PANP804 EXAM 1 Practice

Calculate MIVF for a 10kg infant

40 ml/hr

A patient with central diabetes insipidus (DI) would most likely present with which of the following laboratory findings? A. Hypernatremia B. Urine specific gravity 1.030 C. Urine sodium 50 meq/L D. Decreased serum osmolarity

A. Hypernatremia Central Diabetes Insipidus (DI) is a condition associated with altered release of antidiuretic hormone from the hypothalamus, resulting in inability of the kidneys to concentrate urine. DI is typically a temporary condition. Signs and symptoms of diabetes insipidus (DI) include excessive thirst (in an alert child), polyuria, dilute urine with a low specific gravity, and serum hypernatremia and hyper-osmolarity associated with intravascular volume depletion. Treatment is targeted towards the underlying condition and fluid management with desmopressin (DDAVP)

A previously healthy 3 year old boy presents with lethargy, pallor, and bloody diarrhea. He has had bloody stools for 4 days and in the past 2 days he has developed fatigue and pale skin. He is drinking less than normal and parents deny any travel or medication use. Hi is mildly hypertensive, pale, abdominal tenderness, and a petechial skin rash on trunk and extremities. HUS is suspected. What is true about the renal impairment?

The renal impairment is caused by toxin binding to renal vascular endothelial cells.

The disease process which is characterized by inflammation and edema of the renal interstitum which can be caused by a viral process or drug induced and presents with rigors, fever, flank pain

interstitial nephritis

A 2-month-old infant weighing 4 kg is receiving continuous nasogastric feedings of 27 cal Enfamil at 16 mL/hours. How many calories/kilogram will be administered in 24 hours?

86 cal.The calculation for determining calories is:Calculate how many mL the child is receiving in 24 hours. 16 mL × 24 hours = 384 mL/hour, then determine the number of ounces the volume equals: 384 mL/30 mL (30 mL = 1 ounce) = 12.8 ounces. Multiply the number of ounces by the kcal content (e.g. 27 cal/ounce) which equals 345.6 calories and divide by the child's weight. 345.6 calories/4 kg = 86.4 calories per kilogram

Which of the following is the ideal daily weight gain for a healthy 3 month-old infant and what should be the total calorie expectation per day? a. 0.5 - 1 ounce, 110 calories per kg/day b. 2 - 3 ounces, 150 calories per kg/day c. 1 ounce, 80 calories per kg/day d. 2 ounces, 140 calories per kg/day

A. 0.5 - 1 ounce, 110 calories per kg/day In healthy infants weight gain is typically 0.5 - 1 ounce per day. These requirements may be higher in children requiring high daily caloric intake due to an underlying disease or illness. Typical calorie intake is 110 calories per kg/day in a 3 -4 month old or 12 kg infant. A general estimate of weight gain is doubling birth weight by 6 months of age and tripling birth weight by one year. It is common for newborns to lose weight in the first few days of life, however, further evaluation is warranted if birth weight is not achieved/surpassed by 2 weeks of life.

A child presents with anuria of unclear etiology that has been noted for the last 18 hours. Electrolytes demonstrate mild hyperkalemia. The child's height and weight equal a body surface area of 0.6 m2. The most appropriate fluid administration rate for this child is which of the following? A. 7.5 mL/hour B. 12 mL/hour C. 20.5. mL/hour D. 40 mL/hour

A. 7.5 mL/hour Insensible fluids are fluids lost through the skin through evaporative loss and evaporative water loss through the respiratory tract. It is termed 'insensible' because we are not aware of these losses. The water loss through the skin is different from water loss through the skin in the form of sweat. Water losses can change based on body temperature and changes in respiratory status. In a patient with tachypnea, insensible losses can be even greater than estimated. In patients requiring mechanical ventilation, some of the evaporative losses can be overcome by administration of humidity in the ventilator circuit. An estimate of insensible fluid losses in children is calculated with the equation of 300 mL x body surface area (BSA) = approximated losses for 24 hours. In this case, 300 mL x 0.6 BSA = 180 mL in a 24 hour period. 180 mL divided by 24 hours = 7.5 mL/hour. The estimated insensible loss in adults is 400 mL/day.

A 17-year-old female has complaints of severe, diffuse, lower abdominal pain and unusual vaginal discharge for the past 5 days. She has fever to 102°F and has been vomiting. Laboratory studies indicate a positive urine beta-HCG and an ultrasound is negative for appendicitis. What is the best disposition? A. Admit and treat for pelvic inflammatory disease with intravenous antibiotics B. Ceftriaxone IM and Azithromycin 1 gm oral dose and discharge home C. Metronidazole 100mg BID x14 days, Doxycyline 100mg BID for 14 days and discharge home D. Obtain an abdominal CT with oral and IV contrast and call general surgery

A. Admit and treat for pelvic inflammatory disease with intravenous antibioticsThe American College of Obstetrics and Gynecology (ACOG) has recommended that women who are pregnant with suspected pelvic inflammatory disease (PID) be admitted to the inpatient center for evaluation, treatment and observation. Other reasons for admission include: unclear diagnosis, need for intravenous antibiotics, severe illness or fever, nausea or vomiting, or an abscess in the fallopian tube or ovary.

A 3-year-old with new-onset status epilepticus is treated with fosphenytoin. The phenytoin total level is reported as 4.2 μg/mL. What other laboratory value should be reviewed? A. Albumin. B. Sodium. C. Glucose .D. Blood urea nitrogen.

A. Albumin.Phenytoin is protein bound; therefore, if the albumin is low, the phenytoin level may not be correctly interpreted. A free-phenytoin level should also be obtained prior to administering another bolus of fosphenytoin.

An adolescent girl presents with complaints of fever of 39°C orally, maculopapular rash which has been present for 3 days, and acute difficulty breathing. In addition to fever, the adolescent has a blood pressure of 72/34 mmHg with prolonged capillary refill. After addressing respiratory issues, initial important management includes: A. Fluid bolus of 20 mL/kg. B. Administration of antibiotics to include gentamycin for synergy .C. Administration of diphenhydramine for allergic anaphylaxis. D. Placement of a central venous catheter.

A. Fluid bolus of 20 mL/kg.After management of airway and breathing, circulation should be addressed in this case of potential toxic shock syndrome (TSS). Fluid bolus of 20 mL/kg can be repeated multiple times to manage blood pressure. Placement of a central line would be appropriate if fluid therapy was not sufficient. Antibiotics for the treatment of TSS include a second- or third-generation cephalosporin such as ceftriaxone and vancomycin.

Pancreatitis, celiac disease, short gut syndrome, and inflammatory bowel disease may result in which of the following alterations in serum magnesium levels? A. Hypomagnesemia. B. Hypermagnesemia. C. Severe, life-threatening hypermagnesemia. D. No effect on serum magnesium levels.

A. HypomagnesemiaGastrointestinal losses are one of the leading causes of hypomagnesemia in the hospitalized child.

A 5-year-old presents with chest pain, shortness of breath, and difficulty breathing. His blood pressure (BP) is 64/32 mmHg. In determining whether he is in shock with hypotension, how is BP classification in hypotension determined? A. Hypotension in school-age children is BP that is less than 5% for age. B. Hypotension is calculated by adding 50 plus 2 times the age in years. C. Hypotension is the only parameter that identifies shock and is not always a reliable sign. D. Perfusion and oxygen saturation should be determined before concern about hypotension.

A. Hypotension in school-age children is BP that is less than 5% for age. Hypotension with other symptoms of shock is indicative of uncompensated shock and is a concerning finding. To determine if the BP reading indicates hypotension in school-age children, the calculation is 70 plus 2 times the age; so for a 5-year-old, the lower limit of hypotension or less than 5% would be 80 systolic reading. Typically, BP is one of the last signs in a child who is acutely ill with shock, so when it occurs with other findings, there is serious concern.

