Peds UW

3yo with HTN and 12cm heterogenous, solitary mass arising from superior pole of the right kidney. Dx?

Wilms tumor (nephroblastoma) -unilateral mass -often aSx -HTN from renin secretion due to compression of renal vessels or tumor cell secreting them -from kidney; CT is non-calcified Note: Neuroblastoma & pheochromocytom: from adrenal glands (#2457)

acute onset of psychotic symptoms + neurologic deficits (hand tremor, dysarthric speech) + abn liver fx test. dx?

Wilson disease (#15046)

Is the following normal? 1. I/IV systolic murmur at left upper sternal border that radiates to axilla 2. liver palpable 2cm below costal margin 3. sacral dimple with intact skin

Yes! all normal! 1. faint murmur of pulmonary flow murmur of newborn 2. hepatomegaly is >3.5cm in neonates 3. to be concerned for neural tube defect, should see deep/ large sacral dimple without a base. (#15987)

Nocturnal Enuresis is normal until what age?

5yrs also boys generally complete training later than girls (#2433) -if >5yrs, first line to consider is Enuresis alarm therapy

How many doses of HPV is required?

<15yo: 2 doses; 6mths apart ≥15yo: 3 doses (#16614)

In a kid with febrile seizure, what warrants the following? 1. Brain imaging 2. Admission & observation 3. EEG 4. LP 5. Reassurance

1. show focal neurologic signs 2. who do not return to neurologic baseline after seizure 3. recurrent, unprovoked seizures; to Dx epilepsy 4. You do LP to r/o meningitis! -signs of ↑ICP (morning HA, vomiting, full fontanelle), -meningeal signs (ie. nuchal rigidity), -Prolonged altered mental status (postictal period >10min), -petechial rash 5. If following charac of simple febrile seizure! - age 6mth-5ys - last <15min -short postictal period (<10min) (#4841, 18061)

Name associated Dx 1. Howell-jolly body 2. Helmet cell 3. Heinz bodies 4. Bite cell 5. Basophilic stippling 6. Target cell

1. sickle cell dz (SCD)- RBC remnant DNA aggregates(that didn't get eaten due to asplenia) 2. (aka schistocytes) MAHA, DIC, HUS, TTP -note: SCD hemolysis is intrinsic not traumatic = no schistocytes 3 &4. G6PD deficiency & thalassemia -heinz: aggregation of denatured Hb (been oxidized) -bite cells: when phagocytes eats that part 5. thalassemia, Lead poisoning - ribosomal precipitate 6. thalassemia, -aggregation of Hb in the center (#3647)

Name 3 mechanism for Physiologic Jaundice of newborns (esp. day2-4)

1. ↑fetal RBC (Hct50-60%) with short life span (90days)→ high RBC turnover 2. UGT not at full capacity until 2wks→ ↓Hepatic bilirubin clearance 3. ↓Enteric bacteria→ ↓ conversion of bilirubin to urobilinogen (fecal excretion)→ ↑Enterohepatic recycling (#2475)

When would following jaundice start? 1.Physiologic jaundice 2. ABO incompatibility 3. Crigler-Najjar 4. Biliary atresia

1.Physiologic jaundice would be expected to start <4th day. 2. ABO incompatibility typically causes jaundice within the first 24 hours of life. 3.Crigler-Najjar is extremely rare and causes severe jaundice within the first few days. 4.Biliary atresia would present later, typically at 3-6 weeks of life

recurrent sinopulmonary infx (sinusitis, PNA), GI infx (giardia), atopy (asthma, eczema), anaphylaxis to blood transfusion Dx?

(#3993) *Note: it would be hard to differentiate from CVID (all Ig are↓) but I guess in CVID, you won't have response to vaccine since no IgG

Cervical lymphadenitis in children: Unilateral is usually (1)_________________ 2. what source causes Acute, unilateral lymphadenitis with anaerobic bacteria? 3. Typically, Acute unilateral lymphadenitis is causes by 4. what's the etiology if you have subacute/chronic lymphadenitis & papular skin lesion on the body

(1) bacteria 2. from mouth 3. G(+) (ie. Staph aureus, strep pyogenes) 4. Bartonella henselae (pupular lesion is the site of injury) (#17427)

What is complication of Infectious mononucleosis?

-Acute airway obstruction (due to severe tonsillar enlargement) -autoimmune hemolytic anemia& thrombocytopenia -splenic rupture (#3611)

what warrants as a Tympanocentesis & culture w/ tympanostomy tube placement?

