PEDS-RR
A 2-year-old boy, who is up to date with his vaccinations, presents in mild respiratory distress with noticeable inspiratory stridor and a barking cough on exam. His parents report his symptoms seemed to improve with exposure to the cold outside air. What is the most likely pathogen responsible for the patient's presentation?
Parainfluenza virus Croup
mumps is caused by what virus?
Paramyxovirus
A 4-year-old boy presents to the clinic with his very anxious mother. She reports that her son's penis does not look normal and he complained of pain when she tried to examine it at home. Past medical history is unremarkable. On physical examination, the foreskin appears retracted and edematous and cannot be pulled back over the glans. What is this patient's most likely condition?
Paraphimosis
If the initial two APGAR scores are poor, the score will be repeated at?
10 minutes after birth
When does surfactant begin to be expressed in the fetal lung?
20 weeks gestation
All exclusively breastfed infants should receive how much vit D supp. daily?
400 units vit D
A long QT interval is over?
440 milliseconds
two doses of influenza vaccine are recommended for children of what ages?
6 months to 5 years
A superficial partial-thickness injury is considered a minor burn if it covers?
< 5% of the total body surface area (BSA) in patients under 10 or over 50 or < 10% in patients between 10 and 50 years of age.
How long does racemic epinephrine have an effect on the upper airway?
A maximum of two hours.
conduct disorder behaviors
A patient who bullies or intimidates peers leaves seat when remaining seated is expected lies to get out of trouble, and skips school without permission Manifestations may include aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules.
patient's with Fanconi anemia are at risk for?
AML, solid tumors and aplastic anemia
Systemic juvenile idiopathic arthritis (Still's disease) labs
ANA negative RF negative
Oligoarticular JIA lab findings
ANA positive RF negative ESR normal
Polyarticular JIA lab findings
ANA positive RF positive in 5-10% ESR elevated
An 8-year-old boy presents to his pediatrician with a low-grade fever, new rash, and pruritus. He has not been vaccinated for varicella and mom confirms a recent exposure. On exam, a pink vesicular rash in various stages of development is noted, as well as surrounding linear excoriations. Which of the following is the most appropriate therapy?
Acetaminophen
What is the most common cause of viral conjunctivitis?
Adenovirus
What is the treatment of choice for children with infantile spasm?
Adrenocorticotropic hormone (ACTH).
A 12-month-old boy presents with two days of nasal congestion, red eyes, and fever. On examination, he has bilateral purulent conjunctivitis and purulent nasal discharge. Both tympanic membranes are erythematous, bulging, and dull with limited mobility. What therapy is indicated?
Amoxicillin-clavulanate the combination of acute otitis media and conjunctivitis is typical of infections with nontypeable Haemophilus influenzae. Haemophilus influenzae produce a beta-lactamase, it is prudent to choose an antimicrobial that contains a beta-lactamase inhibitor,
A 17-year-old man presents to the clinic complaining of hair loss. He states, "My father has a full head of hair. Why am I losing mine?" On exam, hair follicles of varying lengths and thicknesses are noted. Hair loss is noted at the vertex of the scalp, revealing healthy-looking underlying skin. The patient denies use of medications or supplements, pruritus, flaking, burning or bleeding scalp. Hair pull test results are negative. Which of the following is the most likely diagnosis?
Androgenetic alopecia male-pattern baldness
Which condition results from the absence of expression of the maternally active genes on the long arm of chromosome 15 or paternal uniparental disomy?
Angelman syndrome.
What finding may be noted on the peripheral smear in patients with infectious mononucleosis?
Atypical lymphocytes.
alopecia areata
Autoimmune disorder that causes the affected hair follicles to be mistakenly attacked by a person's own immune system usually begins with one or more small, round, smooth bald patches on the scalp.
What is commonly seen on peripheral blood smear in patients with lead poisoning?
Basophilic stippling.
A 5-year-old boy with a recent history of constipation is seen by a pediatrician for a chief complaint of stool leaking onto his underwear. He was toilet-trained when he was three, but since then has had occasional periods of constipation which his mother has been treating with apple juice mixed with polyethylene glycol as needed. Per the patient, he did not have a bowel movement today or yesterday and he cannot recall when the last bowel movement was. He does report the last time he had a stool it was painful. Rectal examination confirms the presence of hard, retained stool. Which of the following is the most appropriate next step in management?