1.) A 6-week-old presents with lethargy, fever, decreased PO intake and 2 wet diapers in te last 24 hours, jaundice and hepatomegaly are noted on the physical exam. Which of the first step in management? A. Initiate IV fluids B. Obtain urinalysis, urine culture and CBC C. Obtain transaminase and bilirubin levels D. Consult with Gastroenterology team

A. Initiate IV fluids Rationale: In the initial eval of an ill infant, is is important to address Hydration status. Despite the need to obtain lab sampling and perhaps a gastro consult it is important to reestablish hydration as the most immediate concern. Besides you probably won't be able to get urine for a UA or Culture since the child is so dry at this point.

A 3-year-old female presents with abdominal pain, fever, and periorbital edema. She is diagnosed with nephrotic syndrome and treated with steroids. After initial treatment, she does not go into remission and relapses. What is the treatment for steroid resistant nephrotic syndrome? A. Steroids with immunosuppresion B. Hemodialysis C. Peritoneal dialysis D. Antibiotics

A. Steroids with immunosuppresion The definition of nephrotic syndrome is edema, urine protein:creatinine ratio ≥ 2000 mg/g; urine protein ≥300 mg/dL, dipstick urine protein 3+, and hypoalbuminemia ≤ 2.5 mg/L. After initial treatment with steroid therapy, a kidney biopsy is warranted in some situations, however, administering steroids with a goal of immunosuppression is the recommended treatment.

A dehydrated 4-month-old who weighs 4.9 kg, with electrolyte panel: Na+ 128 meq/dL, CI 96 meq/dL, K+ 4.8 meq/dL, CO2 13 mg/dL, BUN 26 mg/dl, Cr 0. 5 mg/dL & Glucose 82 mg/dl. Which of the following IV fluid replacement therapies should be started? A) NS 100ml and start D5 0.45 NS at 44ml/hr B) NS 50ml and start D5 NS @ 20ml/hr C) NS 50ml and start D5 0.20 NS @ 15ml/hr D) NS 100ml and start D5 NS @ 40ml/hr

B) NS 50ml and start D5 NS @ 20ml/hr

What is the most likely organism to cause peri-orbital cellulitis in a 2-year-old? A) Candida species B) Staphylococcus aureus C) Mycoplasma D) Adenovirus

B) Staphylococcus aureus

A 7-day-old infant presents with lethargy, hypothermia, and is found to have metabolic acidosis. He was born a term, healthy baby, is not in shock, and does not have a history of birth asphyxia or other birth complications. What is the most important laboratory evaluation to request? A. Complete blood count with differential. B. Ammonia level. C. C-reactive protein level. D. Serum lactate level.

B. Ammonia level. When an infant or young child presents with acute illness and metabolic acidosis without evidence of shock, seizures, or documented asphyxia, an inborn error of metabolism (IEM) should be considered as first on the differential list. Other symptoms or suspected diagnoses do not exclude IEM; however, an underlying problem, such as sepsis, may unmask the disorder. Hyperammonemia is an important diagnostic clue to the presence of an IEM.

A 13-day-old female infant presents with lethargy and poor feeding. She is hypotonic, dehydrated, and has ambiguous genitalia. Laboratory evaluation reveals that the infant has hypoglycemia, hyponatremia, hyperkalemia with metabolic acidosis. Which of the following is the most likely diagnosis? A. Hyponatremia secondary to improper formula mixing. B. Congenital adrenal hyperplasia (CAH). C. Acute renal failure D. Sepsis.

B. Congenital adrenal hyperplasia (CAH). CAH is characterized by a 21-hydroxylase deficiency, which typically presents with a salt-wasting crisis in the first few weeks of life. This enzyme deficiency results because of insufficient adrenal production of cortisol and aldosterone, in addition to an excess of androgens, which can also cause ambiguous genitalia in female infants. Clinical manifestation of acute adrenal crisis in CAH includes lethargy, poor feeding, altered sensorium, vomiting, hypotension, and hypothermia. Laboratory findings include hypoglycemia, hyperkalemia, hyponatremia, dehydration, and metabolic acidosis.

Which of the following clinical findings are most likely to be expected on examination of a patient with anorexia nervosa? A. Decreased body weight, hyperthermia, tachycardia. B. Emaciated appearance, hypothermia, bradycardia. C. Normal body weight, abdominal distention, warm/flushed extremities. D. Hair loss, hyperthermia, proptosis

B. Emaciated appearance, hypothermia, bradycardia.maciated appearance, hypothermia, and bradycardia are expected findings with eating disorders. The evaluation of a child with an eating disorder should include a careful clinical examination and consideration of a broader differential diagnosis. Laboratory studies should be obtained to support clinical findings and evaluated for other potential causes of weight loss and electrolyte disturbances

A 5-month-old infant who weighs 7.1 kg underwent a Stage I Norwood procedure for hypoplastic left heart syndrome. She is intubated, receiving total parenteral nutrition (TPN), intermittent lipids due to cholestasis, and slowly increasing feedings. TPN solution is Dextrose 20% solution and Amino Acids at 2 gm/kg/day at 18mL/hr. The infant is also receiving Neocate 20 cal/ounce at 11mL/hr continuously through a nasogastric tube. What are the total fluids (mL/kg/day) and total calories (mL/kg/day)? A. Fluid: 100 mL/kg/day; Calories: 80 cal/kg/day B. Fluid: 98 mL/kg/day; Calories: 74 cal/kg/day C. Fluid: 60 mL/kg/day; Calories: 31 cal/kg/day D. Fluid: 98 mL/kg/day; Calories: 66 cal/kg/day

B. Fluid: 98 mL/kg/day; Calories: 74 cal/kg/day Initially, the total fluids are calculated: (Total Fluid: (18 mL/hour x 24 hours) + (11 mL/hour x 24 hours)/7.1 (patient's weight) =98 mL/kg/day).The calories are obtained from the combination of glucose and amino acids along with enteral calories from formula: Total Calories: (18 mL/hour x 24 hours) = 432 x 0.2(concentration of dextrose) = 86.4 grams/24 hours x 3.4 cal/grams = 292 cal/24 hours along with amino acids, 2 gm/kg/day x 7.1 kg= 14.2gm/24hr x 4 cal/gm= 56 cal/24 hours. Formula is calculated: (11 mL/hour x 24 hours) = 264 mL /30 ounces= 8.8 ounces x 20 cal/ounce = 176 calories/7.1 kg (patient's weight) = 25 cal/kg/24 hours. The total equals 292 (calories from TPN) +56 (calories form intralipids)/ 7kg = 49cal/kg/24hrs + 25 cal/kg/24 hours (from formula)=74 cal/kg/24 hours

A 6 month old female is brought to the ED with a 2 week history of vomiting 3-4 times a day. Her parents also report she has been increasingly fussy . Her growth curve is consistent with no weight gain in 2 weeks. Her CBC is normal but her electrolyte panel shows metabolic acidosis. Which of the following laboratory findings would be consistent with renal tubular acidosis? A. Elevated serum anion gap B. Hyperchloremia C. Hypokalemia D. Hyperphosphatemia

B. Hyperchloremia The classic electrolyte presntation seen in renal tubular acidosis (RTA) is a hyperchloremic metabolic acidosis with a normal serum anion gap.

A 10-year-old patient is now 100 days out from a living donor liver transplant, and presents with dysuria and fever for 2 days. A urine culture is positive for Aspergillus. In choosing an antifungal agent, which of the following treatment options is the most appropriate? A. Oral fluconazole. B. IV amphotericin B. C. IV voriconazole. D. No treatment for a fungal source urinary tract infection.

