peds
A child has a port-wine stain of the face within the distribution of the trigeminal nerve. Which of the following is the most likely diagnosis?
Sturge-Weber Syndrome
A port-wine stain is a sign of what neurocutaneous syndrome?
Sturge-Weber disease
What speech condition is described as a speech disability characterized by abnormal dysfluency with involuntary repetition of sounds, syllables and words, prolongations, blocks, interjections, revisions, word avoidance and/or substitutions, and speech avoidance?
Stuttering
A newborn in your practice has a positive result on the newborn screening test and confirmation test for hemoglobin FSC. What is this indicative of?
The baby has hemoglobin SC disease
What is the tx for toxic synovitis of the hip?
The condition typically resolves in 1-3 weeks and responds to nonsteroidal inflammatory agents.
>5 cafe-au-lait spots = What condition?
Neurofibromatosis
Which x-linked recessive d/o has the clinical features of eczema, microthrombocytes and deficiency of T and B cell immunity?
Wiskott-Aldrich syndrome
What is the treatment for severe lead poisoning?
administration of succimer (Chemet)
What is the MC form of apnea seen in pre-term infants?
central apnea
Which form of apnea has pts who have no respiratory effort described as lack of chest wall movement, and no breath sounds on auscultation?
central apnea
What is considered apnea?
cessation of breathing >20sec associated with bradycardia, cyanosis, pallor or marked hypotonia
What is gallstones in children and teens highly suspicious for?
congenital spherocytosis or hemoglobinopathy
What syndrome is characterized by hypertelorism, microcephaly, severe mental deficiency, and a catlike cry?
cri du chat syndrome
A 14-year-old girl has a 2 to 3-week history of a foul smelling, blood tinged, yellow/white vaginal discharge. Her periods started at 12.5 years of age and have been regular; her last period was about 3-4 weeks ago. In private, she denies any sexual activity. She has had vaginal discomfort with occasional mild dysuria. She denies any abdominal pain or diarrhea. What condition do you expect?
foreign body
You are working as a resident in the ED when a mother brings in a 5-year-old white male. His right knee is badly swollen, and the boy's mother asks for a wheelchair for her son as soon as she carries him into the foyer. She states that her son has a blood coagulation disorder and that he frequently bleeds into his joints when he sustains even a slight injury while playing. History includes the use of the blood product cryoprecipitate or factor VIII concentrates for treatment for his disorder. Which disorder does this patient suffer?
hemophilia A
deficiency of factor VIII is called what?
hemophilia VIII
...
ibuprofen (IV)
What is the initial tx for PDA within the first 10 - 14 days of life?
indomethacin (IV)
What is the cornerstone of treatment for ARDS?
ventilation
What murmur is described as a harsh, holosystolic murmur, loudest at the LLSB, radiating toward the xiphoid, with a thrill often present?
VSD
What murmur is described as a high pitched early to midsystolic murmur, heard best at the left upper sternal border and radiating toward the left clavicle, with a systolic ejection click or systolic thrill often present?
Valvular Pulmonary Stenosis
What are the components of tetralogy of fallot?
1 - VSD
At what age should a child be able to follow simple verbal commands, use jargon, running several unintelligible words together, and begin to say his first words?
12 months
When does the PDA typically close in infants?
15 hours after birth
In the case of mumps orchitis, what is the likelihood of atrophy of the testicles occurring? Additionally, what is the likelihood of the infertility in affected individuals?
30 - 40% of affected testes will become atrophied
What syndrome has the classic symptoms including psychomotor retardation, hypotonia, obesity, short stature, brachycephaly, upslanted palpebral fissures, protruding tongue, small ears, epicanthal folds, simian crease in palms, and speckled irises?
Down Syndrome
At what age will a child be able to understand sentences, learn new words quickly and uses two-word phrases like "go bye-bye" and "go night-night" and will begin using pronouns correctly?
18 - 24 months
...
2 - Pulmonary Stenosis
What condition is described as a viral infection that most commonly affects the salivary glands, resulting in tenderness and swelling of the parotid glands, as well as fever, headache, malaise, and muscular pain?
Mumps
...
3 - Overriding aorta
...
35% in children > 1 y/o
At what age will respond to his name, babbles and may begin to imitate speech sounds?
6 month
What condition in childhood is characterized by painful bilateral swelling of the salivary glands, usually the parotid glands and can be complicated by meningoencephalitis, orchitis, oophoritis, thyroiditis, and myocarditis?
Mumps - paromyxovirus
What is the average duration of orchitis associated with mumps?
4 - 6 days
...
4 - Right ventricular hypertrophy
What is the genotype associated with Klinefelter syndrome?
45, XO
What is the genotype associated with Turner syndrome?
45, XO
A 5y/o female presents to the pediatrician for a well-child visit. On heart exam there a regular rate and rhythm with a normal S1, physiologic split S2. There is a 2/6 musical midsystolic murmur heard best at the left lower sternal border (LLSB), without radiation. There is no systolic click or thrill. Radial and femoral pulses are normal. What is the most likely etiology of this pt's heart murmur?
Chordae tendineae vibration
...
Chorea
What heart condition is associated with Turner Syndrome?
Coarctation of the aorta
The approximate risk of the reoccurence of a febrile seizure in child is what percent?
50% reoccurence rate in children under 1 y/o
A newborn infant vomited and asphyxiated when given her first feeding. She constantly drooled saliva. Physical examination shows a distended abdomen, tachypnea and bilateral pulmonary rales. What is the most likely congenital anomaly causing this infant's symptoms?
Congenital esophageal atresia
...
Corynebacterium minutissimum
At what age is a child expected to understand verbal routines such as waving bye-bye or playing peek-a-boo and will point to objects, he also understands "no", he may begin to follow one step commands with gesture?
9 months
What chromosome is affected in Prader-Willi syndrome?
Defect on chromosome 15
...
Definitive Tx - Ramstedt procedure
Which psychological disorder is described as a pt becoming distressed when away from an attachment figure, usually a parent, and pervasive worry that some unknown event threatens the integrity of the family?
Separation Anxiety D/O
What does radiologic findings including progressive bilateral interstitial and alveolar infiltrates develop without cardiomegaly indicate?
ARDS
A pre-school aged child with Low grade fever, abdominal pain, and intestinal blockage is showing signs of what infection?
Ascariasis (Roundworm infection)
What is the predominant flora of the colon?
Bacteroides, bifidobacterium, E. coli
It is noticed that a newborn is unable to wrinkle the left side of his head and to close the eye on that side. The left corner of the mouth drops and milk dribbles out when the baby sucks. Blood pressure is 80/45mmHg and pulse is 120/min. What condition is the likely cause? What nerve is most likely damaged?
Bell's Palsy, Facial Nerve
What is the appropriate initial eval of a pathologic murmur?
CXR, EKG and Echo
After one years old, what is the MC method of treating a PDA?
Cardiac Catheteritization
What are the major criteria of Rheumatic fever?
Carditis
What is the primary diagnostic study used to evaluate and diagnose patent ductus arteriosus (PDA)?
Echo
What genetic condition is described as usually lethal within the first few weeks of life having characteristics including protruded forehead, downslanted palpebral fissures, microstomy, micronathia, dysplastic ears?
Edward's Syndrome
...
Erythema marginatum
On examination, the patient is well-appearing and afebrile. She has a slightly scaly, reddish-brown rash covering approximately 12cm2 in both axillae. The rash is nontender to touch with a well-demarcated border. There is no axillary adenopathy. Wood's light examination reveals coral-red fluorescence of the involved skin. What is your diagnosis? What pathogen causes it?
Erythrasma
It is noticed that a newborn is unable to wrinkle the left side of his head and to close the eye on that side. The left corner of the mouth drops and milk dribbles out when the baby sucks. Blood pressure is 80/45mmHg and pulse is 120/min. What is the most likely cause of this abnormality?
Forceps delivery causing injury on the left side
A pt presents with a three day hx of diarrhea and excessive abdominal gas, after swimming in a public pool the day before the symptoms began. What condition do you suspect?
Giardiasis
What is a likely but preventable adverse effect of cyclophosphamide? How can it be prevented?
Hemorrhagic cystitis
...
Impairment of fertility occurs in about 13% of pts - absolute infertility is rare
Which condition causes a typical EEG pattern, known as hypsarrhythmia, is characterized by high voltage, chaotic slowing, multifocal spikes, and marked asynchrony: As well as symptoms in a pt including flexor, extensor, and mixed flexor/extensor fits?
Infantile Spasms
What is the first step of treatment in pyloric stenosis? What is the definitive treatment?
Initial Tx -Fluid replacement and correction of metabolic acidosis
What hormone is a pancreatic hormone with anabolic effect?
Insulin
A child is brought to the emergency room with colicky pain, history of irritability, and lethargy. Rectal bleeding and "currant jelly" stool are also noted. Plain abdominal film shows evidence of obstruction and barium enema detects coiled-spring appearance to the bowel. What is your Dx?
Intussusception
A school-age child starts complaining about some soreness on movement of hips, knees, and ankles. Lately, he also noticed discomfort in the eyes and blurred vision. The onset was gradual and the disorder has been present for several months. Physical examination finds tenderness and severe limitation of range. Tests for antinuclear antigens and rheumatoid factors are negative. A thorough search for a cause has failed to identify infection or malignancy in the background. What is this clinical picture characteristic of?
Juvenille RA
What genetic condition has characteristics including subnormal intelligence, small penis and testicles, low testosterone, gynecomastia in late puberty, decreased muscle mass and strength; feminine distribution of adipose tissue; diminished libido; decreased physical endurance; and osteoporosis?
Klinefelter Syndrome
Basophilic stippling of red cells, elevated erythrocyte protoporphyrin concentration, and growth arrest lines in the metaphyseal region are all signs of what condition in childhood?
Lead Poisoning
A 3-year old child is brought to you with symptoms of slow development. Her vocabulary is very limited and does not use appropriate grammatical structures. Her appetite is poor and looks short among others in her age. Her mother is at home, works with stained glass, and does her best in taking care of the children. Diagnostic studies find slower nerve conduction velocities and 52 -g/dl (normal <10). What condition do you suspect?
Lead poisoning
What is the MC congenital malformation of the GI, present before 2 years of age and is found most frequently in boys and can be associated with causing intussusception?
Meckel's diverticulum
Which murmur is classically described as producing a high pitched, holosystolic or late systolic murmur, heard best at the apex and radiates to the axilla and back?
Mitral Valve Regurgitation
What condition results from non-closure of the fetal ductus?
PDA
On physical exam of a 1 week old premature infant (28 week) who has had reports of FTT and poor feeding is being examined. Findings include normal respiratory rate, normal heart rate, widened pulse pressure, prominent suprasternal & carotid pulsations, there is also a machinery murmur, which is continuous heard loudest along the left upper chest. What condition do you suspect?
PDA - Patent Ductus Arteriosus
Since the child is attending first grade for the second time and still seems to be unable to keep up in school, physically and mentally, the teacher had recommended for him to be checked out. He is 110 cm tall and weighs 50 kg. A body composition test shows significantly increased body fat with very little lean body mass. He has almond-shaped eyes and a narrow forehead. Since the scrotum is hypoplastic and there are no testicles palpable you order a hormone status. TSH 0.6 mU/l, fT3: 2.9 pg/ml, T4 1.1ng/dl, GnRH LH FSH, testosterone. What condition do you suspect?
Pader-Willi Syndrome
...
Polyarthritis
...
Prevented using vigorous hydration and mannitol diuretic
MCC of Mitral Valve Regurgitation?
Rheumatic Fever
A 4-year-old child develops swelling of eyes in the morning and swelling of legs and feet at the end of the day. Physical examination finds soft and pitting edema. Blood pressure and serum complement levels are normal. Timed 24-hour urine collection finds heavy proteinuria. Red blood cell casts are absent. Renal function is normal. Serum urea and creatinine concentrations are normal. Which of the following is the most appropriate next step in the management?
Steroid therapy
What is the MC innocent murmur of childhood?
Still's Murmur
Port-wine stains = What condition?
Sturge=weber
Ash-leaf spots, shagreen patch, sebaceous adenomas = What condition?
Tuberous sclerosis
What condition has characteristics indcluding short in stature, neck webbing, juvenile external genitalia, but usually no mental retardation?
Turner Syndrome
What hematologic d/o are Down Syndrome pts at a higher risk for?
leukemia
What labs will be elevated with acetaminophen toxicity?
liver transaminases
What is the MC cause of obstructive sleep apnea in peds?
obesity
What blood findings are associated with Hep B immunization?
only anti-HBs (surface antibody)
What is the med used to reverse acetaminophen toxicity?
oral N-acetyl cysteine
What is the MC pathogen involved in Mumps?
paramyxovirus
Which childhood murmur is present during infancy, disappearing between 3 and 6 months of age, and is described as high pitched, blowing midsystolic murmur, heard best at the LLSB and radiating to the back and axillae?
physiologic peripheral pulmonary stenosis
What blood findings are associated with immunity from previous Hep B infection?
positive antibodies to both hepatitis B surface antigen and to core antibody (IgM anti-HBc)
Which laboratory test should be performed prior to prescribing methotrexate?
renal function test
What is the MC disease associated with ARDS?
sepsis
What is typically the initial PE finding is pts with ARDS?
tachypnea
MC congenital cyanotic heart defect?
tetralogy of fallot
What is patent ductus arteriosis?
there is a persistent communication between the descending thoracic aorta and the pulmonary artery
Greater than 95% of infants have a very good pincer grasp at what age?
1 year
E) Referral to urology
...
On physical exam, the child looks well and is very active. The only abnormal finding is dried blood in both nares. There is no rash, no organomegaly and no pallor. The most likely diagnosis is
...
In normal development, hand dominance is usually first observed around the age of
1 year
The patient usually develops normally until about 5 months of age, when progressive muscle weakness to severe hypotonia is noted. Hyperreflexia and hyperacusis, cherry-red spot on the macula and blindness are also common. Most infants will assume a frog-like position and hardly interacts with their surroundings.
...
What is the expected diagnosis?
...
What is the most likely explanation for his sudden respiratory and clinical change?
...
What should be used to reverse hypoglycemia in infants?
0.5-1 g/kg of glucose as D10W
A child comes to your office to receive a well child exam. During your exam you notice that the child's hands are usually held in a fisted position, his head does lift off the table in the prone position for a few seconds, he stares at your face during the exam, and that he exhibits facial responses to various sounds. This child's development is most consistent with that of a child who has reached the age of
1 month old
...
