Pediatrics Final

GENU VARUM

"Bowed" legs?

GENU VALGUM

"Knock" knees?

Complications Bulimia Nervosa (BN)

- acid/base disturbances -electrolyte abnormalities -dental abnormalities -aspiration pneumonia -esophagitis?

Newborn Hypoglycemia

-Blood glucose <45mg/dL -LGA, SGA, preterm and stressed infants -May be asymptomatic -Infants may have lethargy, poor feeding, irritability or seizures. Treat with frequent feedings and BS checks, D10W if needed?

Causes of Acute Otitis Media (AOM)?

-Hflu -Strep -Moraxila Cataralis?

Bacterial Sepsis in the newborn

-Most infants present at <24 hours -Respiratory distress is most common -Hypotension, acidemia, jaundice, and neutropenia are associated symptoms Sources/Causes: GBS, E. Coli, Staph GBS Prophylaxis during labor?

Pneumothorax

-increased with PPV resuscitation -A type of respiratory distress present in the newborn?

Pneumonia

-respiratory distress, lethargy, fever, abnl CXR -GBS, Chlamydia -A type of respiratory distress present in the newborn?

Transient Tachypnea

-typically present at birth -resolves in 12-24 hours -A type of respiratory distress present in the newborn?

PEDS

10 questions used to assess if anything is developmentally wrong with a child?

Bacteria Pharyngitis/Tonsillitis

10% of children with sore throat and fever have group A strep?

Trisomy 13 (Pateau Syndrome)

1:12,000 births § Most infants with trisomy 13 have anomalies incompatible with life?

Vitamin K

1mg given IM at birth?

Asthma Categories based on Peak Flow Meter

80-100 50-80 <50?

Admission to the hospital with complete sepsis evaluation

A 1-month-old boy has a fever to 102.7°F (39.3°C), is irritable, has diarrhea, and has not been eating well. On examination he has an immobile red TM that has pus behind it. Which of the following is the most appropriate course of action?

Radiographs of the cervical spine should be obtained

A 1-week-old female newborn presents with her new adoptive parents. The family complains that she seems to have a twisted neck. They know only that "delivery was almost a C-section because the baby was lying sideways." She has been feeding well and has had appropriate urine and stool output for the last 24 hours. Physical examination is signifi- cant for torticollis. Which of the following statements is most accurate?

Hospitalize the patient, obtain HSV cultures, and initiate parenteral acyclovir

A 10-day-old infant has a painful, red vesicular rash in the diaper area. He is mildly fussy but afebrile, and he has good oral intake. Which of the following is the most appropriate management of this infant?

Cystic fibrosis

A 10-year-old boy has a history of recurrent sinusitis and multiple episodes of pneumonia. A sweat electrolyte test result is within the normal range. Your differential diagnosis now includes atopy, primary ciliary dyskinesia, and which of the following?

Facial magnetic resonance imaging

A 10-year-old girl complains of left-sided nasal congestion for 5 months. Decongestants and antihistamines have not helped. She denies placing any object in her nose. Today her mother noticed increasing left-sided facial swelling and tenderness. Examination of the girl reveals a pink, nontender, fleshy mass in her left nares that completely occludes the air- way. Initial management should include which of the following?

The girl is responding to the albuterol, and her symptoms are improving

A 12-year-old asthmatic girl presents to the ED with tachypnea, intracostal retractions, perioral cyanosis, and minimal wheezing. You administer oxygen, inhaled albuterol, and intravenous prednisone. Upon reassessment, wheezing increases in all fields, and the child's color has improved. Which of the following is the appropriate explanation for these findings?

Decreasing his activity should alleviate the pain

A 12-year-old boy complains of right knee pain that is worse after he runs. His pain started 1 week after he joined the track team. He has tenderness of the tibial tubercle. Which of the following statements is accurate?

Congenital cytomegalovirus (CMV) infection

A 13-month-old child is noted to be at the 25th percentile for weight, the 10th percentile for height, and less than the 5th percentile for head circumference. She was born at term. She was noted to have a small head at birth, to be developmentally delayed throughout her life, and to have required cataract surgery shortly after birth. She currently takes phenobarbital for seizures. Which of the following would most likely explain this child's small size?

HPV types 16 and 18 are associated with the majority of cervical cancers

A 13-year-old adolescent female comes to the office for a preparticipa- tion sports physical before the start of the basketball season. She has no complaints, but wants to discuss the human papillomavirus (HPV) vaccine some of her friends have received. Which of the following is an accurate statement about human papillomavirus and the vaccine?

M pneumoniae

A 13-year-old adolescent female complains of dry cough, slight fever, and fatigue over the past 2 weeks. She noted increased chest conges- tion and coughing yesterday when walking outside in the cold air. She denies nasal congestion, rhinorrhea, emesis, or diarrhea. Her mother declares her daughter is generally healthy with a history of only sum- mertime allergies. Her vital signs, respiratory effort, and chest examination are normal. Which of the following is the most likely pathogen?

Arrange for an orthopedic surgery consultation

A 13-year-old adolescent male has 1 week of limping and right knee pain. On your growth curve you determine that his weight is greater than the 95th percentile for age. His physical examination is remarkable for mild acanthosis and normal knees. His hip examination demonstrates dimin- ished ability to flex and internally rotate his right femur. Which of the fol- lowing is the best next step in management?

Genetic primary hypophosphatemia

A 14-month-old child has lower-extremity bowing, a waddling gait, genu varum, and is at the fifth percentile for height. Laboratory data include low-normal serum calcium, moderately low serum phosphate, and elevated serum alkaline phosphatase levels, hyperphosphaturia, and normal parathyroid levels. Which of the following is the most likely diagnosis?

Arrangeforimmediatetransfertotheoperatingroomtosecurethe airway via tracheal intubation or tracheostomy.

A 14-month-old girl has a 6-hour history of fever to 102.6°F (39.2°C) and an increasingly ill appearance. She is anxious and does not want to leave her mother's arms, but she gives only a faint cry when approached. Her respiratory rate is 70 breaths/min and her neck is hyperextended. An area of moisture is noted on the shoulder of the mother's blouse. Which of the following is the next most appropriate step in management?

Obtainfurtherhistorywithregardtofever,weightloss,rashes,and arthritis

A 14-year-old adolescent female arrives for a routine well-child eval- uation. The mother reports that her daughter has previously been well, but she wants you to scold the patient since she did not use sun- screen at a recent pool party and returned home 3 weeks ago with a sunburn across her cheeks and nose; the adolescent rolls her eyes at her mother. When the mother leaves the room the patient reports that she did use sunscreen but did not feel like arguing with her mother about the point. She states that she has been well, but also notes that she has had 2 months of intermittent right knee pain that does not appear to be related to exercise. Upon further questioning she reports that she has not been feeling well and is increasingly tired. Your phys- ical examination demonstrates the sunburn across the nose but no knee abnormalities and a normal gait. Which of the following is the most appropriate next step in management?

Strongyloides can develop a "hyperinfection" in immunocompromised hosts.

A 14-year-old adolescent male with HIV and AIDS presents for a physical examination prior to traveling to Southeast Asia. In counseling him on health risks in the area, you mention that he must always wear shoes to help prevent Strongyloides infection, which is particularly dangerous to him for which of the following reasons?

Phencyclidine (PCP)

A 14-year-old has ataxia. He is brought to the local emergency depart- ment, where he appears euphoric, emotionally labile, and a bit disori- ented. He has nystagmus and hypersalivation. Many notice his abusive language. Which of the following agents is most likely responsible for his condition?

Complete atrioventricular (AV) canal (endocardial cushion defect)

A 15-day-old infant has respiratory distress. A quick observation sug- gests she has slight cyanosis, hepatosplenomegaly, and features consis- tent with DS. The cardiac examination demonstrates a loud first heart sound, a wide and fixed split second heart sound, a low-pitched, mid- diastolic murmur at the lower left sternal border, and a harsh apical holosystolic murmur in the mitral area. An echocardiogram is likely to demonstrate which of the following?

Douching twice daily over the past month

A 15-year-old adolescent female has burning on urination, but no fever, urinary frequency, hematuria, vaginal discharge, GU lesions, or abdominal pain. She has regular cycles. Her abdominal examination is normal. Her GU examination reveals erythema surrounding the vagi- nal introitus, but no vaginal discharge, tenderness, or masses during the pelvic examination. Her urinalysis is benign. Which of the following is the most important historical clue to be gathered?

Ruptured ectopic pregnancy

A 15-year-old adolescent female presents to the local hospital emer- gency center complaining of several days of left sided abdominal pain, mild vaginal bleeding, and dizziness. Upon further questioning you learn that she has had near-syncopal episodes the last few times she has tried to stand up. She denies fever, sexual activity, previous episodes of mid-cycle vaginal bleeding, and abdominal or genitouri- nary trauma. On examination, she is pale and tachycardic. She has abdominal pain with rebound and guarding in the upper and lower left quadrants that radiates to the back. Her hemoglobin is 5 g/dL, her white count is 12,000/mm3, and her platelet count is 210,000/mm3. Her serum ß-HCG is 1800 IU/mL. Which of the following is the most likely diagnosis?

Turner Syndrome (XO)

A 15-year-old adolescent female with primary amenorrhea is noted to be well below the fifth percentile for height. She has hypertension, a low posterior hairline, prominent and low-set ears, and excessive nuchal skin?

Obtain more history, including sexual history.

A 15-year-old adolescent male presents with right knee pain; he can- not bear weight on the affected joint. The knee is tender, edematous, warm, erythematous, and has significantly diminished range of motion. Which of the following is the best next step in his evaluation?

He is having a late-phase reaction

A 15-year-old adolescent male uses his albuterol inhaler shortly after he mows the lawn because of a mild feeling of chest "tightness." He later returns home early from dinner at a friend's house when he has the sudden onset of wheezing, cough, and chest pain. Which of the following is the most likely explanation for these circumstances?

Perform urinalysis and urine pregnancy testing

A 16-year-old adolescent female presents with a 1-day history of stab- bing left groin pain, and white vaginal discharge and mild dysuria for the past week. There has been no abnormal vaginal bleeding, with her last menses approximately 3 weeks ago. She reports one UTI since menarche, but no STDs. She has been sexually active for the past year and takes an oral contraceptive. Her partners irregularly use condoms. She is afebrile, but has left lower quadrant and suprapubic abdominal pain on deep palpation and minimal guarding. Which of the following is the most appropriate next step?