B. IV amphotericin B. Oral formulations for invasive fungal disease are seldom appropriate, especially in an immunocompromised child. Fluconazole has no activity against Aspergillus. IV voriconazole is a reasonable choice, but would be inappropriate in light of its interactions with many immunosuppressive medications, which this patient is likely prescribed. Amphotericin is the most appropriate therapy, and urine isolates of invasive fungal species are real and should be treated as such.

When evaluating a child with shock and an EKG demonstrating torsades de pointes, which of the following therapies is indicated immediately? A. Potassium phosphate. B. Magnesium sulfate. C. 3% saline solution. D. Osmotic diuretic

B. Magnesium sulfate. Torsades de pointes is commonly associated with hypomagnesemia. Treatment of hypomagnesemia with administration of magnesium sulfate is the first-line therapy.

A 5-year-old who is recovering from septic shock has had a high BUN and creatinine for the past 3 days. His urine output was more than 3 mL/kg/hour over the past 2 days, but now is decreasing and he has only had 0.5 mL/kg/hour today. The most urgent indication for dialysis in this child includes: A. Anuria. B. Potassium level of 7.3 mEq/dL. C. BUN of 65 and creatinine of 2.4. D. Uremic frost on skin.

B. Potassium level of 7.3 mEq/dL. An elevated potassium level in a child with abnormal kidney function is most concerning and needs to be treated due to the risk of life-threatening arrhythmia in children with high potassium levels.

Secondary hypertension is typically caused by which of the following etiologies? A. Adrenal insufficiency. B. Renal disease. C. Type 2 diabetes mellitus. D. Genetic predisposition

B. Renal disease.Secondary hypertension is more common in children than in adults and is most often caused by renal disease. Adrenal insufficiency, certain medications (including corticosteroids), sleep apnea, stress, and anxiety can also be causative factors. Genetic predisposition is the most common cause of primary hypertension in children.

A child being evaluated for brain death most commonly demonstrates which of the following laboratory findings? A. Serum sodium 155 mEq/L, Specific gravity of 1.010 B. Serum sodium 155 mEq/L, Specific gravity of 1.001 C. Serum sodium 125 mEq/L. Specific gravity of 1.030 D. Serum sodium 125 mEq/L Specific gravity fo 1.020

B. Serum sodium 155 mEq/L, Specific gravity of 1.001 Patients who are deemed brain dead commonly develop central diabetes insipidus due to the brain's loss of its ability to appropriately release antidiuretic hormone. Diabetes insipidus is characterized by increased volume of dilute urine output with low osmolarity and urine electrolytes. Most commonly, laboratory findings demonstrate hypernatremia associated with dehydration.

A patient has been admitted to the intensive care unit for 2 weeks with a necrotizing pneumonia and sepsis. An evaluation of thyroid function in this patient demonstrates a low T3, normal free T4, and low-normal thyroid stimulating hormone. What is the best interpretation of these results? A. Normal thyroid function B. Sick euthyroid syndrome C. Primary hypothyroidism D. Acquired hyperthyroidism

B. Sick euthyroid syndromeSick euthyroid syndrome is a condition of altered thyroid hormone and TSH metabolism in patients with non-thyroidal diseases. Alterations in thyroid hormone may be the result of inflammatory mediators and cytokines acting at the level of the hypothalamus or pituitary. Treatment of sick euthyroid syndrome is treatment of the underlying disease. Replacement of thyroid hormone is generally not needed, however, there are ongoing studies evaluating the most appropriate management of this condition. Thyroid function can be difficult to assess in critically ill patients and its evaluation must not rely on measurement of TSH alone. Patients will normal thyroid function will have normal T3, T4, and TSH. A low T4 is noted in primary hypothyroidism. In early stages of primary hypothyroidism, the TSH may be elevated. Elevation of T3 and/or T4 is noted with hyperthyroidism. A low TSH may also be noted.

A 15-year-old is being managed with an epinephrine infusion for toxic shock syndrome. In order to maintain the blood pressure, the dose has been increased to 3 μg/kg/minute. What is the potential consequence of this dosing? A. The dose is appropriate to maintain end-organ perfusion. B. This is a higher dose which can result in tachycardia and may inhibit end-organ perfusion. C. This is a mid-level dose which will provide adequate tissue perfusion with mild tachycardia. D. The dose is low, which will result in more pronounced alpha effects.

B. This is a higher dose which can result in tachycardia and may inhibit end-organ perfusion. The typical dosing of epinephrine is 0.1 to 1 μg/kg/minute, but higher dosing has been used, up to 5 μg/kg/minute. When using higher doses, the alpha effects will be prominent, resulting in tachycardia and overall inhibition of end-organ perfusion.

A 20-month-old presents with watery diarrhea for 5 days with new-onset high fever. The infant has been tired and listless with loss of appetite. The diarrhea is described as nonbloody recurrent loose stools with unknown urine output. Physical examination reveals a pale, lethargic toddler who has periorbital edema with fine scattered petechiae over face and extremities. In considering the diagnostic evaluation for this child, laboratory findings for diarrhea-associated (D+) hemolytic uremic syndrome (HUS) would be supported by which of the following? A. Prolonged PT, prolonged PTT, and thrombocytopenia. B. Uremia, anemia, thrombocytopenia, and reticulocytosis. C. Decreased fibrinogen, elevated FDP, and normocytic anemia. D. Thrombocytopenia, uremia, factor VIII deficiency

B. Uremia, anemia, thrombocytopenia, and reticulocytosis.HUS often does present with bloody diarrhea versus non-bloody, but still needs to be part of the differential in a child who has findings of anemia, decreased or no urine output, and signs of bleeding (e.g., petechiae). The anemia is normochromic, normocytic, with an elevated reticulocyte count.

Which of the following is a clinical finding of a metabolic disease? A. Loose stools. B. Urine that smells musty or like maple syrup. C. Urine that smells like lemon or sweaty feet. D. Constipation that occurs in the first few weeks of life.

B. Urine that smells musty or like maple syrup. There are three inborn errors of metabolism that include a typical urine odor as a sign of the illness. Maple syrup urine disease is one in which the urine has a maple syrup odor. Musty urine odor is associated with phenylketonuria and a smell of sweaty feet is associated with isovaleric/glutaric acidemia.

A 10-year-old boy who weighs 123 lb has an elevated blood pressure (BP). At his third BP check, it remains 145/88 mmHg. After obtaining laboratory tests, an ECG, and imaging studies, the initial management includes: A. Vigorous weight-lifting program. B. Weight-reduction program. C. Calcium channel blocker medication. D. Low-dose diuretic.

B. Weight-reduction program. The first conservative management of hypertension in a 10-year-old child is to incorporate lifestyle changes, including weight loss with exercise and healthy dieting, such as theDASH diet. Second-line management would include beginning a calcium channel blocker, an ACE inhibitor, or a diuretic based on guidelines or cardiologist recommendation.

1.) A 3-week- old infant presents to the emergency room with jaundice. Labs reveal a total bilirubin of 14mg/dl and conjugated bilirubin of 10mg/dl. Explanation of these findings include which of the following? A.) These results could be from breast-feeding, so they should be repeated in 1 week B.) Laboratory studies are abnormal in an infant at this age, so a pediatric gastroenterologist will need to consult immediately C.) An Elevated conjugated bilirubin is an expected result for infants with physiologic jaundice D.) The infant can be managed at home with exposure to direct sunlight and a biliblanket

B.) Laboratory studies are abnormal in an infant at this age, so a pediatric gastroenterologist will need to consult immediately Rationale: A high total bilirubin with the presence of conjugated or direct bilirubin likely indicated cholestatic liver disease. These results are not physiologic jaundice of the newborn which has an associated elevated unconjugated bilirubin level. Evaluation by a pediatric gastroenterologist is most important as this child could not have biliary atresia, with the best prognosis associated with timely diagnosis and treatment. The interventions of placing the infant in direct sunlight and maintaining hydration with regular bowel movements aid in the resolution of unconjugated hyperbilirubinemia. It is unlikely that repeating the laboratory studies will reveal different results.