- Hypochloremic metabolic alkalosis
A 14-year-old female is hospitalized because of sore throat and dyspnea. She experienced onset of the sore throat approximately 10 days prior to her admission, and was evaluated in an urgent care center one week prior to her admission, where she was diagnosed with "tonsillitis" and placed on amoxicillin. Her symptoms did not improve and her sore throat has worsened to the point to where she has difficulty drinking and eating. Her dyspnea has worsened over the past 24 hours. On examination, Oropharynx reveals dry, tacky mucous membranes and the tonsils are enlarged and erythematous with a gray exudate covering them. She has enlarged cervical and submandibular lymph nodes. Her abdominal exam demonstrates a liver 4 cm below the right costal margin, and her spleen is 7 cm below the left costal margin. What is the dx and tx?
...
A 4-year-old boy starts to readily develop hematomas. He complains to his mother of knee pain, and she notices that they are swollen and painful. He is frequently getting bruised, and she starts to realize that minor cuts on him seem to bleed readily. His mother is very concerned because she knows that her father had a bleeding disorder. What is the most likely diagnosis?
...
A 7-year-old male presents to your office with a one day history of lesions on his hands, feet, and sores in his mouth. He has had no fever or other symptoms. No ill contacts have been noted. He is up to date on his immunizations. His examination is significant for small, gray vesicles in his palms, soles, and the tops of his feet. His oropharyngeal exam reveals whitish-yellow lesions on his tonsillar pillars. He is afebrile. The most likely etiology of these findings is
...
A) Maternal hepatitis C virus
...
A) Voiding cystourethrography (VCUG) prior to discharge
...
B) Breast cancer
...
B) VCUG scheduled later as an outpatient
...
C) Maternal cytomegalovirus
...
C) Repeat renal USG at 2-3 months
...
D) Discharge home on prophylactic antibiotics
...
D) Maternal lithium usage
...
E) Maternal West Nile fever
...
Stands holding onto support occurs at what age?
10 months
A child comes to your office for a routine physical exam. The child is able to walk with one hand held, picks up a pellet with a pincer movement of forefinger and thumb and releases it upon request, says "mama" and "dada," and is able to play a simple ball game. How old is this child?
12 months
Walks with support at what age?
12 months of age
At what age should a child be able to point to body parts by name and is learning new words slowly and usually will know about 4-6 words?
15 months
A mother brings her child into your office for a well child check. The child is growing well and your exam reveals that she is developing normally. She is able to turn the pages of a book, uses 20 words, points to 4 body parts, walks up steps, and feeds herself with a spoon. Her development is most consistent with that of a child of
18 months
A mother brings her son in for a health maintenance examination. You note that the child smiles in response to his mother's vocalizing, he makes cooing noises, and is able to lift his head to 45° when prone. His development is most consistent with that of a child who has reached the age of
2 months
In the majority of infants, the anterior fontanelle normally closes completely by:
24 months
How long should a student with strep be treated before returning to school?
24hrs
A number of physical findings are assessed in the neonate when estimating conceptional age. Complete hypotonia of all four limbs when the infant is lying quietly on its back is seen at approximately ______ weeks?
30 weeks
A number of physical findings are assessed in the neonate when estimating conceptional age. A frog like posture when the infant is lying quietly on its back is seen at approximately _____ weeks?
34 weeks
A number of physical findings are assessed in the neonate when estimating conceptional age. Flexion of all four limbs when the infant is lying quietly on its back is seen at approximately _____ weeks?
36 weeks
A number of physical findings are assessed in the neonate when estimating conceptional age. Hypertonic limbs are seen at approximately ____ weeks?
38 weeks
Her daughter rolls over both front-to-back and back-to-front. She sits with support, turns toward her mother's voice, smiles spontaneously, and brings objects to her mouth. Her development is most consistent with that of a child who has reached the age of
4 months
No head lag when pulled from the supine to the sitting position occurs at what age?
4 months
Lifting the head from the prone position with ability to turn the head from side to side occurs at what age?
4 to 6 weeks of age
What is the recommended daily value of vitamin D in infants?
400 IU/d
A female neonate presents with gonadal dysgenesis (streak ovaries), webbed neck, low posterior hairline with occasional renal and cardiac defects. Occasionally, these infants present at birth with edema of the dorsum of the foot. Chromosome analysis would most likely yield which abnormal karyotype?
45, X
A female newborn on physical exam has the following features: hypotonia, flattened facies with upslanting palpebral fissures, simian crease, and protruding tongue. Chromosome analysis would most likely yield which abnormal karyotype?
47,XX,+21
How much time does it take for breast feeding jaundice to improve after discontinuation of breast feeding?
48 hours
The presence of more than _____?_______ obtained by transurethral catheterization has been proposed as criterion for diagnosis for UTI
50,000 colonies/mL
In normal development, a baby born at term should be able to sit unassisted at:
6 - 7 months
You note that the child is able to roll over, sit independently, smiles spontaneously, and is babbling. The child's development is most consistent with that of a child who has reached the age of
6 months
Rolling over from the prone to the supine position, sitting with support occurs at what age?
6 months of age
Sitting without support, rolling over from the supine to prone position, transferring objects from hand to hand occurs at what age?
8 months of age
A child is brought to your clinic for a well child evaluation. You observe that the child uses a pincer grasp, is able to sit independently, is starting to pull himself to a standing position, and is able to feed himself. The child's development is most consistent with that of a child who has reached the age of
9 months
What is considered Low Birth Weight (LBW)?
Less than 2,500g
A newborn term female infant born 24 hours ago was found to have hydronephrosis of the right kidney on fetal ultrasound during the 3rd trimester. This was recorded as an 8mm dilation of the right renal pelvis in the anteroposterior diameter. Though the baby was born without incidents and seems to be doing well and has a normal newborn exam. The renal ultrasonogram (USG) comes back normal. What is the most appropriate next step?
A) Voiding cystourethrography (VCUG) prior to discharge
A 5-year-old boy is brought to your office due to pallor and easy bruisibility. His mother noted that her son always has bruises on his body and will deny any episode of trauma. He was also noted to be pale which she attributes to having decreased appetite. 3 weeks ago, he had an episode of an acute viral infection, from which he hasn't yet fully recovered. A complete blood count shows evidence of anemia and thrombocytopenia. Peripheral smear shows presence of blast cells. What is the most likely diagnosis?
A.L.L - Acute Lymphoblastic Leukemia
A 7-year old boy is brought to you with symptoms of fatigue, pallor, and gradual weight loss. The results of physical examination are unremarkable. Microscopic examination of peripheral blood finds lymphoblasts with deeply basophilic and vacuolated cytoplasm and prominent nucleoli. Refer to the attached laboratory studies. What is the diagnosis?
A.L.L. - Acute Lymphoblastic Leukemia
Prometaphase analysis detects deletion of the short arm of chromosome 11 in a child with aniridia and mental retardation. Which test is recommended for frequent monitoring?
Abdominal U/S
What is the most important first step in detecting IUGR early?
Accurate dating of pregnancy
What is the gold standard for warming patients who have cardiac arrest or ongoing cardiovascular instability?
Active internal warming
A six-year old child is seen at the urgent care center for suddenly starting clumsy gait and inability to stand or walk without support. He is irritable and there have been several episodes of vomiting during the past days. He had chickenpox three weeks ago. Muscle strength testing does not reveal abnormality but there is resistance to neck flexion. What is the most likely dx?
Acute cerebellar ataxia
An 8-year-old male presents to the emergency room with a one day history of dark colored urine, fever, and lethargy. His physical examination is significant for a blood pressure of 140/95, facial pallor, slight edema of his extremities, and a healing skin lesion around the left nostril. (He had impetigo around his nose approximately two weeks ago that was treated with a topical antibacterial cream.) Urinalysis reveals red blood cell casts, proteinuria, and occasional white blood cells. Complete blood count reveals a mild normochromic anemia. What is the most likely dx?
Acute glomerulonephritis
90% of patients have a unilateral presentation. The scrotal skin is red and tender, but the testis appears to be normal. The redness tends to extend off the scrotum onto the perineum or onto the penis. Doppler ultrasound, if done, demonstrates good blood flow to the testis with peritesticular edema and fluid in the scrotal wall.
Acute idiopathic scrotal edema
A pts labs come back and you note low serum cortisol levels, hyponatremia, high normal serum potassium, and low glucose levels. What condition do you suspect?
Adrenal insufficiency
An 8-year-old child is hospitalized with rapidly worsening bacterial pneumonia treated with broad spectrum antibiotics. Symptoms of weakness, lethargy, and postural hypertension develop. Physical examination finds increased heart rate and decreased skin turgor. There is increased pigmentation in areas of friction. Blood cell count shows leukocytosis with eosinophilia. What is the diagnosis?
Adrenal insufficiency
This neonate has an abnormal heart rhythm, is small, and has abnormal palmar creases. Which drug can cause these symptoms and mental retardation with abnormal facial features?
Alcohol
A 17 year-old girl complains of sore throat and weakness, with a fever of 100oF. There is cervical lymphadenopathy in physical exam, and the test of Monospot is positive. After eight days, the patient develops acute abdominal pain. During the abdominal examination, she suddenly becomes pale, sweaty, and cold. What is the appropriate treatment?
An urgent laparotomy is indicated because patient is in shock with internal hemorrhage, due to rupture of the spleen
The male testis provides two functions. One is production of spermatozoa. What is the other function?
Androgen production
The most appropriate initial management for otitis media is ?
Amoxicillin
Tx for cystitis if allergic to Bactrim?
Ampicillin
How is a acute glomerulonephritis diagnosis confirmed?
Anti-DNase B titers
A four-year old child develops generalized urticaria. Past history and results of physical examination are unremarkable. What is the most appropriate next step in the management?
Antihistamines and follow-up to determine if the urticaria is chronic or recurrent
Which other heart complication is commonly associated with subarterial VSD?
Aortic insufficiency (AI)
Pt presents with a painful ulceration on his oral mucosa. It began as erythematous, indurated papule and now appears eroded forming a necrotic ulcer with an erythematous halo. What is your dx?
Aphthous ulcer
What disease has characteristic signs including organomegaly, petechiae, fever, and severe anemia?
Leukemia
What skin condition is characterized by erythematous, weepy patches on the cheeks then subsequent extension to the face, neck, wrists, hands, abdomen and extensors surface of the extremities, that are extremely pruritic?
Atopic Dermatitis
Removal of a scale from a lesion causes pinpoint bleeding, this sign is known as?
Auspitz sign
A 6-year-old female is referred to your office for further evaluation of "birthmarks". On physical exam, you find multiple café-au-lait spots over her trunk and extremities. What findings would you expect to find to support the diagnosis of neurofibromatosis 1?
Axillary freckling
What deficiency manifests as generalized seizures in infants and polyneuritis and sideroblastic anemia in older children and adults?
B6 or Pyridoxine
Seizures, irritability, hypotonia, restlessness, peripheral neuritis, dermatitis, and microcytic anemia can be seen with deficiency of vitamin _______?
B6 or pyridoxine
Tx for UTI?
Bactrim
What orthopedic maneuver is described as the hip is flexed, the thigh is adducted, and the femur is pushed posteriorly causing the femoral head to dislocate posteriorly from the acetabulum?
Barlow test
Common findings include height and weight greater than the 97 percentile, ear lobe creases or ear pits, a large tongue, omphalocele or umbilical hernia, visceromegaly, embryonal tumor in childhood, asymmetric overgrowth of a region or regions of the body, and renal abnormalities. What condition is described?
Beckwith-Wiedemann syndrome
A 2-year-old female presents for a health care maintenance examination. Her development and growth parameters are normal. Her past medical history is unremarkable. Her parents are concerned about the appearance of her tongue. Over the past 4 months, they have noticed that she has had sores on her tongue that appear to change shape and size slowly over time. On examination, she has multiple, sharply demarcated, irregular, smooth red plaques on the dorsum of her tongue. The margins of the lesions are elevated and gray in color. Which is the most likely dx of this patient's condition?
Benign migratory glossitis
What condition has sx including irritability, fatigue, peripheral neuritis, decreased tendon reflexes, loss of vibration sense, congestive heart failure, hoarseness, and ataxia?
Beriberi - B1 deficiency
Lithium is the appropriate medication for which childhood psychiatric disorders?
Bipolar illness
Which condition is described as an inflammation of the lid margins which is characterized by redness, scaling or crusting lesion that is initially manifested by itching, irritation and burning sensation, which is generally recurrent, chronic and usually bilateral?
Blepharitis
Which test should be performed to confirm the dx of gonorrheal arthritis?
Blood culture
MC diaphragmatic herniation in newborns?
Bochdalek hernia
Infants presents with small cystic lesions located on the buccal and lingual aspects of the maxillary and mandibular ridges in neonates. What is your dx?
Bohn nodules
Radiation therapy is most commonly associated with the development of which secondary malignancy?
Bone and soft tissue sarcoma
An 8-month old infant develops spasticity and episodic sudden contractions of muscles. During such attacks, eyes converge and do not focus on an object simultaneously. The tone of the masseter muscles is increased. Contraction of the back muscles produces an arched back. Examination finds hepatosplenomegaly and pancytopenia. Which of the following tests should be performed to confirm the most likely diagnosis?
Bone marrow biopsy and enzyme analysis - to dx Gaucher's dz
What breast condition usual presents with a fluctuant palpable mass associated with systemic symptom like fever?
Breast Abscess
An 18-month-old female is brought by her mother to the ED for evaluation. The child appeared to have a fainting spell earlier in the day. The child has no previous medical problems. The mother states that the child was playing and became startled by a loud noise. She began crying and then became pale. She then went limp, fell to the ground, and then stiffened. After a few seconds, she "woke up" and cried. The child is now acting normally according to the mother. Based on this history, the most likely diagnosis is
Breath-holding spell
Which sign is described as spontaneous hip flexion when the examiner flexes the patient's neck? What condition does it signify?
Brudzinski: Signifies Meningitis
Jaundice in a child accompanied by acute onset of abdominal pain and ascites are indicative of what condition?
Budd-Chiari Syndrome
What syndrome is caused by acquired thrombosis occluding the hepatic vein leading to jaundice, acute onset abdominal pain and ascites?
Budd-Chiari syndrome
Which condition is described as an inflammation of the meibomian glands characterized by a firm nodule on the upper eyelid which is non-tender?
Chalazion
What condition is clinically manifested by intensely erythematous, confluent plaque with scalloped border with the hallmark being numerous papules and vesicopustules, satellite pustules that stud the contiguous skin?
Candidiasis
1st DOC for Complex partial seizures?
Carbamazepine
Elevation of what substance is the likely cause of yellow skin in a hypothyroid adolescent?
Carotene - In hypothyroid states, carotene from green leafy and yellow vegetables can accumulate. Unlike in jaundice caused by elevated bilirubin, the sclera of the eye is not yellow.
Tx for Grp A Strep if pt is PCN allergic?
Cephalosporin or Macrolide
A 14-year-old girl has had a small, round, slightly tender swelling in her right lower eyelid for 2-3 days that has gradually enlarged, becoming round and painless. There has not been any drainage or itching noted or visual changes. On exam, Her mid right lower eyelid has a 1.5 cm round, nontender, swollen mass that is mildly erythematous without any drainage. The underside of the lid is grayish-red. Based on these findings, what is the most likely diagnosis?