Begin polyethylene glycol and continue for at least six months Fecal incontinence-encopresis
A nine-year-old boy has been diagnosed with Stage 3 non-Hodgkin lymphoma. It is anticipated that he will develop nausea and vomiting during chemotherapy. What class of medication is recommended prior to starting treatment to decrease these side effects?
Benzodiazepines for Pretreatment 5-hydroxytryptamine receptor antagonists for during and after treatment
What can be seen in Prader-Willi and Noonan syndromes?
Bilateral cryptorchidism
procedure of choice to remove the foreign body.
Bronchoscopy
What is the management approach for cryptorchidism discovered after puberty?
Orchiectomy, to minimize risk of testicular cancer.
Dx of mastoiditis
CT Imaging findings such as coalescence of the air cells or subperiosteal abscess may require surgical intervention.
A 12-year-old girl presents to the clinic with a two-day history of a rash and recent known exposure to poison ivy. The rash is erythematous with scattered vesicles localized to a 6-inch segment along the medial aspect of the lower leg. There is no drainage noted and the patient denies systemic symptoms such as fevers or chills. Which of the following is the most appropriate treatment option?
Clobetasol propionate 0.05% ointment twice daily for 14 days high potency steroid
Acute Lymphocytic Leukemia (ALL)
Complaining of limping, bone pain, fever, and lymphadenopathy PE will show hepatosplenomegaly Labs will show anemia, thrombocytopenia and lymphoblasts on peripheral smear
What is another congenital defect associated with long QT syndrome?
Congenital sensorineural deafness
A 6-year-old boy presents to his pediatrician for follow-up due to left ear pain and drainage., diagnosed with acute otitis media, and prescribed amoxicillin. Since starting the antibiotic, his parents have not noticed any significant changes until this morning when he suddenly cried out in pain, holding his left ear. His ear pain has decreased since this morning, but his parents have noticed a clear, sticky fluid around the opening to his left ear. On examination, the patient does not complain of pain with pulling the outer ear or pushing on the pinna or tragus. Using the otoscope, clear fluid, but no blood, can be visualized in the external canal. The light reflex usually seen on the tympanic membrane is obscured, and a small perforation . Weber and Rinne tests confirm conductive hearing loss in the left ear. Which of the following is the most appropriate next step in management?
Continue antibiotic course with close observation
What are five other intrauterine infections which are known to cause similar signs to congenital rubella syndrome in newborns?
Cytomegalovirus herpes simplex virus syphilis toxoplasmosis zika virus.
first-line medication for treating absence seizures?
Ethosuximide
Scoliosis
Diagnosis is made by Cobb angle greater than or equal to 10 degrees Most commonly caused by an idiopathic lateral curvature of the spine
A child with short stature, decreased height velocity, and delayed deep tendon reflexes may be suffering which endocrine abnormality?
Hypothyroidism.
A 1-day-old term infant is seen at his mother's bedside in the postnatal ward for a newborn exam. His mother reports he vomited a few hours after the first feeding and has been fussy but consolable. She has not noticed any other problems. She reports a normal pregnancy. On examination, the infant has a mildly distended abdomen. An abdominal film is ordered and notable for two prominent air bubbles in the stomach and duodenum. Which of the following is the most likely diagnosis?
Duodenal atresia
A full term boy is delivered via Cesarean section to a 34-year-old G1P0 mother. He has good Apgar scores and weighs 2.7 kilograms. Initial physical examination reveals normal findings. An hour after initially breastfeeding, the boy begins to vomit green-tinged milk. He has recurrent bilious vomiting one hour later. On repeat physical examination, he is found to have tachypnea, clear breath sounds and a non-distended abdomen. A nasogastric tube is passed and 30 mL of bilious fluid is aspirated. Which of the following is the most likely diagnosis?
Duodenal atresia
A two-month-old boy presents to the clinic for his vaccinations. On exam, a continuous 3/6 murmur is noted in the left infraclavicular region. Which of the following would be the most appropriate diagnostic study to order in this patient?
Echo PDA PE will show continuous, rough, "machinery-like" murmur, heard best in the first interspaces of the LSB
A 12-year-old girl with no significant medical history presents to her pediatrician complaining of two weeks of joint pain. Initially, the pain started at the same time as a fever, first in her knees, then her ankles, and now she feels like her elbows are bothering her as well. Ibuprofen helps a great deal, but the pain is still present after the medication wears off. Her only recent illness was strep throat which was treated with amoxicillin. On physical exam, mild erythema and swelling around her elbows is appreciated and her lower extremities appear normal but are painful to move. Which of the following is the most appropriate diagnostic test?