A 9-month-old is intubated and ventilated in the pediatric intensive care unit following full cardiopulmonary arrest secondary to suspected nonaccidental trauma. After stabilization and central line placement, she is reported to have excessive urine output over the past 3 hours, which is calculated to be >4 mL/kg/hour. The most likely rationale and management is: A. Syndrome of inappropriate antidiuretic hormone (SIADH); obtain a basic metabolic panel (BMP), urinalysis, urine electrolytes, urine and serum osmolarity. B. Cerebral salt wasting (CSW); obtain BMP, complete blood count (CBC), urinalysis, urine electrolytes panel, and urine osmolarity. C. Central diabetes insipidus (DI); obtain BMP, urinalysis, urine electrolytes, urine and serum osmolarity. D. Increased urine output due to extensive fluid resuscitation during stabilization period; obtain BMP in 8 hours.

C. Central diabetes insipidus (DI); obtain BMP, urinalysis, urine electrolytes, urine and serum osmolarity.Central DI is the inability to concentrate urine secondary to a vasopressin deficiency which can occur as a result of head trauma due to edema in the area surrounding the hypothalamus and pituitary gland. Classic findings of DI include excess urine output with low urine osmolarity (specific gravity <1.005), high serum osmolarity, and hypernatremia. Polyuria can be >4 mL/kg/hour in infants and 150 mL/kg/day in older children. Direct measurements of urine sodium excretion, in addition to serum and urine osmolality, are critical in diagnosing DI. Laboratory studies to confirm the diagnosis of DI and to differentiate it from cerebral salt wasting include a urine sodium <30 mEq/L, urine osmolarity <200 mOsm/L, serum sodium >150 mEq/L, and serum osmolarity >295 mOsm/L. DI should be identified as soon as possible to prevent profound hypovolemic hyperosmotic dehydration. SIADH results in decreased urine output due to an excess in antidiuretic hormone.

Rapid correction of hypernatremia may cause which of the following outcomes? A. Respiratory distress. B. Ventricular fibrillation. C. Cerebral edema. D. Central pontine myelinolysis

C. Cerebral edema.Hypernatremia should be corrected slowly in order to avoid cerebral edema. Central pontine myelinolysis is the result of rapid correction of hyponatremia.

An 8-year-old with a history of low-grade astrocytoma presents to the pediatric intensive care unit (PICU) following cranial surgery. After several hours, her urine output significantly increases. Laboratory results reveal a serum sodium level of 152 mEq/L and a urine sodium level of 25 mEq/L. The most likely diagnosis of this condition is: A. Syndrome of Inappropriate Antidiuretic Hormone B. Diabetic Ketoacidosis C. Diabetes Insipidus D. Cerebral Salt Wastin

C. Diabetes Insipidus Diabetes Insipidus (DI) is a condition in which there is a deficiency of antidiuretic hormone resulting in polyuria. With increasing dehydration, the child will also develop hypernatremia and hyperosmolarity as well as diluted urine with low urine sodium and low urine osmolarity. Similarly, cerebral salt wasting (CSW) is marked by increased urine output but with loss of sodium resulting in hyponatremia, hypo-osmolarity and increased urine sodium and osmolarity. Syndrome of Inappropriate Antidiuretic Hormone (SIADH), caused by an increase in ADH results indecreased urine output, hyponatremia, hypo-osmolarity, and concentrated urine with elevated sodium and osmolarity. Diabetic Ketoacidosis (DKA) usually causes polyuriaand dehydration with altered electrolytes as a result of a deficiency in insulin.

newly diagnosed leukemia patient presents with polyuria. What is your differential diagnosis? A. Adrenal hyperplasia B. SIADH C. Diabetes Insipidus D. Diabetes mellitus

C. Diabetes Insipidus results when the kidneys are not able to concentrate urine. It is characterized by polyuria and polydipsia. It can be caused by either deficiency of antidiuretic hormone (ADH) from the pituitary - aka as central/neurogenic DI) or renal unresponsiveness to it (nephrogenic DI).

A 6-year-old with normal renal function develops acute hyperphosphatemia. Which of the following is appropriate management for this patient? A. Fluid restriction and loop diuretics such as furosemide to promote phosphate removal. B. Aggressive fluid resuscitation with 5% albumin to increase oncotic pressure and promote forced diuresis. C. Fluids containing normal saline and osmotic diuretics such as mannitol for forced diuresis. D. Fluid restriction and avoidance of any diuretics to promote phosphate removal

C. Fluids containing normal saline and osmotic diuretics such as mannitol for forced diuresis.In patients with normal renal function and some degree of hyperphosphatemia, fluids consisting of normal saline along with osmotic diuretics may be used for forced diuresis to promote some phosphate excretion. Other therapies including phosphate binders (e.g., aluminum hydroxide) or dialysis may be indicated for severe symptomatic hyperphosphatemia.

A 2-year-old is found with pill fragments in his mouth after playing with his grandmother's purse which contained a bottle of β-blockers which she was taking for hypertension. If the child has taken almost the entire bottle of these pills, which of the following therapies should be anticipated? A. Flumazenil infusion. B. Digoxin loading dose. C. Glucagon infusion. D. Lorazepam dose.

C. Glucagon infusion. A child with a significant β-blocker ingestion may present with cardiovascular depression or frank cardiovascular collapse. While evaluating and supporting the child's airway, breathing, and circulation, a glucagon infusion will increase heart rate, cardiac contractility, and atrioventricular conduction.

A 4-year-old presents with lethargy, a 2-day history of diarrhea which is now bloody, and absence of urine output for the past 12 hours. He is febrile and ill-appearing. The most likely diagnosis is: A. Gastroenteritis. B. Clostridium difficileinfection. C. Hemolytic uremic syndrome. D. Pyelonephritis.

C. Hemolytic uremic syndrome. Hemolytic uremic syndrome is an infectious illness characterized by the presentation of bloody diarrhea and progressive renal failure. The causative organism is typicallyE.coli0157 which produces a toxin and is contracted through contaminated water, meat, fruits, and vegetables. It results in damage to endothelial cells and erythrocytes, producing a prodrome of hemorrhagic enterocolitis. Endothelial swelling of the glomerular arterioles in the kidneys results in decreased glomerular filtration rate, proteinuria, and hematuria with hemolytic anemia, thrombocytopenia, and acute renal failure.

A preschool-aged child with a diagnosis of hemolytic uremic syndrome (HUS) is being managed on the inpatient pediatric unit for acute renal failure. Which of the following electrolyte disturbances can be expected? A. Hyperkalemia, hypernatremia, hypercalcemia, and metabolic acidosis. B. Hypochloremia, hyponatremia, hyperphosphatemia, and metabolic alkalosis. C. Hyperkalemia, hyponatremia, hyperphosphatemia, and metabolic acidosis. D. Hypokalemia, hypomagnesaemia, hypercalcemia, and metabolic alkalosis.

C. Hyperkalemia, hyponatremia, hyperphosphatemia, and metabolic acidosis. Hyperkalemia and hyperphosphatemia can result in acute renal failure secondary to the kidney's inability to excrete potassium and phosphorus. Hyperkalemia can result in cardiac arrhythmias and EKG changes including peaked T waves and widened QRS complexes. Hyperphosphatemia results in acidosis, cardiac arrhythmias, extraosseous calcifications, and hypocalcemia. Uremia further contributes to metabolic acidosis. Fluid overload secondary to lack of glomerular filtration can result in hemodilution and relative hyponatremia.

Peaked T waves found on a pediatric EKG are typically caused by which of the following electrolyte abnormality? A. Hypocalcemia. B. Hypophosphatemia. C. Hyperkalemia. D. Hypoglycemia.