Chalazion
A 12-year-old, Caucasian boy is admitted to the pediatric intensive care unit by the emergency care physician, since the doctor could not control the asthma attack the patient was suffering from. He is on inhaled albuterol, intravenous aminophylline, and high dose intravenous methylprednisone as well as oxygen by nasal cannula. You proceed with the medication, but increase the albuterol dosage. Which side effect are you worried about?
Chest pain - High dosages of beta-agonistic drugs can cause angina and endanger the blood supply to the heart.
What condition includes disordered thought, delusions, and visual or auditory hallucinations, such as imaginary persons or voices with onset that is insidious, and may include paranoid delusions, aggressive behavior, changing moods, social withdrawal, or pathologic silliness?
Childhood schizophrenia
In which age group should tetracycline be avoided?
Children < 8y/o
Which type of children most often present with stereotypical movement d/o?
Children with cognitive impairment
MC cause of pneumonia in infants aged 2 weeks to 3 months?
Chlamydia trachomatis
staccato cough, afebrile infant, and eosinophilia in a 2 mo old are classic symptoms of what type of pneumonia?
Chlamydia trachomatis
A three-month old infant develops rapid breathing and staccato cough, but otherwise appears well and is afebrile. Physical examination detects fine rales over the lungs. The tympanic membrane is red and thickened. A chest x-ray shows bilateral patchy infiltrates. Laboratory studies indicate eosinophilia and elevated serum immunoglobulin concentrations. Which of the following is the most likely causal organism? What is the tx?
Chlamydia trachomatis and tx is erythromycin
A non-inflammatory disorder characterized by diffuse pain and at least 5 or more specific tender points found on physical examination. Chronic anxiety, fatigue, poor sleep, chronic headaches, irritable bowel syndrome, subjective soft tissue swelling, numbness, pain modulation by physical activities, weather factors or anxiety, and stress may also be present. What condition is described?
Chronic Fatigue Syndrome
A big, healthy child for his 12 years, he has many motor tics. The actions are sudden, rapid, recurrent, and nonrhythmic and occur frequently on a daily basis. The child is upset by his classmates' laughing at him and tries to be a good sport, but he is becoming more withdrawn as the months go on. What is your dx?
Chronic Motor or Vocal Tic Disorder
Which condition is characterized by at least 6 months of profound fatigue and may include impaired memory or concentration, headache, vertigo, and visual disturbances, patients will also have enlarged nodes and frequent sore throat?
Chronic fatigue syndrome
A 12-year-old boy is brought to you with short stature. Complete blood count, sedimentation rate, serum electrolytes, and BUN can be used to confirm or rule out:
Chronic systemic disease
Which class of lipoproteins is a source of VLDL?
Chylomicron reminant
The deficiency of which intestinal brush border functions will cause congenital chloride diarrhea?
Cl-/HCO3- exchanger
What condition is a rare cause of sports related cardiac deaths when cardiac disease is not present and occurs when nonpenetrating trauma to the chest produces ventricular fibrillation during the vulnerable period of cardiac repolarization?
Commotio cordis
What is the most consistently reported effect on adjustment of children from divorced families?
Conduct disorders
A 10-year old boy is brought to the emergency room with symptoms of blurred vision, difficulty of swallowing, and weakness. The symptoms evolved rapidly, and his speech became slurred. Pupils are dilated. There is ptosis and loss of accommodation. The muscle action potential is low, and there is an incremental response on rapid repetitive stimulation. Which of the following is the most likely causal organism?
Clostridium botulinum
What food pathogen causes gastrointestinal symptoms as well as blurred vision, diplopia, dry mouth, and descending paralysis?
Clostridium botulinum
...
Clotrimazole,
Patients present with hypertension in the upper extremities and relative hypotension in the lower extremities. On exam, there is diminished femoral relative to radial pulse. Auscultation may reveal a palpable thrill over the suprasternal region and characteristic notching of the rib may be present on chest x-ray. What is your dx?
Coarctation of the aorta
What condition is described as a congenital, pathological narrowing of the aorta that usually occurs distal to the takeoff of the left subclavian artery?
Coarctation of the aorta
Occurring about 60 - 100 minutes after going to sleep, there may be thrashing and moaning that lasts between five and fifteen minutes. The child may appear to be awake with eyes open and confused or upset. The episodes are difficult to interrupt, and children do not respond to parental consoling. They may occur multiple times, but tend to decrease in intensity if they extend into the second half of the night. They occur more commonly when the child's schedule has been altered, the child is overly tired, or the child is upset or ill.
Confusional arousals
On physical exam, the child appears smaller than the stated age of 6 months. The head circumference is in the 90th percentile for age. The temperature is 35° C (95° F). The child is sluggish. The anterior and posterior fontanels are widely open, but flat and soft. The eyes appear far apart and the nose is broad with a depressed bridge. The eyes appear swollen and the palpebral fissures are narrow. The tongue is thick and protrudes from the mouth. The hands are broad and the fingers are short. There is no simian crease or clinodactyly. The skin is dry and scaly. The hair is coarse, brittle, and scant. The abdomen is large and distended. The baby appears lethargic and developmentally delayed. This child most likely suffers from
Congenital Hypothyroidism
Affected infants present with hypotonia and weakness at birth. There may be joint contractures of variable severity and swallowing difficulties. Some types are also characterized by intellectual retardation, seizures, hydrocephalus, and evidence of structural brain abnormalities or ocular abnormalities. What is the condition?
Congenital Muscular Dystrophy
Pt has decreased serum T4, decreased serum T3, decreased T4 index, normal TSH and increased T3 resin uptake. What is this indicative of?
Congenital TBG deficiency
Which of the following is the correct diagnosis for a clinical picture of an infant with a weak cry and weak sucking reflex and a lack of anti-acetylcholine receptor antibodies?
Congenital myasthenia
A 2y/o breast feeding child presents with diarrhea, what is the appropriate dietary treatment?
Continue breast feeding and add an age-appropriate diet
Tx for febrile seizure is?
Control of fever with anti-pyretics
MC complication of Kawasaki's syndrome?
Coronary artery aneurysms
What hormones promotes conversion of protein to glycogen and antagonizes insulin facilitated transport?
Cortisol
What is the best biomarker of exposure to environmental tobacco exposure?
Cotinine level
Question:
Coxsackie - Hand, Foot and Mouth dz
What hepatic disorders corresponds with a clinical picture involving jaundice, has a good response to phenobarbital, and is autosomal dominant with incomplete penetration?
Crigler-Najjar Type II
...
Crigler-Najjar syndrome
What condition is described as a lymphatic malformation of childhood, presents as a painless soft tissue swelling in the neck?
Cystic hygroma
Cystic lesions, some of them calcified, are pathonomic for ?
Cysticercosis
A school-age child has several attacks starting with recurrent contractions at the left corner of the mouth, progressing to adjacent muscles, and ultimately involving the entire left side of his body. The attack lasts a few minutes. The parents are anthropologists and a few months ago the family visited several villages in Central America. EEG detects irregular focal spikes over the right frontal lobe. Examination of CSF reveals decreased glucose, increased protein, and a few eosinophils. CT studies show cystic parenchymal lesions, some of them are calcified. What is the diagnosis?
Cysticercosis - caused by the pork tapeworm (Tenia solium)
What breast condition is described as asymmetric breast enlargement associated with a firm, mobile, circumscribed mass that can increase in size rapidly and become quite large?
Cystosarcoma Phylloides - low grade malignant lesion
The area around the lacrimal sac becomes painful, red and swollen with the eye becoming red and watery and oozes a purulent discharge. Pressure to the lacrimal sac may push pus through the opening near the nose. Fever is common. What condition does this describe?
Dacryocystitis
A blockage of flow of tears from the eye to the nose due to narrowing of the nasolacrimal ducts, what condition does this describe?
Dacryostenosis
A tall, 10-year old boy is brought to you with right leg pain. During the last couple of months he occasionally complained about pain in the right leg but that did not seem to be significant. Lately he is awakened by the pain during the night. Physical examination finds swelling and a palpable mass on the right femur. Plain x-ray finds laminated onionskin type periosteal reaction. What is the dx?
Ewing's sarcoma
A lumbar puncture is performed on a patient with bacterial meningitis. What abnormalities of the cerebrospinal fluid is most predictive of residual neurologic deficits?
Decreased glucose
Term
Definition
A school-age girl develops erythematous flat-topped papules over the knuckles and violet discoloration and swelling of the eyelids. Lately she started to complain about weakness and has difficulty in getting up from the floor and climbing stairs. Laboratory studies find elevated aldolase and creatine phosphokinase. What is the most likely diagnosis?
Dermatomyositis
What condition has signs and symptoms including include insidious onset of proximal muscle weakness; stiff, sore and/or indurated muscles; respiratory difficulty, nasal regurgitation, nasal voice, and/or aspiration due to involvement of palatorespiratory muscles; skin lesions, typically violaceous erythema on upper eyelids, a butterfly malar facial rash, and atrophic, scaly, erythema on extensor surfaces of joints?
Dermatomyositis
What condition involving the scalp is very common during childhood and consists of a combination of inflammation with hair breakage and loss. And includes Inflammatory changes that can range from mild scaling and redness to a severe response including tenderness, redness and edema known as a kerion?
Dermatophyte infection - Tinea Capitus
What skin condition consists of individual and grouped red, scaly papules and small plaques that progressively enlarge and migrate, forming rings and arcs?
Dermatophyte infection - Tinea Corporis
A 3-year-old boy is brought in by his parents for an evaluation of his stuttering. They state he has word and phrase repetitions, with only occasional sound repetitions. He does not appear to be aware of his problem, and shows no adverse behavioral reactions when his parents attempt to help him finish his sentences. He has demonstrated normal development prior to this problem. He is on no medications. No family history of stuttering is elicited. Physical exam is entirely within normal limits. The most likely cause of this patient's condition is
Developmental dysfluency
The most appropriate treatment for a pt with croup if stridor is present?
Dexmethasone
Which condition is described as deficient T cell immunity and viral infections, cardiovascular defects like interrupted aorta or truncus arteriosus, thymus hypoplasia, fish-shaped mouth, low-set ears lymphocytopenia?
DiGeorge Syndrome
Which childhood diseases corresponds with thymic hypoplasia?
DiGeorge syndrome
What is the treatment for Cystosarcoma Phylloides?
Excision
A 13-year old child has recurrent pulmonary infections. All childhood immunizations have been received as scheduled. Results of laboratory studies, including blood counts, plasma immunoglobulins, and sweat test, are within normal limits. Intradermal injection of 1:5 dilution of tetanus toxoid does not lead to an erythematous, indurated lesion during the next 3 days. What is the most likely dx?
Impaired T cell function which needs further investigation
DOC for rocky-mountain spotted fever?
Doxycycline
Which tetracycline is safest in pts with renal impairment?
Doxycycline (as it is mainly secreted through the feces)
What eye condition is described as being characterized by limited abduction and/or limited adduction, is typically unilateral, with the left eye being affected more than the right?
Duane syndrome
Which hepatic disorders corresponds with a clinical picture involving conjugated hyperbilirubinemia, gastrointestinal symptoms, and dark pigment in hepatocytes?
Dubin-Johnson syndrome
What is the correct diagnosis for a clinical picture of progressive weakness starting at age 2-4 and the child never runs or climbs upstairs normally?
Duchenne muscular dystrophy
What is a superficial skin infection begins as a small, tender, erythematous papule that progresses to a vesicular stage and may become rapidly "honey-crusted" with a serous discharge?
Impetigo
A 5-week-old male presents to his pediatrician with a 2-week history of vomiting. The vomitus is white in color and occurs after feedings. Initially, the patient had 2 episodes of emesis daily, but the frequency has increased to 5 times daily and the vomiting has become projectile. The patient is breast fed only, for 20-30 minutes every 3 to 4 hours. The mother has noted that he has developed a yellow color to the skin in the past 3 days. There is no history of fever, diarrhea, cough, respiratory distress, or trauma. The patient has produced fewer wet diapers in the past 2 days and is crying more than usual.The abdomen is soft with positive bowel sounds. There is no organomegaly or guarding. A 2 X 1 1/2 cm mobile mass is intermittently palpated in the midepigastric area. What is the dx? A capillary blood gas is most likely to show a:
Dx - Pyloric Stenosis
Two weeks after an upper respiratory infection, an adolescent starts complaining about diarrhea, sweating, and increased heart rate. Physical examination finds tremor and a swollen, tender, and painful thyroid gland. Pulse rate is 110/min and blood pressure is 130/60mmHg. Refer to the attached laboratory studies. What is the diagnosis? What is the appropriate treatment?
Dx - hyperthyroidism caused by subacute thyroiditis
What GI pathogen causes acute infectious diarrhea and can be paired with the pathogenic mechanism of enterotoxic, enteropathogenic, enteroinvasive and enterohemorrhagic effects?
E. Coli
...
In adults Tetracycline
Define the term premature pubarche
Early appearance of pubic hair
...
Early onset breast feeding jaundice
The following symptoms, 1) anorexia with regular menses, 2) loss of weight but a weight within normal limits, 3) bulimic behavior at a rate where binging and purging is less than two times a week, and 4) bulimic behavior for a period of less than three months; would warrant a diagnosis of which of the following?
Eating Disorder NOS
What antenatal ultrasound finding might be a marker for cystic fibrosis?
Echogenic bowel
What condition is described as the lid margin is turned outwards or everted associated with overflow of tears, maceration of the lid skin, inflammation of exposed conjunctiva or superficial exposure keratopathy?
Ectropion
Intense perianal pruritus is the classic c/o of what pathogen?
Enterobiasis (Pinworms)
Which condition is described as the lid margins are directed inwards causing discomfort and corneal damage?
Entropion
At birth a child presents with small, white, keratinized lesions found on either side of the mid-palatine raphe. What is the dx?
Epstein pearls
A 17 year-old girl complains of sore throat and weakness, with a fever of 100oF. There is cervical lymphadenopathy in physical exam, and the test of Monospot is positive. After eight days, the patient develops acute abdominal pain. During the abdominal examination, she suddenly becomes pale, sweaty, and cold. The illness described above is caused by:
Epstein-Barr virus (EBV)
What form of paralysis is described as causing the inability to abduct the arm at the shoulder, rotate externally and supinate the forearm? What nerve does it affect?
Erb-Duchenne paralysis; cervical nerves 5, 6 and in 50% 7
What infectious disease of childhood is characterized by three stage rash (erythema of the cheeks, spread from the arms to the trunks and legs, phase of fluctuating severity)?
Erythema infectiosum (Fifth's disease)
Rash associated with acute rheumatic fever?
Erythema marginatum
Neonatal skin condition described as typically 1-2 mm white-to yellow papules or pustules on an erythematous base will be observed. What condition is described?
