Peds
What do the letters in APGAR stand for?
Appearance, Pulse, Grimace, Activity, Respiration
hemangioma is associated with
PHACES syndrome
A 16-year-old woman comes to the office because her urine is cola-colored and she has not urinated since yesterday morning. Her past medical history is significant for pharyngitis two weeks ago. Her mother and grandmother have type 2 diabetes. Her blood pressure is 146/92 mmHG. On physical examination, she has edema of her face and hands. Which of the following is the most likely diagnosis?
PSGN
What is the most common cause of nephritic syndrome in a 4-year-old?
PSGN
Normal age for puberty: ____ M; ___ F
9-14 M; 8-13 F
diagnosis of scoliosis: cobb angle must be > __ degrees
10
Dx for cushing syndrome
24 hr urine cortisol, dexamethasone suppression test
Scheuermann's Kyphosis is a thoracic hyperkyphosis of childhood defined by > __ degrees. How do you dx? Tx?
45 must have anterior wedging of >5 degrees across three consecutive vertebrae. observation 50-75: bracing Kyphosis > 75: Operative
what is the age range croup typically presents
6 months to 2 years
An infant is born with a heart rate of 96 beats per minute. He has a regular respiratory rate and active motor movements. His skin is mostly pink, but his hands and feet are blue. He cries in response to irritable stimuli. What is the correct Apgar score?
8
A two-week-old male newborn is evaluated by echocardiogram for a murmur detected on exam. The echocardiogram is notable for a hemodynamically significant patent ductus arteriosus. What is the circulatory pathology noted to make this diagnosis? A. Left-to-right shunting from the aorta to the pulmonary arteries B. Left-to-right shunting from the left atrium to the right atrium C. Left-to-right shunting from the left ventricle to the right ventricle D. Right-to-left shunting from the pulmonary arteries to the aorta
A
A 10-year-old boy presents to the clinic with a papular lesion on his arm. Physical examination reveals tender epitrochlear and axillary lymphadenopathy with erythema of the overlying skin. His mom states that they have multiple cats that sometimes scratch him. What is the etiologic agent of the most likely diagnosis? A. Bartonella henselae B. Pasteurella multocida C. Staphylococcus aureus D. Streptococcus pyogenes
A (cat scratch dz)
high ACTH, low aldosterone
Addisons
A 13-year-old boy reports to the pediatrician with his mother. His complaints include fever, sore throat, and excessive fatigue that have worsened since onset last week. Physical exam reveals symmetric posterior cervical lymphadenopathy, splenomegaly, pharyngeal erythema with white tonsillar exudates, palatal petechiae, and fever of 102.1°F. Which of the following is the most likely diagnosis? A. Adenovirus infection B. Epstein-Barr virus infection C. Influenza virus infection D. Streptococcus pyogenes infection
B
The classic triad of congenital rubella syndrome includes all of the following except A. Patent ductus arteriosus (PDA) B. Chorioretinitis C. Cataract D. Sensorineural hearing loss
B
You are evaluating a patient whom you suspect has asthma. You perform spirometry before and after administration of an inhaled short-acting bronchodilator. After administration of the bronchodilator, which of the following spirometry results would suggest reversibility? A. Decrease In FEV1 B. Increase in FEV1 C. Decrease in FVC D. Increase in FVC
B
A 7-year-old girl presents to her pediatrician with a malar rash with circumoral pallor. Her mother states that the rash was preceded by fever and rhinorrhea. Which of the following is the most likely causative pathogen? A. Human herpesvirus 6 B. Parvovirus B19 C. Rubella D. Rubeola
B (Erythema infectiosum)
A 12-year-old boy presents to the clinic for asthma evaluation. He has daytime symptoms three days per week. He has nighttime awakenings due to asthma four times per month. He uses his rescue inhaler three times per week, and he states that he thinks his asthma causes mild limitation on his activities. Which of the following is the most appropriate treatment regimen for this patient? A. Short-acting bronchodilator alone B. Short-acting bronchodilator and low-dose inhaled corticosteroid C. Short-acting bronchodilator, low-dose inhaled corticosteroid, and long-acting bronchodilator D. Short-acting bronchodilator, low-dose inhaled corticosteroid, long-acting bronchodilator, and oral steroids
B (mild persistent asthma)
precocious puberty; ___ M, ___ F
Before 9 M, 8 F
prolonged need for supplemental oxygen in premature infants after 28 days of age or after 36 weeks postmenstrual age and who do not have other conditions requiring oxygen
Bronchopulmonary dysplasia
A 15 year-old-boy is in the office for an asthma recheck. He has been using his albuterol inhaler three times weekly for the past four weeks. You want to add a daily preventative inhaler. Which class of inhaled medications do you choose for your next step? A. Anticholinergics B. Long-acting beta agonists C. Low dose glucocorticoids D. Short-acting beta agonist
C
A 2-year-old boy presents to the emergency department with a barking cough and respiratory distress. There is a high-pitched sound heard on inspiration. Intercostal retractions are also visible on exam. He is diagnosed with croup. Vital signs are T 99.6°F, HR 130, RR 40, and oxygen saturation is 94% on room air. What is the best initial treatment? A. Azithromycin B. Dexamethasone C. Dexamethasone and nebulized epinephrine D. Nebulized epinephrine
C
Newborn conjunctivitis that presents days 5-14 of life. cause and tx?