-multiple episodes of Acute Otitis media (≥3 episodes in 6mths) or -persistent (>3mths) of middle ear effusion w/ hearing loss (#3972)

Most common etiology of: 1. Acute otitis media 2. Acute bacterial rhinosinusitis 3. Otitis externa 4. Osteomyelitis in Healthy children 5. Osteomyelitis in SCD

1 & 2) S. pneumoniae, nontypeable H. influ, & M. catarrhalis 3) Pseudomonas aeruginosa & S. aureaus -txt: topical cipro 4) S. aureus 5) S. Aureus & Salmonella

1. nl # of wet diapers in 1st week of life? How about after 1st wk of life? 2. When is birth weight regained by? 3. how much weight do newborns lose in first 5 days of life?

1. ₀1st wk of life: #of wet diapers= age in days ₀After 1st wk: ≥6/day 2. regained by 10-14days 3. lose up to 7% of birthweight in first 5 days (#7726)

@ what age is this screened? 1. Autism 2. Depression 3. Vision

1. Autism: 18mths & 2yrs 2. Depression: starting 12yo 3. Vision:@ every visit ₀Infants: reflexes (red, corneal light,), horizontal & vertical tracking ₀Toddlers: strabismus ₀>3-4yrs: visual acuity test (#4531)

what's the following dx? 1. baby. recurrent sinopulmonary infx. low B cell count & serum immunoglobulins 2. adolescent. recurrent sinopulmonary infx. nl B cell count / low serum immunoglobulins

1. Bruton agammaglobulinemia (XLA) -think "Bruton: Boys, Low Bcells" 2. CVID (common variable immunodeficiency) (#3195)

What type of hemorrhage is described?what's mgmt? 1. 1day old baby with firm, nonfluctuant swelling confine to the right side of the skull. 2. 1day old baby with diffuse, fluctuant scalp swelling that expands after delivery

1. Cephalohematoma (subperiosteal vessel rupture) -btw skull & periosteum -well demarcated & don't cross suture lines -resorb spontaneously w/in a mth -as blood breaks down, can lead to hyperbilirubinemia &require phototherapy 2. Subgaleal hemorrhage -btw periosteum & gala aponeurotica -life-threatening bc of potential massive blood loss -serial Hb monitoring (#18604)

Name the antidote for following: 1. lead poisoning 2. ethylene glycol or methanol 3. beta blocker or Ca2+ channel blocker 4. cholinergic toxicity 5. Methemoglobinemia 6. Iron poisoning

1. Dimercaprol: chelating agent, will ↑urinary &fecal excretion of lead 2. Fomepizole: inhibits alcohol dehydrogenase 3. Glucagon 4. Pralidoxime (w/ atropine) reactivates cholinesterase enzyme 5. Methylene blue and vit C 6. Deferoxamine (#12418, 2655)

1. why do you have macrocytic anemia with sickle cell? 2. what is nl reticulocyte count (%)

1. In chronic hemolysis (like sickle cell), bone marrow use up FA to continuously reproduce RBC. thus, w/o adequate folic acid supple will have macrocytic anemia (w/ low reticulocyte #) 2. 0.5-1.5% (#4468)

list clinical finding of the following Dx: 1. fibrillin-1 gene mutation 2. Cystathionine synthase deficiency

1. Marfan syndrome 2. Homocystinuria (#3686)

16yo boy with pain in the left proximal femur, which is unrelated to physical activity, worse at night. it responds to NSAID 1.Dx? 2. Which is the one that doesn't respond to NSAID?

1. Osteoid osteoma (picture) 2. Ewings sarcoma (onion skinning) *Note: osteosarcoma is sunburst (# , 8772)

what's the Dx? 1. dry mild cough, rhinitis, by 2nd wk dry cough can lead to emesis, clear lungs 2. fever, lymphadenopathy, nasal discharge, pseudomembranous pharyngitis, dyspnea, sore throat (can have myocarditis and arrhythmia)

1. Pertussis (Bordetella pertussis) "whopping cough" 2. Diphtheria (Corynebacterium diphtheriae) "bull neck" (#3905)

Newborn has not passed meconium >48hrs. What are the 2 DDx and how to differentiate them?