Nasal steroids and oral antihistamines

A 16-year-old adolescent female reports frequent URIs for the last few years. She said her last doctor always prescribed antibiotics and she would eventually improve. She reports clear nasal drainage with con- gestion, itchy eyes and nose, and cough. Which of the following is the best next step in managing this patient?

IgA nephropathy

A 16-year-old adolescent male complains of intermittent cola-colored urine of several years' duration, usually when he has a "cold." He is otherwise well and has no medical complaints. When the dark- colored urine is present, he has no dysuria. None of his family mem- bers has similar complaints or renal disease. On physical examination he is normotensive and appears healthy. Which of the following is the most likely cause of his intermittent hematuria?

Intravenous conjugated estrogens (Premarin) and high-dose com- bination OCP

A 16-year-old presents to your office with a complaint of persistent vaginal bleeding. She had been seen 3 months ago when you noted a mild anemia of 13 g/dL, diagnosed her with dysfunctional uterine bleeding and started her on iron supplements. Today she is listless and pale. Her hemoglobin in your office is 6 g/dL, her platelet count is nor- mal, and her urine pregnancy test remains negative. You admit her to your local hospital and order a transfusion of packed red blood cells. In addition to stabilizing her circulatory system, which of the follow- ing is the most appropriate next step in the acute management of her condition?

Systemic lupus erythematosus (SLE)

A 17-year-old adolescent female has joint tenderness for 2 months; the pain has affected her summer job as a lifeguard. In the morning, she awakens with bilateral knee pain and swelling and right hand pain. The pain eases during the day but never completely resolves. Nonsteroidal anti-inflammatory drugs help slightly. She also wants a good "face cream" because "her job has worsened her acne." On physical examina- tion you notice facial erythema on the cheeks and nasolabial folds. She has several oral ulcers that she calls cold sores, bilateral knee effusions, and her right distal interphalangeal joints on her hand are swollen and tender. Her liver is palpable 3 cm below the costal margin. She has microscopic hematuria and proteinuria. Which of the following is the most likely cause of this young woman's arthritis?

Fitz-Hugh-Curtis syndrome

A 17-year-old adolescent female presents with severe pain in the right upper quadrant and has some pain in her right shoulder. She has nausea, fever, and chills. The abdominal pain increases with movement or Valsalva activities. On physical examination, you confirm pain over the gallbladder, but also notice that she has right lower quadrant abdominal pain. Her pelvic examination is significant for discharge from the cervical os and pain upon cervical motion. Which of the following is the most likely etiology for her complaint?

Fluid resuscitation and blood transfusion

A 17-year-old adolescent male has left shoulder and left upper quadrant abdominal tenderness and vomiting. He reports having "mono" last month but says he is completely recovered. He was playing flag football with friends when the pain started an hour ago. On examination, his heart rate is 150 bpm and his blood pressure is 80/50 mm Hg. He is pale, weak, and seems disoriented. He has diffuse rebound abdominal tenderness. Emergent management includes which of the following?

Use a second form of birth control in addition to her oral contraceptive

A 17-year-old girl is prescribed oral tetracycline, topical tretinoin, and topical benzoyl peroxide. She is sexually active and takes an oral contraceptive. You should counsel her to do which of the following?

Ceftriaxone, 250 mg IM as a single dose and doxycycline, 100 mg orally twice a day for 14 days

A 19-year-old adolescent female presents with a temperature of 101.2°F (38.4°C), lower abdominal pain, bloody vaginal discharge, and dys- pareunia. She has no nausea or vomiting, and is tolerating fluids well. She has cervical motion tenderness on examination. Her urine preg- nancy test is negative, and an ultrasound of her right lower quadrant is negative for appendicitis. Appropriate outpatient management for her likely condition is which of the following?

Antimicrobial prophylactic therapy should be started when her current course of antibiotics is completed

A 2-month-old girl presents with fever and vomiting. Her serum white blood cell (WBC) count is elevated. Urinalysis reveals 100 WBC per high-power field (unspun); it is positive for nitrates and leukocyte esterase. Urine culture results confirm a UTI; renal USG and VCUG show mild hydronephrosis and grade II VUR on the right. Which of the following is the best next step?

Vitamin A excess

A 2-month-old infant arrives with bulging of his anterior fontanelle. He is fussy, refuses to nurse or to take a bottle, and has vomited once en route to the hospital. He has had no fever. Computerized tomo- graphic (CT) scan of the head is negative for trauma or tumor. In addi- tion to meningitis, your differential diagnosis should include which of the following?

Reassurance and counseling for family about childhood normal developmental stage

A 2-year-old boy had been slightly less than the 50th percentile for weight, height, and head circumference, but in the last 6 months he has fallen to slightly less than the 25th percentile for weight. The pregnancy was normal, his development is as expected, and the family reports no psychosocial problems. The mother says that he is now a finicky eater (wants only macaroni and cheese at all meals), but she insists that he eat a variety of foods. The meals are marked by much frustration for everyone. His examination is normal. Which of the fol- lowing is the best next step in his care?

Spasmodic croup

A 2-year-old boy is seen in your office after his parents report a "rough night." Following a few days of a mild upper respiratory symptoms but no fever, last night he had an episode of stridor and increased effort of breathing. He has done this twice previously in the last 2 months and was well before each episode. In the interim period he has been normal. Today, apart from some mild rhinorrhea, his physical examination is normal. Which of the following is the most likely etiology?

Aerosolized racemic epinephrine and steroids

A 2-year-old boy with a 3-day history of upper respiratory congestion and cough now has inspiratory stridor, respiratory rate of 50 breaths/min, chest retractions, and a fever of 101°F (38.3°C). The next step in the management of his condition should be which of the following therapies?

Pulse oximetry

A 2-year-old girl has increased work of breathing. Her father notes she has had cough and subjective fever over the past 3 days. She has been complaining that her "belly hurts" and has experienced one episode of posttussive emesis but no diarrhea. Her immunizations are current, and she is otherwise healthy. Her temperature is 102°F (38.9°C). She is somnolent but easily aroused. Respirations are 28 breaths/min, and her examination is remarkable for decreased breath sounds at the left base posteriorly with prominent crackles. Which of the following acute interventions is the next best step in your evaluation?

Listeriosis

A 2150-g infant is delivered at 34-week gestation. The mother had prenatal care in Mexico and says she had no problems. Her highest temperature during labor was 100.8°F (38.2°C). The amniotic fluid had a brown-stained appearance. At birth the infant had a diffuse ery- thematous pustular rash, pallor, poor feeding, tachypnea, and cyanosis. His CBC indicates marked monocytosis. He dies at 4 hours of age, soon after initiation of antibiotics. He most likely had which of the following?

Perform otoscopy with insufflation.

A 26-month-old boy presents because of maternal concern about his hearing. Over the past few weeks, his mother has had to speak more loudly in order for him to respond. He has a greater than 50-word vocabulary and can put together 2- to 3-word sentences. Three weeks prior he had an upper respiratory infection (URI). Which of the following is the best next step in treatment?

If the urine culture reveals UTI, renal USG and VCUG should be performed

A 3-month-old boy presents with fever without a source. As part of his evaluation a urinalysis is performed; a UTI is suspected. Which of the following is the best next step?

Evaluate him for gastroesophageal reflux disease (GERD)

A 3-month-old male infant has intermittent neck contortions and arching. He was term at birth, with an uneventful prenatal course and delivery. He frequently spits up after feeding, and has had one episode of pneumonia. Which of the following is the best next step in management?

Start phototherapy

A 30-hour-old full-term infant has face and chest jaundice. He is breast- feeding well and has an otherwise normal examination. His bilirubin level is 15.5 mg/dL. Which of the following is the most appropriate course of action?

Hyaline membrane disease

A 35-week-gestation infant is delivered via cesarean section because of macrosomia and fetal distress. The mother has class D pregestational diabetes (insulin-dependent, with vascular disease); her hemoglobin A1C is 20% (normal 8%). This infant is at risk for birth asphyxia, cardiac septal hypertrophy, polycythemia, and which of the following?

True hermaphroditism

A 3650-g term infant has ambiguous genitalia, including an enlarged clitoris/microphallus and one palpable testis in the labioscrotal folds. Sonogram reveals a uterus and ovaries. Which of the following is the most likely explanation for the child's ambiguous genitalia?

He is at risk for SNHL; order an audiologic evaluation.

A 4-month-old boy has a white forelock, a broad mandible, and lateral displacement of his inner canthi. His mother also has a white forelock. Which of the following statements is true?

Oral supplementation with bicarbonate

A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile, height about the 10th percentile, and head circumference at the 50th percentile. The planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were dis- charged after a 48-hour hospitalization. Feeding is via breast and bot- tle; the quantity seems sufficient. The child has had no illness. The examination is unremarkable except for the child's small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33%, respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbon- ate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells, bacteria, protein, ketones, or reducing substances. Which of the following is the most appropriate therapy for this child?

Sweat chloride test

A 4-year-old boy has a 3-month history of bilateral purulent nasal drainage but no fever or other complaints. Examination reveals several small, shiny, gray, pedunculated masses partially occluding both nasal meatus. A diagnostic workup should include which of the following?

Otolaryngology evaluation for possible foreign body

A 4-year-old boy has nasal drainage for 2 months. His mother has asthma and his father has eczema. On examination, you find foul- smelling, blood-tinged left-sided nasal drainage; he is completely obstructed on that side. His other nostril is without drainage or edema. Which of the following is the best next step in managing this patient?

Serum 17α -hydroxyprogesterone level

A 4-year-old boy has started growing pubic hair and has recently exhib- ited aggressive "bullying" behavior at his preschool. History reveals the boy to be a term infant without postnatal complications. The child takes no medications. Family history is unremarkable. He has one younger sister who is well. Physical examination reveals height and weight above the 95th percentile, marked muscular development, Tanner stage II pubic hair development, scant axillary hair, prepubertal testicular size, a masculine voice, and oily skin. The abdominal exami- nation is normal. The child's bone age is 6 years. Which of the follow- ing is the most appropriate next step in management?