C. trachomatis, oral erythro
A five-day-old female infant delivered at 36 weeks' gestation has increased lethargy. Birth history is significant for Cesarean section due to non-reassuring fetal heart tones, neonatal hypoglycemia, and ambiguous genitalia. The patient's temperature is 36.6°C (98.0°F), pulse is 130/min, respirations are 36/min, and blood pressure is 60/46 mm Hg. Physical examination shows a lethargic infant with decreased muscular tone. Serological findings reveal a sodium level of 128 mEq/L and a potassium level of 6.1 mEq/L. What is the most likely diagnosis? most common cause? tx?
CAH 21-hydroxylase deficiency steroids
pt presents w/ decreased extraocular movement, pain with movement of the eye and proptosis. What diagnostic tests do you order, what is the diagnosis, MC cause and tx?
CT orbits orbital cellulitis strep IV ABX
Early activation of HPG axis is defined as
Central precocious puberty (txt with leuprolide)
Signs of nephritic syndrome include:
Coca-Cola urine (Hematuria) HTN Oliguria
high cortisol, high ACTH
Cushing's disease
high cortisol
Cushing's syndrome
A 2 year-old presents to the emergency department in acute respiratory distress. The parents relate a history of a recent upper respiratory illness that was followed by a sudden onset of barking cough during the night, but this morning they noted increased difficulty breathing. The child is noted to have stridor at rest, but has no evidence of cyanosis. Which of the following is the most appropriate initial intervention? A. Intravenous antibiotics B. Endotracheal intubation C. Inhaled mucolytic agent D. Nebulized racemic epinephrine
D
A 22 month-old male infant presents with one day of barking cough preceded by three days of cold symptoms. On physical examination, his axillary temperature is 100.4°F and he has no stridor at rest. Inspiratory stridor is evident when he becomes agitated during the examination. There are no signs of respiratory distress or cyanosis. Which of the following is the most appropriate treatment for this patient? A. Nebulized albuterol B. Nebulized epinephrine C. Oral amoxicillin D. Oral dexamethasone
D
On physical examination you note diminished breath sounds over the right lower lobe with decreased tactile fremitus and dullness to percussion. Which of the following is the most likely cause? A. asthma B. consolidation C. pneumothorax D. pleural effusion
D
An unvaccinated boy presents to the pediatrician with bilateral parotid gland swelling. His mother states that the swelling was preceded by fever, fatigue, and decreased appetite. Which of the following describes the causative pathogen of this condition? A. The condition is caused by a gram-negative bacterial pathogen B. The condition is caused by a gram-positive bacterial pathogen C. The condition is caused by a virus from the Herpesviridae family D. The condition is caused by a virus from the Paramyxovirus genus
D (Mumps)
46 XY DSD (presentation and cause)
Disorders involving male hormone/testicular development Male with External genitalia ambiguous or female
A 6-day-old infant is in the neonatal intensive care unit (NICU) because of premature birth at 31 weeks' gestation and low birth weight. She develops new acute onset bloody diarrhea and has also vomited twice after her last feed. Physical examination shows a distended, tender abdomen with decreased bowel sounds. Which of the following would most likely be seen on abdominal X-ray? A. Air-fluid levels proximal to a point of obstruction B. Malrotation C. No abnormalities D. Peritoneal abscess E. Pneumatosis intestinalis
E (pt has necrotizing enterocolitis)
condition characterized by extreme skin fragility and blistering, must monitor for SCC
Epidermolysis bullosa
An 8-year-old boy presents to the office with an erythematous maculopapular rash that is in a lacy pattern on his trunk and arms that is nonpruritic. His cheeks are noticeably red, but he is afebrile. He had a fever one week ago, but it resolved within two days without any other symptoms until now. What is the most likely diagnosis?
Erythema infectiosum
Abduction of the flexed hip of a 1-month-old elicits a "clunk." What test is this and what does it assess?
Ortolani sign; developmental dysplasia of the hip
MC etiology for pneumonia in 0-28 days of life
GBS (followed by e.coli, listeria, HSV)
infant is vomiting but no signs of fussiness or weight issues
GER
infant is vomiting with signs of fussiness and poor weight gain
GERD
what is commonly associated with Bronchopulmonary dysplasia? what are the common complications?
GERD FTT, cor pulmonale, pulmonary HTN
TSH receptor antibodies
Graves disease
what is the MC causative agent if patient has concurrent AOM and purulent conjuncitivis? tx?
H flu augmentin
The most common cause of erythema multiforme minor is
HSV
TPO antibodies
Hashimotos
infant born at 40 weeks gestation, presents with jaundice within the first 24 hours of life. Labs: total bilirubin is increased, Coombs positive. what is the diagnosis and tx?