Echocardiogram migratory polyarthritis> acute rheumatic fever
A newborn examination is conducted on a 1-day-old, 36-week gestation infant. His physical exam is unremarkable except for an empty left scrotum., one hand is used to gently express any palpable tissue from the anterior superior iliac spine along the inguinal canal towards the scrotum, which is held by the examiner's other hand. the hand on the scrotum receives testicular tissue which is gently held in the scrotum for at least one minute. Upon letting go, the testis disappears out of the scrotum. Which of the following is the most likely explanation for these findings?
Ectopic testis Cryptorchidism
Which syndrome is a concern if scoliosis is noted in the context of skin hyperextensibility, joint hypermobility, and joint dislocations or subluxations?
Ehlers-Danlos syndrome.
MC viruses to cause splenomegaly in kids
Epstein-Barr virus and cytomegalovirus
What are two risk factors for strabismus?
Family history of strabismus and low birth weight.
3 year old boy with a chief complaint of easy bruising, nosebleeds and decreased activity for one week. He has no history of fever or appetite changes. His past medical history is remarkable for multiple congenital anomalies but no workup has been done. The PE reveals an active boy with short stature, notable hyperpigmentation of the trunk, neck, and intertriginous areas, as well as café-au-lait spots and vitiligo. The boy also has microcephaly, broad nasal base, epicanthal folds, micrognathia, anicteric sclera, pale palpebral conjunctiva. Laboratory tests reveal hemoglobin 7.9 g/dL, hematocrit 24%, platelet count 12,000/mcL, WBC 3,000/mcL with 90% lymphocytes, absolute neutrophil count 210 cells/L, and reticulocyte count 0.5%. Which of the following is the most likely diagnosis?
Fanconi anemia
Most common form of inherited aplastic anemia?
Fanconi anemia
Normally, when lactose is taken into the digestive system, it is broken down by the enzyme lactase. What two products are created by this process?
Glucose and galactose
What is the treatment of tinea capitis?
Griseofulvin
A 10-year-old boy presents to your office with complaints of dark, cola-colored urine that developed yesterday. His mother states that he had a sore throat about a week ago that resolved on its own. Upon physical examination, you notice some puffiness in the periorbital areas bilaterally. His blood pressure is within normal limits. What is the most likely underlying cause of his condition?
Group A beta-hemolytic Streptococcus infection Glomerulonephritis
What are the three most common causes of bacterial meningitis in neonates?
Group B Streptococci, E. coli, Listeria.
common features of SJS
Hemorrhagic erosions with a greyish white membrane on mucous membranes severe conjunctivitis Nikolsky positive bullae
Roseola is caused by?
Human Herpes Virus 6 (HHV-6)
Persistent vomiting in a patient with pyloric stenosis can cause mild to moderate dehydration, leading to what type of electrolyte/metabolic disturbance?
Hypochloremic, hypokalemic metabolic alkalosis.
A 9-year-old girl. Her mother is concerned she may have had a seizure yesterday and has since been too weak to play outside the house. On physical examination, the girl is found to be below the 5th percentile in height for age with normal vital signs. She has multiple dental caries, widening of costochondral junctions, bowing of the legs, and enlarged wrists and ankles. Which of the following laboratory screening studies suggest nutritional vitamin D deficiency?
Hypophosphatemia, hypocalcemia, and elevated parathyroid hormone Rickets
Which endocrinopathy is associated with slipped capital femoral epiphysis?
Hypothyroidism
A 12-month-old boy presents to your clinic with his concerned mother for abnormal movements. The mother reports that the child has sudden flexion and stiffening of the neck, limbs, and trunk followed by gradual extension and relaxation. These jerking spells have become more frequent and occur in clusters throughout the day. The baby will cry briefly after the spells and then become sleepy. The mother also reports that about a month ago, he started walking consistently; however, he is no longer doing that at present. Which electroencephalographic finding is most consistent with the diagnosis?