Obtain imaging studies of the airway and soft tissues of the neck

A 4-year-old boy presents with torticollis, fever, sore throat, and diffi- culty swallowing but no drooling. He denies headache and dyspnea, and he remains only somewhat playful. Examination reveals posterior pharyngeal edema. Which of the following is the best next step in management?

She is likely having a dystonic reaction to one of her medications

A 5-month-old female infant presents with sudden onset of torticollis and facial grimacing, but otherwise she appears alert and interactive. She has been doing well and has gained weight for the last month after having been prescribed ranitidine and metoclopramide for GER disease. Which of the following statements is accurate?

Tympanocentesis and culture of middle ear fluid

A 5-year-old girl developed high fever, ear pain, and vomiting 1 week ago. She was diagnosed with OM and started on amoxicillin-clavulanate. On the third day of this medication she continued with findings of OM, fever, and pain. She received ceftriaxone intramuscularly and switched to oral cefuroxime. Now, 48 hours later, she has fever, pain, and no improvement in her OM; otherwise she is doing well. Which of the following is the most logical next step in her management?

Premature thelarche

A 5-year-old girl has bilateral breast development that was first noticed 6 months ago. She takes no medications, and no source of exogenous estrogen is present in the home. Family history is unremarkable. Physical examination reveals a girl who is at the 50th percentile for height and weight, with normal blood pressure, normal skin without oiliness, Tanner stage II breasts, soft abdomen without palpable masses, no body odor, no pubic/axillary hair, and mild estrogenization of the vagina. Which of the following is the most likely explanation for the child's breast development?

Schmid metaphyseal dysplasia

A 5-year-old girl is somewhat short and has mild leg bowing. Her med- ical history is significant only for well-controlled seizure disorder. Serum calcium, phosphorus, and alkaline phosphatase levels and uri- nary amino acid concentration are normal. A bone age is notable for abnormal distal radius and ulna mineralization. Which of the follow- ing is the most likely diagnosis?

Ask the parent to leave the room and then ask the girl in an open-ended fashion whether she has ever been inappropriately touched in her private area

A 5-year-old with dysuria is found on examination to have herpetic genital lesions. Which of the following is the best next step in management?

Beckwith-Wiedemann syndrome with Wilms tumor

A 6-month-old infant male presents to your clinic with an abdominal mass, which was discovered by his new foster mother during the child's bath. On physical examination, you also find macroglossia and right-sided hemihypertrophy. This infant is likely to have which of the following?

C trachomatis

A 6-week-old boy, born by vaginal delivery after an uncomplicated term gestation, has experienced cough and "fast breathing" for 2 days. His mother relates that he has a 1-week history of nasal congestion and watery eye discharge, but no fever or change in appetite. He has a tem- perature of 99.4°F (37.4°C) and a respiratory rate of 44 breaths/min. He has nasal congestion, clear rhinorrhea, erythematous conjunctivae bilaterally, and watery, right eye discharge. His lungs demonstrate scat- tered crackles without wheezes. Which of the following is the most likely pathogen?

Stool for ova and parasites

A 6-year-old boy who recently moved from the southeastern United States complains of "something coming out" of his buttocks while straining during defecation; it seems to resolve when he relaxes. He also complains of abdominal pain and bloody stools for the last week. Examination reveals a normal external anus without evidence of trauma. When straining, he produces a pink mucosal mass from his anus; it returns when he relaxes. Initial diagnostic evaluation should include which of the following studies?

Recommend no treatment

A 7-day-old infant is brought to clinic because of "pimples" on his cheeks and forehead. He is breast-feeding well, and the parents have no other concerns. The skin around the pimples and elsewhere is unremarkable, as is the rest of his examination. Which of the following is appropriate advice or therapy?

Administer aerosolized racemic epinephrine and corticosteroids immediately.

A 7-month-old boy with respiratory difficulty is brought to the emer- gency department at 3 AM. His mother reports that several family mem- bers have had "colds" over the past week. He first developed cough and coryza 3 days ago, and the cough has become "barky." On examination, he has an axillary temperature of 100.4°F (38°C), respiratory rate 55 breaths/min, and heart rate 140 bpm (beats/min). A moderately inflamed pharynx and inspiratory stridor are noted on physical exami- nation. Which of the following is the next step in management of this patient?

Complications of prematurity

A 7-year-old boy with MR was born at home at 26 weeks' gestation to a 28-year-old mother who had received no prenatal care. An evalua- tion is likely to suggest his MR is related to which of the following?

Lymphadenopathy

A 9-year-old girl complains of sore throat and anterior neck pain of 1-day duration, and nasal congestion and cough over the past 3 days. There has been no nausea or change in appetite. She describes "lumps growing in her neck" over the past day. Her past medical history is unremarkable. She is afebrile with a clear posterior oropharynx and a supple neck. She has four firm, fixed, and minimally tender submandibular masses without overlying skin changes; the largest mass is 1 cm in diameter. Which of the following is the most likely explanation for these findings?

HYPOGLYCEMIA

A blood glucose level less than 40 mg/dL is the usual def- inition, although other definitions exist. Symptoms include lethargy, listlessness, poor feeding, temperature instability, apnea, cyanosis, jitteriness, tremors, seizure activity, and respiratory distress?

PULSUS PARADOXUS

A blood pressure that varies more widely with respi- ration than normal. A variance of greater than 10 mm Hg between inspiration and expiration suggests obstructive airway disease, pericardial tamponade, or constrictive pericarditis?

Nipple Discharge/Galactorrhea

A common side affect of BC pills. A prolactinoma most commonly causes this?

OTITIS MEDIA WITH EFFUSION

A condition in which fluid collects behind the TM but without signs and symptoms of AOM. Sometimes called serous OM?

ACUTE OTITIS MEDIA (AOM)

A condition of otalgia (ear pain), fever, and other symptoms along with findings of a red, opaque, poorly moving, bulging tympanic membrane (TM)?

OSGOOD-SCHLATTER DISEASE (OSD)

A condition of painful inflammation of the tibial tubercle?

BILIARY ATRESIA

A congenital condition affecting approximately 1 in 16,000 live births in which the liver's bile ducts become blocked and fibrotic, resulting in reduced bile flow into the bowel?

EPSTEIN-BARR VIRUS (EBV)

A double-stranded DNA herpes virus that infects human oropharyngeal and salivary tissues and B lymphocytes. It can cause persistent viral shedding, is associated with oral hairy leukoplakia in HIV-infected individuals, and causes several malignancies?

Klinefelter syndrome

A father brings his 14-year-old son to your clinic because his teacher has concerns about his poor school performance and maladjusted behavior. He has poor grades in all subjects, is extremely shy, and has always had difficulty in adjusting socially. On examination, he is at the 95th percentile for height and 5th percentile for weight. It is very dif- ficult to engage him in conversation. The testes are prepubertal, he has mild hypospadias, and he has no secondary sexual characteristics. Which of the following is the most likely cause of his pubertal delay?

Prescribe intravenous acyclovir

A father brings his 8-month-old daughter to an emergency room for worsening skin rash and fever. He reports that his daughter usually has weepy, red lesions on her face that is relatively well controlled with bathing her with gentle soaps, using topical emollients and steroids, and giving oral antihistamines. Over the previous few days, however, the rash has gotten progressively worse and the child has become "sicker." Your physical examination reveals a lethargic child with an oral tem- perature of 103°F (39.4°C). The child's cheeks are red and contain numerous red, punched-out, and umbilicated vesicles; some lesions are pustular. Which of the following is the best therapy at this point?

Commence a broad-spectrum antibiotic and advise her to see a dentist as soon as possible.

A father states that his 7-year-old daughter has a 1-week history of mouth and neck pain. She describes pain on chewing and swallowing. Slight swelling around her right, lower jaw was first noted yesterday. She has been afebrile and exhibits no URI symptoms. Her examination reveals a temperature of 100.2°F (37.9°C) with swelling, tenderness, and warmth overlying the right, posterior mandible without fluctuance or skin changes. Scattered, bilateral neck lymphadenopathy is appreciated. Her posterior oropharynx is minimally erythema- tous, with marked swelling and tenderness of the gum surrounding the posterior molars of the right mandible. Which of the following is the most appropriate next step?

Kellymom.com

A great evidence based website for moms that may have or think they have postpartum depression, etc?

Stridor

A high-pitched, monophonic musical sound resulting from partial airway obstruction. The obstruction may be supraglottic (ie, above the vocal cords), glottic, and/or subglottic (ie, below the vocal cords)?

Allergic Crease

A horizontal skinfold across the nasal bridge from chronic nose rubbing (an "allergic salute")?

Andrew Wakefield

A man who faked study numbers on giving children with autism immunizations. He also patented his own MMR. There is not any evidence to back up his studies. It was an article published in The Lancet?

TYMPANOCENTESIS

A minor surgical procedure in which a small incision is made into the TM to drain pus and fluid from the middle ear space. This procedure is rarely done in the primary care office, but rather is done by the specialist?

Mebendazole

A mother brings a stool sample for your review. In the stool are several 15- to 20-cm long, round, whitish worms. You initiate treatment with which of the following?

Ketoconazole-containing shampoo

A mother brings her 2-week-old son to the clinic for a well-baby visit. Her only concern is a rash on his face and scalp that began 1 week ear- lier. Examination reveals a healthy white male with normal vital signs and a normal examination except for yellowish, waxy-appearing, adher- ent plaques on the scalp, forehead, cheeks, and nasolabial folds. Which of the following therapies is appropriate for this condition?

Serum 17α-hydroxyprogesterone level

A mother brings in her 1-week-old son who has vomited four times over the last 24 hours. He has no fever or diarrhea. The infant is breast-feeding poorly and is "floppy" per the mother. He has had only one wet diaper in the last 12 hours. Physical examination reveals a lethargic infant who has lost 250 g since birth, with pulse of 110 bpm, dry oral mucosa, and no skin turgor. Which of the following tests would be reasonable to consider after stabilization and electrolyte measurement?

Testicular feminization

A mother brings in her 15-year-old daughter because she has never started her periods. She otherwise is healthy and takes no medications. Her past medical history is unremarkable except for inguinal hernia repair as an infant. Family history is unremarkable. She is at the 75th percentile for height and weight, has Tanner stage IV breast develop- ment, and no pubic or axillary hair development. Her anogenital examination reveals a short, pocketlike vaginal opening. Which of the following is the most likely explanation for her amenorrhea?