Erythema toxicum
A five-month old infant is presented with tachypnea and cough. Conjunctival blood vessels are hyperemic and the temperature is 100.1° F. Chest auscultation reveals occasional wheezes and diffuse rales. Chest x-ray shows hyperinflation and diffuse interstitial infiltrates. Laboratory studies indicate eosinophilia. Which of the following antibiotics is the most likely choice for this patient?
Erythromycin (Tx of choice for chlamydial trachomatis)
When examining the patient's eyes you find that the left eye is deviated medially. When asked to track your finger with both eyes open, the left eye moves but remains medially deviated. When you cover his right eye, he is able to focus on you by centering his left eye. When you uncover his right eye, then left eye drifts back towards his nose. Vision is normal when you test each eye individually on a Snellen chart. Funduscopic examination is normal. What is the dx and tx?
Esotropia of left eye which can be treated by atropine drops of the right eye
What agent can cause a deficiency of Vitamin B1 after a period of prolonged application?
Ethanol - Causes thiamine deficiency
DOC for absence seizures?
Ethosuximide
Onionskin type periosteal reaction = ?
Ewing's Sarcoma
What condition is most commonly present as intermittent, brawny, swelling of the extremities with recurrent facial and subglottic swelling as well as recurrent, crampy abdominal pain, and wheezing with edema usually lasting 24-72 hours?
Hereditary Angioedema
What factor is deficient in Hemophilia A?
Factor VIII
A 14 year old boy is brought to you with chest pain. Physical examination finds xanthomas, nodular swellings of the tendons (Achilles, knee, elbow, and dorsum of the hand). What is the most likely diagnosis?
Familial hypercholesterinemia
Tx for iron deficiency?
Ferrous gluconate 3 mg/kg of elemental iron twice a day for three months
A newborn was brought to the emergency department after being delivered accidentally in a taxicab. Upon physical examination, he is limp, small, weighing 2000gms. Distinct facial facies were also noted, such as mild ptosis, epicanthal folds, short nose and a smooth upper lip. There is a harsh murmur heard best at the midsternal border. Upon questioning the relative, the mother has a history of drinking alcohol while she was pregnant. Based upon the findings, what would be the likely diagnosis?
Fetal Alcohol Syndrome
Parents bring a 3-year-old, hyperactive boy for evaluation and counseling. The boy speaks only in words and his vocabulary consist of only a few words. He never combines words into sentences. He is often angry and attacks others for no apparent reason. The child's head is visibly small and he has a flat nasal bridge, short nose, and long smooth philtrum. There is clinodactyly of fifth fingers on both hands. He has a short stature, below the fifth percentile of normal growth. Blood pressure, thyroid tests, serum electrolyte, and blood count are normal. What is your suspected dx?
Fetal Alcohol syndrome
A 16-year-old girl is brought to your office because of a mass palpated over the left breast. There are no associated signs or symptoms noted. Physical examination showed a non tender mass on the upper, outer part of the left breast measuring about 2x3 cm. What is the most likely diagnosis?
Fibroadenoma
For what childhood endocrine and metabolic disorder is the appropriate pharmacologic test (stimulation or suppression) intravenous TRH?
Hypothyroidism
It is characterized by moderate mental retardation. With the phenotypic manifestations of the syndrome including developmental delay, hyperactivity, abnormal craniofacies, and macroorchidism (in post-pubertal males). What is the syndrome?
Fragile X syndrome
...
Fragmented and dense calcaneal apophysis
A 4-year-old child is seen in a pediatrician's office for inability to stand or walk without support. He had chickenpox a month ago. There has been no vomiting during the past days. On examination he is alert and smiling. A kyphosis is noted and tendon reflexes appear to be weak or absent. There is no resistance to neck flexion. What is the most likely dx?
Friedreich's ataxia
Tx for Prader Willi syndrome?
GH - Growth hormone
A male newborn is brought to the neonatal intensive care unit with an anterior abdominal mass. The mass extends off the right side of the abdomen and measures 3.5 centimeters. This uncovered mass appears to contain small bowel. No other physical abnormalities are seen and a genetic profile is pending. What is the most likely differential diagnosis for this child?
Gastroschisis
A 10-year old boy develops bone pain. Parents also noticed that his learning disability is worsening. He cannot remember simple tasks and now he needs help for dressing. Physical examination finds hepatosplenomegaly, but there is no sign of motor or sensory impairment. There are no coarse facial or other dysmorphic features. Laboratory studies show anemia, thrombocytopenia. Which disorders is most likely present?
Gaucher's Dz - Glucocerebrosidase deficiency
Jaundice caused by elevated stress, decreased appetite. Vital signs WNL. Elevated total and unconjugated bilirubin. These are indicative of what condition?
Gilbert's Syndrome
What hormone is a pancreatic hormone that stimulates the hormone-sensitive lipase?
Glucagon
What hormone level is suppressed by Metyrapone?
Glucocorticoids
A sexually active adolescent develops fever, pain with movement of fingers, and weak grasp. Physical examination finds point tenderness in the hand and petechial rash on the dorsum of the hands. Culture of the joint fluid is sterile. What is the dx?
Gonococcal Arthritis
An abrasion on a 4y/o begins to develop redness around the site and purulent drainage from the wound, what pathogen is the most likely cause of the infection?
Grp A Strep
What pathogen causes scarlet fever?
Grp A Strep
Infants profoundly affected by this d/o may have coarse facial features with a dull look, large protruding tongue, and puffy-appearing face. Hair may be dry and brittle while skin may be jaundiced. Feeding is poor and constipation is common. Affected infants do not cry a lot, are sluggish, and are inactive with decreased muscle tone. What condition is this describing?
Hypothyroidism
A 10-year-old male presents to his primary care physician with a 2-day history of sore throat, fever up to 39.0°C orally, and dull midepigastric pain. He has had a single episode of non-bilious emesis. He also reports a moderately severe, non-throbbing frontal headache. There is no history of rhinorrhea, cough, or diarrhea. On physical exam, the patient looks ill but nontoxic. Temperature - 39.3° C, heart rate 105, blood pressure 110/65, respiratory rate - 20. Head, ears, eyes, and nose are normal. Tonsils are enlarged, beefy-red with purulent exudate. Petechiae are present on the soft palate. There is a white "coat" on the tongue. Neck is supple with prominent bilateral anterior cervical adenopathy. Skin is warm with a confluent red "sandpaper-like" rash over the trunk and more prominently in the groin area. What is the dx?
Grp A beta Strep - Scarlett Fever
Which of the following is the correct diagnosis for a clinical picture of progressive muscle weakness two weeks after an infectious disease or vaccination?
Guillain-Barre syndrome
Physical exam of a 5y/o, reveals a thin male in no distress. Weight is 26 kg. Temperature is 99.8o, RR- 26, HR- 112, and BP- 110/62. His head is normocephalic and atraumatic, OP is unremarkable. TMs- normal Neck- supple without adenopathy Chest- clear Heart-rate/rhythm regular without murmur Abdomen- mild, diffuse tenderness throughout, no rebound or guarding present Neurological- intact Extremities- dorsa of both hands with non-pitting edema and tender, bilateral ankles are slightly swollen with some pain upon motion Skin- 1-2 cm erythematous maculopapules on buttocks, thighs, and shins.
HSP - Henoch Schonlein Purpura
Which method of assessment would provide clues about the duration of exposure and the degree of lead accumulation?
Heme precursor, protoporphyrin level
Case #200014:
Hemophilia A
The triad of abdominal pain, lower extremity rash, and joint pain is suggestive of what diagnosis?
Henoch-Schönlein purpura (HSP)
You are called to the nursery to examine a newborn who is slightly jaundiced on the second day. Your examination is normal and there is nothing significant in the history except that the mother received essentially no prenatal care. She did have a test for syphilis, which was negative; she was immune to rubella; and there is no blood group incompatibility. Upon further questioning of the mother, she admits to having had occasional "recreational" IV drug use during pregnancy. What is this infant at risk for that could cause her sx?
Hepatitis
An 8-year-old male presents to your office with a history of a blister on the ring finger of his left hand. It has been present for three days. His mother has been applying a topical antibiotic ointment with no significant improvement of the blister. Review of systems reveals that the patient had a cold sore approximately one week ago. Past medical history is unremarkable. Examination reveals vesicles with an erythematous base surrounding the nail of the patient's left ring finger. The vesicles appear to have a clear exudate in them. A cold sore is resolving on the patient's upper lip. What is the diagnosis and appropriate treatment?
Herpetic Whitlow - Analgesics and splinting of the involved digit
The typical clinical picture for which disease is described as;
Hexosaminidase A Deficiency/Tay-sachs
A 6-month-old Jewish infant was brought to your office due to inactivity. The mother noted that the baby is limp and will cry very loud if he hears a noise and his muscles are weak for his age. She observed that her baby cannot turn-over yet and will not even try to turn on either side. Upon physical examination the infant assumes a frog-like position and reddish discoloration on the eye was also noted. What is the most likely diagnosis?
Hexosaminidase A Deficiency/Tay-sachs Dz
A 4-year-old boy is brought in by his mother for assessment of possible Attention Deficit Hyperactivity Disorder (ADHD). He has continued to show some immature behavior; unwillingness to eat or dress independently, an inability to consistently toilet train as well as poor attention skills. He achieved his major developmental milestones more or less on time, though fine motor and language development were attained late. What is an essential part of this child's evaluation with cognitive impairment as part of your dx?
High resolution chromosome analysis
An 8-year-old child was brought to your office because of swelling of the left upper eyelid associated with redness and tolerable pain. No fever was noted. Physical examination showed a localized swelling and redness on the upper middle lid of the left eye with slight tenderness on palpation. Vital signs were within normal limits. What is the most likely diagnosis?
Hordeolum
A 10-year-old female presents to your office with a 6-month history of constipation and occasional right-sided abdominal pain. She has no history of fevers, night sweats, urinary frequency, dysuria, emesis, or hematuria. Her appetite and activity have been normal.Abdominal exam reveals a 5cm by 7cm smooth mass in the right upper quadrant. No tenderness is elicited. No hepatosplenomegaly is noted. Some hard stool is palpated in the left lower quadrant. Rectal exam is heme negative. Neurological exam is within normal limits. Computed tomography shows a large cystic mass in the right upper quadrant contiguous with the right renal collecting system. No solid soft tissue component to the mass is noted. The remaining renal parenchyma on the right enhances normally with contrast and is otherwise unremarkable. The left kidney is normal, as are the remaining structures of the abdomen. Which of the following is the most likely cause of the patient's condition?
Hydronephrosis
Which autosomal disorder usually manifests during puberty or later with the classic clinical triad of obesity, hyperglycemia, and hyperinsulinemia? What is the tx?
Hypertriglyceridemia - Fibrates (Gimfibrozil)
What is the most common cause of sudden cardiac death in young athletes?
Hypertrophic Cardiomyopathy
The onset is usually of an acute nature, with multiple ecchymoses, petechiae, and epistaxis being common findings. Petechiae are most commonly noticed on the lips and buccal mucosa. Typically there is a preceding viral illness. The onset is usually of an acute nature, with multiple ecchymoses, petechiae, and epistaxis being common findings. Petechiae are most commonly noticed on the lips and buccal mucosa. What condition is described?
ITP
What is the MCC of acute onset of low platelets in an otherwise well child?
ITP
A 5-year-old male presents to the emergency room with a one week history of bruising and bleeding gums. He has previously been healthy, with only a viral upper respiratory infection noted a month ago. He lives at home with his parents and a 2-year-old sibling. He is up to date on his immunizations and he is taking no medications. He had an uncle who died from acute lymphoblastic leukemia at the age of twenty-one. On examination, the vital signs are normal. HEENT exam shows palatal petechiae and gingival bleeding. Tympanic membranes are normal. Neck is supple without adenopathy. Extremities are remarkable for large ecchymoses over his anterior tibias. He is active and appears to be in no distress. What is the dx? Which of the following is likely to be abnormal on a complete blood count?
ITP; Platelet count
MCC of precocious puberty in females?
Idiopathic
What is atopic dermatitis mediated by?
IgE
A five year old child has paroxysms of cough that increase in severity and duration. Some coughing episodes are followed by a whooplike, high-pitched inspiratory noise, and vomiting also occurred after paroxysms. Which laboratory test could lead to the earliest confirmation of the likely diagnosis?
Immunofluorescent antibody staining
What is the treatment of choice for chlamydia trachomatis pneumonia in children? ... in adults?
In children Erythromycin
When is isotretinoin (Accutane) contraindicated?
In prego women
An infantile onset or classic form, which accounts for the vast majority of cases, is characterized by spasticity, irritability, hypertonia, hyperesthesia, psychomotor arrest, and rapidly progressive neurologic degeneration, optic atrophy, and early death. Feeding difficulties, such as vomiting and reflux may cause failure to thrive. Sequelae, including infection and respiratory failure, cause most deaths. What is the condition?
Krabbe Dz
What is the MC defect leading to infantile hypothyroidism?
Incomplete development of the thyroid
An infant presenting with widened sutures, a bulging fontanelle, persistent downward eye deviation (sunset eye sign) and increasing head circumference are all signs of what?
Increased ICP
During the examination of the infant, either for a well baby checkup or if ill, it is important to listen carefully to the infant's breathing and the quality of the cry. What might a shrill high-pitched cry indicate?
Increased ICP
What is a negative PPD test? What is a pos PPD test?
Induration of less than 5mm is a negative test. Induration of 10mm or more is a positive reaction.
What is jaundice appearing during the 4th - 7th usually due to?
Infection
A 5 year-old-male child was brought to the emergency department due to generalized edema and weakness. Liver is enlarged, there is hyperpigmentation of the covered areas. Weight is normal but height is on the 10th percentile. What is the most likely diagnosis?
Kwashiorkor
A 2-year-old female presents to your office with a complaint of severe anal itching over the past 3 weeks. The itching has kept her up at night. No others in the household have similar symptoms, but a few children in the day care have manifested similar itching recently. Her physical exam is completely unremarkable except for minimal perianal erythema. What is the most appropriate treatment option?
Mebendazole
In what childhood disease does free fatty acids reach dangerous levels in untreated cases?
Medium chain acyl-CoA dehydrogenase deficiency
A 5-month-old male is brought to the ED by paramedics after his mother found him having a seizure involving all 4 limbs. His mother tells you that he was born full term without any complications and has been well until two days ago when he developed a fever. He vomited multiple times yesterday and was irritable. He has not had diarrhea or cough. He was given antipyretic medication for his fever. On physical exam, his temperature is 102.7 F, his pulse is 154/min, and BP- 90/50 mmHg and RR- 20/min. He is lethargic, pale, and focal neurological deficits are present. His anterior fontanel is bulging. You suspect that he has bacterial meningitis. After drawing blood samples for investigations, what is the next appropriate step in the management?