Hypsarrhythmia>diffuse giant waves with a chaotic background of irregular, multifocal spikes and sharp waves infantile spasms>severe type of epilepsy syndrome with a peak incidence b/w 4 and 12 months of age
In the case of a HBsAg positive pregnant woman, what can be done to help prevent transmission of the virus to the newborn?
Infants should receive hepatitis B immunoglobulin and vaccine immediately after delivery plus two additional immunizations. They should have follow-up screening between ages nine and twelve months.
the most common epilepsy syndrome presenting with generalized tonic-clonic seizures in a patient aged 12-30 years old who is otherwise neurologically normal?
Juvenile myoclonic epilepsy
A 2-year-old girl presents with her grandmother to clinic due to constipation. The grandmother observes that since birth and despite recurrent use of stool softeners, the child only moves her bowels once a week. There is no fecal soiling or diarrhea noted. Her grandmother states that the child was not discharged immediately after birth since she did not pass any stool for 48 hours after birth. However, she was well thereafter and has not been in the hospital since. Which of the following would best explain the girl's symptoms?
Lack of ganglion cells in Auerbach's and Meissner's plexus Hirschsprung disease
A three-week-old infant presents to the clinic with his parents who state he is not gaining weight and is feeding poorly. Cardiac auscultation and exam reveal a 2/6 mid-frequency holosystolic murmur heard best at the fourth left intercostal space, a diastolic rumble, and a prominent apical impulse displaced laterally. Tachypnea and tachycardia are also noted. Which of the following is the most likely diagnosis?
Large ventricular septal defect
Which two pathogens most commonly cause nontuberculous mycobacterial disease?
M. avium and M. kansasii.
What is the most common congenital abnormality of the small intestine?
Meckel diverticulum
Which of the following is caused by a persistence of the omphalomesenteric duct beyond fetal development?
Meckel's diverticulum
Kawasaki disease
Mnemonic: CRASH and burn: Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/feet edema, burn (uncontrolled high fever)
Which of the following is the most common cause of hypertrophic cardiomyopathy in the newborn?
Mutations of sarcomeric proteins
What is the second most common cause of Stevens-Johnson syndrome?
Mycoplasma pneumoniae
emergent is hyperacute bacterial conjunctivitis caused by?
Neisseria gonorrhoeae characterized by rapid onset, irritation, copious discharge, and possible preauricular adenopathy
What are the two classic symptoms of primary hyperparathyroidism?
Nephrolithiasis and bone disease (osteitis fibrosa cystica).
An 8-year-old girl presents with complaints of difficulty walking over the past few days. She initially had numbness and tingling in her hands and feet which then progressed to a heavy, weak feeling in her legs. Physical exam is notable for the absence of deep tendon reflexes. Which laboratory finding is most consistent with this patient's diagnosis?
Normal CSF WBC count, elevated protein Guillain-Barré Syndrome (GBS).
A four-year-old patient , who complains that he is "wall-eyed". The child is demonstrating well-coordinated, well-aligned gaze during the exam. A cover test shows no abnormalities, but a cover-uncover test is positive for slight medial repositioning of the covered eye immediately upon uncoverage. Visual acuity is 20/20, red reflex is present bilaterally, and fundoscopic examination is normal. Which of the following is the best choice for ongoing care of this patient?
Observation with regular follow-up with ophthalmologist every six months Strabismus
A 16-year-old boy presents with mild left-sided hearing loss following a scuba diving trip. He also noticed reddish discharge from the left ear but denies vertigo or facial muscle weakness. On physical exam, there is a perforation of his left tympanic membrane. Which of the following is the appropriate management of this patient?
Ofloxacin otic drops when TM perforation occurs in a contaminated environment such as under water
What is the most common comorbid condition in children with attention deficit hyperactivity disorder?
Oppositional defiant disorder is the most common comorbid condition associated with ADHD with a prevalence of up to 50%.
An 18-year-old pregnant woman presents to her primary care physician for treatment of her acne vulgaris. Which of the following would be the recommended treatment?
Oral erythromycin
An 18-month-old uncircumcised boy. His parents report increasing fussiness throughout the day and he seemed to be itching or playing with his diaper region more than usual. significant swelling of his foreskin and he vigorously fought having his diaper area cleaned. He is still producing wet diapers and has been eating fine. On physical exam, the patient has notable swelling of the distal foreskin and a band of tissue proximal to the head of the penis appears constricting. Both the glans penis and the distal foreskin are swollen and exquisitely tender to manipulation. The penile shaft appears flaccid and normal. Which of the following is the most likely diagnosis?