C. Hyperkalemia.Hyperkalemia typically causes peaked T waves on EKG and is the most common presentation of this abnormality in children. If a child has an elevated potassium level, an EKG can support the reliability of the laboratory result. In all cases, however, the electrolytes should be repeated

Which of the following is a significant concern and a late finding following toxic ingestion of ethanol? A. Bradycardia. B. Pulmonary edema. C. Hypoglycemia. D. Blurred vision.

C. Hypoglycemia.Ingestion of alcohol-based solutions can cause significant neurologic problems in any child. Profound hypoglycemia secondary to impaired gluconeogenesis can be problematic, and often is a delayed presentation following ingestion of ethanol.

A full-term infant is brought to the emergency department with concerns about feeding. The infant had a birth weight of 6 lb, 8 oz and has been bottle-fed exclusively with Similac Sensitive. Caregivers report some emesis with every feeding. The infant weighs 5 lb, 2 oz with this visit, is lethargic, and is found to have a rectal temperature of 36.4°C. Which of the following differentials should be highest on the list? A. Formula intolerance. B. Sepsis. C. Inborn error of metabolism. D. Lactose intolerance.

C. Inborn error of metabolism.Any infant who has findings of inappropriate weight gain, failure to thrive, lethargy, or a sepsis presentation should be evaluated for an inborn error of metabolism as well as other differential diagnoses.

Twenty four hours following a neurosurgical procedure to repair a Chiari I malformation, a 10-year-old is arousing only to significant stimulation and has had 3 episodes of emesis. His blood pressure is stable, and urine output is 0.7 mL/kg/hr since surgery. An emergent head CT is obtained with no acute fluid accumulation or changes noted since surgery. Which laboratory results would help guide management? A. Decreased serum sodium, increased serum osmolarity, and decreased urine specific gravity B. Decreased urine specific gravity, increased serum sodium, and increased serum osmolarity C. Increased urine specific gravity, decreased serum sodium, and decreased serum osmolarity D. Increased serum sodium, increased urine specific gravity, and increased serum osmolarity.

C. Increased urine specific gravity, decreased serum sodium, and decreased serum osmolarity The findings of increased urine specific gravity, decreased serum sodium, and decreased serum osmolarity can indicate post-operative SIADH(Syndrome of inappropriate antidiuretic hormone secretion). After completing a head CT to rule out any other abnormalities, consider evaluation and management for SIADH. A serum sodium less than 135 mEq/L, serum osmolarity less than 280, and urine specific gravity greater than 1.020 in addition to urine output less than 1 mL/kg/hr indicates an inappropriate excretion of antidiuretic hormone, or SIADH

An infant presents with vomiting, diarrhea, and hepatomegaly. Laboratory studies indicate hypoglycemia, elevated liver enzymes, and hyperbilirubinemia. Galactosemia is first on the differential diagnosis list. While waiting for definitive diagnosis, which adjustment should be made for the newborn? A. Initiate a formula that does not contain cow's milk .B. Initiate enzyme replacement therapy. C. Initiate lactose-free formula. D. Administer cornstarch supplementation.

C. Initiate lactose-free formula. Galactosemia results in a deficiency of galactose-1-phosphate uridyl transferase (GALT), and is a disorder of glycogen breakdown. The clinical presentation involves vomiting, diarrhea, poor weight gain, jaundice, and hepatosplenomegaly during the first few weeks of life. Laboratory findings include hypoglycemia, hyperbilirubinemia, elevated liver transaminases, and metabolic acidosis. Treatment includes initiation of a lactose-free formula. Untreated infants with galactosemia may develop severe growth failure, mental retardation, cataracts, and cirrhosis.

A 14-year-old presents acutely with a significant headache and is found to have a blood pressure (BP) of 230/110 mmHg. The goal of intravenous (IV) labetalol therapy is to: A. Decrease the BP to normal level in a short amount of time. B. Provide general vasodilation which will increase blood flow to the kidneys. C. Slowly bring BP to a safe level. D. Use diuretics to assist with decreasing circulating fluid volume.

C. Slowly bring BP to a safe level. A hypertensive crisis can be caused by a variety of factors. The immediate goal of therapy is to decrease the BP to a safe level with the use of IV medications including nicardipine, labetalol, esmolol, or hydralazine. Fluid management and restriction can be part of the plan, but the main goal is to not bring the BP to a normal level, but to reduce the BP no more than 25% to 33% of the overall goal reduction within the first 6 to 12 hours.

A neonate is admitted to the pediatric unit with a diagnosis of possible sepsis. The infant was born at 29 weeks, is currently 35 weeks' gestation, and was discharged 3 days ago from the neonatal intensive care unit. The nurse reports repeated temperatures of 35°C taken rectally and two episodes of apnea. The infant has had a full sepsis workup and is being treated with antibiotics. The first management is to: A. Repeat a complete blood count with differential. B. Place oxygen by nasal cannula. C. Warm the infant in an Isolette or by overhead warmer. D. Check the blood culture result and change antibiotics.

C. Warm the infant in an Isolette or by overhead warmer. Preterm infants are at risk for hypothermia, and even though they can present with hypothermia as a response to illness, they also have immature thermoregulatory response so temperature can vary more than expected. Preterm infants also have a body surface area (BSA) relative to weight. The elevated BSA in preterm infants is approximately 3 times that of an adult, placing them at risk for heat loss by varied mechanisms. Cold stress can contribute to other symptoms, including apnea and bradycardia. Warming the infant is the first action indicated.

A 4-week old infant who is formula fed presents with a hostiry of blood-tinged stools with mucus for the past few days. His mom reports that he has been fussier than usual but she denies fever, vomiting, or cold symptoms. Exam reveals abdominal distension but is otherwise normal. You suspect cow's milk protein allergy. What is the most appropriate next step to confirm diagnosis?

Change his diet to an alternative protein source

You are called to the delivery room to evaluate a newborn infant with ambiguous genitalia. The mother had an amniocentesis done that revealed a fetus with an XX genotype. Physical exam of the neonate indicated no palpable gonads, a small phallic structure, and labial fusion with a urogenital opening. What is the likely diagnosis?

Congenital adrenal hyperplasia caused by 21-hydroxylase deficiency

Two month old male presents with fever of 102F and fussiness. He has decreased urine output, but mild symptoms of dehydration. A full sepsis workup is completed and he needs to be started on antibiotics. Your orders include Ampicillin and Gentamycin. The following morning his urine culture grows 50,000 CFU of E. coli. UA: Nitrites +, WBC 50, RBC 10, Bacteria 1+. Susceptibilities are Ampicillin resistant, Cefotaxime sensitive and Gentamycin sensitive. What do you do with your antibiotics? A. Change to Sulfa drug B. Continue Gentamycin C. Continue Ampicillin and Gentamycin D. Discontinue antibiotics as this patient does not have a UTI

Correct Answer: Continue Gentamycin Explanation: A. Once an organism and its susceptibility pattern are known, antibiotic coverage may be adjusted. In this patient you would continue Gentamycin as the organism is susceptible to this medication. B. Discontinue Ampicillin if the organism is resistant to it. C. Sulfa drugs should not be administered to infants of this age

Acute tubular necrosis (ATN) occurs when a hypoxic condition causes renal ischemia that damages tubular cells of the glomeruli so they are unable to adequately filter the urine, leading to acute renal failure. Treatment of ATN includes: A. Loop diuretics B. Fluid restriction C. Antibiotics D. FFP for coagulopathy

Correct Answer: Loop diureticsExplanation: A. Adequate fluid balance is necessary to perfuse the kidneys. Identifying and treating underlying cause is key C. Antibiotics including sulfonamides and streptomycin can cause ATN. Antibiotics should only be continued if infection is present D. Coagulopathy may develop if uremia is present. Uremia leads to destruction of platelets and bleeding.