Delayed passage of meconium >48hrs→ 2 DDx to consider: 1. Meconium ileus: -think Cystic fibrosis! (CF) - so sticky can't pass - see dilated SI & narrowed colon (underdeveloped) - bilious emesis 2. Hirschsprung dz - asso w/ Down synd - aganglionic rectosigmoid - see proximal dilated colon, transition zone, and then narrow sigmoid (#4183, 2466)

6yo boy with 10days of thick nasal discharge, congestion, and cough. Vitals nl. PE: nasal turbinates red&swollen, maxillary sinuses tender to palpation, nl: ears, CV, skin. Dx? What's the most likely etiology?

Acute bacterial rhinosinusitis (ABRS) = nasal discharge & cough for ≥10days w/o improvement Most common cause of ARBS 1. Nontypeable H. influ ~40% 2. Strep pneumoniae ~25% 3. Moraxella catarrhalis ~25% (#3286)

Kid age 2-5 w/ fever, fatigue, weight loss, and bone pain. PE: hepatosplenomegaly, lymph enlargment & tenderness, pallor, petechiae. Lab: pancytopenia Dx? What is the diagnostic test to confirm?

Acute lymphoblastic leukemia (ALL) Test: Bone marrow Bx & see >25% lymphoblasts -extramedullary leukemic spread: hepatosplenomegaly and lymphadenopathy -others show bone marrow failure (#3824)

child with fever, ear pain. PE: protruding auricle with tenderness & swelling behind the ear. Otoscopy: narrowing of external ear canal; can't see the tympanic membrane Dx?

Acute mastoiditis -complication of acute otitis media -usually <2yo -by Strep pyogenes, Strep pneumoniae, Staph aureus (#2832)

Aplastic anemia vs Aplastic crisis

Aplastic anemia: -causes PANcytopenia -Due to congenital (fanconi) or acquired (drug-induced, autoimmune, infx) Aplastic crisis: -sudden halt in RBC production; not enough to replace existing ones -ppl with sickle cell, spherocytosis, etc are susceptible since their RBCs die faster -Caused by Parvo 19, (#3838)

2day girl develops seizures and bulging anterior fontanelle. Vitals: 98.2F, 180/min, cap refill >4sec. PE: UE contractions, tongue thrusting, and lip smacking. Dx? Risk factor?

Dx: IVH (ruptured germinal matrix vessels) Risk factor: Prematurity, very low birth weight -involution of germinal matrix begins @32 gestational wks. hemorrhage→ tachycardia, bulging fontanelle, anemia Cranial US is diagnostic (#3657)

14old boy with PMH of T1DM comes into the office for: - 8lb loss in 4mths - pruritic & painful vesicular rash over extensor surfaces of elbows and knees - mucosal pallor Lab: Hb10, MCV 72, ferritin 9 (low), & nl plt, WBC Dx? what test to diagnose?

Celiac disease ₀ anti-tissue transglutaminase Ab assay Sx: weight loss, IDA, & dermatitis herpetiformis! - commonly asso with another autoimmune dz (T1DM) (#2773)

10mth old, who was a premie baby, show bilateral LE that are hypertonic w/ significant resistance to passive extension. She can't pull herself up or cruise. Dx? Txt?

Cerebral palsy -risk factor: premie/ low birthweight -clinical features: Delayed motor milestones, abn tone (spastic, dyskinetic, or ataxic) *Babinski reflex can be nl up to 2yo Txt: baclofen/ dantrolene (or botox) to prevent contractions (#2443)

2yo boy with recurrent skin abscess. This time he has abscess of right thigh (+) for S. aureus. Dx? What is the test to diagnose?

Chronic granulomatous disease -NADPH oxidase defect test: Nitroblue tetrazolium or Dihydrorhodamine 123 *Note: staph(+) & strep(-) (#12518)

infant <3mth of age that cries for no apparent reason for >3hrs a day for at least 3days/wk. Crying usually occurs at same time of day & difficult to console. Dx? and mgmt?

Colic mgmt: review soothing techniques, reassurance (#4856)

17yo with recurrent kidney stones. UA: hexagonal crystals Urinary cyanide nitroprusside test: (+) Dx?

Cystinuria defect in renal PCT so can't absorb Cystine (Ornithine, Lysine, Arginie)→ keep getting kidney stones! "Sixtine stones have Six sides" (#3949)

baby with fair skin, eczematous rash, mild dehydration, and urine with musty odor. What's the diagnostic test?