Paraphimosis
Infectious Mononucleosis CM
Patient will be complaining of low-grade fever, headache, malaise, severe fatigue PE will show mildly tender lymphadenopathy involving the posterior cervical chain, hepatosplenomegaly Diagnosis is made by heterophile antibody test (monospot test), or a generalized maculopapular rash following administration of amoxicillin Most commonly caused by Epstein-Barr virus Treatment is self-limiting, refrain from contact sports for four weeks post-infection
What is the most appropriate treatment modality for an infant, six months old or less, diagnosed with developmental dysplasia of the hip?
Pavlik harness.
most common cause of anemia in young infants between six and nine weeks of age
Physiologic anemia
A 7-year-old boy with a history of cystic fibrosis presents with increased cough and fever. He has been doing well and has not been hospitalized for pneumonia in the last seven months. His X-ray demonstrates pneumonia and he requires supplemental oxygen. Which of the following antibiotic regimens is most appropriate?
Piperacillin/tazobactam
A 2-month-old boy presents to the emergency department with his mother after she noticed that he turned blue during his last feeding. In the emergency department, the baby had a heart rate 135 beats per minute, respiratory rate 38 breaths per minute and an oxygen saturation of 84% on room air. On physical examination, the baby was crying and appeared cyanotic. You were able to console the baby briefly with a pacifier. Upon auscultation, you appreciated a grade 3/6 harsh, systolic ejection murmur loudest at the left upper sternal border. The baby began crying again and became more cyanotic. Which of the following is the most appropriate next step in the management?
Place the baby in a knee-to-chest position TOF
commonly associated with duodenal atresia
Polyhydramnios Down Syndrome
A 12-year-old boy presents with three days of fever, malaise, and sore throat. Which favors a diagnosis of infectious mononucleosis over streptococcal pharyngitis?
Posterior cervical adenopathy
A 14-year-old boy presents with two erythematous plaques on his right arm. The plaques are pruritic and have developed a mild scale and central clearing. Other boys on the patient's wrestling team have similar lesions. Which of the following is most likely to confirm the suspected diagnosis?
Potassium hydroxide preparation tinea corporis
leading risk factor for surfactant deficiency
Prematurity
A 6-year-old boy presents to an urgent care clinic with a history of low-grade fevers, diffuse abdominal pain, and multiple episodes of non-bloody diarrhea for the last two days. He also had one to two episodes of non-bloody, non-bilious emesis each day, but this is slowing down. He is not eating as well as usual, but he is taking small bites and drinking plenty of fluids. On evaluation, he appears tired and is not playful, but his vital signs are normal and he appears to be well-hydrated. Which of the following is the most appropriate therapeutic approach for this patient?
Probiotic treatment >may decrease frequency of stooling and decrease the duration of illness without introducing adverse side effects. Acute gastroenteritis
A five-year-old boy presents to the clinic with his parents, who state he had a syncopal episode which lasted less than one minute and spontaneously resolved. The syncope happened while the child was running in the house. An ECG is performed and shows QT segment duration of 500 milliseconds. Family history is positive for a paternal grandfather who died suddenly in his fifties of unspecified cardiac problems. Which of the following represents the best initial therapeutic choice for this patient?
Propranolol 2.9 mg/kg/day- beta blockers 1st line Congenital long QT syndrome
primary cause of respiratory distress syndrome?
Pulmonary surfactant deficiency
The most common pathogens of orbital cellulitis are?
S. pneumoniae S. pyogenes anaerobes S. aureus.
A five-year-old boy has a height which is 2.1 standard deviations below normal for his age. His height velocity is six centimeters per year. When calculated, the boy's projected height is 2.2 standard deviations below the mid-parental height. Which of the following is the most appropriate next step in evaluation of this boy's short stature?
Radiographs of left wrist and hand to determine bone age
A 4-year-old girl . During the visit, her mother asks about a skin lesion she noticed recently. The area in question is a pale, firm, hyperkeratotic papule about 4 millimeters in diameter on the lateral aspect of the patient's right knee. When scraped gently with a tongue depressor, some of the overlying debris can be removed, revealing scattered, pinpoint, deep-red dots. The area is not painful. Which of the following is the most appropriate therapy?