Chromosome analysis

A mother brings to your office her 13-year-old daughter who is "falling behind" in growth and who has not yet exhibited pubertal changes. Physical examination reveals a height less than the fifth percentile, no signs of secondary sexual characteristics, a small mandible, low poste- rior hairline, prominent ears, and a broad chest. Which of the following is the most appropriate next step in management?

Thyroglossal duct cyst

A mother notices a lump on her 5-year-old son's neck. He complains about pain in the region and difficulty swallowing. Appetite and intake are normal. He had a "chest cold" last week that has since resolved. His past medical history is otherwise unremarkable. On examination, he is afebrile with a 3-cm × 3-cm area of mild erythema, fluctuance, and ten- derness of the central anterior neck. The mass moves superiorly when he opens his mouth. His oropharynx is clear. Which of the following is the most likely explanation for these findings?

Rapid streptococcal test of the anal area; oral antibiotics

A mother states her 4-year-old son has had 2 days of "buttocks pain." She reports several blood-streaked stools and frequent scratching of the area. He is afebrile, but his perianal region is bright red with a clearly demarcated erythematous border. The area is diffusely tender, but no nodularity, fluctuance, or trauma is found. Appropriate diagnostic testing and therapy includes which of the following?

Gonococcal ophthalmia

A newborn infant was born at home. At 2 days of life he is has puffy, tense eyelids, red conjunctivae, a copious purulent ocular discharge, and chemosis. Which of the following is the most likely diagnosis?

Impaired cardiac function

A premature infant of a class B pregestational (insulin-requiring, but without vascular disease) diabetic mother is delivered via cesarean section due to fetal distress. The mother's axillary temperature at delivery is 98.6°F (37°C). The child has poor color and tone, no spon- taneous cry, minimal respiratory effort, and a weak pulse of 80 bpm. After endotracheal intubation, the color and tone improve a bit, but she still has perioral cyanosis and her heart rate is 90 bpm. Which of the following is the most likely cause of her persistent distress?

Referring the child to a pulmonologist

A previously healthy 2-year-old girl presents with the complaint of acute-onset wheezing. Her mother denies previous wheezing episodes and denies a family history of asthma or atopy. The mother says that she left the child playing in her older brother's room. Approximately 20 minutes later she heard the child coughing and wheezing. Which of the following is the best next step in management?

Neuroimaging

A previously healthy adolescent male has a 3-month history of increas- ing headaches, blurred vision, and personality changes. Previously he admitted to marijuana experimentation more than 1 year ago. On examination he is a healthy, athletic-appearing 17-year-old with decreased extraocular range of motion and left eye visual acuity. Which of the following is the best next step in his management?

Streptococcal tonsillitis

A previously healthy, 4-year-old boy has been febrile for 1 day. He does not want to drink and vomited this morning. There have been no URI symptoms nor diarrhea. On examination, he is sleepy, but arousable, and has a temperature of 102.8°F (39.3°C). His posterior oropharynx is markedly erythematous with enlarged, symmetrical, and cryptic ton- sils that are laden with exudate. Shoddy cervical lymphadenopathy is noted. He moves his head vigorously in an effort to thwart your exam- ination. Which of the following is the most likely explanation for these findings?

VOIDING CYSTOURETHROGRAM (VCUG)

A radiographic study in which a catheter is placed in the bladder and contrast is instilled. Upon voiding, the urethra is visualized and, in cases of vesicoureteral reflux, the ureters are outlined?

TACHYPNEA

A respiratory rate that is faster than normal for the person's age. The resting respiratory rate for an infant or young child is faster than that of an older person. The average resting respiratory rate for an infant is 30 breaths/min, whereas an 8-year-old child breathes at 20 breaths/min, and an adult breathes at a rate of approximately 16 breaths/min?

Edwards syndrome (trisomy 18)

A small-for-gestational age infant is born to a 35-year-old woman. He has low-set and malformed ears, microcephaly, rocker-bottom feet, inguinal hernias, cleft lip or palate, and micrognathia. Chromosomal analysis is likely to reveal which of the following?

Patau syndrome (trisomy 13)

A small-for-gestational age, dysmorphic newborn infant has micro- cephaly and sloping forehead, cutis aplasia (missing portion of the skin and hair) of the scalp, polydactyly, microphthalmia, and omphalocele. Which of the following is the most likely diagnosis?

MYRINGOTOMY AND PLACEMENT OF PRESSURE EQUALIZATION TUBES

A surgical procedure involving TM incision and placement of pressure equalization (PE) tubes (tiny plastic or metal tubes anchored into the TM) to ventilate the middle ear and help prevent reaccumulation of middle ear fluid?

Klinefelter syndrome (XXY)

A tall, thin 14-year-old adolescent male has no signs of puberty. He was delayed in his speech development and always has done less well in school than his siblings. He is shy, and teachers report his activity is immature. Physical examination reveals breast development, and long limbs with a decreased upper segment-lower segment ratio. He has small testes and phallus?

It requires close contact with saliva (ie, kissing or drinking from the same cup)

A teenage boy arrives for a check-up. His friend recently was diagnosed with mononucleosis. He is worried he will contract it. Which of the following is true regarding transmission of EBV?

Oral antifungal

A teenage boy complains of a several-week history of facial "zits" that are painful and itchy. There are no other breakouts. He has inflam- matory papules and pustules in the beard and moustache area and has mild cervical lymphadenopathy. He occasionally works weekends on a farm. Which of the following therapies is appropriate?

Discontinue isotretinoin and refer her to a psychiatrist

A teenager with severe cystic acne started using isotretinoin 1 month ago. Initially her acne worsened, but is now starting to improve. However, she is "not feeling like herself." She does not want to go to school, cries fre- quently during the day, and feels hopeless. She also feels "achy" all over. Which of the following is the best course of action?

Observation for a period of several hours

A term 3500-g female delivered by cesarean section develops a respi- ratory rate of 70 breaths/min and expiratory grunting at 1 hour of life. She has good tone, good color, and a strong suck. Which of the fol- lowing is the most likely diagnosis?

Observe and administer supplemental oxygen as needed

A term female is born via repeat cesarean section to a 30-year-old woman. Immediately after birth she has mild respiratory distress. Chest auscultation in the delivery room reveals clear breath sounds. Which of the following is the most appropriate next step?

Hydronephrosis

A term infant born to a mother with class C pregestational diabetes (insulin-dependent, but without vascular disease) requires endotra- cheal intubation at delivery for poor respiratory effort, tone, and color. His initial serum glucose level is 10 mg/dL, and the level stabilizes over 36 hours with intravenous administration of glucose. On the third day of life, his physical examination is remarkable for macrosomia and a new abdominal mass. Which of the following is the most likely cause of the abdominal mass?

You are concerned about the possibility of meconium ileus and would like to obtain some family history. Change from enteral to intravenous feeds and obtain a STAT pediatric surgery consultation.

A term infant delivered vaginally develops vomiting and abdominal distention at age 10 hours. No stool passage has been noted. An abdominal radiograph shows distended bowel loops and a "bubbly" pattern in a portion of intestine; the colon is narrow. Which of the following should you tell the parents? Appropriate clinical management of this patient includes which of the following?

Beginning a course of zidovudine for the infant

A term infant is born to a 23-year-old known HIV-positive mother. The mother has been followed closely during the pregnancy, and she has been taking antiretroviral medications for the weeks prior to the delivery. Routine management of the healthy infant should include which of the following?

Total bilirubin and a hematocrit

A term infant weighing 4530 g is born without complication to a mother with class A pregestational diabetes (non-insulin requiring). His initial glucose level is 30 mg/dL, but the level after he consumes 30 cc of infant formula is 50 mg/dL, and another level obtained 30 minutes later is 55 mg/dL. His physical examination is unremarkable except for his large size. Approximately 48 hours later he appears mildly jaundiced. Vital signs are stable, and he is eating well. Which of the following serum laboratory tests are most likely to help you evaluate this infant's jaundice?

Assess the abdomen to evaluate for possible congenital diaphrag- matic hernia

A term male is born to a 33-year-old woman who had little prenatal care. Immediately after birth he has cyanosis and respiratory distress. Chest auscultation in the delivery room reveals right-sided heart sounds and absent left-sided breath sounds. Which of the following is the most appropriate next step?

Endotracheal intubation with direct suction

A term male is born vaginally to a 22-year-old primigravida woman; the pregnancy was uncomplicated. Just prior to delivery, fetal brady- cardia was noted, and at delivery thick meconium is found. The infant has hypotonia and bradycardia. Which of the following is the first step in resuscitation?

SPIROMETRY

A test of pulmonary function. For patients with asthma, this test demonstrates reversibility and can be used to determine an individual's response to treatment?

The child most likely has bronchiolitis, and is at risk of respiratory failure

A well-developed 4-month-old boy presents to the ED on a cold winter's night with the complaint of worsening respiratory distress and decreased oral intake. His parents report that he was well until yesterday, when he developed upper respiratory symptoms and a low-grade fever. Upon examination of the child, you note pallor and perioral cyanosis, a respi- ratory rate of 65 breaths/min, and tight wheezes throughout the chest. An arterial blood gas shows a pH of 7.15, a PCO2 of 65 mm Hg, and a serum bicarbonate of 20 mmol/L. Which of the following is the the most likely explanation regarding the child's condition?

Perform a cesarean delivery if herpetic lesions or prodromal symptoms are present when labor has begun

A woman presents for her first prenatal visit at 9-week gestation. She reports that she is generally healthy, except that she has an outbreak of genital herpes approximately once per year. To prevent transmission of the virus to her infant, her physician should do which of following?

STRIDOR

Abnormal, musical breathing as a result of large airway obstruction?

Puberty

Activation of the hypothalamic-pituitary -gonadal axis?

35

Advanced Maternal Age is what?

Transillumination of the chest is likely to transmit excessive light on the right side

After the infant discussed in Question 48.3 is stabilized and admitted to the neonatal intensive care unit, a chest radiograph reveals bilateral patchy infiltrates with coarse streaking and flattening of the diaphragm. He abruptly has an increased oxygen requirement. Physical examination reveals decreased right-sided breath sounds. Which of the following is an accurate statement?