Dx: PKU Test: 1.Quantitative Amino Acid analysis→ see ↑↑ phenylalanine levels 2. Tandem mass spectrometry @ newborn screening (#3123)

4mth boy with 1mth of lethargy, poor feeding, pallor. PE: webbed neck, cleft palate, mild hypertelorism, flat nasal bridge, mucosal pallor, triphalangeal thumb. tachycardia with mild systolic ejection flow murmur Lab: Hb 4, MCV 104, Reticulocyte 0.4% -plt and WBC nl Dx?

Diamond-Blackfan Anemia (DBA) -Pure RBC aplasia w/ reticulocytopenia & nl plt & WBC! -most have physical anomalies like this pt -pallor, poor feeding, systolic murmur is all due to severe anemia (#3818) *Note: Diff from Fanconi -fanconi is pancytopenic bone marrow failure

Newborn born with vacuum assistance due to macrosomia has crepitus over left clavicular bone. passive mvmt of left UE elicits crying. Dx? Txt?

Displaced clavicular fracture reassurance, gentle handling, fix arm in garment while flexing elbow 90⁰ (#2485)

16yo girl with painless non-pruritic pustular rash including palms & left knee pain with effusion but no redness. arthrocentesis shows WBC 30k but culture is (-) Dx?

Disseminated gonococcal infx Triad: Dermatitis, migratory, polyarthralgia, tenosynovitis -hematogenous spread -monoarthritis w/o systemic Sx -Usually synovial fluid has <50k of WBC Txt: 3rd gen cephalosporin IV & PO azithro (#15847)

11yo with 1day of abd pain, n/v, diarrhea, and fever comes in. PE: mild tenderness in lower abd. no CVA tenderness. all else nl UA: +2 protein. no growth in culture All her Sx resolves within 2 days. what should you do about her proteinuria?

Do a First morning urine protein/creatinine ratio Transient proteinuria : common cause of isolated proteinuria in children; triggered by fever, stress, exercise, of hypovolemia. -so her GI bug and its fever caused this! (#2234)

baby <2yrs, fever, cough, nasal congestion that peaks on day 3-5days of illness. worsening cough & tachypnea/retractions. PE: diffuse wheezing and crackles Dx? managment?

Dx: Viral Bronchiolitis (RSV most likely) Mgmt: supportive, out patient , close f/u (unless premature, <2mths, or severe resp distress) -may not have fever (#19296, 17488)

child with -erythematous, papular rash on trunk and groin -hypernatremia -wakes up nightly to urinate -leg pain that is worse at night -> small, well defined lytic distal femoral diaphyseal lesion Dx?

Langerhans cell histiocytosis -lytic bone lesion -eczematous rash -Central diabetes insipidus (polyuria, hypernatremia) -lymphadenopathy -hepatosplenomegaly -pulmonary cyst/nodules (#4642)

9yr girl with 1 wk of rt ear that is ringing and popping when swallowing. she few home from colorado few days before this started. PE: retracted right TM, mild reduction in hearing on rt side Dx?

Eustachian tube dysfunction -connects middle ear to nasopharynx & by opening/closing will equalize middle ear pressure, drain. Inflammation of this→ obstruct→ pressure dysregulation→ Ear fullness/tinnitis/ "popping"/ conductive hearing loss PE: retracted TM (neg pressure in middle ear) Note: if TM rupture, hearing loss/tinnitus will occur at the time of incident (#18424)

4mth old with noisy breathing. -louder when crying, feeding, laying -inspiratory stridor, that resolves when prone (-) cyanosis, feeding difficulties Dx?

Laryngomalacia -inspiratory stridor that is worse @ supine -most common cause of stridor in infants -most have Gastroesophageal reflux -will resolve spontaneously by 18mths -But if feeding difficulties, cyanosis, or FTT= refer to surgery (#16086)

hypoplastic thumbs, dev delay, pancytopenia

Fanconi Anemia pancytopenic bone marrow failure

3yr old boy with sudden onset of uncontrollable cough. can hear wheezing. PE: rt lung diminished breath sounds and expiratory wheezing. What would xray be? what's txt?

Foreign body aspiration Xray: Hyperinflation of affected side & mediastinal shift towards unaffected side (IF complete obstruction= atelectasis of affected side) txt: rigid bronchoscopy (to remove obj) (#2451)

common causes of osteomyelitis & septic arthritis in <2mths old?

GBS & E. coli (#3571)

16yo girl with : -"growing pains" of arms & legs -5th percentile h&w (height &weight) -severe splenomegaly. moderate hepatomegaly -Tanner stage 1 pub&breast Labs -Hb 8.6, plt 78K, wbc 8k Dx? etiology?