Hemolytic Hyperbilirubinemia light therapy, plasma exchange
small red macules on the soft palate-tonsillar pillar area due to coxsackievirus
Herpangina
Epiglottis most commonly caused by
Hib - usually unvaccinated children
Newborn presents with enlarged posterior fontanelle, large tongue, umbilical hernia, feeding problems
Hypothyroidism
A 9 year-old boy who has had cold-like symptoms for the past few days is brought to the clinic by his mother who states that her son had gross hematuria this morning. Prior to the cold-like symptoms the boy has been in excellent health. He is up-to-date on all of his immunizations. The patient does not have any edema, hypertension or purpura. Urinalysis reveals the urine to be cola-colored with a 2+ positive protein and 2+ hemoglobin. Microscopic analysis reveals 50-100 RBCs/HPF, no WBCs, bacteria, casts or crystals. What is the most likely diagnosis
IGA nephropathy ( current URI)
Pyelonephritis treatment
IV ceftriaxone
An 11-year-old boy presents to the pediatrician with a pruritic, circular, erythematous, and scaling plaque. The lesion began three days ago and spread outwards with central clearing. His sibling has a similar lesion. What is the best method to confirm the most likely diagnosis? Tx?
KOH prep (ringworm) topical antifungal
47, XXY
Klinefelter syndrome
Tx of nephrogenic DI
Low salt diet, fluids, thiazides
Labs in pt with DI
Low specific gravity and urine osmolality
A 4-year-old boy presents to the clinic with erythematous papules and an overlying thick and adherent gold-colored crust on his left cheek. Which pathogen is the most likely cause? Tx?
S. aureus (impetigo) topical mupirocin
precocious puberty + irregular cafe au lait spots THINK....
Mccune Albright syndrome
A 7-year-old boy presents to his pediatrician with concern for bumps on his chest and armpits. The bumps are itchy but not painful and seem to be growing in number. The school nurse advised that the child should be kept out of school until evaluated and deemed noncontagious. There are no other new concerns. On exam, there are about one dozen < 0.5 cm, flesh-colored, umbilicated, dome-shaped papules across his chest and five to six similar but smaller lesions in both axillae in linear distributions. What is the dx and MC cause?
Molluscum contagiosum poxvirus
A 6-year-old boy is brought in by his mother for left testicular pain and swelling for the past two days. About a week ago, he had a swollen gland in his mouth that went away on its own. He is diagnosed with orchitis. What is most likely responsible for this condition?
Mumps!!
Newborn conjunctivitis that presents within 1st few days of life. cause and tx?
N. gonorrhea, erythromycin eye ointment and IM ceftriaxone
A 1-week-old infant is referred to a neonatal consultant because of abdominal distension and rectal bleeding. The infant was observed in the neonatal intensive care unit after premature birth at 35 weeks' gestation. Abdominal radiography series shows pneumatosis intestinalis. What is the most likely diagnosis? tx?
Necrotizing enterocolitis fluids, abx, NG tube
A 4-year-old boy comes to the emergency department with his mother because he has a high fever, stiff neck and photophobia. His mother says that he started being very restless 4 hours ago and was very sensitive to light. He did not have any nausea or vomiting. His temperature is 38.1°C (100.7°F), pulse is 115/min, respirations are 16/min, and blood pressure is 135/75 mm Hg. Physical examination shows a petechial non-blanching rash on his left arm. What is the most likely etiological agent?
Neisseria meningitidis
Premature newborn presents with LBW, goiter, large staring eyes. Diagnosis, cause, tx?
Neonatal thyrotoxicosis, mother w graves (transmitted TSI antibodies), methimazole/ BB
Cafe au lait spots are associated with what syndrome
Neurofibromatosis Type 1
Delayed puberty: __ M, ___F
No testicular development by 14, no breast development by 13
Tumors causing early release of hormones
Peripheral precocious puberty
a 19-year-old male who you are seeing for follow-up from the urgent care where he was seen 2 days earlier with a sore throat. The patient is febrile (102°F), has a muffled (hot potato) voice, and extreme difficulty opening his mouth (trismus). He opens it just far enough for you to note uvular deviation.
Peritonsillar abscess
The antidote for the anticholinergic toxidrome is
Physostigmine
MC etiology for pneumonia in 28 days- 1 yr
S. pneumo
A patient presents with occasional wheezing and chest tightness that occurs approximately once a week and at night only about once a month. Peak expiratory flow is 85% of predicted. What is the most appropriate initial treatment?
SABA prn (intermittent asthma)
The infant is well hydrated but appears ill. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical examination. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. The most common cause of this condition is
RSV (pt has bronchiolitis)
Diarrhea breakout in a daycare center
Rotavirus
An unvaccinated, 6-year-old boy presents to his pediatrician with an exanthematous macular rash that began two days after a fever. He is also noted to have cough, coryza, and conjunctivitis. The rash began on the face and spread to the trunk and extremities. The child is still febrile. What is the most likely diagnosis?
Rubeola
an obese 16-year-old boy with pain in his left groin, hip, and thigh. His mother notices a limp when he walks. The patient denies any recent significant trauma to his left lower extremity. On physical exam, his gait is antalgic. With the patient in the supine position, there is external rotation and abduction of the thigh with passive flexion of the hip.What is the most likely diagnosis and tx?