This is a cognitive milestone for 3 yo

All of the following are examples of milestones that should be met by age 2 EXCEPT:

Lysergic acid diethylamide (LSD)

An 11-year-old girl has dizziness, pupillary dilatation, nausea, fever, tachycardia, and facial flushing. She says she can "see" sound and "hear" colors. The agent likely to be responsible is which of the following?

Admit the child and call child protective services

An 8-month-old African-American baby arrives to the emergency department with his mother with the complaint of decreased left arm movement. He is the product of a normal term pregnancy, has had no medical problems, and was in good health when his mother dropped him off at the day care center. Upper arm radiographs show a left humerus spiral fracture. Which of the following is the most appropriate next step in management?

Wiskott-Aldrich syndrome

An 8-month-old child has refractory eczema that was first noticed at 2 months of age. His past medical history reveals multiple episodes of otitis media and pneumonia, and he has now developed severe nose- bleeds. His CBC shows a white blood count of 8500/mm3, his hemo- globin is 11.1 mg/dL, his hematocrit is 33.4%, and his platelet count is 15,000/mm3. Which of the following is the most likely diagnosis?

Administration of topical mixture of polymyxin and corticosteroids

An 8-year-old boy has severe pain with ear movement. He has no fever, nausea, vomiting, or other symptoms. He has been in good health, having just returned from summer camp where he swam, rode horses, and water-skied. Ear examination reveals a somewhat red pinna that is extremely tender with movement, a very red and swollen ear canal, but an essentially normal TM. Which of the following is the most appropriate next course of therapy?

Use of enuresis alarm

An 8-year-old boy presents with bedwetting 3 to 4 times per week for "as long as he can remember." He has a strong urine stream, daytime urine continence, and no UTIs. His physical examination is normal. Which of the following is the most appropriate next course of action?

Supportive therapy

An 8-year-old girl arrives at your clinic complaining about a minimally itchy rash on her chest, abdomen, and arms. It started with one small, scaly, red area on her chest and then spread. She is taking no medica- tions. Physical examination reveals salmon-colored, flat, finely scaly, oval eruptions on her chest, abdomen, back, and upper arms. Which of the following is the most likely explanation for these findings?

XYY Male

An institutionalized male juvenile delinquent upon close examination has severe nodulocystic acne, mild pectus excavatum, large teeth, prominent glabella, and relatively long face and fingers. His family says he has poor fine motor skills (such as penmanship), an explosive temper, and a low-normal IQ?

KASAI PROCEDURE

An operative procedure in which a bowel loop forms a duct to allow bile to drain from a liver with biliary atresia?

6 months

Antibiotics should be given to all children under what age that you suspect to have AOM?

Erythromyacin Ointment

Applied to eyes within 1 hour of birth to prevent bacterial ophthalmia?

Montgomery Glands

Are the glandular areas around the breasts?

FLEXURAL AREAS

Areas of repeated flexion and extension, which often perspire on exertion (antecubital fossae, neck, wrists, ankles)?

Post-Term Babies

Asphyxia Meconium aspiration Trisomies and other syndromes

Current impairment and Risk of future attacks <based on daily use of steroids/albuterol>

Asthma Severity is based on? (2)

Pre-Term Babies

At risk for: Respiratory distress syndrome Necrotizing enterocolitis Patent ductus arteriosis Apnea?

5 years

At what age should a child be able to understand and know about things used in daily life such as money and food?

18 months

At what age should your child be able to drink from a regular cup?

Menarche

Average age for girls is 12 years, but can occur between 10 and 16 years old?

10 to 15 years old

Average age for scrotal and testes growth, pubic hair, then penile growth?

13

Average age to start smoking?

MEAN CORPUSCULAR VOLUME (MCV)

Average size of a red blood cell; large cells are macrocytic; small cells are microcytic?

Fibroadenoma in breast

Benign and is usually about 1 or 2 cm, the are usually perfectly circular, and like a squishy ball and you can move it around. You do a ultrasound on it?

Seborrheic Dermatitis

Benign cradle cap?

Milia

Benign white dots on infants skin?

Neonatal Pustular Melanosis

Benign, baby acne, goes away?

Nevus Flammeus (Stork Bite)

Benign, fades or goes away, mostly on back of neck, purple or reddish in appearance?

RETROPHARYNGEAL SPACE

Bordered by layers of the deep cervical fascia; located posterior to the esophagus; contains lymphatics draining the middle ears, sinuses, and nasopharynx; contiguous with the posterior mediastinum?

PERITONSILLAR SPACE

Bordered by tonsils and pharyngeal musculature; peritonsillar abscess is typically an extension of acute tonsillitis?

True

By the age of five years old your child should be able to determine the difference between make believe and reality?

5 years old

By what age should a child be able to use future tense?

4 months

By what age should you hear your baby cry in different ways that correlate to their physiological state?

Hemangioma

Can be anywhere from benign to devastating. Reddish or purplish in appearance. Can cover a small area on back of the neck or could cover the whole face including eye?

Single Simean (Palmar) crease

Can be normal or a sign of down syndrome?

Gestational Age

Can predict problems, morbidity, mortality, and can help you keep alert for certain problems?

PCOS

Cause of secondary ammenorhea?

Otitis Externa "Swimmer's ear"

Cause: Bacterial - pseudomonas and staph fungal (10%). Presents as pain with inflammation and swelling of the ear?

Epiglottitis

Causes: H. influenza and Streptococcus Much less common with H. Flu vaccine - ask about immunization history Treatment: INTUBATE! Steroids Antibiotics?

Bacterial Pharyngitis

Centor Score: • History of fever • Tonsillar exudates • Tender anterior cervical adenopathy • Absence of cough • <2 pts - No antibiotic or throat culture necessary • 2-3 pts - Throat culture and treat with an antibiotic if culture is positive • >3 pts - Treat empirically with an antibiotic

Trisomy 21 (Down Syndrome)

Characteristic features: o upslanting palpebral fissures o epicanthal folds o midface hypoplasia o small, dysplastic pinnae § Generalized hypotonia § Cognitive Disabilities § Associated anomalies Associated heart and GI anomalies: o Endocardial cushion defects (holes in the heart and other heart problems) o Septal defects o Esophageal and duodenal atresias?

ASTHMA EXACERBATION

Characterized by the triad of bronchoconstric- tion, airway inflammation, and mucus plugging?

Fragile X

Children have the characteristics of: -Low set ears -Something just doesn't look right?

In 3 to 6 months intervals until the effusion is no longer present

Children with persistent OME that are not at risk should be inspected how often?

Asthma

Chronic disease of the airways that may cause Wheezing Breathlessness Chest tightness Nighttime or early morning coughing Episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment?

Barlow and Ortaloni exam

Clicks are common and benign due to estrogenic effect. Clunks are indicative of hip dislocation/relocation and can represent developmental dysplasia of the hip?

Edwards Syndrome (Trisomy 18)

Clinical Findings: SGA Extremities - overlapping fingers, rockerbottom feet Congenital Heart Defects 1:6000 births § Median survival age: 10-15 days § ~8% survival rate at 1 year?

Rhonchi

Coarse breath sounds heard in patients with chronic mucus in the upper airway (bronchi). Usually assoc. w/ pneumonia. Sounds that are most pronounced during expiration. Low pitched occur in the larger bronchi and occur early in expiration, while high pitched occur in the terminal bronchi and are late in expiration?

ATELECTASIS

Collapse of a portion of the lung. Atelectasis may be due to intrinsic factors, such as blockage of the airway proximal to the atelectatic tis- sue, or extrinsic factors, such as a pneumothorax?

Thrush

Common in healthy infants Dx: Clinical or microscopic Tx: nystatin or fluconazole?

Rhonchi

Commonly occur in both acute and chronic bronchitis and bronchiolitis • Can occur in bronchial asthma patients?

PARAPHARYNGEAL (LATERAL) SPACE

Comprises anterior and posterior compartments containing lymph nodes, cranial nerves, and carotid sheaths; infections in the lateral space can originate from the oropharynx, middle ears, and teeth?

SPRENGEL DEFORMITY

Congenital elevation of the scapula?

KLIPPEL-FEIL SYNDROME

Congenital fusion of portions of the cervical ver- tebrae, restricted neck movement, short neck, and low hairline. Associated features include Sprengel deformity (see below) and structural urinary tract abnormalities?

STACCATO COUGH

Coughing spells with quiet intervals, often heard in croup and chlamydial pneumonia?

EMOLLIENT

Cream or lotion that restores water and lipids to the epidermis; those containing urea or lactic acid are more lubricating and may be more effective; creams lubricate better than lotions?

Cystic Fibrosis

Cuts your life expectancy in half. These are usually the failure to thrive kids. They usually have very virulent pneumonia?

NEMATODE (ROUNDWORMS)

Cylindrical organisms, with thousands of different species, only a few of which are parasitic (Table 38-1). Nematode infection is one of the most common types of infection in humans?

PMS and PMDD

DSM-IV criteria as a menstrual disorder?

1. Crigler-Najjar 2. Gilbert Syndrome 3. Hypothyroidism

Decreased conjugation production of hyperbilirubineamia?

Sensorineural hearing loss

Defect in CN VIII • Congenital • Acquired?

Encopresis

Defined: 2 or more of the following >4y/o ... -Less than 3 BM per week -One or more encopresis per wk -Impaction -BM obstructing toilet -Retentive posturing and withholding -pain with defecation 90% caused by constipation?

Expiratory Wheezing

Described as a whistling or sighing sound during exhalation?

RAPID STREP IMMUNOASSAY

Detects GAS antigen by latex agglutination or enzyme-linked immunosorbent assay; high specificity and variable sensitivity with false-negative results possible?

Bulimia Nervosa (BN)

Diagnostic Criteria 1. Recurrent episodes of binge eating 2. Recurrent inappropriate compensatory behavior in order to prevent weight gain 3. The above both occur 2/wk for 3 months 4. Self-evaluation is unduly influenced by body shape and weight 5. Disturbance does not occur exclusively during episode of anorexia nervosa?

Anorexia Nervosa (AN)

Diagnostic Criteria: 1. Refusal to main body weight at or above the minimal normal for age and height 2. Intense fear of gaining weight/being fat despite being underweight 3. Disturbance in the way in which one' body weight or shape is experienced 4. The absence of 3 menstrual cycles in postmenarchal females?

DYSPHAGIA

Difficulty swallowing?