Reassurance and watchful waiting verrucous or warty lesion majority of children will experience a spontaneous remission of the lesion within two years
While commonly found in adults with rheumatoid arthritis, which of the following is only rarely found in a patient with juvenile idiopathic arthritis?
Rheumatoid factors
At a 4-week well-child check, a mother raises concern for a rash on her infant's scalp. For the last two weeks, the scalp has been shedding greasy scales, and now the area anterior to the ears has begun to scale, too. No family members have the rash. The family has a dog and cat at home. Which of the following is the most likely diagnosis?
Seborrheic dermatitis
A 14-year-old boy presents with one month of increasing knee pain. Initially, he noted the pain in his right knee, but now his left knee is also bothering him. His parents note he has been walking with a limp, which at first improved when treated with ibuprofen but now he seems to be getting worse. On initial inspection you note an obese adolescent boy, with limping gait, and no apparent lower extremity irregularities. During your exam, no tenderness to palpation over the lower extremity is found, including the knee joints bilaterally, but manipulation is significant for decreased range of motion of the hips bilaterally, particularly internal rotation and abduction. Which of the following is the most likely diagnosis?
Slipped capital femoral epiphysis
A 3-year-old boy is undergoing a diagnostic work-up for a hereditary cause of a moderate anemia. Lab studies reveal a microcytic anemia and an increased reticulocyte count. Labs also reveal hyperbilirubinemia and an increased mean corpuscular hemoglobin concentration. An osmotic fragility test is abnormal. Which of the following may be eventually considered as a treatment option for this disorder?
Splenectomy> because it eliminates the most prevalent site of hemolysis Hereditary spherocytosis
What percent of body surface area is involved in Stevens-Johnson syndrome?
Stevens-Johnson syndrome is less severe and affects < 10 percent of body surface area.
The most common bacterial etiologies of pneumonia in young children are?
Streptococcus pneumoniae Moraxella catarrhalis nontypeable Haemophilus influenzae
MCC of bacterial conjunctivitis in kids?
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
Dx criteria for ADHD
Sx present in 2 areas of interaction Sx must present before 12 years Sx > 6 months Sx maladaptive/inappropriate for child's developmental stage
A 2-year-old girl presents to the emergency room because of rectal bleeding. The mother noticed the reddish-colored stools three days ago and has since changed several diapers with just blood. The child is afebrile, alert and active, but slightly tachycardic. Other than finding a small amount of blood in the diaper, the rest of the physical examination is normal. What would be the best diagnostic step for confirmation of diagnosis?
Technetium scan Meckel's diverticulum
What drugs should be avoided in a patient with primary hyperparathyroidism bc they can exacerbate hypercalcemia?
Thiazide diuretics and lithium
first-line treatment for tinea corporis
Topical azoles
What is the treatment for candidal diaper dermatitis?
Topical nystatin.
Which chromosomal disorder is frequently associated with coarctation of the aorta?
Turner Syndrome
What cells produce surfactant?
Type II pneumocytes
A two-day-old, full-term female with a history of breech presentation and delivery by cesarean section has an unremarkable newborn examination, including a normal bilateral hip exam. There is no family history of developmental dysplasia of the hip reported. Given this patient's presenting risk factors, which of the following is the most appropriate plan for follow-up of her hip exam?
Ultrasound of the hips at four to six weeks of age Developmental dysplasia of the hip
A previously healthy 10-year-old boy presents to the clinic with his mother because she is worried he has an infection. He has had a fever and malaise for five days for which he was given antipyretics. On physical examination his vital signs are within normal limits for age except for a low-grade fever. Which of the following is most consistent with mumps virus infection?
Unilateral parotid swelling and tenderness that becomes bilateral
A 2-year-old boy presents to the ED with a three-day history of increasing fussiness, decreased appetite, and intermittent non-bloody, non-bilious vomiting. He has not had any sick contacts, but he recently visited relatives who live in an old home currently undergoing renovations. His mother is concerned he may have been exposed to lead paint. Which of the following is the best test to confirm the diagnosis?
Venous blood lead level
Which of the following should be recommended to parents of a child with pediculosis capitis?
Wash clothing and linens in hot water head louse
A 4-year old boy presents to the office for his well-child examination. Upon listening to his heart, you hear a soft murmur. Which of the following features would be concerning for a pathologic murmur?