SCFE Surgery (pin fixation)
A 12-year-old girl is brought to the clinic by her mother for evaluation of leg pain. The patient first noticed a dull ache in her left thigh a month ago. The pain is intermittent, worse after skipping rope with friends, and typically resolves after rest or ibuprofen. She does not recall any inciting injury to the leg. Temperature is 37.5 C (99.5 F). BMI is at the 97th percentile for age. The left hip demonstrates decreased range of motion with internal rotation. There is no increased warmth over the joint. The left foot points laterally during ambulation. Which of the following is the most likely underlying cause of her symptoms?
SCFE (obese, thigh pain, external rotated foot, trouble with internal rotation)
Increased ADH, pt will present with hx of head trauma and decreased urine output.Diagnosis and tx?
SIADH, fluid restriction
16 y/o comes to the emergency department with a two-day history of febrile illness and a progressive, red, painful rash on the left lower extremity. The affected area is warm and tender to the touch. The right leg appears to be unaffected. What are the most likely causative agents of this skin disease? Tx?
Staphylococcus aureus Streptococcus pyogenes (cellulitis) mild: cephalexin severe/MRSA: bactrim/doxy/clinda
What is the classic finding on chest X-ray in patients with croup?
Steeple sign
port-wine stain is associated with
Sturge-Weber syndrome
A 2-day-old male newborn is being evaluated in the neonatal intensive care unit for progressive cyanosis, breathing difficulty and poor feeding. He was born to a 22-year-old mother who received no prenatal care. Temperature is 37.0° C (98.6° F), pulse is 160/min, blood pressure is 87/55 mm Hg, and respiration rate is 55/min. On physical examination, no craniofacial deformities are seen. Central cyanosis is present, and cardiac auscultation reveals fixed splitting of the second heart sound (S2) over the left upper sternal border. Chest radiograph is obtained and shows classic "snowman" sign
TAPVR
A 3-day-old female infant is brought to the emergency department due to difficulty breathing. She was born at term through normal vaginal delivery to a 30-year-old woman who had full prenatal care. The mother reports that the patient was fine after birth and recently started developing blue-colored skin and rapid breathing at home. Temperature is 37°C (98.6°F), pulse is 155/min, respirations are 65/min, and blood pressure is 80/50 mm Hg. Pulse oximetry shows an oxygen saturation of 80% on room air. Arterial blood gas analysis on room air shows PO2 of 30 mm Hg. Physical examination shows central cyanosis and retractions of the rib cage. 100% oxygen through a nasal cannula and PGE1 are administered. The patient's airway is stable, and a chest radiograph is obtained showing classic "egg on a string" apperance
TGA
What are the "five Ts" of congenital heart disease representing common cyanotic lesions?
Transposition of the great arteries, Tetralogy of Fallot Truncus arteriosus, total anomalous pulmonary venous return tricuspid atresia
A 3-day-old newborn male is evaluated in the neonatal intensive care unit for breathing difficulty. The patient was born at 39 weeks gestation via vaginal delivery at home, and this is his first medical evaluation. The mother is a 26-year-old woman who had minimal prenatal care. She reports that he "was fine" after birth, but after the first few days, she noted a constant bluish color of his lips. Temperature is 37°C (98.6°F), pulse is 170/min, respirations are 65/min, and blood pressure is 80/50 mm Hg. Pulse oximetry shows an oxygen saturation of 84% on room air. Physical exam shows low-set ears and bulbous nasal tip. Cardiac auscultation reveals a loud, single second heart sound, an ejection click, and bounding peripheral pulses. Chest radiograph shows pulmonary congestion with increased pulmonary markings and decreased soft-tissue attenuation in the right anterior mediastinum.
Truncus arteriosus (digeorge syn, bounding pulses, ejection click)
45, X
Turner syndrome
A 2-day-old female newborn presents to her pediatrician for her first visit after birth. When she cries, the pediatrician notices her nail beds and lips have a bluish color. She is sent for echocardiogram to confirm the pediatrician's suspicions of Tetralogy of Fallot. Which anatomic findings on echogram confirm the diagnosis?
VSD, overriding aorta, pulmonary stenosis, RVH
A 3-week old female neonate presents at the emergency on account of 3-day history of persistent, copious, projectile vomiting of feeds, which is non bilious. Mother complains that patient is always hungry in between feeds and sucks eagerly only to vomit immediately after. She also says that her baby has not passed stool for 2 days. On examination, patient looks severely dehydrated, a firm olive shaped, mobile, non tender mass is present at the right upper quadrant at the right edge of the rectus abdominis muscle. What is diagnostic of choice, the most likely diagnosis, and tx?
abd US pyloric stenosis pyloromyotomy
a 3-year-old previously healthy male is brought to your office by her mother. The mother reports the child has been crying and pulling at her right ear over the past 2 days and reports the patient has been febrile the past 24 hours. The patient's past medical history is unremarkable, although the mother reports the patient had a "common cold" a week ago which resolved without intervention. His temperature is 101.6 F, blood pressure is 100/70 mmHg, pulse is 120/min, and respirations are 22/min. The otoscopic exam reveals bulging of the TM. What is the diagnosis, MC cause, tx?