Intravenous empirical antibiotics
Systolic murmurs, tachycardia, and irritability may be present. Laboratory tests generally show a low hemoglobin, low MCV, low MHC, and high RDW. The peripheral blood smear shows a hypochromic microcytosis. The reticulocyte count may be low, and the platelet count may be elevated. Serum iron will be low. Total iron binding capacity will be high. The signs and lab test are congruent with what dx?
Iron def anemia
A 2½-year-old white male presents to the clinic with a 1-month history of decreased energy and increased somnolence. His mother admits that he is a picky eater and that he "loves to eat mattresses." Review of systems reveals that he drinks milk only with cereal and has occasional constipation. His vital signs are within normal limits. What deficiency do you suspect in this pt?
Iron deficiency
What medication can cause a deficiency of Vitamin B6 (pyridoxine) after a period of prolonged application?
Isoniazid
Pain in the right groin area, a two week history of limp, and limited abduction of the right hip in an afebrile 5-year-old boy is consistent with
Legg-Calve-Perthes disease (LCPD)
A child is brought to the emergency room with colicky pain, history of irritability, and lethargy. Rectal bleeding and "currant jelly" stool are also noted. Plain abdominal film shows evidence of obstruction and barium enema detects coiled-spring appearance to the bowel. Intussusception is diagnosed. Which of the following diseases would you suspect if intussusception is before age 10, there is bleeding, anemia and protein-loosing enteropathy?
Juvenile polyposis
What disease commonly presents as intussusception before age 10?
Juvenile polyposis
Parents notice a gradual change in the behavior of their two year old daughter. She has become withdrawn, lost interest in playing outdoors, and tends to sit around. Parents also noticed symmetric swelling of the knees and ankles. The girl did not have any infections during the last six months and there is no apparent explanation for these changes. Tests for antinuclear antibody are positive, but for rheumatoid factor are negative. What is the dx?
Juvenille RA
A 12-year-old white male presented to his local ER a week ago with a 1-month history of progressive confusion, lethargy, and memory loss. A CT scan of the head revealed an isolated, hypodense, cerebral mass. Histologic examination has revealed a high-grade large-cell immunoblastic lymphoma (Non-Hodgkin's lymphoma). A complete oncologic staging evaluation reveals that this is a primary brain tumor with no evidence of metastatic disease. What other malignancy has a higher incidence in children with this patient's underlying disease?
Kaposi's sarcoma - Most children who develop an isolated primary central nervous system lymphoma (PCNSL) of the brain have acquired immunodeficiency syndrome (AIDS); this is a late complication
Characterized by profound thrombocytopenia in conjunction with a single, large hemangioma or diffuse hemangiomatosis. Other clinical manifestations include petechiae, ecchymoses, or intimal bleeding. Thrombocytopenia is secondary to platelet trapping. What condition is described?
Kasabach-Merritt Syndrome
A 9-year-old boy presented to the emergency room with sudden onset of anterior chest pain, vomiting and general malaise. Twelve months before, the patient had a febrile illness associated with conjunctivitis and peeling of the skin on the hands and feet. Physical exam is as follows: Temperature 99°F; pulse 120 beat per minute: respirations 23 per minute; blood pressure 110/60. Skin: normal with no petechiae or splinter hemorrhages. Lungs: Clear. Heart: Normal. Lab: WBC 8,900/mm3, hematocrit 35%. EKG: ST elevation in the right precordial leads with an anterior myocardial infarction. Based on the history and physical exam, what is the most likely diagnosis?
Kawasaki's disease
Which sign is described as pain with and limitation of knee extension when the hip is flexed 90° to the trunk? What does it signify?
Kernig Sign, Meningitis
Which intravenous anesthetic is used mainly for children and young adults for diagnostic procedures of short duration ?
Ketamine
...
Ketoconazole
What sex chromosome linked disease has the clinical feature of eunuchoid body habitus, low serum testosterone, high estradiol/ testosterone ratio and high urinary gonadotropin levels?
Klinefelter Syndrome
47XXY = ?
Klinefelter syndrome
Characterized by a cutaneous port-wine stain overlying a combined vascular malformation; limb hypertrophy frequently results. What condition is described?
Klippel-Trenaunay-Weber Syndrome
As you examine a 4 day old infant born through vaginal delivery, you notice that she has a very poor grip reflex of the right hand. Evaluation of her face also reveals slight ptosis and miosis of the right eye. What condition explains the findings regarding this infant?
Klumpke's paralysis with involvement of the sympathetic fibers of T1
Which form of paralysis affects the small hand and wrist muscles causing limpness and inability to grip? Which nerves are affected?
Klumpke's paralysis; cervical nerves 7, 8 and the 1st thoracic
What hormone regulates the synthesis of dihydrotestosterone?
LH
The deficiency of which intestinal brush border functions will cause milk intolerance?
Lactase
What condition seen in newborns is described as being caused by a congenital deformity or flabbiness of the epiglottis and supraglottis that leads to collapse of the airway during inspiration?
Laryngomalacia
What is the most common cause of stridor in the newborn period?
Laryngomalacia
A 3 day old pt is making noisy, crowing sounds upon inspiration. The sounds worsen when the infant cries. The infant is the product of a normal pregnancy and delivery. No intubation occurred around the time of birth. Symptoms appear worse when the infant is placed on his back. Slight intercostal retractions are noted when the infant is agitated. Direct laryngoscopy reveals collapse of the laryngeal tissues upon inspiration, and no other abnormalities. What is the dx? What is the tx?
Laryngomalacia - Usually requires no tx as it tends to spontaneously resolve
What is the MC source of lead exposure?
Lead based paint
These children typically present with a limp or mild anterior thigh pain. Antalgic gait, muscle spasm, limitation of range of motion, and proximal thigh atrophy are often seen. What condition is described?
Legg-Calve-Perthes Dz - Avascular necrosis of the femoral head
A 5-year-old boy is seen in the family medicine clinic by his physician for limping. According to his mother he had fallen in the playground 2 weeks ago. He has been afebrile and complains only of pain in the right groin area. The pain is worse at the end of the day. Physical examination demonstrates a child who appears comfortable. There is limited abduction of the right hip. The likeliest explanation for these findings is
Legg-Calve-Perthes disease
Which condition is described as having a clinical presentation of mild or intermittent pain in the anterior thigh and a limp: with physical exam findings including an antalgic gait, proximal thigh atrophy, and mild shortness of stature?
Legg-Calve-Perthes disease
What condition is characterized by chronic, pruritic, eczematous, circumscribed solitary plague that is usually hyperpigmented and lichenified, and is most commonly see in the posterior aspect of the neck, dorsum of the feet, wrists and ankles?
Lichen Simplex Chronicus
A newborn with multiple cutaneous hemangiomas has high output congestive heart failure. A visceral hemangioma is most likely to be found in which organ?
Liver
What condition is described as having symptoms including erythema migrans, an annular rash, common in the axilla, periumbilical area, thigh, and the groin; fever; myalgia; headache; paralysis of the seventh (facial) nerve; and arthritis (usually large joints)?
Lyme Disease
It arises most often in puberty and females are affected 4 times as often as males. About 70% of cases are unilateral, with the left lower extremity being involved more often than the right. Histologically the lymphatics are reduced in caliber and number and demonstrate a hypoplastic pattern. What condition is described?
Lymphedema praecox
...
MCC is chronic lymphocytic thyroiditis (Hashimoto's thyroiditis)
In which type of MEN does Islet cell tumor, pituitary adenoma, and adrenocortical adenoma only occur in?
MEN Type 1
The 5-year-old daughter of African immigrants is brought to your office because she is running a high fever, coughing, and that morning the mother had discovered a rash. The little girl holds her hands in front of her eyes and complains about the light hurting. After questioning the mother, she remembers having seen white dots in her daughter's mouth a few days ago. The girl has not had any vaccination yet. Upon examination you see conjunctivitis, clear secretion coming out of her nose, and a rash with dark-red, irregular macules, up to 1cm in diameter and some confluent. They are most intense behind the ears and it looks if they were spreading centrifugally over trunk and extremities. There are no enlarged lymph nodes, the pharynx is slightly red, and there is no abdominal tenderness or enlargement of liver and spleen. The girls temperature is 40° C (104° F) What is your dx? What is the MC complication?
Measles, Pneumonia
In which sex is pyloric stenosis more common?
Males
Amish parents bring their infant to the emergency room in a coma. Parents mention difficulty in feeding and slow development during the last few months. The baby opens his eyes and withdraws only to pain and there is no verbal response to pain. Pupils are responsive and cold water vestibular stimulation is normal. There is tachypnea and hyperpnea. His urine has a burned sugar odor. Laboratory studies indicate metabolic acidosis. Which of the following is the most likely cause of the coma?
Maple Syrup urine dz - Accumulation of branched chain ketoacids
Symptoms are typically vomiting, poor feeding, and decreased activity, sometimes progressing to severe lethargy or coma. The presence of alloisoleucine with a sweet syrup smell to the urine is diagnostic. What is the condition?
Maple syrup urine disease, an organic acidemia, results from a defect in the processing of certain amino acids.
What parathyroid testing pattern corresponds with sarcoidosis?
Markedly elevated serum calcium, close to normal serum PTH
Which of the following is a contraindication to breastfeeding?
Maternal Lithium Usage
What childhood infectious condition has a characteristic rash beginning on the head and spreading downward?
Measles (rubeola) - rubies on the forehead
Which condition is characterized by macrocytosis and hypersegmented neutrophils on the peripheral blood smear, the MCV is elevated, as is the RDW?
Megaloblastic Anemia
What gland is infected in a Hordeolum?
Meibomian, Zeis and Moll glands
(+) antiGBM antibody and renal pathology showing focal to diffuse proliferation with crescent formation under Light microscopy is characteristic of what condition?
Membranoproliferative GN
It is usually seen between 12-18 months of age with irritability, gait difficulties, ataxia, hypotonia and optic atrophy. It rapidly progresses to death within the first decade of life.
Metachromatic Leukodystrophy (MLD) - Infantile Form (MC and most severe form)
Tx for giardiasis?
Metronidazole
...
Miconazole,
A 4-day-old male infant is seen by the pediatric resident in the newborn nursery for bilious vomiting and abdominal distention. The child had been feeding poorly and has been difficult to console according to the mother. He passed meconium shortly after birth and has passed several seedy, yellow stools per day since then. Physical examination reveals abdominal distention. The likeliest explanation for these findings is
Midgut volvulus
Which drug is used to prevent gastric injury by NSAIDs?
Misoprostol
As a pediatric resident you see a 6-month-old African American girl whose mother is concerned about her daughter developing a pigeon breast. She also tells you that her child is still exclusively breast-fed and has not been sick since she was born. Pregnancy and delivery had been normal. Since you find a Harrison's groove and costochondral thickening, besides the sternal protrusion, you order a skull X-ray, which shows craniotabes. What is the dx?
Moderate Rickets
A one-month old male infant is brought to you with non-bilious vomiting. Physical examination finds dry mucous membranes, slightly decreased skin turgor, jaundice, and a firm, peanut-sized swelling in the epigastrium. The upper GI series finds non-progression of the peristaltic wave and railroad track sign. What condition do you suspect?
Pyloric Stenosis
Case #200594:
Mono - Intravenous rehydration and corticosteroids
Paul-Bunnell-Davidson test is used to confirm what illness?
Mononucleosis
In children, the most common malignant tumor of the parotid gland is ___?
Mucoepidermoid carcinoma
What group of conditions has four criteria including (1) it is a primary myopathy; (2) it is hereditary; (3) it follows a progressive course; (4) degeneration and death of the muscle fibers occur?
Muscular Dystrophy
Widespread inward migration of sarcolemmal nuclei is suggestive of what condition?
Muscular dystrophy
Which disease is caused by autoantibodies against neuromuscular acetylcholine receptors and on biopsy has characteristic lymphorrhages around degenerating myofibers and widened synaptic clefts?
Myasthenia gravis
Which of the following is the correct diagnosis for a clinical picture of an infant, born to mother with myasthenia gravis, who hours after birth experiences weakness of bulbar muscles? How is it treated?
Neonatal myasthenia
Approximately eight hours after a forceps delivery the newborn is observed to be lacking unilateral facial movement. What is the most probable cause?
Neurapraxia of the facial nerve (VII)
The presence of rosette patterns in a highly cellular tumor is characteristic of what childhood condition?
Neuroblastoima
A 4-year-old boy presents to the emergency department late one night with remittent abdominal as well as right hip pains, fever, sweating, decreased appetite, and constipation with pencil-thin stools worsening over a 2 week period. Abdominal exam reveals alarge, distinct, palpable, firm, slightly tender 10 x 12cm mass crossing the midline centered in the lower right quadrant. What is the most likely dx?
Neuroblastoma
Abdominal tumors arising from the adrenal glands or retroperitoneal sympathetic ganglia account for 75% of all neuroblastomas and present as solid, often fixed, painful or painless, irregularly shaped masses crossing the midline. Constitutional symptoms may be caused by catecholamine production and include fever, weight loss, flushing, sweating, and irritability. What is the most likely dx?
Neuroblastoma
What is the most common solid tumor in children outside the CNS?
Neuroblastoma
What is the only solid tumor which rarely metastasizes in the lungs?
Neuroblastoma
What is the most important diagnostic test for defining a suspected brain tumor?
Neuroimaging - MRI
Pellagra = ?
Niacin deficiency
What is the most common respiratory pathogen of early childhood and the major cause of bronchiolitis and pneumonia in infants younger than one year?
RSV
A 5-month-old male baby is brought to the hospital by his parents. They fear that the baby's developmental milestones are lagging behind and that the baby is mentally retarded. Examination reveals massive splenomegaly, hepatomegaly, enlarged cervical and inguinal lymph node, and atypical psychomotor functions. Ophthalmoscopy reveals a cherry red spot. A liver biopsy is performed. It shows numerous foamy macrophages. The frozen section of the fresh tissue stains positive for fat with oil red O. The most likely diagnosis in this case is
Niemann-Pick Dz
Patients usually present with hepatosplenomegaly, failure to thrive, and deterioration of psychomotor function. A cherry red spot is seen in the retina. On histology the affected cells are enlarged and filled with numerous small vacuoles that impart foaminess to the cytoplasm. What is the dx?
Niemann-Picks disease
A mother brings her 2-year-old son to your office because she has concerns about his sleep. She notes that he is easy to put to sleep and has a regular bedtime at 7:30 P.M. For the past three weeks, on most nights, about 90 minutes after being put to sleep, he begins to thrash violently in the bed and, at times, lets out blood-curdling screams. He has his eyes open and seems to be talking, but he does not respond to either parent when spoken to. He sweats a lot. The episodes last about 15 minutes and then he goes back to sleep. He seems fine in the morning. What is the dx?
Night terrors
More common early in the morning, most common between 3 and 6 years and more common in children with mental retardation, depression, and certain CNS disorders. They are characterized as frightening dreams and often reflect daytime stress and the child is easily arousable and comforted. What condition does this describe?