Widely split and fixed S2 Atrial septal defect
For infants who continue to have undescended testis after four months of age, what is recommended?
a surgical orchiopexy is recommended to free the testis
Infants with duodenal atresia may present with?
abdominal distension failure to pass meconium history of bilious emesis within hours of the first feeding
oppositional defiant disorder behaviors
actively defies or refuses to follow teachers' rules easily annoyed by classmates frequently angry or resentful, and argues with teachers
what lymph nodes are affected in strep pharyngitis?
anterior cervical adenopathy and does not cause generalized lymphadenopathy
APGAR stands for?
appearance, pulse, grimace, activity, respiration
Malrotation symptoms
bilious vomiting hemodynamic instability abdominal distention, and abdominal tenderness.
hallmark of duodenal obstruction is?
bilious vomiting without abdominal distention which is usually noted on the first day of life
tx for fanconi anemia
bone marrow transplant
DiGeorge syndrome
causes a hypoplastic thymus and immunodeficiency
Benign rolandic epilepsy ( benign partial epilepsy of childhood)
characterized by centrotemporal spikes on EEG may present with a history of orobuccal numbness on one side of the mouth or tingling sensation on one side of the face. During sleep, patients may have generalized tonic-clonic convulsions. Patients with benign rolandic epilepsy are typically aged 3-10 years.
Lennox-Gastaut syndrome
childhood epileptic encephalopathy with an onset at 3-5 years atonic seizures, tonic seizures, and atypical absence seizures associated with intellectual disability EEG pattern of abnormally slow background and diffuse slow spike and wave activity
patho of cystic fibrosis
chronic sinopulmonary disease gastrointestinal and nutritional abnormalities salt loss syndromes such as acute salt depletion and hypochloremic metabolic alkalosis male urogenital abnormalities resulting in obstructive azoospermia
A partial-thickness burn would also not be considered minor if it is?
circumferential or affects critical areas such as the face, hands, feet, genitals, perineum, or major joints
when should an ASD be referred to cardiology?
clinically significant atrial septal defects, specifically defects greater than 3 mm in diameter
Duodenal atresia
congenital abdominal obstruction due to failure of the duodenum to recanalize in early fetal development
CXR in respiratory distress syndrome
decreased lung volume increased reticulogranular ground glass appearance with air bronchograms
parotitis develops how soon in mumps
development of parotitis within 48 hours Swelling can be unilateral or bilateral and last up to ten days
infection with nontuberculous mycobacterial disease symptoms
dry cough, fatigue, malaise, night sweats, and weight loss
anxiety disorder behaviors
easily distracted, frequently worries afraid to go to school or be called on by the teacher to answer questions
CM of scurvy
easy bruising gingivitis dental decay arthralgias impaired wound healing
Dx of Mono
heterophile antibody test (monospot test) a generalized maculopapular rash following administration of amoxicillin
Known risk factors for developmental dysplasia of the hip
female sex breech positioning at ≥ 34 weeks gestation family history of DDH tight lower extremity swaddling
First-line treatment of androgenetic alopecia is?
finasteride, an inhibitor of dihydrotestosterone.
when would an ASD need surgical repair?
for patients with greater than 2:1 pulmonary to systemic flow evidence of right heart enlargement, increased heart size, and an appreciation of a tricuspid flow rumble
Risk Factors for JIA
genetics infection antibiotics
true undescended testis
has not completed its descent and will be palpable in the inguinal canal along the typical path of testicular descent. It cannot be brought into the scrotal sac during exam
What are retractable testis?
have developed and descended normally but are kept in a suprascrotal position due to the cremasteric reflex. upon being brought into the scrotal sac, the cremasteric muscle can be fatigued to a point where the testis will remain in the sac when released
A 6-year-old boy with nausea, vomiting, bloody diarrhea, and decreased urine output; UA shows microscopic hematuria and hyaline casts; blood tests show a high WBC count, low hemoglobin, and low platelets
hemolytic-uremic syndrome (HUS) triad of acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia (Schistocytes- helmet cells )
VSD has what kind of murmur?
holosystolic murmur.
