal abstinence baby -> usually presents in first few days of life.

irritability, high-pitched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachy, poor feeding, vomiting and diarrhea

what about alcohol? VPA? cocaine? phenytoin?

Hint 146

alcohol: no withdrawal sx unless mother was drinking just prior to delivery

VPA: NT defects, cardiac anomalies, dysmorphic facies including cleft lip, midface hypoplasia, broad and depressed nasal bridge, and long philtrum

cocaine: jitteriness, excessive sucking, and a hyperactive Moro reflex.

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Beckwith-Wiedemann syndrome

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macrosomia, macroglossia, umbilical hernia/omphalocele, hemihyperplasia, and hypoglycemia

children must be closely monitored for development of Wilms tumor or hepatoblastoma.

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red cell distribution width vs mean corpuscular hemoglobin concentration

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RDW values > 20% are suggestive of iron deficiency anemia (think of it like a catcher's mitt trying to catch iron); nl values of 12-14% are seen in thalassemia

mean corpuscular hemoglobin concentration is calculated by diving the hemoglobin by the hematocrit and is a measure of the hemoglobin concentration of each RBC. Decreased in conditions such as iron deficiency and thalassemia and elevated in pts with hereditary spherocytosis 2/2 loss of rbc surface area

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unconjugated hyperbili in a newborn

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almost all newborns have jaundice that appears on day 2-4 of life. newborns have unconjugated hyperbili d/t several physiologic differences in bili metabolism.

1) at birth, RBC concentration is elevated with shorter life span resulting in high hemoglobin turnover and bili production
2) bili clearance initially slow bc hepatic uridine diphosphogluconurate glucoronsyltransferase (UGT) does not reach adult levels until age 2 weeks. ASIAN NEWBORNS have decreased UGT activity compared to other ethnicities
3) Enterohepatic recycling is increased as the STERILE newborn gut cannot break down bili to urobilinogen for ffecal excretion. More bili is resorbed in the gut and recycled in the enterohepatic circulation until the gut is colonized and produces bacterial enzymes for reduction to urobilinogen.

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Todd's paralysis

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sudden LOC with following disorientation and slow gain of consciousness is a characteristic description of a seizure, if the convulsive episode was missed.

Postictal paralysis may follow generalized as well as focal seizures.

motor deficit usually improves rapidly with restorationo f function within 24 hours.

usually indicates that a structural abnormality underlying the seizure is present.

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esophageal atresia with tracheoesophageal fistula

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suspected when a newborn chokes and coughs during the first feeding. attempts at naso- or orogastric tube insertion will fail and xray will show the tube in the proximal esophageal pouch

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long term neurologic sequelae a/w bacterial meningitis

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hearing loss, loss of cognitive functions (due to neuronal loss in the dentate gyrus of the hippocampus), seizures, mental retardation, spasticity or paresis

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CF patients increased likelihood of developing what?

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nearly all with sinopulmonary dz

also sensorineural hearing loss, fertility problems

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tinea corporis, or ringworm

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treat with topical antifungals (ie terbinafine)

pruritic, erythematous, scaly, and have a red ring with central clearing.

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boy develops sudden onset abdominal pain, bloody diarrhea

then develops anemia, thrombocytopenia and renal failure

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classic for HUS!

E.coli

treatment usually supportive and involves plasmapharesis, dialysis if necessary, and steroids. antibiotics not indicated

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angiofibroma

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male adolescent with epistaxis, localized mass (typically on back of nose or upper throat), and a bony erosion on the back of the nose

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cri-du-chat syndrome

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d/t 5p deletion and presents as microcephaly, hypotonia, short stature, adn cat-like cry

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spondylolisthesis

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developmental disorder characterized by forward slip of vertebrae (usually L5 over S1) that usually manifests in preadolescent children.

typical: back pain, neurologic dysfunction (urinary incontinence) and a palpable step-off at the lumbosacral area are present if dz is severe.