Nightmares
MC form of Nephrotic syndrome?
Nil (lesion) disease or Minimal change
A 3-year-old female presents to your office with a 4-day history of burning with urination. Her mother states that she has had no fever, no diarrhea, and is on no medications. She uses a bubble bath twice a week. Her mother has also noted a clear mucoid discharge from the vagina. She does not attend day care. She is potty trained and performs her own wiping. Physical exam reveals an erythematous and slightly swollen vaginal introitus. A clear, thin, mucoid discharge is noted. The hymen is intact. Anus appears normal. Unusual odors are not detected. Urinalysis is within normal limits. The most likely cause of her condition is:
Nonspecific vulvovaginitis
A longer incubation period of 16-48 hours, together with abdominal pain and watery diarrhea is typical of what food pathogen contaminant?
Norwalk and Vibrio cholerae
What is the most frequent viral cause of diarrhea in older children?
Norwalk virus
Typically weight gain occurs throughout the day as edema collects in the lower extremities after prolonged sitting or standing. It occurs almost exclusively in postpubertal women and can occur at any time during the menstrual cycle. Headaches are common and may be related to increased pressure. Many patients will also urinate infrequently during the day and have increased urination during bedtime hours when recumbent. Psychological symptoms are very common and adolescents often become depressed, anxious, and frustrated. In addition fatigue, dizziness, light-headedness, syncope, and unexplained tachycardia may all be present. What condition is described?
Orthostatic edema
What is the treatment for Candidiasis?
Nystatin,
Which disorder is characterized by an individual has obsessions, recurring or persisting thoughts, images, or impulses that interfere with general thinking and cause significant distress or anxiety and/or compulsions, the need to repeat physical behaviors?
OCD - Obsessive Compulsive D/O
A maternal serum alpha-fetoprotein done at 18 weeks was abnormally high; the acetylcholinesterase level was normal. During the sonographic examination the spinal column was surveyed and found to be normal. What is another possible reason for an elevated MSAFP?
Omphalocele
How can you tell the difference between tinea of the skin and dermatophyte infection of the hair?
On Wood's lamp dermatophyte infection will have a pale green fluorescence
What are the MC side effects of inhaled steroids?
Oral candidiasis and hoarseness
In what childhood disease does ammonia reach dangerous levels in untreated cases?
Ornithine transcarbamylase deficiency (OTCD)
What orthopedic maneuver is described as the thigh is gently abducted, bringing the femoral head from its dislocated posterior position opposite to the acetabulum, reducing the femoral head into the acetabulum?
Orthopedist
What vitamin deficiency is characterized by diarrhea, dementia, and a sunburn-like dermatitis?
Pellagra - Niacin Deficiency
...
Penicillin and immunization
What orthopedic sign is defined as the palpable sensation of gliding the femoral head in and out of the acetabulum?
Ortolani Maneuver
What condition is described as avascular necrosis of the bone underlying the articular cartilage that can be asymptomatic or have sx including edema, pain, and limited mobility?
Osteochondritis desiccans
Which condition is described as anterior swelling or enlargement of the thigh without pain, with x-ray findings including solitary or multiple lucent, cortical diaphyseal lesions surrounded by sclerosis?
Osteofibrous dysplasia
Brodie abscess, Sequestrum and involucrum are all signs of what condition?
Osteomyelitis
Usually located in the metaphysis of a long bone, it presents with a progressively enlarging painful swelling occurring during the growth spurt What condition is suspected?
Osteosarcoma
Tx for Grp A Strep?
PCN
What is the treatment for Scarlett Fever?
PCN for 10 days
Bone condition described as having signs of high turnover of bone, particularly accumulation of woven bone, and large atypical cells with slightly basophilic cytoplasm and MC occurs in adults > 40y/o?
Paget's disease
Pt prsents with abrupt onset of fever, throat pain, dysphagia, headache, abdominal pain, absence of cough, hoarseness, rhinitis. There are exudates on 4 + tonsils, and cervical lymphadenopathy, what condition do you suspect?
Strep
What is the treatment for most congenital hip dislocations?
Pavlik harness
A five year old child has paroxysms of cough that increase in severity and duration. Some coughing episodes are followed by a whooplike, high-pitched inspiratory noise, and vomiting also occurred after paroxysms. What is the most likely diagnosis?
Pertussis
Primary drugs for generalized seizures (3)
Phenobarbital, primidone, and phenytoin
In what childhood disease does phenylalanine reach dangerous levels in untreated cases?
Phenylketonuria
What nerve injury is likely to result from lateral hyperextension of the neck especially during breech births or difficult forceps delivery?
Phrenic nerve injury
A seven-year old girl has a one centimeter mass in her right cheek. This lesion is painless, firm, sharply demarcated, and the overlying skin has a bluish discoloration. What is the most likely diagnosis?
Pilomatrixoma - calcifying epithelioma of Malherbe
3 weeks after a virus infection, a 7-year-old child develops muscle weakness. It first started with the legs and subsequently progressed to other muscles. On examination, the child is alert but strength testing confirms muscle weakness and areflexic motor paralysis. Analysis of cerebrospinal fluid shows acellular rise of total protein. What is the most important test in follow-up of this disorder?
Pulmonary function
What pathogens are responsible for impetigo?
Streptococcus pyogenes than by Staphylococcus aureus
Clinically there is massive cardiomegaly and muscle hypotonia. Mild hepatomegaly may also be found. The phenotypic expression is variable in age of onset and organ involvement, though all involve a myopathy. Affected children appear normal at birth but soon develop generalized muscle weakness, feeding difficulties, macroglossia, hepatomegaly, and progressively worsening heart failure due to hypertrophic cardiomyopathy. Dx?
Pompe's dx
A 6-year-old boy was brought to your office due to edema and brownish discoloration of the urine. Upon physical examination, a grade 1-2 pitting edema over the lower extremities was noted. Vital signs show a BP+ 130/100. Three weeks prior to the onset of the present symptoms, the patient had a fever and sore throat for which he was given medications and improved after several days. A routine urinalysis was requested which revealed RBC-(+++), RBC cast-( ++). What is the most likely diagnosis?
Post streptococcal glomerulonephritis
Which psychiatric d/o is described as occurring after an individual faces a catastrophic event involving threat of death or serious injury, witnessing such an event, or awareness of such events occurring in the community, causing intrusive recollections of the event, recurrent dreams, a flashback - like re-living of the event that may include sensory hallucinations and symbols that represent the event?
Post-traumatic Stress D/O
In your pediatric clinic you see an 8-year-old white boy who is attending first grade for the second time and still seems to be unable to keep up in school, physically and mentally. He is 110 cm tall and weighs 50 kg. A body composition test shows significantly increased body fat with very little lean body mass. He has almond-shaped eyes and a narrow forehead and the scrotum is hypoplastic. What is your dx?
Prader-Willi syndrome
Phenotypic characteristics include neonatal hypotonia that improves with age, difficulty in feeding as a newborn, excessive weight gain between the ages of 1 and 6 years, distinct facial features, hypogonadism, mild to moderate mental retardation, and atypical behavior concerning food, such as excessive appetite, foraging behavior, or obsession. Behavioral problems are often seen and include temper tantrums and outbursts, rigidity, possessiveness, stealing, and lying. Sleep disturbances are often noted. These individuals also often have a high threshold for pain and do not vomit. Obesity is common due to the compulsive eating and obsession with food and individuals must be strictly monitored. What is the condition described?
Prader-Willi syndrome
Tx for tapeworms?
Praziquantel
Tx of schistosomiasis?
Praziquantel
As a pediatric resident you see a 6-month-old African American girl whose mother is concerned about her daughter developing a pigeon breast. She also tells you that her child is still exclusively breast-fed and has not been sick since she was born. Pregnancy and delivery had been normal. Since you find a Harrison's groove and costochondral thickening, besides the sternal protrusion, you order a skull X-ray, which shows craniotabes. What is your treatment?
Prescribe 3000 IU/day vitamin D3 p.o. for 30 days for the child
A 12-year-old boy is brought to you with short stature. Bone age, T4, T3 resin uptake and TSH level can be used to confirm or rule out
Primary hypothyroidism
What is suggested by the absence of any cry?
Profound mental retardation
MC pathogen causing OE?
Pseudomonas
What condition has an associated Auspitz sign?
Psoriasis
What skin condition is characterized by erythematous papules that coalesce to form plagues with irregular borders that appear as silvery or yellow-white scale and when removed induce pinpoint bleeding?
Psoriasis
When assessing pubertal development, what information is important to remember in children of Asian descent?
Pubic hair distribution may not progress beyond stage 3
A 6 month old child with congenital heart disease develops severe cough, rhinorrhea, and fever in late fall. During hospitalization, worsening cyanosis and radiographic appearance of bronchiolitis are observed. What is the most likely pathogen? What is the drug of choice if laboratory test confirms the most likely pathogen?
RSV; Ribavirin
Early afternoon, an adolescent boy is brought to the emergency room with abdominal pain, nausea, and vomiting. The pain has been worsening since the onset of symptoms in the morning. Physical examination finds no abdominal tenderness, but psoas sign and tenderness on rectal examination are detected. Temperature and pulse are slightly elevated. Skin turgor is reduced and there is a 10 mm Hg drop in postural blood pressure. Laboratory studies find 18,000 white blood cells per microliter. What could confirm the diagnosis of acute appendicitis without perforation?
Radiopaque fecalith
What is the preferred method of imaging the hip in the first months of lives?
Real-time ultrasound
A 24-year-old white female, gravida 2, para 2, comes to the emergency department in a distressed state. She has brought her 5-day-old daughter with her and reports that the child started to bleed spontaneously from her vagina. The pregnancy was without any complications; labor was at term and occurred spontaneously without any problems. Examination of the child reveals an afebrile child with blood at the introitus. The child does not appear to be in pain and sleeps through the examination. Which of the following would be the next step in management?
Reassure the mother and send her home;
The distinguishing feature that differentiates Anorexia Nervosa from Bulimia Nervosa is:
Refusal to maintain a minimally normal body weight
A 2-year-old female presents to the emergency room having swallowed a coin approximately 2 hours prior to her arrival. She has some drooling and appears anxious during the examination. Her parents have noted no stridor or dyspnea. Physical examination is unremarkable. A chest radiograph reveals a radiopaque round object at the distal esophagus. What is the most appropriate treatment option?
Removal of coin via esophagoscopy
Which type of metabolic acidosis, typically presents with failure to thrive, polyuria, and constipation?
Renal tubular acidosis (RTA)
What is aldosterone secretion primarily regulated by?
Renin-angiotenisin system
Which type of Anorexia Nervosa, is specifically characterized by Failure to engage in bingeing and/or purging?
Restricting Type
Onset is typically in the second year of life, beginning with regression in motor and language development, and progressing to autistic behaviors, microcephaly, and a characteristic hand-wringing behavior. This describes what condition?
Rett Syndrome
What vitamin deficiency results in chelosis, glossitis, keratitis, photophobia, blurring of vision, seborrheic dermatitis, and anemia?
Riboflavin, vitamin B 2
A 6-year-old boy with a history of strabismus goes to his ophthalmologist for follow up and corrective intervention. His exam expectedly reveals his condition is as follows: on the cover test when his left eye is covered, his right eye moves toward his nose while observing a target. Based on your vision exam, which of the following eye deviations does this boy have?
Right exotropia
What infectious disease of childhood is characterized by abrupt fever and rush spreading from the trunk peripherally?
Roseola infantum
A 14-year-old female presents to your office with a complaint of the onset of a rash that began on her face yesterday and it now seems to be spreading down her body. She also has been complaining of sore lymph nodes in the back of her neck for the past 3 days. She has only had a slight fever since yesterday. She is uncertain about her immunization status. Her examination reveals a maculopapular rash that is most prominent on her trunk, abdomen, and back. There is confluence of the rash on some areas and her face appears flushed. She has tender posterior cervical lymph nodes bilaterally. She exhibits some joint tenderness of her distal phalanges. The most likely etiology of these findings is:
Rubella - German Measles
A 6-year-old male is brought to your clinic with complaints of high fever and a rash all over his face. The boy arrived in this country a week ago from his home in the Asian subcontinent. His mother states that he has a 4 to 5-day history of a cough and cold with a fever and suddenly developed a rash over his face today. She says that he had 3 vaccinations when he was an infant and none after that. On examination, the boy looks malnourished and very ill, with a 104 degree temperature. There was some congestion of the conjunctiva, and some red spots were observed inside his buccal cavity. The rash on his face was maculopapular. What is his dx?
Rubeola - Measles
Which cause of infective endocarditis is common in children?
S. aureus and S. epidermidis
Typically presents in obese or rapidly growing adolescent males, usually between the ages of 12 and 15. It may occur from an upward blow through the femoral shaft, but is generally not associated with any significant trauma. Radiographic findings include widening of the epiphyseal plate in the pre-slip condition and frank slippage of the femoral neck in relation the capital epiphysis. What condition is suspected?
SCFE - Slipped Capital Femoral Epiphysis
A 13-year-old male is brought to your urgent care center with the complaint of right knee pain that began acutely 2 days prior to his visit. He does not recall any trauma. He has not been ill. His past medical history is unremarkable with the exception of parental concerns over his weight, which has been over the 99%tile since age 5. Extremities- left leg within normal limits, right leg reveals significant pain upon any hip motion and he maintains the leg in external rotation and adduction. AP and frog legs views of the hips demonstrate anterior rotation of the femoral neck in relation to the capital epiphysis. The most likely cause of the patient's symptoms is:
SCFE -Slipped capital femoral epiphysis
Which tanner stage or sexual maturity stage in a female is described as pubic hair is sparse, lightly pigmented and straight while the breast and papilla are enlarged, areolar diameter is also increased?
SMR II or Tanner Stage II
A 13-year-old female came to your office for a routine physical exam. She appeared to be well nourished and well developed. She has not started menstruation yet. Physical examination of the breast showed enlargement of areolar diameter. Her pubic hair is darker and beginning to curl. Based upon the physical findings, what is her Sexual Maturity rating at present?
SMR III
Which tanner stage or sexual maturity stage in a female is described as the pubic hair is darker with increasing amount and it starts to curl, while the breast and areola are enlarged but does not form secondary mound?
SMR III or Tanner Stage III
Which tanner stage or sexual maturity stage in a female is described as pubic hair is coarse and curly, abundant in amount but is less than in adult and the areola and papilla form a secondary mound?
SMR IV or Tanner Stage IV
Which tanner stage or sexual maturity stage in a female is described as the pubic hair has achieved the adult female triangular shape spreading to the medial surface of the thigh and the nipple projects and becomes a part of the general breast contour?
SMR V or tanner stage V
Intensely pruritic rash with pustules between the fingers are characteristics of what infectious condition?
Scabies
What is the MCC of entropion?