Chronic kidney disease may lead to vitamin D deficiency and rickets which presents with what lab findings?
hyperphosphatemia, hypocalcemia, and elevated parathyroid hormone
patho of pyloric stenosis
hypertrophy and hyperplasia of the muscular layers of the pylorus causing a functional gastric outlet obstruction
Paraphimosis
inability to return a retracted foreskin to a normal position
Meckel's diverticulum patho
incomplete obliteration of the omphalomesenteric (or vitelline) duct during the seventh week of gestation
side effects of Zofran in kids
increased diarrhea, urticaria, and headache
Fleet enema contraindicated in?
infants risk of
Tropia describes?
manifest strabismus, which can be seen with both eyes uncovered.
Phoria refers?
latent strabismus that becomes evident when one eye is covered
innocent murmur
less than, or equal to, grade II in intensity short, systolic murmur that is less intense while sitting or upright and more intense when supine "musical" quality or a vibratory quality
lab findings in mumps
leukopenia with a relative lymphocytosis and an elevated serum amylase concentration
non-viral, causes of splenomegaly in children
liver disease malignancy hemolytic anemia portal vein thrombosis autoimmune disorders.
Cryptorchidism is associated with?
low birth weight and prematurity
A 10-year-old girl presents to clinic due to a generalized rash. History reveals that four days prior the onset of rash she was noted to have low-grade fever, runny nose, cough, and conjunctival congestion. The rash is characterized as red, maculopapular eruptions which were noted to first appear on the forehead before spreading downward to the extremities. The physical examination reveals a weak-looking girl with anicteric sclerae, pink conjunctivae, cervical and occipital lymphadenopathy, harsh breath sounds, adynamic precordium, no heart murmur, soft non-tender abdomen, full equal pulses, capillary return time of less than two seconds, and maculopapular rashes on the lower trunk and extremities with brawny desquamation on the upper trunk. Further history reveals that she is missing some of her immunizations. Which of the following is the most likely diagnosis?
measles
lab findings in hereditary spherocytosis
microcytic or normocytic anemia Reticulocytosis and a peripheral smear will show spherocytes. only disorder that will cause an increase in mean corpuscular hemoglobin concentration (MCHC) Coombs test indicating autoimmune hemolysis will be negative.
The majority of children with ALL will present with at least one of the following symptoms
palpable liver or spleen, fever, pallor or bruising
Fanconi anemia presents with?
pancytopenia hyper- or hypopigmentation or cafe-au-lait spots on the trunk, neck and intertriginous areas, short stature, upper limb abnormalities, hypogonadism, skeletal anomalies, eye or eyelid changes, renal malformations more rarely, deafness
encopresis
passage of stool at inappropriate times when a child has completed toilet training or can be reasonably expected to maintain bowel control
When foreign body aspiration is suspected, the first step in the evaluation is to perform?
plain radiography of the chest,
Zofran is contraindicated with what condition?
prolonged QT interval
Signs of orbital cellulitis include?
proptosis painful extraocular movements ophthalmoplegia.
Urticaria presents as?
pruritic, circumscribed, erythematous plaques
What serious gastrointestinal complication is associated with macrolide use in newborns?
pyloric stenosis
Infants and children with congenital rubella syndrome most commonly present with?
sensorineural hearing loss congenital cataracts or glaucoma congenital heart disease
the contraindications to vaccinations at two months of age
severe allergic reaction after a previous dose or vaccine component known severe immunodeficiency or family history of altered immunocompetence
generalized lymphadenopathy is NOT a feature of
streptococcal pharyngitis
A 13-year-old boy presents with four days of sore throat, low grade fever, and generalized malaise. He denies significant nasal congestion or cough. On examination, he has 2+ erythematous tonsils covered in white exudate, bilateral posterior cervical adenopathy, as well as shotty axillary and inguinal lymphadenopathy. Which of the following is indicated?
supportive care infectious mononucleosis
What will show on EEG with an absence seizure?
symmetric 3-Hz spike and wave activity
Which part of the body is spared by the erythema marginatum associated with acute rheumatic fever?
the face
In the case of patients who are not pregnant, initial treatment of acne is?
topical antimicrobial, such as benzoyl peroxide, with a topical retinoid
what is west syndrome?
triad of infantile spasms, developmental regression, and hypsarrhythmia on EEG
ASD has what kind of murmur?
wide and fixed, split S2 consistent with right ventricular volume overload
MCC of DDH?
↓ pressure of the femoral head against the acetabulum resulting in a shallow socket
Chelation therapy is recommended for blood lead levels?
≥ 45 mcg/dL or greater.