Gaucher disease cause: Glucocerebrosidase deficiency (#12495)

12yo boy went to petting zoo, developed febrile diarrheal illness that resolved. Now has bilateral flaccid paralysis of LE. Dx? which fibers are affected?

Guillain-Barre Syndrome -ascending weakness Can get Campylobacter with direct contact with animals (usually poultry, raw milk ingestion) (#3664)

4yo boy with palpable, nontender, soft, coiled mass superior to the rt testicle. Mass does not transilluminate or decrease in size when supine. BP is 160/96. otherwise pt seems fine Next step? A. abd U/S B. Bx C. Surgical orchiectomy

He has secondary Varicoele, most likely due to fixed mass compressing his left renal vein (Wilms tumor) -so do abd US to see this -varicoele= coiled ("bag of worms") that don't transilluminate -If nl (1⁰ varicocele): should ↓ w/ supine -2⁰ more likely if: prepubertal, Rt-sided mass, Don't ↓ when supine Note: -never do Bx of testes or ovaries→ can seed! -cancer is usually 15-35yo; initial mgmt is surgical orchiectomy (#15922)

16yo pt with Chronic, progressive swelling/ pain of knee Have Hx of prolonged bleeding

Hemophilic Arthropathy Hemophilia A&B complication: Recurrent hemarthrosis→ hemosiderin deposition→ inflam & fibrosis (#4249)

3yo boy was sick 2 days ago with runny nose & cough. but yesterday started have yellowing of eyes and skin with fatigue. PE: spleen is 4cm below costal margin Labs: Hb8.6, plt 160k, wbc 7k Dx? What's following? 1. Reticulocyte count: high/ low 2. Direct coombs: (+) or (-) 3. MCHC: high/nl/ low Diagnostic Test?

Hereditary spherocytosis 1. Reticulocyte count: high 2. Direct coombs:(-) 3. MCHC: high -bc membranes chip off & cytosol gets concentrated NOTE: >2cm costal margin is abn (#15406, 2870) Compare to G6PD def: Males (x-linked recessive), intravascular hemolysis, heinz

5yo boy with fever and several gray, shallow ulcers on soft palate and uvula, but not on tongue/lips.buccal mucosa. Dx & causal organism?

Herpangina caused by Coxsackie A virus *Note: Coxsackie A virus can cause both Herpangina & Hand-foot-mouth dz, but these 2 are diff! -Herpangina is NOT associated with a rash -HFM dz can have oral mucosal ulcers (#9849)

What is the 1st line medication to help with recurrent vaso-occlusive crises in SCD pts? What is the AE?

Hydroxyurea - will ↑ fetal Hb AE: myelosuppresion (#3786)

8yo boy w/ 2days of non-blanching rash on leg and butt. over the last 24hrs, also dev abd pain and 2x non-bloody/bilious emesis. passive range of motion of both hips elicits pain. Dx?

Immunoglobulin A vasculitis (aka. Henoch-Schonlein purpura) vasculitis 2° to IgA immune complex deposition -asso w/ IgA nephropathy * most common childhood systemic vasculitis -often follows URI -nl plt count! (unlike leukemia or ITP) Sx: 1. Palpable purpura on butt/leg 2. Arthralgia 3. Abd pain (asso w/ intussuception) 4.hematuria±proteinuria* (#7764, 3554, 4279)

3yo girl with Chronic, joint swelling/warm, no pain, may limp (in the AM but gone by midday) Dx? complication to be concerned about?

Juvenile idiopathic arthritis ; Oligoarticular -Autoinflammatory No fever or systemic sx with oligo/poly articular JIA Complication: uveitis (#16831)

14yo girl with 3mth of leg pain that spread to bilateral knees, elbows, and wrists this month. pain/stiffness is worse in the AM but better over the day. No fever and other PE is normal besides mild swelling & tenderness to these joints. Dx?Txt?

Juvenile idiopathic arthritis; polyarticular Note that pain/stiffness improves over the day. Symmetric involvement of arthritis Txt: NSAID (#16830)

4yo with 9days of fever w/: -bilateral conjunctival injection -tender anterior cervical lymph node >1.5cm (unilateral) -maculopapular eruptions on trunk & extremities -hands & feet are red and swollen -mucositis Dx? what is a complication to be concerned about?

Kawasaki disease Complication: coronary artery aneurysm. DO Echo! Txt: asa + IV IgG *Note: mucositis= strawberry tongue -Also, can have complication of gallbladder hydrops: RUQ pain (#3079)

1day old girl with Turner's have bilateral, non-pitting carpal & pedal edema. Why?