A 10 year old had strep throat 3 weeks ago, which was treated with amoxicillin for 10 days. He presents today with edematous face and ankles, and complains of a headache and flank pain. BP is 142/86, he has been oliguric for the past 12 hours, and has 3+ proteinuria. If the symptoms are severe what is the best treatment?

Corticosteroids

An 8-month-old presents with a 5-day history of fever, diarrhea and poor feeding. His skin is mottled with prolonged capillary refill, HR 180, RR 50, BP 65/30. Given this brief history and clinical data, what is the first diagnosis on the differential list? A) Systemic inflammatory response B) Dehydration with hypovolemic shock C) Dehydration with cardiogenic shock D) Septic shock

D) Septic shock

Which of the following substances has the highest fatality if ingested by a young toddler? A. Anticholinergic B. Antiepileptic C. Melatonin D. Calcium channel blocker

D. Calcium channel blockersCalcium channel blocker toxicity is one of the most concerning results of accidental ingestion. This medication can cause hypertension, hypotension, bradycardia and different forms of heart block on ECG. Hypokalemia, hyperglycemia and acidosis are among the most common side effects. Toxic ingestions of Glypizide, can also result in complete AV block and some other cardiac arrhythmias, so monitoring and administration of calcium are the mainstays of treatment.

A 13-year-old has a history of food binging and then using magnesium citrate as a laxative. Which of the following electrolyte disorders would be expected if she presents with dehydration? A. Hypophosphatemia and hypernatremia. B. Hyperkalemia and hypernatremia. C. Hyperphosphatemia and hyperkalemia. D. Hypokalemia and hyponatremia.

D. Hypokalemia and hyponatremia.Bulimia nervosa consists of food binging and then emesis, misuse of laxatives and/or diuretics. The use of magnesium citrate as a laxative would predispose this teen to hypokalemia and hyponatremia as the laxative works by osmosis in the small intestine. In addition to losing water through defecation, sodium and potassium are excreted as well. Patients with eating disorders often present with total body depletion of magnesium due to poor intake and urinary losses.

When administering albuterol in a continuous nebulized form, it is important to monitor for which of the following electrolyte disorders? A. Hyponatremia. B. Hypernatremia. C. Hyperkalemia. D. Hypokalemia.

D. Hypokalemia. Albuterol is a β2-adrenergic agent which is used for the treatment of bronchospasm in children with asthma. Side effects of inhaled albuterol include tachycardia, hypertension, nausea and vomiting, and hypokalemia.

8. A full term, now 10-month-old male presents to the ED with a 3-day history of watery, non-bloody diarrhea and cough. Mom denies fever, vomiting, or symptoms. He has refused his bottle and cup for most of the day but is alert and playful. Mom is unsure of last urine due to large amounts of diarrhea in each diaper. His mucus membranes are tacky. Serum chemistry is unremarkable except for elevated BUN. A normal saline IV bolus is given once. Which treatment would be ordered after the initial bolus for dehydration? A.) anti-diarrhea medication B.) Stool Cultures C.) Initiation of maintenance IV fluids D.) Attempt oral rehydration

D.) Attempt oral rehydration Rationale: This is a well appearing child. A NS bolus was given to "catch up" on the dehydration so oral rehydration can be attempted. If the child does not tolerate or refuses fluids, IVFs can be ordered. Due to the unknown cause of the diarrhea and the patients age, anti-diarrhea medication is not recommended. Stool cultures are rarely done esp. in well appearing children in that they make take several days for results to come back.

Which supplementation is often needed in infants/children with DiGeorge syndrome?

DiGeorge Syndrome, also known as 22q11.2 deletion syndrome can affect many different body systems including congenital heart disease, palatal defects, mild differences in facial features, difficulties with the immune system from an absent or hypoplastic thymus, and malfunctioning parathyroid glands. Hypocalcemia can result from the malfunctioning parathyroid glands.

A previously healthy 4-year-old child presents with fever, abdominal pain, pallor, petechiae, hematuria, oliguria, azotemia, and watery diarrhea that progress to hemorrhagic colitis. The stool culture will most likely be positive for:

E. coli 0157:H7 Hemolytic uremia syndrome (HUS) is a disease of the microcirculation characterized by hemolytic anemia, thrombocytopenia, and acute renal failure. It occurs most frequently in children < 4 years of age and is the most common cause of acute renal failure (ARF). D+HUS, post diarrheal HUS, occurs in previously healthy children who have had recent gastroenteritis. The mortality rate is 3%-5%; associated with renal failure in 50% to 70% of patients affected. HUS diagnosis is supported by patient history and the presence of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Laboratory findings associated with D+HUS include reticulocytosis and abnormal RBC morphology, shistocytes, burr and helmet cells on smear; fragmented erythrocytes, anemia, decreased haptoglobin, thrombocytopenia, leukocytosis, abnornal coagulation, Coombs negative, and stool cultures are often positive for E. Coli 0157:H7. Microscopic hematuria and proteinuria are common on urinalysis.

A 9 year old female presents to the ED with confusion and dizziness. HPI reveals she has had gastrointestinal viral symptoms including diarrhea (~10 foul smelling stools since this morning). The mother has been trying to keep her hydrated by offering ice chips, diluted juice and water. On exam her deep tendon reflexes are diminished throughout. What electrolyte abnormality could be contributing to her confusion and dizziness? A. Hyperkalemia B. Hyponatremia C. Hypomagnesaemia D. Hypochloremia

Explanation: B. Children with diarrhea, loose electrolytes in their stools. When they are rehydrated with free water or dilute juices, the are prone to develop hyponatremia. Symptoms of hyponatremia include anorexia, confusion, and lethargy. Hypomagnesaemia is uncommon unless the patient has bee receiving medication or parenteral nutrition Hyperkalemia presents with symptoms of paresthesia's and weakness but is less likely given this patient's HPIC. Hypochloremia may be present but usually does not cause these symptoms

Which electrolyte derangements may be noted in a child requiring a massive transfusion of packed red blood cells?

Hypocalcemia and hyperkalemia There are several side effects of massive blood transfusion. Hypocalcemia is often noted from citrate required to store the blood product and hyperkalemia from potassium leakage from the stored red blood cells. Coagulopathy (dilutional), hypothermia, and risk for transfusion associated lung injury (TRALI) are additional risks of massive transfusion therapy.

A 5 yr old boy with a 3 day history of HA, puffiness and dark colored urine. Physical exam shows HTN, periorbital edema, and peripheral edema. UA reveals hematuria with RBC cases and 1+ proteinuria. What is correct regarding post streptococal glomerulonephritis?

If confirmed this is streptoccal glomerulonephritis, prognosis is excellent.

What is the difference in sodium in a solution that contains normal saline (NS) and one that contains 3% saline?

NS = 154 meq/L & 3% NS = 513 meq/LIt is important to differentiate between types of saline infusions as NS is the basis for most fluid boluses and hypertonic saline or 3% saline is used to increase sodium levels quickly in the process of correcting hyponatremia or to treat other problems that can result in cerebral edema or fluid overload. 3% saline is also called 'hyertonic' saline and due to its composition, it is ideal to administer via central venous catheter.

A 4-year old girl is brought to the urgent care center with an acute onset of vomiting blood. Her parents report that it started 3 hours ago and she has had 4 episodes of bloody emesis since that time. Vitals include HR=152, BP=110/56. Which is the most appropriate first step of management?

Place 2 PIVs and administer 20 ml/kg NS fluid bolus

A 6 year old girl is brought to the clinic for a routine health maintenance visit. Her growth was normal until 2 years of age, when her height started to fall off the growth chart, steadily decreasing to below the 5th percentile. On exam, you note a webbed neck with normal range of motion, broad chest with widely spaced nipples and scoliosis. Past medical history is also pertinent for a repaired coarctation of the aorta at 3 years of age. Which of the following is the most likely diagnosis?