Scarring (usually from SJS or trachoma)
Clozapine is the appropriate medication for which childhood psychiatric disorders?
Schizophrenia - it is an atypical antipsychotic
An 8-month-old infant was brought to your office due to rashes over the scalp and eyebrows. Physical examination showed a dry, scaly, and crusting lesion over the scalp, eyebrows, and nape area. What is the most likely diagnosis?
Seborrheic Dermatitis
What condition has typical features of including fever, toxicity, and limited range of motion, externally rotated and partially flexed posturing of the involved leg, elevated white blood cell count and erythrocyte sedimentation rate, and a positive bone scan.
Septic arthritis of the hip
An 11-year-old presents to your office with a 3-week history of right heel pain. He has been active playing baseball over the past 2 months. No history of trauma is elicited. His past medical history is unremarkable. His only medication is occasional ibuprofen. On physical examination, he has tenderness to lateral compression of his right heel. His height and weight are in the 90th percentile. The remainder of the examination is within normal limits. What is your dx? What is an expected radiographic finding associated with that diagnosis?
Sever dz - osteochondrosis
What is subdural hemorrhage in children usually a results of?
Shaken baby syndrome/Abuse
Which disease is characterized by bloody mucopurulent diarrhea i.e., dysentery, and has neurotoxic effects i.e,, seizures?
Shigella
Which pathogen, causing acute infectious diarrhea, can be paired with the pathogenic mechanism of mucosal invasion with intense inflammatory response?
Shigella
What test is used to confirm vit B-12 malabsorption?
Shilling test
What is the most reliable method of establishing the diagnosis of sinusitis in children?
Sinus aspiration for bacterial culture - although it is rarely used
This is a situation where an infant has an association with going to sleep, such as nursing or having a parent lie down in the bed. If the child wakes and does not have the association present, then the child does not have the skills to go back to sleep alone. What is the disorder?
Sleep association disorders
What is the MC reason infants wake within the first thirty minutes of going to sleep?
Sleep association disorders
In children with juvenille RA, what screening should be done to find the MC and most concerning complication?
Slit-lamp examination for chronic iridocyclitis which can lead to blindness
What is the hallmark of hypothyroidism in children?
Slow linear growth
What is the most common cause of secondary amenorrhea in adolescents?
Stress-related conditions (2nd MC is pregnancy)
A 12-month-old female is seen by her pediatrician for a well-baby check-up. The physician notes that the child's height and weight are greater than the 98 percentile, and has been consistently since birth. Her head is also large for her age, as are her hands and feet. She is delayed in both gross and fine motor skills, and has yet to communicate verbally. Hypotonia is present. Karyotype analysis is normal. What is the most probable diagnosis for this child?
Sotos syndrome
It is not obvious at birth and there are no specialized laboratory tests that can confirm a diagnosis. Rapid growth occurs in the first 5 years of life. At the same time, motor skills and cognitive development are delayed. Hypotonia is present as well. The phenotype includes a large head with a tall narrow skull, eyes that are wide set and downward slanting, flat nose, pointed chin and "receding hairline", advanced bone age, and large hands and feet. What condition is described?
Sotos syndrome
Clinical manifestation is by feeding difficulties and failure to thrive. In general, their development is delayed but this is not very apparent since some of them may be able to sit, stand and learn other skills early in life. Later, mental retardation is more pronounced and children become malnourished and hypotonic. Hearing and vision are affected. Protruding abdomen and hepatosplenomegaly, cherry-red spot on the macula are also noted. Bone marrow aspirate will show foam cells.
Sphingomyelinase deficiency /Niemann-Pick Disease
Which clinical dz has characteristic described as:
Sphingomyelinase deficiency /Niemann-Pick Disease
What is the standard test to confirm adrenal insufficiency?
Standard ACTH test
Cause of bacterial tracheitis?
Staph Aureus
What is the MC causative agent of a hordeolum?
Staph Aureus
A 14-year-old male presents the emergency room with the complaint of the acute onset of nausea and vomiting. He attended a school picnic approximately 4 hours ago. He knows of two other classmates with similar symptoms. On examination he is well developed, well nourished with a temperature of 99.2° F, pulse of 110, and a blood pressure of 108/68. His mucous membranes are slightly tacky. His abdomen is soft and non-tender. What is the most likely etiology of his condition?
Staph aureus
What pathogen is usually indicated in bacterial tracheitis?
Staph aureus
What are the MC pathogens causing breast abscesses?
Staphylococcus Aureus and Streptococcus
What disorder is characterized by repetitive, driven, and non-functional motor behavior which lasts greater than four weeks? Examples include thumb sucking, nail biting, biting or hitting oneself, hand waving or shaking, head banging, body rocking, picking at nose, or mouthing objects.
Stereotypical Movement D/O
Which murmur is described as a vibratory, musical low to medium pitched midsystolic murmur that is heard best at the LLSB, with minimal radiation?
Still's Murmur
...
Subcutaneous nodules
Which class of anti-biotics can lead to kernicterus in newborns?
Sulfonamides
A febrile child with acute onset of painful swelling of the parotid gland, accompanied by drainage from Stensen's duct, is the clinical picture of what condition?
Suppurative parotitis
Tx for entropion?
Surgery
What is the tx for ectropion?
Surgery
A 1-month-old former premature male infant with BPD remains intubated and monitored in the NICU. He has been doing relatively well and is being gradually weaned from the respirator. Suddenly, his O2 saturations and heart rate plummet and he becomes very dusky. On quick exam, there are decreased breath sounds on the right with an asymmetric chest rise.
Tension pneumothorax
Physical examination is normal except for the following findings: The left testicle is approximately 1½ times the size of the right testicle. The skin is diffusely erythematous. Due to tenderness when touched, it is difficult to palpate the scrotum. Cremasteric reflex is absent. There are small, soft, pea-sized lymph nodes in both inguinal areas. Penis is circumcised and appears normal. Because you are unsure of the diagnosis, you order scrotal ultrasonography with Doppler ultrasound that demonstrates decreased blood flow to the testis. The most likely diagnosis is
Testicular torsion
Drug of first choice for Lyme disease of a 10-year-old child.
Tetracycline
Which condition has symptoms including a violaceous erythema on upper eyelids, a butterfly malar facial rash, mouth ulcers, alopecia, arthralgia, joint stiffness, serositis, seizures, psychosis, and hemolytic anemia?
Systemic lupus erythematosus
What condition is described as having symptoms including a fever that is usually high and occurs in the evenings, and is accompanied by a pale pink rash on the trunk and proximal extremities which may be accompanied by myalgias, but often suffer from severe arthritis?
Systemic onset JRA
A 16-year-old female is brought by paramedics to the ED for seizure activity. She has recently emigrated from Central America and has no previous medical problems. She was watching television and began to have a generalized tonic-clonic seizure based on the mother's description. The seizure lasted two minutes; the child was sleepy but then returned to her normal state when the paramedics arrived. There is no family history of seizures. The patient denies head trauma, any recent illnesses, fever, or headache. She denies using any medications or illicit drug use. Her neurological exam is normal. You perform a computed tomography of the brain, which reveals two calcified cyst-like lesions. These findings are most likely caused by what organism?
Taenia solium (Pork tapeworm) - cysts in the brain
This causes motor and mental deterioration commencing at about 6 months of age, blindness, and also a cherry red spot in the retina. Histologically there is ballooning of neurons with cytoplasmic vacuoles that stain positive for lipids with Oil red O or Sudan black B. What is your Dx?
Tay-Sachs disease
...
The treatment is anticholinesterase medication (e.g., pyridostigmine)
A 14-year old girl is brought to you with lack of menarche. Physical examination finds normal breast development but the vagina ends in a blind pouch and there is no palpable uterus. Serum testosterone is in the male range and LH is elevated. What is the most likely karyotype of this child?
This girl is most likely a boy with androgen insensitivity syndrome (X,Y)
A teenager develops pneumonia which is confirmed by chest roentgenography. Tetracycline is prescribed. A day later diffuse macular eruption is observed not only on the skin but also on several mucous membranes. The macules evolve into annular target or iris lesions and persist for several days. What is the most likely cause of the superimposing abnormalities?
This is a sign of M. pneumonia
On examination, the patient is well-appearing and afebrile. She has a slightly scaly, reddish-brown rash covering approximately 12cm2 in both axillae. The rash is nontender to touch with a well-demarcated border. There is no axillary adenopathy. Wood's light examination reveals coral-red fluorescence of the involved skin. What is the treatment of choice?
This is erythrasma so erythromycin or another macrolide is the DOC
A newborn presents to your office for his 2-week physical exam. The only finding on exam is white plaques on the buccal mucosa and palate. When you try to remove the plaques, there are small punctate areas of bleeding. Your diagnosis is ?
Thrush
A 6-year-old child is seen at your center for a school physical exam-on examination you note a neck mass. The child has been asymptomatic according to the mother. On physical exam, you find a 3-cm fluctuant cystic midline neck mass just below the level of the hyoid bone. The mass rises with protrusion of the tongue and with swallowing. The most likely diagnosis is
Thyroglossal duct cyst
She is 12-hours-old, feeding well, and maintaining her temperature adequately. Physical examination is notable for small superficial pustules on the chin, lower back, and extremities, some which have ruptured and are surrounded by a collarette of fine scale. Some of these ruptured vesicles have a central hyperpigmented macule in the center. A smear is taken of the vesicular contents. What is the most likely diagnosis?
Transient neonatal pustular melanosis
In which condition does the patient usually complains of a limp, with pain in the hip or referred to the knee? What usually precedes these symptoms/condition?
Transient synovitis: Usually preceded by URI 1 - 2 weeks previously
A 4-year-old male presents to his family doctor with a 1-month history of a red area on his cheek that has gradually enlarged. The rash is slightly pruritic but nontender. The patient was given a new kitten for his birthday 2 months ago. Past medical history and family history are unremarkable. On examination, the patient is well appearing and afebrile. He has a 3-cm annular erythematous lesion on his right cheek. It is slightly scaly with central clearing and a papulovesicular border. The rash is nontender to touch. There is no cervical adenopathy. What is the dx? What is the tx?
Tinea corporis - Clotrimazole cream
You are the attending physician at a progressive hospital-based urgent care center. A 5-year-old female is brought in with a generalized seizure associated with a fever of 105° F. Her spinal tap is negative. After the seizure, she is unable to move her left arm for 1 hour. This paralysis is known as
Todd's paralysis
What clinical sign has been proposed as one of the most reliable predictor of Group A streptococcus pharyngitis?
Tonsillar exudates
What is the treatment for lichen simplex chronicus?
Topical Flourinated Corticosteroids
...
Topical scabicide - Permethrin 5% cream (lindane/kwell is not safe in infants)
Tenderness is usually localized to the upper portion of the testis and, typically, a blue dot is seen on the scrotal skin resulting from the venous congestion in the appendix testis. Cremasteric reflex is usually present. What condition is described?
Torsion of the appendix of the testis
What disorder is characterized by the presence of multiple motor tics and one or more vocal tics, although all are not necessarily present at the same time?
Tourette Disorder
t typically follows a respiratory infection. Children are not able to bear weight on the extremity or may limp or complain of knee pain. The CBC is normal, as is the erythrocyte sedimentation rate. Radiographs are normal or may show a small effusion. What condition is described?
Toxic Synovitis of the hip
A 3-year-old female presents to the emergency room with a 4 day history of limp and left leg pain. She points to the anterior thigh as the source of her pain. Upon review of symptoms, it is noted that she had a viral upper respiratory infection approximately 1 week ago. She has been afebrile. She has otherwise been well. Exam is notable for normal range of motion of all lower extremity joints. She is afebrile. CBC and ESR are normal. Radiographs of her hips and legs are normal. What is the likely cause of her symptoms?
Toxic synovitis of the hip
Which disorder is characterized by either single or multiple vocal and/or motor tics that occur frequently, many times during a day, and last for at least four weeks, but no longer than twelve months?
Transient Tic D/O
Usually occurs in previously healthy children and usually follows a viral illness. MCV is normal for age and normal RBC morphology is noted. Reticulocyte count is low to zero. Signs are pallor and tachycardia. What do these signs and sx point to?
Transient erythroblastopenia
What term best describes premature closure of the metopic suture?
Trigonocephaly
Urinalysis from a transurethral catheterized specimen is positive for nitrite and leukocyte esterase. The most appropriate treatment for this patient is:
Trimethoprim-sulfamethoxazole 10 mg/kg/day PO divided bid for 10 days
Children with this trisomy have multiple congenital anomalies, such as cleft lip, hemangiomas of the face, forehead, or neck, broad flat nose, low-set malformed ears, small abnormal skull, cerebral malformations, cardiac malformations, and visceral and genital anomalies. what is the trisomy?
Trisomy 13
The clinical manifestations are severe mental retardation, rocker bottom feet, micrognathia, and cardiac and renal malformations. What trisomy is described?
Trisomy 18
On physical exam, you note that the child has upward-slanting eyes, a small upturned nose with a saddle bridge, inner epicanthal folds, small ears, simian creases, and clinodactyly of both fifth fingers. The child appears to have floppy tone as well. These findings are typical for what trisomy?
Trisomy 21
Which sex chromosome linked diseases has the clinical feature of short stature, streak gonads, and degradation of oocytes by 2 years of age?
Turner syndrome
...
Tx - Symptomatic (NSAID, beta blocking drug)
What is the most common complaint with an ectopic ureteric orifice?
Urinary Incontinence
What is the shilling's test?
Used to determine the absorption of B-12
What is the principal cause of asymmetric intrauterine growth restriction (IUGR)?
Uteroplacental insufficiency
What vitamin deficiency causes muscle weakness, double vision, loss of position sense, hemolytic anemia, reduced reflexes, and constricted visual fields?
Vit E
An 11-year-old boy presents to your office in the summer complaining of extreme itching of both eyes, with increased tearing, of three months duration. There is a family history of atopy. On examination, you find large, flattened, cobblestone-like papillary lesions of the palpebral conjunctivae with a milky conjunctival pseudomembrane. A conjunctival exudate is present. A smear of the exudate reveals many eosinophils. What is the most likely diagnosis?
Vernal Conjuntivitis
MCC of watery diarrhea in the US?
Viral etiology
Which disease would you suspect if the child is under the age of 2 years and has hypertrophy of Peyer's patches?
Viral infections
What vitamin deficiency is described as characterized by pinpoint spots on the skin especially on the thighs and legs, called as petechiae, spongy gums, poor healing of bruises, joint pain, bleeding from mucous membranes and thin hair?