Lymphatic network dysgenesis → congenital lymphedema→ protein-rich interstitial fluid in hands, feet, and neck→ NON-pitting edema *Note: horseshoe kidney has nl kidney fx; may ↑ UTI tho (#4764)

1yr boy with cyanosis since today. He had been teething and mom has been putting topical anesthetic past week. Vitals: RR50, pulse 158, Pulsox 85% PE: lungs clear, CV nl, no hepatosplenomegaly. 100% O2 is given but fails to increase pulsox reading or cyanosis Dx? Txt?

Methemoglobinemia ₀from too much oxidizing agent (anesthetic) ₀Iron in Hb got oxidized from Fe²⁺ →Fe³⁺ -which binds to O₂ but won't let go∴ no change with oxygen therapy -also since O₂ is bound still, just can't get dropped off, PaO₂ is nl! Txt:methylene blue & vit C (#12417, 12418)

Child with acute, unilateral cervical lymphadenitis: etiology? txt?

Most common: S.aureus, S. pyogenes txt: Clindamycin -I thought Azithromycin: but this txt catscratch dz (#4843)

Management of hydrocele in a neonate

Most hydroceles (both communicating & noncommunicating) should resolve by 1yo -just reassure & observe IF it doesn't resolve >1yo, then surgery (#2373)

7day-old term baby, s/p congenital heart surgery in NICU, has sudden onset of poor feeding and abd distention. afebrile. PE: lethargic, cyanotic neonate, abd distention & absent bowel sounds. BRB in stool. Dx?

Necrotizing enterocoilitis (NEC) -so premies are usually risk factors BUT, even with term infants w/ ↓mesenteric O₂ delivery (ie. from heart defect or HoTN) can also get this too! -Note that baby doesn't have to have fever. & had/have BM *AxR shows pneumatosis intestinalis: extravsation of bowel gas into the damaged bowel wall(red arrow). air in portal venous system (yellow) (#2474, 2465)

5yo boy with numerous freckles in axillae, multiple flat-small uniformly hyperpigmented macules on the trunk. recent complaint of headache in the morning and can't see clearly. Dx? what are we concerned about?

Neurofibromatosis I -Autosomal Dominant risk for dev intracranial neoplasm: Optic pathway glioma is most common lesion (#3550,4202)

In pt with Guillain Barre, what is a complication that you have to screen for? & what test do you screen it with?

Neuromuscular respiratory failure (30%) do Spirometry! -decline in FVC warrants endotracheal intubation (#4271)

6yo boy with noisy breathing. -sounds like gasping for air while sleeping -during the day, breathes through his mouth. eats&drinks w/o any problem -day time inattention, irritability height: 40th per/ weight: 25th Dx?

Pediatric obstructive sleep apnea (#14272)

18yo with dry mild cough & rhinitis for over a week. by 2nd wk dry cough can lead to emesis. he received routine childhood vaccinations up until age 11. no PMH. Vitals unremarkable PE shows clear lungs. Dx?

Pertussis Although he would've gotten the Tdap booster at 11, pertussis immunity wanes over 5-10yrs. that's why he got it even if he is fully immunized (#3905)

4yo got Bordetella pertussis at daycare. she lives with parents and 1yo sister. everyone is up-to-date with immunizations. other family members are aSx. 1. Mgmt? 2. If someone who is fully vaccinated get exposed to pertussis, within how many days do you have to get prophylactic txt?

Regardless of immunization status, Close contacts & High-risk indv need to get prophylactic Macrolide Abx -Vaccination prevents most cases. BUT, immunity can wane in some cases & since Pertussis is so contagious, it's worth getting prophylactic txt for some ppl 2. within 21 days! (#3906, 4258)

Baby with FTT. Lab: Na⁺ 140/ K⁺ 3 (L)/ Cl⁻ 121 (H)/ HCO₃⁻ 14 (L) ABG: pH7.21 / PaCO2 31 (L) UA: pH 7.9 Dx?

Renal Tubular acidosis (type 1) - pt has normal AG metabolic acidosis - low bicarb & ↑↑Cl⁻ - FTT bc you can't excrete H⁺, also can't exchange/absorb HCO₃⁻ *Anion Gap calc: Na⁺ - (Cl⁻ + HCO₃⁻) (#4828)

Guillain Barre Syndrome can proceed after which infections?