Cyst

Dilated and often tender intradermal follicle?

Ever, but if you expect a foreign body

Do not finger sweep when?

Rales (Crackles)

Due to presence of fluid in the smaller airways (Bronchioles). In children, almost always on inspiration, but can be heard on inhalation and exhalation. Can be a course, medium, or fine sound?

Encopresis

Dx: H&P, abd xray (KUB) Tx: Behavioral Intervention Bowel Regulation (i.e. constipation prevention)?

Viral Pharyngitis/Tonsillitis

EBV Coxsackie A16 (Herpangina) Enterovirus (Hand-Foot-Mouth) Adenovirus?

Indirect hyperbilirubinemia

Early symptoms-acute bilirubin encephalopathy- poor feeding, abnormal cry, hypotonia, Intermediate phase-stupor, irritability, hypertonia Late (kernicterus) - shrill cry, no feeding, opisthotonus, apnea, seizures, coma, death?

POLYCYTHEMIA

Elevated hematocrit that can lead to thrombosis if the level is significant and remains untreated. Levels greater than 65% in a newborn are often treated by partial exchange transfusion?

Expert Panel Report 3 (EPR-3) of the National Asthma Education and Prevention Program

Emphasizes the monitoring of clinically relevant aspects of care and the importance of planned primary care, and by providing patients practical tools for self- management?

LICHENIFICATION

Epidermal thickening, with normal skin lines resem- bling a washboard?

Anterior Nose Bleeds

Epitaxis most commonly caused from a child picking their nose?

Cerebral Palsy

Fetal monitoring was used to prevent rates of what, but no change in numbers have been made?

Pleural Effusion

Fluid accumulation in the pleural space; may be asso- ciated with chest pain or dyspnea; can be transudate or exudate depending on results of fluid analysis for protein and lactate dehydrogenase; origins include cardiovascular (congestive heart failure), infectious (mycobacterial pneumonia), and malignant (lymphoma)?

Hydrocele

Fluid in the testicle?

Candidal balanitis

For the past few days, a 12-year-old boy has been complaining of an irritated and itchy penis and burning on urination. He has not had fre- quency or change in urine appearance. His mother noted a whitish- yellow staining of his underwear yesterday when she was doing the laundry. His past medical history is unremarkable. He is an uncircum- cised boy without penile or scrotal lesions, other than marked ery- thema of the glans penis with whitish coronal exudate upon foreskin retraction. Urinalysis is unremarkable. Which of the following is the most likely diagnosis?

SANDIFER SYNDROME

Gastroesophageal reflux (GER), hiatal hernia, and posturing of the head?

GLOMERULONEPHRITIS

Glomerular inflammation resulting in the triad of hematuria, proteinuria, and hypertension?

INTRINSIC FACTOR

Glycoprotein secreted in the stomach that binds to vitamin B12; the intrinsic factor-vitamin B12 complex then attaches to receptors in the distal ileum and is absorbed?

Females

HPV 16 and 18 come from?

Males

HPV 6 and 11 come from?

Primary Herpes Infection

HSV infection in a previously seronegative host. Most primary infections are subclinical, but they can cause localized lesions or severe systemic symptoms?

SENSORINEURAL HEARING LOSS (SNHL)

Hearing loss caused by cochlea disorders (damage from infection, noise, ototoxic agents, or genetic defects)?

RETROCOCHLEAR (CENTRAL) HEARING LOSS

Hearing loss caused by deficits in the auditory nerve or central auditory nervous system?

CONDUCTIVE HEARING LOSS

Hearing loss caused by disorders of the outer ear (external auditory canal atresia and otitis externa) or middle ear (otitis media and cholesteatoma)?

The dysmorphic infant

History: prenatal history, delivery history Physical Imaging: x-ray, US, CT Labs: cytogenic analysis (karyotype, FISH) Chromosomal abnl found in 10-15% of infants who die?

FSH

Hormone for females - ovaries, estrogen males - spermatocytes?

LH

Hormone for females - ovulation testosterone males - testes?

Duration, as antibiotics are not recommended unless it has at least a 10 day duration

How do you tell the difference between sinusitis and the common cold?

Anything over 18 hours

How long is too long for a ruptured membrane?

FEV1

How much air that you can blow out forcefully in 1 second?

Only about 3% of the time

How often are GI problems related to colic?

once yearly

How often should an adolescent have an office visit?

Wet Prep

How to dx Trichamonas?

Azithromycin or doxycycline

How to treat Chlamydia?

Metronidazole

How to treat Trichimonas?

G6PD

If jaundice unexplained or AA w/severe jaundice?

Syphilis

If lesions on genital area do not hurt, it is usually?

Herpes

If lesions on genital area hurt, it is usually?

Asthma

If they are sick all the time, they have had RSV multiples times, lots of wheezing and abnormal breath sounds, allergies- seasonal and food, atopic dermatitis, ezyema, constantly rubbing their nose, vasoconstriction of the eyes. Pathophysiology: Mass cells over react and release cascade and inflammation?

Think HSV

If you see vesicles in the ear?

Fetal Alcohol Syndrome

In appearance, the child: Do not have a filtrum. (they two lines under nose)?

TRISMUS

Inability to open the mouth secondary to pain or inflammation or mass effect involving facial neuromusculature?

Candidates for surgery

Include children with OME lasting 4 months or longer with persistent hearing loss or other signs and symptoms • Recurrent or persistent OME in children at risk regardless of hearing status • OME and structural damage to the tympanic membrane or middle ear. Ultimately the recommendation must be individualized.

Clubbing

Increase in the angle between the nail and nail base of 180° or greater, and softening of the nail base to palpation. Although the condition can be familial, clubbing is uncommon in children, usually indicating chronic pulmonary, hepatic, cardiac, or gastrointestinal disease?

-Immune mediated (coombs) -NonImmune -Sepsis

Increased Production of hyperbilirubinemia (Hemolysis)?

-Extravascular Hemorrage -Polycythemia -INcreased hepatic circuation -Breast Feeding

Increased Production of hyperbilirubinemia (Non-Hemolytic)?

EPIGLOTTITIS

Infection of the cartilaginous structure protecting the airway during swallowing; bacterial etiology (classically Haemophilus influenzae) requiring intravenous antibiotics; fever, drooling, and toxicity are common; emergent airway obstruction is possible?

Genital Herpes

Infection of the genital tract with HSV type 1 or 2, the majority caused by HSV-2?

PUSTULE

Inflammation and exudate around comedones occurring in the superficial dermis?

RHINITIS

Inflammation of the nasal mucosa?

RED CELL CASTS

Injured glomeruli have increased permeability and leak red cells and proteins into the proximal convoluted tubule; the material subsequently clumps in the distal convoluted tubule and in the collecting ducts. When passed, these cell clumps retain the shape of the tubule in the urine. Red cell casts are markers for glomerular injury?

Pleural Rub

Inspiratory and expiratory "rubbing" or scratching breath sounds heard when inflamed visceral and parietal pleurae come together?

Fragile X & Fetal Alcohol Syndrome

Intellectual Disability/MR (IQ<70), probably will not be discovered until they begin school?

Categorization

Intermittent Persistent-mild Persistent-moderate?

Orthostatic Hypotension

Is a red flag for anemia?

Pediatric grunting

Is a sound that occurs primarily in neonates when the infant exhales air against a partially closed epiglottis. • Natural function which generates back pressure to keep smaller airways open. • Occurs because of underdeveloped accessory muscles • Occurs in almost all infants with respiratory distress,flu or infections. Usually preterm babies?

Subcutaneous Emphysema (SCE)

Is the presence of air in soft tissues around upper chest and neck • It is often felt and heard during examination of the upper chest and lower neck while palpating and auscultating. • It is often described as "rice crisps"?

Subcutaneous Emphysema (SCE)

Is usually seen in chest trauma • Flail chest • Tracheal tears • Penetrating chest and neck trauma • Others (spontaneous pneumo, missed ET and crichs)?

MACROSOMIA

Larger than normal baby, exceeding the 90th percentile for gestational age?

MONOSPOT

Latex agglutination of heterophile antibodies to erythrocytes in Epstein-Barr virus (EBV) infection; high specificity and sensitivity in patients older than 3 years; infection may be confirmed by EBV immunoglobulin (Ig)M antibody if heterophile negative?

Caput Secundum

Like a cone head on infant. Crosses Midline?

Dysfunctional Uterine Bleeding (DUB)

Long periods with serious bleeding that can cause anemia?

Wheezing

Lower partial airway obstructions • Asthma • Edema • Upper partial airway obstruction • Croup (progresses to stridor) • Foreign body • Edema Almost always assoc. w/ asthma?

(Enuresis)

More common in boys than girls, Daytime continence by 3y/o -15% over 7y/o wet the bed Dx: H&P, UA, Urine Cx Tx: Behavioral intervention, DDAVP?, TCA?

Fibrocystic Breast Changes (FBC)

Most common cause for breast pain, usually assoc. with cycles. Sometimes caffeine can help, and there are medications that you can use to treat?

Marijuana

Most common illicit drug use?

Marijuana

Most common illicit drug used in adolescence?

Alcohol

Most common substance in which adolescents abuse?

Cigarettes & alcohol

Most commonly used drugs in adolescence (2)?

Sinusitis

Mucous membrane inflammation of a sinus cavity?

Down Syndrome, Edwards Syndrome, Patau Syndrome

Name of trisomies 21, 18, & 13?

Dubowitz-Ballard

Neuromuscular signs chart as an estimate for gestational age?

Parasomnias

Night Terrors and Sleepwalking, more common in boys than in girls, 3-12 y/o, peaks at 3.5 y/o Not awake, does not remember Intense fear and abnormal autonomics?

Parasomnias

Nightmares Common throughout childhood Remembers "dream" Awakens?

PULSE OXIMETRY

Noninvasive estimation of arterial oxyhemoglobin concentration (SaO2) using select wavelengths of light?

Group B Strep

Normal GI flora that lives in the vagina of 1/3 of women. Mom has to get antibiotics in labor to avoid transmission to baby?

Congenital Dermal Melanocytosis (Mongolian spot)

Not a bruise. More common in darker skin babies- most commonly on back or butt?

Neonatal Jaundice

Observed during the 1st wk in approximately 65% of term infant and 80% of preterm infant?