Vit C
Does Rett disorder affect females or males?
females
What vitamin deficiency is the leading cause of preventable blindness in children and also increases the risk for severe infections, causing the skin of extensor surfaces becomes dry and scaly with follicular hyperkeratosis; Dryness of the eyes is caused by keratinization of the conjunctiva and lacrimal glands. Bitot spots are small triangular, silvery, foamlike patches that appear on the conjunctiva due to keratinization. Night blindness will occur due to a delay in resynthesis of rhodopsin. Severe inflammation may result in keratomalacia and blindness
Vitamin A
What vitamin deficiency results in cheilosis, glossitis, keratitis, photophobia, blurring of vision, seborrheic dermatitis, and anemia?
Vitamin B2
An 8-month-old girl is brought in to the office, by her young mother, with increasing irritability and decreased appetite that started 2 days ago. She has also had some diarrhea and low grade fever. On exam she is afebrile, very fussy, and hard to console, though she appears alert and active. She lies with her hips and knees flexed, crying harder with any movement. A few petechiae are noted on her skin. Leg x-rays are done to assess for possible fracture that shows pencil-thin cortex and a ground glass appearance of the bones. Further history reveals that she has been given evaporated milk since birth to save money and has not yet been started on solids. Which vitamin deficiency would most likely cause this infant's symptoms?
Vitamin C
Exclusively breast fed babies and dark skinned infants are two risk factors for the development of what vitamin deficiency?
Vitamin D deficiency - Rickets
The inadequate availability of which vitamin listed below can cause hemorrhagic disease of the newborn?
Vitamin K
A 4-year-old boy presents to your office for further evaluation. He has had a history of frequent nosebleeds since age one year. His father has a similar history but has not sought medical evaluation. There is no history of hospitalization or surgery. The child was treated with iron for a diagnosis of anemia when he was 15 months old.
Von Willebrand Disease
A 17-year-old female presents to the clinic due to chronic fatigue. Review of systems reveals heavy monthly menses since menarche began at age 13. Labs are as follows: pregnancy test negative; cervical cultures negative; thyroid studies within normal limits; white blood count 9 K, hemoglobin 10, platelet count 250 K. Peripheral blood smear is consistent with microcytic, hypochromic anemia. Prothrombin time, partial thromboplastin time (PT, PTT), and fibrinogen are normal. Bleeding time is prolonged. The most likely diagnosis is:
Von Willebrand disease - Iron deficiency anemia
Treatment for a Hordeolum?
Warm compress, possible antibiotic ointment
A 3-month-old male is seen by his pediatrician for a well-baby check-up. His physician notes that he has had excessive growth since his birth. He is hypertonic and shows some motor delay. His cry is hoarse. He has a distinct facial appearance, including micrognathia, hypertelorism and large, low-set ears. Karyotype analysis is normal. What is the most probable diagnosis for this child?
Weaver syndrome
It is characterized by a distinct facial appearance, a low-pitched and hoarse cry, and hypertonia. Also present are psychomotor delay, loose skin and umbilical, and inguinal hernias. Excessive growth is seen in early infancy in all cases, and prenatally in most. Characteristic facial features include micrognathia with a distinctive dimpled chin, hypertelorism, large and low-set ears, and telecanthus. What condition is described?
Weaver syndrome
It presents with hypotonia and eventual flaccid paralysis resulting in death usually before 2 years of age, though survival may be dependent on the degree of respiratory function. It can also be associated with structural congenital heart defects, but not cardiomyopathy. Dx?
Werdnig-Hoffman disease
MC involved bone in Ewing's sarcoma?
femur
What is the MC benign breast solid tumor?
fibroadenoma
A 3-year-old girl presents with progressive abdominal enlargement associated with abdominal pain and occasional vomiting. Physical examination shows a palpable mass over the right upper quadrant extending to the right flank. She looks pale and the BP is slightly elevated. Urinalysis shows microscopic hematuria. What is the most likely diagnosis?
Wilm's tumor
MC renal tumor in children 0 - 5y/o
Wilm's tumor
What condition is commonly manifested by an abdominal mass that is described as generally smooth, firm and rarely crosses the midline, and it causes abdominal pain and vomiting and sometimes occurs along with HTN?
Wilm's tumor
Which alternative intervention has been found to improve certain skills for children who have ADHD?
Zinc Supplementation
Pt presents with hypoglycemia, and most have hypotension. Orthostatic changes in blood pressure and pulse are cardinal signs of this d/o?
acute adrenal insufficiency
A 5-year-old male presents with a 4-day history of swelling around his left upper neck. He had been previously complaining of a sore upper left tooth. His past medical history is unremarkable. His immunizations are up to date. There are no animals in the house and there is no history of exposure to wild animals. Upon examination, his temperature is 100.5° F; his neck is significant for a unilateral, firm, tender, discrete, erythematous swelling just below the angle of the left mandible. The swelling does not appear to be fluctuant. Oral examination reveals an obviously infected premolar on the left side of his jaw. The remainder of the examination is within normal limits. What is the most likely diagnosis?
acute suppurative lymphadenitis
What is cortisol secretion regulated by?
adrenocorticotropic hormone (ACTH)
What nerves are damage with phrenic nerve injury?
anterior roots of cervical nerves 3, 4 and 5
In urine obtained by suprapubic aspiration, ________?_______ is diagnostic of a UTI.
any growth of gram-negative bacteria
What is the MCC of sudden death in Marfan's syndrome?
aortic dissection
MCC of primary adrenal insufficiency?
autoimmune destruction of the adrenal cortex
When should the triple-screening be done?
between 15 - 20 weeks of gestation.
When is the Hep B vaccines given?
birth, one, and six months
Jaundice appearing after the first week of life is usually due to what?
breast milk jaundice
Which is non-tender, chalazion or hordeolum?
chalazion
Pt presents with chronic fatigue, anorexia, asthenia, nausea, vomiting, loss of appetite, weight loss, recurring abdominal pain, and weakness and a lack of energy. Increased skin pigmentation and salt craving are also an initial presentation of this dz?
chronic adrenal insufficiency
What are the MC used drugs in adolescence?
cigarettes and alcohol
What bone is MC fractured during delivery?
clavicle
Which speech condition involves rapid, irregular speech that impedes intelligibility?
cluttering
How can pyloric stenosis be confirmed?
confirmed by barium swallow
A palpable lump in the center of the clavicle that does not change or heal with any amount of time and is characteristic of what condition?
congenital pseudoarthrosis of the clavicle
What is the MCC of short stature in boys?
constitutional delay
What clinical sign is is demonstrated by pressing the bone along the area where the bones of the skull come together, causing the bone to pop in and out, similar to pressing on a Ping-Pong ball? What can this sign be associated with?
craniotabes; Assoc with rickets and osteogenesis imperfecta
hour-glass sign on x-ray = ?
croup - laryngotracheobronchitis
What does beriberi result from?
deficiency of vitamin B1 or thiamine
Muscle biopsy showing inflammatory infiltrates and shrunken, atrophied muscle fibers with central vacuolation, is a pathonomic sign for what condition?
dermatomyositis
Which speech condition is characterized by a lack of awareness of the speech pattern, onset at approximately 2-3 years, spontaneous resolution, and word and phrase repetitions much more common than sound and syllable repetitions?
developmental dysfluency
Where is Ca chiefly absorbed?
duodenum
What is the most common manifestation of inborn errors of metabolism?
encephalopathy
...
erythroblastosis fetalis
What factor is deficient in Hemophilia B?
factor IX
Tx for acute suppurative lymphadenitis is?
first-generation cephalosporin or penicillin
Tx for shigella?
fluid replacement and antibiotics (ampicillin or trimethoprim-sulfamethoxazole).
How can phrenic nerve injury be detected?
fluoroscopy
What type of seizure is associated with febrlie seizures?
generalized (nonfocal)
It is characterized by bone pain, fractures, thrombocytopenia and hepatosplenomegaly. Diagnosis is by demonstration of deficiency of the enzyme β-glucosidase.
glucocerebrosidase deficiency/ Gaucher's Disease
What dz is described as:
glucocerebrosidase deficiency/ Gaucher's Disease
A 2-year-old African-American boy is brought to you with painful swelling in the dorsal surfaces of hands, feet, fingers, and toes. His temperature is 38.9° C (102° F). Hemoglobin is 8g/dl and reticulocytes 7%. The peripheral smear shows several elongated and crescent shaped red blood cells. What is the dx? What is the tx?
hand-foot syndrome (serious infection seen in pts with sickle cell anemia)
If jaundice is present at birth, what conditions would you expect?
hemorrhage
A 6-month-old white male presents to his primary care physician's office for a well child visit and immunizations. The mother reports that he has had no recent illnesses, but is nursing for shorter periods of time and is taking an extra nap in the middle of the day. His past medical history is notable for hyperbilirubinemia in the newborn period requiring phototherapy. Both he and his mother are blood type O positive. Family history is significant for the patient's father having a cholecystectomy and splenectomy at 15 years of age. Physical exam is notable for slight pallor of the skin and conjunctiva and there is a faint yellow cast to the skin. The spleen tip is palpable 1cm below the left costal margin. What is the probable dx?
hereditary spherocytosis (HS)
Pyloric stenosis creates what type of metabolic derangement?
hypochloremic metabolic alkalosis
A 9-year-old girl who was found to be 122.5 cm tall (3rd centile) during a routine school health check up was referred by the school nurse to a pediatrician in the hospital.She is not doing well at school. The mother states that the girl has constant constipation and has become very lethargic lately. On examination, the physician finds that the girl is a little pale and has dry scruffy hair. Further laboratory tests reveal a low total T4 and high Thyroid Stimulating Hormone levels. What is the dx? What is the MCC of this illness?
hypothyroidism
What is the MCC of central adrenal insufficiency?
iatrogenic - long-term corticosteroid administration
What is the most common cause of thrombocytopenia in childhood?
idiopathic thrombocytopenic purpura (ITP)
On Thanksgiving day, a five month old child is brought to the emergency room with wheezing, rapid respirations (>45 breaths/min), and chest retractions. During the last 2 days, the patient had rhinorrhea and a low-grade fever. Breath sounds are normal and there is no cyanosis. Which test can confirm the most likely diagnosis?
immunofluorescence of nasal secretion - can lead to rapid viral identification of RSV
...
infections with cytomegalovirus, rubella, or toxoplasmosis
Bilious vomiting is caused by ?
intestinal obstruction distal to the ampulla of Vater.
What is the MC hematological dz of childhood?
iron deficiency anemia
A newborn has multiple cutaneous hemangiomas, further examination and evaluation determines hepatomegaly and anemia are also present. What serious, potentially life threatening condition must you suspect?
large liver hemangioma
steeple sign = ?
laryngotracheobronchitis
A microcytic anemia with the peripheral smear showing basophilic stippling of the red blood cells. Physical exam is usually normal, though occasionally abdominal pain, poor appetite, vomiting, and constipation may occur. These are signs and sx of what condition?
lead poisoning
Edrophonium chloride test is used to dx what condition?
myasthenia gravis
What speech condition is described as occurring after an injury to the central nervous system, such as a stroke or closed head trauma?
neurogenic stuttering
The classic triad of strabismus, trismus (lockjaw), and opisthotonus in association with spastic and seizure disorder is highly suggestive of what condition?
neuronopathic infantile form of Gaucher's disease
Symptomatic Cysticercosis is treated with what?
niclosamide or praziquantel
A 5-year-old boy develops severe pharyngitis with a low grade fever. Parents note his pallor and fatigue during the previous weeks. They explain his gradual weight loss with lack of appetite. Physical examination finds lymphadenopathy and an enlarged spleen. Microscopic examination of peripheral blood finds white blood cells with scant cytoplasm and inconspicuous nucleoli. What is the most likely diagnosis?
non-T, non-B cell ALL
What is the MC sign of iron def anemia?
pallor
What organism is responsible for acute laryngotracheobronchitis?
parainfluenza virus
What are the causes of jaundice that appears on the 2nd or 4th day of life?
physiologic jaundice - jaundice caused by the breakdown of fetal red blood cells, at a time when the liver is unable to conjugate bilirubin very quickly
Which bacteria would most likely infect a wound site in a puncture wound of the foot?
pseudomonas
This child, with wide epicanthal folds, whose corneal light reflex and cover tests are normal, but who still gives the impression of eyes turning inward, is a good example of what condition?
pseudostrabismus
An 8-year-old male presents to your office, complaining of a pruritic rash. The rash began as a few small, red bumps on the arms a few weeks ago, but has now spread across his body, and is much itchier. The itching is worse at night, and he is having problems sleeping because of the pruritus. His mother and brother now have a similar eruption. Examination of his skin reveals diffuse excoriation, with scattered vesicles and erythematous papules. In a few areas, the lesions appear linear. What is the dx? What should you prescribe?
scabies
...
sepsis
Which speech condition is described as a voice disorder with momentary disruption of voice caused by involuntary movements of the muscles of the larynx, and seen usually in adults?
spasmodic dysphonia
Which medication may precipitate the onset of Tourette's syndrome in susceptible individuals?
stimulant methylphenidate or dextroamphetamine for attention deficit hyperactivity syndrome
Which strict diet has a high chance of producing macrocytic megaloblastic anemias?
strict vegetarian diet
What is the MC congenital neck mass?
thyroglossal duct cyst
Adenoma sebaceum, ash-leaf macule, and Shagreen patches are all cutaneous manifestations of what conditions?
tuberous sclerosis (TS)
A 9-year-old male presents to your office for evaluation of a heart murmur. He is in general good health. On examination you note a mid to early systolic ejection murmur, middle to high pitched heard best at the upper left sternal border. A pulmonic ejection click is also auscultated. The intensity is grade III/VI. No cyanosis is present. Pulses are equal and strong. What murmur do you suspect?
valvular pulmonic stenosis.
Elastase is responsible for what consequence of childhood acute pancreatitis?
vascular necrosis and hemorrhage
Seizures, irritability, peripheral neuritis, dermatitis, and microcytic anemia can be seen with deficiency of vitamin ?
vitamin B 6 or pyridoxine
What is the treatment for atopic dermatitis?
wet dressings (Burrow's solution), Topical corticosteroids creams or lotion
What maneuver will decrease a venous hum?
will decrease with rotation of the head or compression of the jugular venous system
Which adrenal zone secretes aldosterone?
zona glomerulosa
Clinical manifestation is by neuropathy and skin lesions. Pain crises of the extremities are extremely common, which is due to the deposition of sphingolipids in the vascular endothelium supplying the peripheral nerves. Skin eruptions in the naval area, buttocks and angiokeratomas are characteristic. Hypohidrosis and corneal dystrophy are also seen. As they age, cardiac and renal manifestations are noted such as mitral insufficiency, ischemia, conduction defects, proteinuria and kidney failure.
α-galactosidase/ Fabry's Disease
Which disease is described as:
α-galactosidase/ Fabry's Disease
Which dz is described as:
α-galactosidase/ Fabry's Disease
Which subtype of the opioid receptor has an enkephalins as a natural ligand?
δ subtype
Which opioid receptor seems to be most concerned with the central pain mechanisms and is the receptor for which the morphine antagonist naloxone has the greatest affinity
μ receptor