Respiratory or GI infx (Campylobacter)

what is the Hb pattern for SCD pt vs SCD on hydroxyurea?

SCD: HbF 5-15% HbS 85-95% SCD on hydroxyurea: HbF>15% (#4835)

2mth baby with cyanosis. lips turn blue while feeding. 5th percentile. CV: 2/6 crescendo-decrescendo systolic ejection murmur at the left upper sternal border. & single S2 Knee-chest position helps. What's the mechanism that is causing this? A. increased systemic venous return B. increased systemic vascular resistance C. Increased pulmonary vascular resistance

Tetralogy of Fallot (ToF) - increased systemic vascular resistance -cyanosis is depended on how bad the pulmonic stenosis is (which will increase Rt-to-Lft shunting) *Single S2=ToF, truncus arteriosus, tricuspid atresia "Knee-chest positioning" helps to kink the femoral arteries→ ↑systemic vascular resistance→ ↓Rt-to -Lft shunting→ improves cyanosis (#4842, 2439, 3541) *Why you get crescendo-decrescendo systolic ejection murmur? RVOT obstruction (exp in NBME cards; search ToF)

What are the most common causes (2) of osteomyelitis in children with sickle cell disease? Txt?

Salmonella & Staphylococcus aureus Txt: vanc + ceftriaxone (#3571)

Microcytic Anemia: 3 DDx & how to differentiate them

See Chart *Note: In β-thalasemia minor, ↑in HbA₂ (2α2δ): these are usually 3% while HbA(2α2β) is 95%. -HbA₂ are ↑than nl bc there's not enough β chains to make HbA -Reticulocyte is nl in thalassemia (#4875)

2yo with 3min of convulsions comes to ED at post-ictal state. had fever of 103F since this morning. PE: neck supple, but otherwise alert & playful. Dx? nxt step?

Simple Febrile Seizure Can go home! Dx is clinical & no need to more eval Note: -do not recur w/in 24hrs -Antipyretics don't ↓risk of future febrile seizures (#4841)

6yo boy with Cystic fibrosis has another episode of PNA. sputum culture is pending. What is the most likely causative organism?

Staphylococcus aureus (#3830)

What does APGAR look for? when do you measure & if not suffice what to do?

The Apgar score is reported at 1 minute & 5 minutes after birth for all infants. - change in score between 1 & 5 minutes may be a useful indicator of response to resuscitation. According to Neonatal Resuscitation Program guidelines, a score below 7 @ 5 minutes should prompt continued resuscitation, with reassessment every 5 minutes, up to 20 minutes, until a score of 7 is achieved.

1yo with fever, drowsiness, and nuchal rigidity. suddenly develops purpuric lesions and HoTN. Dx?

Waterhouse-Friderichsen syndrome Complication of N. Meningitidis infx: sudden vasomotor collapse + skin rash (purpuric/petechiae) = due to adrenal hemorrhage *Note: CSF will have -Glucose low -Protein high -Neutrophilic leukocytosis >1k (#3442, 4265)

Breastfeeding jaundice vs Breast milk jaundice

Think of it as: -Breastfeeding "failure" jaundice: so not enough -Breast milk "content causing" jaundice (#4817)

If a child has clinical presentation suspicious of strep but rapid strep antigen testing is (-), what's the next step?

Throat culture! (#2193)

When large volume of blood product is rapidly transfused. pt shows Respiratory distress, HTN, tachycardia, and pulm edema. Dx? txt?

Transfusion- associated circulatory overload (TACO) -fluid overload! -for very young & very old! -happens <6hrs of transfusion txt: Diuresis and Respiratory support (#17425)

14yo girl with CC of primary amenorrhea. Also have myopia, coarcation of aorta, multiple hyperpigmented nevi. Height 5th, weight 55th pecentile Dx? What is a complication this pt might have?

Turner Syndrome osteoporotic fracture (due to estrogen deficiency from streak ovaries) (#4765)

3mth old with 3days of fever, fussiness, and not wanting to feed. No rhinorrhea, cough, congestion. PE: nl eyes, ears, nose, throat. lungs are clear. abd is soft with bowel sounds but baby cries w/lower abd palpation. what to do next?

UTI should be suspected in infants w/ fever & no identifiable source since presentation can be nonspecific (ie. fussiness, poor feeding) UA & urine culture is 1st step; not toilet trained pt shud obtain via straight catheterization (#4005)

5day old girl has "pink/ brick dust-like stains" in the diaper. what is this?