Turner Syndrome

A 16 year old girl presents to your urgent care clinic for enuresis, frequent urination, a white vaginal discharge, and a dark rash around her neck. She is greater than the 97th percentile for her weight. Her serum glucose level is 250mg/dL, and her urinalysis is positive for 2+ glucose, but otherwise unremarkable. What is the likely diagnosis?

Type 2 diabetes

A 14-year-old is post op posterior spinal fusion from T8-L1 and remains intubated and SG 1020. Urine output < 30 mL/hr. Patient is currently on normal saline at maintenance. 4.0meq/dL, CL 98meq/dL, CO2 22 mg/dl, BUN 10mg/dL, Cr 0.7mg/dL, glucose 100 mg/dL, units of PRBC's and 3 L of LR in the OR. Current electrolytes: Na+ 130meq/dL, K+ mechanically ventilated due to a prolonged surgical course and blood loss. She received 2 Which of the following interventions is MOST appropriate? a. Administer normal saline fluid bolus b. Administer 3% saline bolus c. Change IV fluids to lactated ringers' d. Decrease IV fluids to 2/3rds maintenance

a. Administer normal saline fluid bolus

A 3-year-old female presents with a 4 day history of abdominal pain, nausea, vomiting, diarrhea, and fever, with temperatures over 102°F. The child had eaten at fast food restaurants twice in the past 2 weeks, but no one else at home is ill. Initial laboratory evaluation: Na 126 mEq/L, K+4.5 mEq/L, Cl 105 mEq/L, CO2 13 mEq/L, BUN 100 mg/dL Cr 2.1 mg/dL, Glucose 90 mg/dL, WBC 25,000 cells/mcl ,Hemoglobin 8.7 g/dL, Hematocrit 23%, platelets 90,000 cells/mcL; prothrombin time 12, INR 1.2, APTT 26, Fibrinogen 250 mg/dL; peripheral smear indicates + schistocytes. What is the most likely diagnosis? A. Hemolytic uremic syndrome (HUS) B. Gastroenteritis C. Urinary tract infection D. Intussusception

a. Hemolytic uremic syndrome (HUS) includes a triad of microangiopathic anemia with red blood cell fragmentation, thrombocytopenia, and acute kidney injury. HUS typically has a prodromal gastrointestinal illness often presenting as bloody diarrhea. Electrolyte disturbances include hyponatremia, azotemia, renal failure, and acidosis. Leukocytosis, anemia, thrombocytopenia, and + shistocytes are common findings in the CBC. Goal of treatment is to reverse or prevent ongoing kidney failure, appropriate fluid and electrolyte management.

A 2 year old male presents after mom found him with a bottle of vitamins. He presents with lethargy that is progressively getting worse. Labs reveal hyperkalemia. What is treatment for hyperkalemia?

a. Insulin with d10 b. Albuterol c. Kayexalate

The disease process which is characterized by infflammation and edema of the renal interstitium and can be caused by a viral process or drug induced and presents with rigors, fever, flank pain and skin rash is called: a. Interstitial nephritis b. Glomerulo-nephrosis c. Nephrotic syndrome d. Acute renal failure

a. Interstitial nephritis

Renal vein thrombosis commonly presents with:

an abrupt onset of hematuria, flank mass (unilateral or bilateral), oliguria, and/or hypertension. Doppler ultrasound of the kidneys is diagnosticfor renal vein thrombosis, demonstrating absent renal venous blood flow, reversal of arterial diastolic flow, intraluminal thrombus, elevated resistive index in the renal artery. Treatmentincludes diligent fluid and electrolyte balance, blood pressure monitoring (hypertensive agents or nephrectomy in some cases), anticoagulants or thrombolytics (some cases), thrombectomy (some cases), and treatment of the underlying disease.

An 11-month-old infant weighing 10 kg in septic shock presents with a potassium of 7.6 meq/dL and peaked t-waves on EKG. What is the most appropriate emergent treatment? a. 100 units of insulin, and 10 mg of sodium bicarbonate IV b. 1000 mg of calcium gluconate IV c. 100 units of calcium gluconate IV l d. 10 units of insulin and 100 mL of D10W IV

b. 1000 mg of calcium gluconate IV

A 2-month-old, born at 32 weeks gestation weighs 4 kg and is receiving Similac Sensitive 24 cal/oz at 15 mL/hour via NG tube. How many kcals/kg is the infant receiving? a. 60 b. 72 c. 90 d. 110

b. 72

A 10-year-old had strep pharyngitis 3 weeks ago, which was treated with amoxicillin for 10 days. He presents today with edematous face and ankles, and complains of a headache and flank pain. BP is 142/86, he has been oliguric for the past 12 hours, and has 3+ proteinuria. If the symptoms are severe what is the best treatment? a. Emergent dialysis b. Corticosteroids c. Fluid bolus of 20mL/kg d. Continued antibiotic therapy with amoxicillin

b. Corticosteroids

A breastfeeding one-week old infant is seen in the ED for nasal congestion, which does not require intervention. Her birthweight was 6lbs, 3 ounces (2806kg) at term. Her weight today is 5lbs, 2ounces (2325kg). What is the best intervention? a. Admit the baby for IV fluids and feeding assessment. b. Due to excessive weight loss, assess intake and output and evaluate breastfeeding c. The infant's weight loss is acceptable at this time, discharge and continue breastfeeding. d. Recommend that the infant receive supplements of formula every 2 hours.

b. Due to excessive weight loss, assess intake and output and evaluate breastfeeding

A 13-year-old is diagnosed with IDDM. He learns insulin dosing and carbohydrate counting. He adds a nutrition app to his cell phone and wants to use this with each meal. He does not want the school nurse to be involved with checking his blood sugars, but wants to obtain them himself. Based on his developmental level, which is most appropriate? a. Allow self-care until he experiences a problem and then involve the school nurse. b. Encourage the teen to have a discussion with the school nurse with his plans and her support c. Tell the teen that it is better if the nurse assists with checking his blood sugars until his illness has stabilized. d. Assist him in a plan for his care that he can check off daily along with writing down his BG and meals

b. Encourage the teen to have a discussion with the school nurse with his plans and her support

A 16-year-old is brought in emergently after a whole day of football practice. He apparently was not feeling well, due to a viral gastroenteritis the last two days, but went to practice anyway. In addition to oliguria, which sets of signs and symptoms are most consistent with 10% dehydration? a. Less active than usual, normal skin turgor, moist oral mucosa. b. Less active than usual, sticky oral mucosa, normal or slightly diminished skin turgor. c. Sunken eyes, soft doughy skin (diminished skin turgor) without tenting . d. Sunken eyes, tenting, tachycardia, hypotension

b. Less active than usual, sticky oral mucosa, normal or slightly diminished skin turgor.