acute otitis media s. pneumo high dose amoxicillin
lesion with "soap bubble" appearance of XR and "eggshell" sclerotic rim
aneurysmal bone cyst
A 12 year-old presents with complaint of both eyes "watering." He also complains of sinus congestion and sneezing for two weeks. On exam vital signs are T-38°C, P-80/minute, and RR-20/minute. The eyes reveal mild conjunctival injection bilaterally, clear watery discharge, and no matting. Pupils are equal, round, and reactive to light and accommodation. The extraocular movements are intact. The funduscopic exam shows normal disc and vessels. The TMs are normal and the canals are clear. The nasal mucosa is boggy, with clear rhinorrhea
allergic conjunctivitis
red eyes, itching and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid. Diagnosis and tx?
allergic conjunctivitis topical antihistamine
a 13-year-old boy with clear fluid discharge from his nose for 2 days duration. This has also been associated with sneezing. On nasal exam, the mucosa and turbinates appear edematous and slightly bluish, he has swollen dark circles under his eyes, and a transverse nasal crease. Diagnosis and tx?
allergic rhinitis nasal corticosteroids antihistamines
A 15-year-old boy comes to the office because of malaise, anorexia, nausea, and decreased urination. His mother says that he is having problems hearing. Physical examination shows decreased hearing bilaterally with the Rinne test and bilateral edema in the lower extremities. Urinalysis shows microscopic hematuria and proteinuria. A peripheral blood smear reveals microcytic anemia. What is the most likely diagnosis?
alport syndrome
___ toxidrome presents with mydriasis, hallucinations, anhidrosis, hyperthermia and urinary retention
anticholinergic
What complication is parvovirus B19 infection known to cause in patients who have sickle cell disease?
aplastic crisis
a 15-year-old complaining of a painful sore for 2 days. He denies any alcohol or tobacco use and otherwise feels fine. The examination is significant for a 2-mm round ulceration with a yellow-gray center surrounded by a red halo on the left buccal mucosa
apthous ulcer
a 5-year-old boy who is brought to the emergency department by his parents for a cough and shortness of breath. He has a past medical history of eczema and seasonal rhinitis. On physical exam, you note a young boy in respiratory distress taking deep slow breaths to try and catch his breath. He has diminished breath sounds in all lung fields with prolonged, expiratory wheezes.
asthma
An 8-year-old boy with a history of allergies and asthma presents to his pediatrician for routine follow-up. His symptoms have flared up and his mother thinks it is because of all the pollen. She reports he has also been itchy lately, especially on his neck, behind his knees, and in his elbow creases. He is taking his allergy medicine daily but it does not seem to help the skin problem. On exam, erythematous, dry, excoriated skin is noted in these areas. What is the most likely diagnosis?
atopic dermatitis
The antidote for the cholinergic toxidrome is
atropine
MC etiology for pneumonia in > 5 y/o
atypicals (mycoplasma, chlamydia)
A 2 year-old female presents with purulent nasal discharge bilaterally with fever and cough for several days. Her mom had taken her out of daycare for a similar occurrence 2 months ago, that was treated with Amoxicillin. Exam further reveals halitosis and periorbital edema. Treatment?
augmentin (bacterial sinusitis)
purulent (yellow) discharge from both eyes ("glued shut"), crusting, usually worse in the morning. Diagnosis and MC cause? Tx?
bacterial conjunctivitis staph (MC) or strep topical abx (erytho, aminoglycoside, polymixin B + trimentroprim)
a 14-year-old previously healthy male with complaints of facial pressure and rhinorrhea for the past 3 weeks. The patient reports that several weeks prior, he had a "common cold" which resolved. However, he has since developed worsening facial pressure, especially over his cheeks and forehead. He reports over 1 week of green-tinged rhinorrhea. His temperature is 100.1 F (37.8 C), blood pressure is 120/70 mmHg, pulse is 85/min, and respirations are 15/min. The nasal exam reveals edematous turbinates and purulent discharge. The patient has facial tenderness with palpation over the involved sinus.
bacterial sinusitis
The antidote for the sympathomimetic toxidrome is
benzo
infant born at 40 weeks gestation, presents with jaundice within the first 24 hours of life and pale stool. Labs: total bilirubin and direct bilirubin are increased
biliary atresia
newborn presents with jaundice, direct bilirubin >4
biliary atresia
a 34-year-old female with crusting, scaling, red-rimming of eyelid and eyelash flaking along with dry eyes. The patient has a history of seborrhea and rosacea. What is the diagnosis and tx?
blepharitis baby shampoo
newborn presents with jaundice. Mom A+, kids total bilurbin increased, direct bilirubin normal, weight loss > 10%, coombs negative: MC cause
breast feeding jaundice
2 week old newborn presents with jaundice, increased total bilirubin, direct bilirubin low, pt is being breast feed
breast milk jaundice
Croup is most commonly caused by
parainfluenza virus
Deficiency of ADH, pt will present with hx of head trauma and polyuria/polydipsia. Diagnosis and tx?
central DI, DDVAP
UTI treatment of choice
cephalexin
___ toxidrome presents with miosis, salivation, lacrimation, urination, GI emptying, bronchorrhea, bronchospasm, bradycardia
cholinergic
newborn presents with both feet extremely plantar-flexed with inversion of the arch. Infant is unable to dorsiflex at the ankle. What is the most likely cause and tx?