Denver

Old and very time consuming?

Cephalohematoma

On top of infants head?

Croup

Only stridor on expiration?

COMEDONES

Open comedones (blackheads) are composed of compacted melanocytes; closed comedones (whiteheads) contain purulent debris?

Colic

Overdiagnosed in the lay and professional world?

BV (Bacterial Vaginosis)

Overgrowth of vagina bacteria-- bad odor. Usually not an STD. Blood, semen, and douching can cause this. Is usually not sexually transmitted unless you are sharing sex toys?

ODYNOPHAGIA

Pain on swallowing?

Dysmenorrhea

Pain with period?

Explore the reasons for the request with the parents and the ado- lescent, and perform a UDS with the adolescent's permission if the history warrants.

Parents bring their 16-year-old daughter for a "well-child" checkup. She looks normal on examination. As part of your routine care you plan a urinalysis. The father pulls you aside and asks you to secretly run a urine drug screen (UDS) on his daughter. Which of the follow- ing is the most appropriate course of action?

Normal ex-premie infant growth

Parents bring their 6-month-old son to see you. He is symmetrically less than the fifth percentile for height, weight, and head circumfer- ence. He was born at 30 weeks' gestation and weighed 1000 g. He was a planned pregnancy, and his mother's prenatal course was uneventful until an automobile accident initiated the labor. He was ventilated for 3 days in the intensive care unit (ICU) but otherwise did well without ongoing problems. He was discharged at 8 weeks of life. Which of the following is the mostly likely explanation for his small size?

PKU (Phenylketonuria) Testing

Part of the newborn screening Decreased/absent phenylalanine hydroxylase enzyme, which breaks down aa phenylalanine. "Mousy" or "musty" odor in breath, skin and urine. Is a treatable disease with good outcomes using a strict diet of extremely low phenylalanine proteins?

RETICULOCYTE COUNT

Percentage of red blood cells that are immature (new)?

GESTATIONAL DIABETES

Persistent hyperglycemia during pregnancy, with untreated serum glucose levels greater than 100 mg/dL in the fasting state or greater than 130 mg/dL otherwise?

RICKETS

Poor mineralization of growing bone or of osteoid tissue?

42 or more weeks

Post term babies are bornat?

37 weeks

Preterm babies are born before?

Asthma

Problems associated with expiratory flow?

Vocal cord dysfunction

Problems associated with inspiratory flow?

EMPYEMA

Purulent infection in the pleural space; may be associated with chest pain, dyspnea, or fever; usually seen in conjunction with bacterial pneu- monia or pulmonary abscess?

CAUDAL REGRESSION SYNDROME

Rare congenital malformation found almost exclusively in the IDM, characterized by hypoplasia of the sacrum and lower extremities?

Initiation of substance abuse

Rarely occurs after 20 years old?

Erythema Toxicum Neonatorum

Rash on newborn?

Recurrent Infection

Reactivation of a latent infection in an immune host. Lesions tend to be localized and are not associated with systemic symptoms?

Group B Strep (GBS)

Rectal/vaginal swab results at 35-37 weeks gestation?

INFLAMMATORY PAPULE

Red "bump" under the skin due to sebum, fatty acids, and bacteria reacting within a follicle?

Bed Wetting (Enuresis)

Repeated urination in clothes/bed by a child older than 5 years, 2x/wk for 3 months?

VESICOURETERAL REFLUX (VUR)

Retrograde urine flow from the blad- der into the ureter(s) and, if severe, into the kidney. In general this condition is more common in females and may lead to recurrent urinary tract infections (UTI) and diminished renal function. Depending on the degree of reflux, treatment ranges from antibiotic prophylaxis to surgical intervention?

Colic

Severe, paroxysmal crying that occurs mainly in the late afternoon. Known as the "witching hour"?

Complications of Anorexia Nervosa (AN)

Short-Term 1. Early satiety 2. Superior Mesenteric Artery Syndrome 3. Constipation 4. Refeeding syndrome Long-Term 1. Osteoporosis 2. Brain Changes 3. Effects on future children?

Newborn Assessment

Should be the most thorough exam a child ever receives?

Down Sydrome Identifiers (Trisomy 21)

Simean crease, wide-spread open toes, puffy moon-shaped eyes, Nucal Fat

Stage II

Stage of breast bud with elevation of papilla, enlargement of areola?

Stage II

Stage of enlargement of scrotum and testes, scrotal skin reddens and changes in textures growth of testes to 4cc or greater in volume, 2.5 to 3.2 in length?

Stage III

Stage of enlargement of the penis, in length at first, further growth of the penis, 3.5 inches in length?

Stage III

Stage of further enlargement of breast and areola, no separation of contour?

Stage IV

Stage of increased size of penis with growth in breadth and development of glands, testes and scrotum larger, scrotal skin darker, 4.1 to 4.5 in length?

Stage I

Stage of prepubertal, testicular size of less than 4cc in volume and 2.5 cm is the longest dimension?

Stage I

Stage of prepubertal?

Stage V (Mature Stage)

Stage that represents adult genitalia, greater that 4.5 inches in length?

Stage IV

Stage where areola and papilla form secondary mound above level of breast?

Stage V (Mature Stage)

Stage where projection of papilla only, related to recession of areola?

Indirect hyperbilirubinemia

Staining of the brain by bilirubin?

Conductive hearing loss

Structural abnormalities Most commonly caused by OM and Eustachian tube dysfunction?

Inborn Errors of Metabolism in Newborns

Suspect when: Critically ill newborn Seizures FTT Developmental regression Electrolyte abnormalities?

37-41 weeks (6 to 7 week interval)

Term babies are born at?

Asthma

The diagnosis when (1) episodic symptoms of airflow obstruction are present; (2) airflow obstruction is at least partially reversible; and (3) alternative diagnoses are excluded?

Vitamin D

The diet of a 3-year-old child with cystic fibrosis should be supplemented with which of the following?

Severe deficiency of uridine diphosphate glucuronosyltransferase

The hyperbilirubinemia associated with Crigler-Najjar syndrome type I is caused by which of the following?

Cystic Fibrosis (CF)

The major cause of chronic debilitating pulmonary disease and pancreatic exocrine deficiency in the first three decades of life. It is characterized by the triad of chronic obstructive pulmonary disease, pan- creatic exocrine deficiency, and abnormally high sweat electrolyte concentra- tions. Characteristic pancreatic changes give the disease its name?

Chlamydia, gonorrhea, and syphilis

The most prevalent reportable STDs in NC include (3)?

Explain that medications are not routinely used in EBV infection

The mother of a 15-year-old adolescent female recently diagnosed with infectious mononucleosis calls for more information. She reports that her daughter, although tired, seems comfortable and is recovering nicely. She remembers that her 20-year-old son had "mono" when he was 10 years old, and he received an oral medicine. She requests the same medication for her daughter. Which of the following is the most appropriate course of action?

Thinning of the basement membrane

The parents of a healthy 12-year-old girl bring her to you for a physi- cal examination required for summer camp. They have no complaints, and the girl denies any problems. Her last menses was normal 2 weeks prior. The camp requires a urine screen. To your surprise, the clean- catch urine screen has significant hematuria. Red cell casts are noted. You tell the findings to the parents, and they respond that "everyone on dad's side of the family has blood in their urine and they are all doing well." The family history is negative for deafness and for renal failure. Microscopy of renal tissue from this patient or from her father will most likely reveal which of the following?

Vitamin B12 deficiency

The parents of a previously healthy 3-year-old girl bring the child to your office because she is complaining that her tongue hurts. The par- ents also report she has appeared weak and listless over the last several months, and has not been eating well. Recently she has exhibited trouble walking. The family usually eats a regular diet, including meats and vegetables. On physical examination, her tongue is smooth, red, and tender. She is pale and tachycardic. Her complete blood count reveals a macrocytic anemia. Which of the following is the most likely diagnosis in this child?

Tennis

The parents of an 8-year-old DS boy arrive for his annual well-child visit. He wants to participate in sports, including the Special Olympics. Until further evaluation can be completed, which of the following sports would you suggest as being safe?

PNEUMATIC OTOSCOPY

The process of obtaining a tight ear canal seal with a speculum and then applying slight positive and negative pressure with a rubber bulb to verify TM mobility?

Most children with HSV encephalitis survive; many (but not all) are left with some permanent neurologic deficits

The results of PCR of CSF from a 15-year-old adolescent male with encephalitis demonstrate an HSV infection. His parents ask about his prognosis. Which of the following is likely to be true?

INFECTIOUS MONONUCLEOSIS

The typical EBV presentation in older children and adolescents. Fever, posterior cervical adenopathy, and sore throat are seen in more than 80% of cases?

Neonatal Jaundice

The visible clinical manifestation of skin and sclera yellowing during the neonatal period, resulting from deposition of bilirubin in the neonatal bodies?

FEV1/FVC ratio

Their lungs are normal, they have a normal FVC, but as their lungs tighten, it takes them longer to blow it out?

In the placenta

There are two arteries and one vein?

Mittelschmerz

These women can actually feel ovulation occurring?

Suicide

Third leading cause of death among children and adolescents 10 - 24. Attempts more common in females, completion more common in males?

Giant Congenital Nevus

This needs to be evaluated. Can be at risk for cancer later in life?

Myringotomy and parenteral antibiotics

Three days after beginning oral amoxicillin therapy for OM, a 4-year- old boy has continued fever, ear pain, and swelling with redness behind his ear. His ear lobe is pushed superiorly and laterally. He seems to be doing well otherwise. Which of the following is the most appropriate course of action?

Croup

Treatment: Mild - supportive care Moderate/Severe - admission Steroids? Prognosis - most are uneventful?

Phototherapy and in extreme cases exchange transfusion (taking all the blood out and putting it back)

Tx from hyperbilirubinemia?

Treatment for Acute Otitis Media (AOM)

Tx: 1st line: Amox (High dose) 2nd line: Augmentin (Amox w/ acid)- the acid breaks through 3rd line: Ceftriaxone (rochephin)?

Atopic dermatitis (eczema)

Typically is pruritic, recurrent, and flexural in older children and symmetrical in adults?

MCHAT

Used for screening autism?

Apgar Score

Used to asess general condition of the newborn. Rated at 1 minute and 5 minutes post- partum:Color, HR, Reflexes, Activity, Respirations?