An infant with suspected pyloric stenosis would typically present with which of the following? a. Metabolic acidosis b. Metabolic alkalosis c. Hyponatremia and hyperkalemia d. Hyperchloremia and hypocalcemia

b. Metabolic alkalosis

A 4-year-old with significant injuries sustained in a car crash several days ago is oliguric for 15 hours, lethargic, appears mildy edematous, with a blood pressure of 82/34 mmHg, and HR of 148 beats per minute. Electrolytes are Na 130 meq/dL, CI 98meq/dL, K 5.6 meq/dL, BUN 88mg/dl, HCO3 13meq/L, and Cr 1.8mg/dl and Ca 6.8mg/dL. Urine specific gravity is 1.030 and FeNa is <1. The most likely explanation for these findings is: a. Intrinsic renal failure b. Pre-renal failure c. Chronic renal failure d. Post renal failure

b. Pre-renal failure

Which of the following is the correct IV fluid rate for a 24 kg child who is receiving fluids at 2/3 maintenance? a. 20 mL/hr b. 30 mL/hr c. 40 mL/hr d. 62 mL/hr

c. 40 mL/hr

A 2-month-old breastfeeding infant is admitted to the PICU with bronchiolitis requiring Vapotherm therapy. He was NP0 for 2 days and now with lower settings, he is allowed to nurse. He has not stooled for 4 days. What is the most appropriate initial response? a. Order a glycerin suppository b. Offer pear or prune juice, one ounce per day c. Assess his previous stooling patterns d. Supplement breastfeeding with pedialyte

c. Assess his previous stooling patterns

A 2-year-old with a history of prematurity with chronic lung disease and meningitis who is febrile has a serum sodium of 128 meq/dL serum osmolarity of 230 and urine sodium of 120. What is the most likely diagnosis? a. Diabetes insipidus b. Syndrome of inappropriate anti-diuretic hormone c. Cerebral salt wasting

c. Cerebral salt wasting

A 15-year-old with a history of diabetes since age 7, presents to the ED with diabetic ketoacidosis. She has never had an admission for DM, since initial diagnosis. Further questioning indicates that she has missed half of school days and is failing several subjects, when a year ago she was a "B" student. After managing the acute illness, the most appropriate referral is to: a. Dietician for review of diet plan b. School counselor to evaluate reason for missed school days c. Counselor/psychologist for mental health evaluation d. Endocrine social worker to check diabetic supplies

c. Counselor/psychologist for mental health evaluation

A 6 month female infant with a 2 week history of vomiting is brought to the ED. The vomiting occurs 3-4 times a day. She presents with FTT, irritable. CBC is normal, electrolyte panel show metabolic acidosis. Which laboratory findings is most consistent with renal tubular acidosis? a. Hypokalemia b. hyperphosphatemia c. Hyperchloremia d. Elevated serum anion gap e. Hypocalcemia

c. Hyperchloremia

Electrolyte disorders noted with a child who has leukemia and tumor lysis syndrome include: a. Hypernatremia, hyperkalemia and hypoglycemia b. Hypernatremia, hypokalemia and hyperphosphatemia c. Hyperphosphatemia, hyperkalemia and hyperuricemia d. Hypophosphatemia, hyperuricemia and hyperglycemia

c. Hyperphosphatemia, hyperkalemia and hyperuricemia

The most appropriate indications for beginning dialysis for a child with acute renal failure include: a. Hypovolemia, hyperkalemia and hypocalcemia b. hypervolemia, hypocalcemia and hypertension c. Hypervolemia, hyperkalemia and acidosis d. Hypovolemia, hypertension and acidosis

c. Hypervolemia, hyperkalemia and acidosis

A 3-week-old infant presents to the ED with fever to 102, without other symptoms. The infant is breast feeding well and gaining weight. What information is MOST important in completing the history? a. Sick contacts b. Maternal history of smoking during pregnancy c. Maternal history of positive group B strep culture d. 36 week gestational age

c. Maternal history of positive group B strep culture

A sexually active 16-year-old male presents with acute testicular pain and mild abdominal discomfort. The most important action to complete first is to: a. Obtain a urethral swab for STI b. Obtain CBC with differential and blood culture c. Obtain a surgical consult d. Obtain a nephrology consult

c. Obtain a surgical consult

A toddler is admitted to the PICU with suspected urosepsis. Her urine culture results indicated bacteria count >100,000 CFU/ml. What is your interpretation and what is the next step? a. Positive culture and requires 10 days of treatment with intravenous antibiotic. b. Negative culture, but should be repeated due to the presence of bacteria c. Positive culture, continue treatment with antibiotics to cover gram negative infection and follow organism identification. d. Negative culture, continue treatment with antibiotics for 3 days due to the patient's presentation

c. Positive culture, continue treatment with antibiotics to cover gram negative infection and follow organism identification

A five-year-old had treatment with two antibiotics for a recurrent Urinary Tract Infection (UTI) which was resistant to Bactrim and Keflex, and now presents with high fever, lethargy and decreased urine output. In the Emergency department, which initial diagnostic tests are most appropriate? a. CBC with differential, abdominal US and Urine culture by catheter specimen b. CBC with differential, electrolytes with renal function, CRP and clean caught urine culture c. Renal US, CBC with differential, blood culture, CRP, ESR and electrolytes with renal function d. VCUG, Urine culture by catheter specimen, CBC with differential and blood culture

c. Renal US, CBC with differential, blood culture, CRP, ESR and electrolytes with renal function

A 2-year-old female, who has had frequent urinary tract infections has a BP of 136/88 mmHg. She has not had BP checked on regular intervals. Which work up is most appropriate to complete FIRST? a. Cardiac evaluation b. Liver function testing c. Renal function d. Follow BP over the next 2 weeks

c. Renal function

You are called to a patients room in the PICU to evaluate a 4 year old girl with new onset type 1 diabetes who presented in diabetic ketoacidosis. The nurse reports to you that she was previously alert and talking, but suddenly has become obtunded and listless. What is the most likely cause of her change in mental status?

cerebral edema

A 4-month-old presents with nonbilious, nonbloody vomiting and diarrhea. VS: T 37°C, HR 160 beats per minute, BP 60/40 mmHg, RR 48 breaths per minute. Clinical exam reveals irritable infant with sunken fontanel, dry mucous membranes, and capillary refill of 4 seconds. His current weight is 4.9 kg. He has had no wet diapers for the past 4 hours. Which of the following is his fluid deficit? a. 180 mL b. 250 mL c. 460 mL d. 735 mL

d. 735 mL

A 6-year-old has complaints of joint pain in 3 areas with warmth, joint swelling and pain on motion. The most appropriate lab studies to identify the diagnosis for this child include: a. ANA, CBC with differential, electrolytes and Lyme titer b. Electrolytes, blood culture, RF and CRP c. Lyme titer, ESR, ANA and electrolytes d. CRP, ESR, ANA and CBC with differential

d. CRP, ESR, ANA and CBC with differential

A 6-day-old infant with no other signs of illness presents with severe dehydration and is found to have a serum potassium of 6.3, sodium of 130 and glucose of 95. The most likely diagnosis is: a. Diabetes insipidus b. Hypothyroidism c. Syndrome of inappropriate anti diuretic hormone d. Congenital adrenal hyperplasia

d. Congenital adrenal hyperplasia

A 6 month old female with a 2 week history of vomiting comes to your ER. The vomiting occurs 3-4 times a day. She has been very fussy. Growth records reveal FTT. A CBC is normal but electrolytes show metabolic acidosis. Which laboratory value is consistent with renal tubular acidosis?

hyperchloremia

A 1 year old infant with FTT is brought in. Her parents note that she is often fussy and spits up after feeds. She has had two loose foul-smelling stools each day. Testing reveals elevated serum tissue translutaminase antibody. Which of these following foods can she eat safely without aggravating or inducing her symptoms? rice, wheat, oats, barely, or rye

rice

During a routine health maintenance visit, the mother of a 1 year old girl is particularly concerned about the family's history of food allergies. Which of the following foods are the most likely to cause food allergic reactions?Soy, Citrus fruits, Chocolate, Tomatoes, Cruciferous vegetables

soy

A 13 year old girl is brought to the office by her mother for poor attention span, deteriorating grades, and inability to sit still. Her mother is also concerned because of a 5 pound weight loss in the last 2 months. Physical exam reveals a blood pressure of 130/75 mmHg, heart rate of 115 bpm, and thyromegaly. You suspect Graves' disease. What is true about thyroid stimulating immunoglobulins (TSI)?

they are usually present and bind to the TSH receptors

An 8 year old male presents with testicular heaviness. A physical exam reveals a Non tender twisted mass along the spermatic cord. What is most likely the diagnosis?

variocele