clubfoot ponseti method of casting and bracing
severe and paroxysmal crying in the late afternoon to evening
colic
A 5-month-old female infant comes to the clinic because of seizures. She was born at term and there were no antenatal or intrapartum complications. Physical examination shows microcephaly, jaundice, and hepatosplenomegaly. Hearing examination shows hearing loss. CT scan of the head shows periventricular calcifications. What is the most likely diagnosis?
congenital CMV
A female newborn delivered at 38 weeks' gestation has violaceous nodules on the skin. She was born by spontaneous vaginal delivery after an uncomplicated labor. The mother received sporadic prenatal care but reports only a mild viral illness during the pregnancy. Physical examination shows enlargement of the liver and spleen. Laboratory tests are pending, but the infant failed the newborn hearing screen
congenital CMV
MC cause of ambiguous genitalia
congenital adrenal hyperplasia
elevated serum 17-hydroxyprogesterone is used to make the diagnosis of
congenital adrenal hyperplasia
Duodenal atresia is closely associated with
down syndrome
Complaining of URI symptoms with barky, seal-like cough, inspiratory stridor, low-grade fever
croup
A 2-year-old girl is brought to the pediatric office by her father due to recurrent cough with increased sputum as well as dyspnea that worsens with exertion. He reports that she has no significant past medical history, but she was recently adopted from an African country. Examination reveals bilateral apical crackles on chest auscultation with hyperresonance to percussion. Elevated sweat chloride levels are found with laboratory testing. What is the most likely diagnosis?
cystic fibrosis
Patient with a history of multiple recurrent respiratory infections or failure to thrive is a sign of
cystic fibrosis
Meconium ileus is MC associated with what disorder? How is it treated?
cystic fibrosis constrast enema
What is the most frequent defect seen in congenital rubella syndrome?
deafness
a 4-month old female with asymmetric thigh creases during a routine checkup. Physical exam reveals that the left lower limb is shorter than the right and lay externally rotated. Hip abduction is limited to 30 degrees. Diagnosis and tx?
developmental hip dysplasia pavlik harness
tx of Bronchopulmonary dysplasia includes
diuretics, bronchodilators, steroids
An 11-year-old boy presents to the emergency department with severe pain to his left groin. Upon physical examination, you notice that the left testicle is elevated and slightly tender to palpation, but there is no edema or erythema present. What dx will confirm the diagnosis?
doppler US - decreased blood flow (testicular torsion)
Within two hours of birth, neonate begins to have bilious vomiting. Temperature is 36.3°C (97.4°F), pulse is 120/min, and respirations are 30/min. Physical examination shows mild abdominal distension. An abdominal X-ray shows a pocket of air present before and after the duodenum.
duodenal atresia
a 3-year-old girl with growth retardation has a long history of recurrent pneumonia and chronic diarrhea. Her mother states that he has 6-8 foul smelling stools per day. Physical exam reveals a low-grade fever, scattered rhonchi over both lung fields, crepitant rales at the left lung base and dullness to percussion. Other findings include mild hepatomegaly and slight pitting edema of the lower extremities. CXR reveals hyperinflation, mucus plugging, and focal atelectasis. What is the dx of choice and diagnosis?
elevated sweat chloride test cystic fibrosis
abnormal urethral opening on dorsal side
epidpadias
a 3-year-old boy who is brought to the ER with a sudden onset of fever (104.0 F), respiratory distress, and stridor. On examination, the boy appears acutely ill. He is sitting, leaning forward with his mouth open, he has a muffled voice and is drooling. When asked the parents report "we don't believe in vaccinations."
epiglottis
A 2-year-old boy presents to the emergency room with one day of fever and stridor. The patient is leaning forward, drooling, and is in distress. Direct visualization of the oropharynx is not possible due to patient discomfort. Oxygen saturation is 88%, pulse is 120 beats per minute, and temperature is 101.2º F. A lateral X-ray of the neck reveals a radiolucent protrusion of the anterior hypopharynx ("thumbprint sign"). What is the diagnosis and MC cause?
epiglottitis H. flu
19-year-old female with a painful rash on her left leg. She has a small bug bite in the same area about three weeks ago. Since then, the area has become red, painful, and hot. On physical exam, you not a shiny, raised, indurated, and tender plaque-like lesions on the left leg. The redness is well-demarcated and hot to the touch. What is the diagnosis and tx?
erysipelas PCN
a 15-year-old complaining of several red lesions on her palms, back of hands, and on her lips of one-week duration. On examination, you note a symmetrical red papular rash with many target lesions. The rash appeared just a few days after herpes facialis.
erythema multiforme
___intoxication presents with slurred speech; incoordination; unsteady gait; nystagmus, impairment in attention or memory; and stupor or coma.
ethanol
A 15-year-old man comes to his pediatrician's office because of pain in his right humerus for the past 3 months. He also reports a recent low grade fever. Further examination reveals midshaft swelling on his right humerus. The patient denies any recent history of trauma. An x-ray of his right arm is taken and shows a lesion with an onion skin appearance.