Physiologic Jaundice

Visible jaundice appearing after 24 hours of age. Total rise of <5mg/dL per day Peak bilirubin occurs at 3-5 days of age, with a total bili of no more than 15mg/dL Visible jaundice resolves by 1 week in full-term infants and 2 weeks in preterm infants?

21- drinking age 18- election 13- puberty

Way to remember trisomies?

Rales

Wet or "crackly" inspiratory breath sounds due to alveolar fluid or debris; usually heard in pneumonia or congestive heart failure (CHF)?

T - Toxoplasmosis / Toxoplasma gondii O - Other infections, Varicella/Zoster, Syph, Coxsach, ParvoB19, R - Rubella C - Cytomegalovirus H - Herpes simplex virus-2 (can cause death if transmitted to the infant)

What are the TORCH infections to look for?

Gonadotropin, LH, FSH

What are the three key hormones for puberty?

It causes too much water in their bodies which, in turn, causes their Sodium to decrease and they can go into a coma.

What does "cutting" formula do to a child?

Long arm of chromosome 7

What gene mutation is CF causes by?

As long as the child does not have a fever, vaccinate the child, always. If the child has fever, do not.

What is a rule of thumb for giving sick children vaccinations?

Exclusive breast feeding for 6 month, continued breast feeding for 1 year

What is the AAP's stance on breast feeding?

The bed alarm

What is the most effective tool for bed wetters?

It must be greater than or equal to 3 hours per day for at least three days per week for at least 3 weeks

What is the rule for diagnosing colic?

Prevention, Home remedies, and Topical Antibiotics

What is the treatment for Otitis Externa, "Swimmer's Ear"?

About 7%

What percent is teen suicide?

About 30%

What percent of teens has rode in the vehicle with someone who was intoxicated?

About 50%

What percent of women are still breast feeding 2 weeks after childbirth?

About 25%

What percent of women are still breast feeding 3 months after childbirth?

About 75%

What percent of women breast feed when they are discharged from the hospital to return home after childbirth?

Check for jaundice and check circumcision site

What should be done 48 hours after birth?

You should be very supportive and get them an appointment with a certified lactation consultant

What should you do for women who want to breast feed?

Shake the baby

What should you not do when the baby cries?

Tympanostomy

When a child becomes a surgical candidate because of hearing issues, what is the preferred initial procedure?

Asthma

When a child has chest pain, think what first?

Can begin as soon as 2 weeks, and the mother's follow up after birth is usually at 6 weeks

When can postpartum depression start, and when it the mother's usual follow up visit after birth?

If the child has some sort of auto-immune disorder like HIV or something else wrong with them

When does the CDC offer different immunization guidelines for children?

11

When does the CDC recommend giving Guardasil to prevent against HPV?

1 year after testes grow

When is a male's first ejaculation?

Fluid inside

When light reflects on the testicle, this usually means?

After 2 weeks

When should an infant return to their birth weight?

When OME persists for 3 months or longer or there is any language delay

When should hearing tests be conducted?

Juice should not be given before 6 months (a year is even better). When you give it to them, you should cut the concentration in half with water because of the amount of sugar that the juice contains

When should juice be given to a child and how should it be given?

Around 4 to 6 months. In order to receive the solids, they should be able to move food from the front to the back of the mouth and swallow it

When should solids be introduced to a child?

Scapula

Where do you not auscultate when listening to breath sounds?

6, 11, 16, 18

Which 4 types of HPV does the vaccine prevent against?

HEADSSS

Which mnemonic should you use when addressing what you should talk to teens about?

Maternal ingestion of phenobarbital during pregnancy

Which of the following decreases the risk of neurologic damage in a jaundiced newborn?

A term AGA infant born by cesarean section for placental abruption with Apgar scores of 3 and 5 at 1 and 5 minutes, respectively

Which of the following groups of children is at especially high risk for hearing loss?

A 50-word vocabulary and 2-word combinations to make a sentence

Which of the following would be the expected language development of a normal 24-month-old child?

Posterior Nose Bleeds

Which type of epitaxis (nose bleed) is most life threatening?

Because of botulism. Their immunities are not strong enough to fight it.

Why should you not give children honey before the age of 1?

Gilbert Syndrome

You are about to return a telephone call to the mother of an 8-day-old infant who continues to have jaundice which was first noted on the second day of life; you are about to report to her that his latest total and direct bilirubin levels are 12.5 and 0.9 mg/dL, respectively. You look over your chart and see that he and his mother have O type blood, the direct and indirect Coombs test is negative, his reticulocyte count is 15%, and a smear of his blood reveals no abnormal cell shapes. He is bottle-feeding well, produces normal stools and urine, and has gained weight well. Which of the following diagnoses remains in your differential diagnosis?

Obtain EBV-VCA IgG and IgM, EBV-EA, and EBV-NA tests

You are asked to see a 2-year-old boy in consultation. His general prac- tice doctor admitted him to the hospital 2 days ago because of 3 days of fever. He has generalized lymphadenopathy but is otherwise well. Results of Monospot, HIV testing, and CMV antigen tests are nega- tive; his liver function test values are mildly elevated. His physician diagnosed the boy's 7-year-old sibling with "mono" the month prior. You should suggest which of the following?

Infants are provided supplemental vitamins and minerals

You are called to the bedside of a mother who just delivered a healthy term infant and has a question regarding her infant's nutrition. The mother was fed goat's milk as a child and wants to do the same for her infant. Under which of the following conditions is goat's milk acceptable as infant nutrition?

PPD placement

You are evaluating a previously healthy 8-year-old boy with subjective fever, sore throat, and cough over the past week. There has been no rhi- norrhea, emesis or diarrhea, and his appetite is unchanged. According to your clinic records, his immunizations are current and his weight was at the 25th percentile on his examination 6 months ago. Today he is noted at the 10th percentile for weight. He is afebrile, with clear nares and posterior oropharynx, and a normal respiratory effort. He has bilat- eral cervical and right supraclavicular lymphadenopathy. Chest auscul- tation is notable for diminished breath sounds at the left base. Beyond obtaining a chest radiograph, which of the following is the best next step in your evaluation?

Goodpasture syndrome

You are not surprised to see one of your most challenging patients, a 16-year-old adolescent female who has been seen several times per week over the last 2 months complaining of cough, occasional hemop- tysis, malaise, and intermittent low-grade fever. Thus far you have identified a microcytic, hypochromic anemia for which she has been taking iron (without response) and migratory patchy infiltrates on chest radiograph that seem unaffected by antibiotic treatment. She has no tuberculosis (TB) exposure risks, and her TB skin test was neg- ative. Today she also complains of facial edema and tea-colored urine. You suddenly realize her symptoms can be grouped as which of the following syndromes?

Doesn't speak in sentences, make eye contact, or pay pretend/make-believe

You are seeing a 3 year old child in your office. Which of these could be a sign of a possible developmental delay?

Stool for ova and parasites

You are working at a Native American clinic in Alaska. A 16-year-old adolescent female comes to your office for an evaluation of lethargy. Her father notes that recently she has looked pale. She eats a regular diet and has no significant past medical history. Her menses are regu- lar and have not been excessive. During the last few years, she has helped her mother in the family seafood restaurant after school, but is increasingly tired and unable to complete all of her work. Her complete blood count reveals a megaloblastic anemia. Which of the following is the next appropriate study?

Prader-Willi syndrome

You examine a full-term 3780-g newborn in the nursery and notice that he has marked hypotonia, a very small penis, and unilateral cryp- torchidism. Which of the following is the most likely explanation for these findings?

Measurement of vitamin B12 and folate levels

You receive the results of a CBC you performed in your clinic on a pal- lorous 9-month-old boy. Other than pallor, no historical or physical examination concerns were noted during the patient's visit. The labora- tory technician reports a hemoglobin of 8.6 g/dL, an MCV of 105 fL, and platelet count of 98,000/mm3. You are also told that the white blood cell count is 8500/mm3 and the differential reveals 47% neutrophils and 42% lymphocytes, and that no atypical lymphocytes are seen. Which of the following is the most appropriate next step in this child's care?

Follow-up care for Acute Otitis Media (AOM)

You want to see them back after their round of AntiB (usually about 10 days). If you are not exactly sure and they still have fever, etc, you may want to see them back the next day?

Pertussis

• "Whooping cough" • Prodromal catarrhal stage (1-3 weeks) = mild cough, coryza • Persistent cough Diagnosis: PCR or nasopharyngeal culture Treatment: PREVENTION! Antibiotics, supportive Tdap or Dtap prevent spread, not shorten duration, most severe in children before 6 mos. because it is a 3 part vaccine?

Cystic Fibrosis

• Genetic (prenatal/newborn screening) o Autosomalrecessive o Mostcommonlethalgeneticdisease1:3000(caucasian) o CFTRproteinabnl,causingwater/NaClmovement across cell membranes abnormalities • Sx: o FTT/malabsorption o abnormalstools o recurrentrespiratoryinfections • Dx: Sweat Cloride >60mmol/L • Tx: CF care center?

Rales (Crackles)

• Initially occurs in the lower lobes, but can advance to upper areas (in the alveoli, but below bronchioles) • Pulmonary Edema • CHF • Near drowning • Toxic inhalation -Usually Fluid?

Stridor

• Laryngeal edema from croup or epiglottitis • Croup is laryngealtracheobronchitis • Epiglottitis is inflammation of the epiglottis •Is more pronounced in children because of smaller airways • Others • Toxic inhalation • Cancer • Foreign body obstruction?

Stridor

• On inspiration is a high-pitched, brassy sound • ..and a forceful expiration creates a barking cough • Often referred to as a "seal-like" bark -Very musical sounding?

Children at risk for hearing problems

• Permanent hearing loss • Suspected or diagnosed speech/language delay • Developmental delay • Autism-spectrum disorder • Syndromes (eg, Down) • Blindness/visual impairment • Cleft palate?

Epiglottitis

• Sudden onset of high fever, drooling, muffled voice, inspiratory retractions, cyanosis and stridor • Imaging: "thumbprint sign"?

Croup

• Viral or bacterial • Affects younger children in the fall and early winter • Parainfluenza, RSV, flu, adenovirus, metapneumovirus • Edema formation in the subglottic space accounts for the signs of upper airway obstruction, "barking" cough?