Uric acid crystals this is normal! - esp high at birth and ↓ until adolescence -commonly seen during 1st week w/ mother's milk & with morning void after infant starts to sleep throughout the night (#7726)

For Campylobacter infx (C jejuni or C coli), what's the management?

Usually, just Supportive care only. Abx for High risk cases: >7days, bloody stools, high fever, immunocompromised *Not all Campylobacter infx has GBS. it is just a complication (#17637)

1mth old with: 1. I/IV holosystolic murmur over left lower sternal border 2. diastolic rumble at apex 3. S2 prominent Dx& why you hear each

VSD 1. larger VSD have less turbulence. thus is quieter 2. due to ↑blood flow across the mitral valve (since ↑in Blood volume from L to R shunt) 3. as ↑ in RV pressure→ Pulmonic HTN→ pulmonic valves shuts against stronger force= louder S2 (#4705)

newborn boy with -absence of iris bilateral -urethral opening at ventral side of penile shaft and absent left testis. Dx? what is this pt increased risk of developing?

WAGR syndrome ↑risk of Wilms tumor: -renal malig -abd US every 3mths for early detectoin (#16615)

Mom had brief febrile illness and joint pain during 1st trimester. her newborn has: -<5th percentile -absent red reflex -harsh murmur both systole &diastole over left 2nd intercostal space -hepatosplenomegaly etiology? A. CMV B. Parvo C. Rubella

ans: Rubella -patent ductus arteriosus -hearing loss -leukocoria (white pupillary reflex) from cataracts -FTT -hepatosplenomegaly -purpuric rash children: fever, head to trunk rash, cough, red eye post auricular & suboccipital lymphadenopathy (#3663) -CMV: periventricular calcification (toxo is intracranial calcification)

4yo just got Varicella-zoster vaccine and dev 6 scattered papular and vesicular lesions on her chest. what is causing this?

attenuated varicella virus in the vaccine is replicating usually get <10 lesion that is maculopapular (rather than entirely vesicular) & NO fever. This is still somewhat contagious (less than wild type) so avoid contact with high risk indv (#12260)

what type of pts are at risk for SCFE (slipped capital femoral epiphysis)

obese &/or big growth spurt (adolescents) hypothyroidism (<10yo) (#3403)

3yr was well until this morning. pt is alert & awake but has difficulty articulating. PE: significant weakness, hypotonia, hyperreflexia of right arm or leg. Dx? what are possible causes?

pediatric stroke just like adults, acute focal neurologic deficits= stroke! cause is just different! *chart! (#4439)

Pt with: Acute, fever, swelling/ warm/ pain Refusal to bear weight Synovial fluid WBC >50k IF Txt with vancomycin does not resolve Sx, what to do?

pt has Septic Arthritis Most cases caused by: S. Aureus that hematogenously disseminated = Vancomycin BUT, if it doesn't resolve, add 3rd gen Cephal (for g(-) coverage) (#15848) Note: Acute osteomyelitis may have similar presentation but prompt give you an imaging (ie. tech-99m uptake at metaphysis) to distinguish (pic)

risk factors for developing Cholesteatoma?

recurrent acute otitis media, chronic middle ear effusion, and tympanostomy tube placement (#15148)

kids with myopia that requires >6diopter of correction is in risk for which complications?

retinal detachment & macular degeneration myopia occurs bc eyeball is too long. if severe, it can cause stretching and thinning of sclera, choroid, & RETINA. ∴ at risk of these 2 complications (#18897)

For primary nocturnal enuresis, what's the order of intervention?

so these are kids >5 who never achieved nighttime dryness. 1. behavioral modification: -void before bed -min evening fluid intake 2. enuresis alarms (take 3-4mths) 3. Desmopressin: -ADH analog; ↓urine production during sleep -although immediate effect, high relapse with d/c 4. TCA (ie. imipramine) -reserved for #3 failure due to AE (cardiotoxicity,etc) (#2513)

How to prevent (NOT treat) gonococcal disease for a newborn shortly after birth?

topical erythromycin *treatment is IM cefotaxime (3rd gen ceph) (#3660)

Know the 4 diff E. coli and its associations 1. EIEC 2. ETEC 3. EPEC 4. EHEC

₀EIEC: I for Invasive (like shigella)-bloody ₀ETEC: T for Traveler's diarrhea ₀EPEC: P for pediatric diarrhea ₀EHEC:H for HUS - bloody (O157:H7) (#17499)