ewings sarcoma (onion skin, systemic sx)
46 XX DSD (presentation and cause)
female fetus exposed to excess androgens Normal internal genitalia, ambiguous external genitalia
caused by mutation in the GNAS1 gene, assoc with mucune albright syndrome and mazabraud syndrome. will have "shepherds crook" varus deformity and "ground glass" matrix on XR
fibrous dysplasia
this lesion is MC found around the knee, will present with limited mvmt, metastases to the lungs
giant cell tumor
Diarrhea after drinking (not so) fresh mountain stream water
giardia
salter harris fracture type 4
goes above and below growth plate
Salter-Harris Fracture type 2
goes above growth plate
salter harris fracture type 3
goes below growth plate
A 9-month-old female presents to her pediatrician. Her parents are concerned that she has been refusing to eat and drink for two days and is very fussy. She has only had two wet diapers all day. She has had a low-grade fever but no other symptoms. She perks up a bit with acetaminophen but is still pushing away offers of food and drink. On exam, two ulcers are noted on her tongue and four on her buccal surfaces. The ulcers are pale and surrounded by a thin red rim. She also has a few red spots on her palms and soles. Her pulses are +2 throughout, and she has < 3 second capillary refill. What is the diagnosis and MC cause?
hand, foot, mouth dz coxsackie virus
signs of nephrotic syndrome include
heavy proteinuria, edema, hypoalbuminemia, hyperlipidemia
A 4-year-old Asian boy comes to the emergency department because of a fever for the past six days. His temperature is 39.4°C (102.9°F), pulse is 100/min, respirations are 20/min, and blood pressure is 90/60 mm Hg. Physical examination shows bilateral conjunctivitis, maculopapular rash, pedal edema, and cervical lymphadenopathy. What is the most appropriate treatment?
high dose aspirin and IVIG (kawasaki dz)
treatment for severe persistent asthma
high-ICS + LABA
A 1-day-old neonate has not yet passed any meconium and her abdomen looks bloated. Rectal examination shows an explosive passage of stool. There also appears to be gas accumulation in her abdomen. What is the diagnosis and tx?
hirschsprung's dz surgery
A three-hour-old female newborn delivered at term has ambiguous external genitalia. The mother notes an uneventful pregnancy and spontaneous vaginal delivery. The patient's temperature is 36.9°C (98.5°F), pulse is 184/min, respirations are 46/min, and blood pressure is 70/40 mm Hg. Physical examination shows hyperpigmentation around the areolae and genitalia as well as fused labia. The child is irritable but neurological exam shows no abnormalities. Ultrasound shows normally developed ovaries and the patient's karyotype is 46XX. What electrolyte abnormalities are most likely to be found during diagnostic workup?
hyperkalemia, hyponatremia (CAH results in hypoaldosteronism and hypocortisolism)
PE will show harsh crescendo-decrescendo systolic murmur which increases in intensity with Valsalva maneuver and decreases with squatting
hypertrophic cardiomyopathy
electrolyte abnormalities in pyloric stenosis
hypochloremia hypokalemia metabolic alkalosis
abnormal urethral opening on ventral side
hypospadias
condition characterizes by extremely dry and excessive scaling of the skin
icthyosis
A 2-month-old infant is brought to your office by his mother. He developed an erythematous, dry rash on both cheeks approximately 1 week ago.
infantile eczema
bilious emesis in a newborn should be evaluated for
malrotation with/out volvulus
classic triad: colicky abdominal pain, sausage shaped mass, current jelly stools
intussception
A 10-month-old boy presents to the emergency department with his mother with complaints of vomiting, intermittent abdominal pain, and lethargy. On physical exam, a sausage-shaped mass is palpated in the right upper quadrant of the abdomen, and a sensation of emptiness is found in the right lower quadrant. What diagnostic testing method is recommended and what will is show? What is the dx? Tx?
intussesception US (target sign) Air enema
A 2-year-old boy comes to the emergency department because of high fever and rash for 7 days. His pediatrician saw him two days ago and felt the symptoms were likely due to a non-specific viral infection. Since this appointment, he has become even more irritable. His temperature is 39°C (102.2°F). Examination shows conjunctival injection bilaterally and the tongue is bright red and edematous. Tonsils are small but erythematous and without exudate. There is a 1.5 cm lymph node along the left anterior cervical chain. There is a diffuse, erythematous maculopapular type rash on his chest, abdomen, and back extending into the groin region. His hands and feet are red and painful to touch.
kawasaki dz
You are evaluating a 13-year-old male for progressively worsening thoracic pain that has been present for the past 6 months. The patient characterizes the pain as a dull ache that is present all of the time. If he tries to lean backward and extend his upper back, the pain will become sharp. His parents have noticed that his upper back has been becoming progressively more rounded over the past several years. Radiographs (x-rays) of the thoracic spine reveal anterior wedging of four adjacent thoracic vertebrae, the degree of wedging ranges from 7 to 10 degrees. What is the most likely cause of his pain?
kyphosis
A 5-year-old boy comes to the clinic with his father because he has been limping for three weeks. Past medical history includes attention deficit hyperactivity disorder, but the boy does not take any medications. History is unremarkable for trauma or recent illness. His temperature is 37.1°C (98.8°F), pulse is 90/min, respirations are 22/min, and blood pressure is 100/70 mm Hg. Physical examination shows a painless limp of the right lower extremity with limited internal rotation and abduction of the right hip joint.
legg calve perthe
A 6-year-old comes to the clinic with a limp and left knee pain. He is notably short for his age. The pain is worse after soccer practice and exacerbated by internal rotation of his hip. At times the pain is severe enough that he refuses to walk. His temperature is 37.1°C (98.8°F), pulse is 102/min, respirations are 24/min, and blood pressure is 102/74 mm Hg. A hip radiograph is obtained and shows the left proximal femoral epiphysis to be misshapen and more horizontal compared to the unaffected right hip, the femoral head appears collapsed. Diagnosis and tx?
legg calve perthe (limp, knee pain, loss of internal rotation, femoral head collapse) limit activity, PT
A 6 year-old boy is brought to the pediatric clinic by his mother for an evaluation of his asthma. He coughs about 3 days out of the week with at least 2-3 nights of coughing. What would be the most appropriate treatment for this patient?
low dose ICS (mild persistent)
A 12 year-old female presents complaining of spiking fevers. She was seen four weeks ago with a complaint of left ear pain and was treated for otitis media. She continues to have symptoms, but now has pain behind the ear. On examination you note left post auricular tenderness and erythema
mastoiditis
treatment for moderate persistent asthma
medium ICS
A 15 year-old female with a history of asthma presents with complaints of increasing "asthma" attacks. The patient states she has been well controlled on albuterol inhaler until one month ago. Since that time she notices that she has had to use her inhaler 3-4 times a week and also has had increasing nighttime use averaging about three episodes in the past month. Spirometry reveals > 85% predicted value. What type of asthma?
mild persistent asthma
infant is vomiting, increased fussiness, bloody streaks in stool
milk protein allergy
A 16-year-old girl presents to the clinic for evaluation of her asthma. She is using a short-acting beta-agonist inhaler every day, sometimes twice per day. She also uses it at night about twice weekly. She misses an average of one day of school per month due to her symptoms. What type best describes her asthma?
moderate persistant
A 19 year-old college student complains of a sore throat for over a week, with fever and general malaise. On exam T-38°C P-70/minute R-20/minute BP-110/76 mmHg. The patient is alert and oriented x 3. The skin is warm, dry, and without rash. The TMs have a normal light reflex and the canals are clear. The oropharynx is inflamed, with bilaterally enlarged tonsils, and a small amount of exudate. The neck is supple, with anterior cervical adenopathy. The lungs are clear. The heart has a regular rhythm without murmurs. The abdomen is soft, nontender and a spleen tip is palpable. The labs reveal a negative rapid strep screen and positive Monospot.
mono
A 15-year-old male comes to the office because of a sore throat and fever for two days. He says his throat started hurting several days ago and he has been experiencing increased fatigue. His medical history is noncontributory, and he has no allergies. His temperature is 38.5°C (101.3°F), pulse is 87/min, respirations are 18/min, and blood pressure is 117/78 mm Hg. Physical examination shows a erythematous posterior pharynx, tonsillar edema with exudates, palatal petechiae, and several enlarged posterior cervical lymph nodes. Rapid group A beta-hemolytic streptococci screen and Monospot tests are performed in the office and both are negative. The patient begins course of amoxicillin, but calls the next day saying that he has developed a diffuse rash
mono (epstein barr virus)
The antidote for the opioid toxidrome is
naloxone
this lesion will appear as a well define eccentric expansile lytic lesion that has scalloped sclerotic boarders
non ossifying fibroma
A 25-year-old female comes to the office because of an itchy skin rash for 3 weeks. She states that the lesions mostly affect her arms, and have never been on her scalp. Her past medical history includes atopic dermatitis. Examination shows that the lesions are discrete, round/oval, erythematous plaques affecting both the legs and arms. There is noticeable xerosis of the affected skin. A KOH preparation of lesion scrapings is negative.
nummular eczema
A 2-year-old girl is brought in to the emergency department because of immobility in her left arm for the past 3 hours.Three hours ago patient, and her father, were playing in the park where he held her by the hands and swung her around. During this, she momentarily let go with her right hand. Afterwards, she refused to use her left arm and cried at any attempt to move it. Patient is sitting in her father's lap, in no acute distress, and holding her left arm slightly flexed across her belly. Diagnosis and tx?
nursemaids elbow (radial head subluxation) closed reduction with supination
tx of scoliosis
observation: < 25 bracing: 25-45 surgery: > 45 (immature), > 50 (mature)
type of arthritis in kids that has < 5 joint involvement, + ANA, has a high risk of uveitis, and typically affects large joints
oligoarthritis (pauarticular)
A 3-month-old girl presents to her pediatrician, brought in by her mother due to concern for a rash on her head. She has otherwise been well with no fever and no recent illnesses. On exam, yellowish, greasy scales are noted on the top and frontal areas of her scalp consistent with "cradle cap." What is the best first treatment approach?
olive oil compress, baby shampoo
This infection is caused by Trichophyton rubrum
onychomycosis
a 29-year-old field worker with a rash on his nails. On physical exam, mild paronychia, loss of the cuticle of some nails, dirt-like yellowish-green nail pigmentation, subungual debris, and dystrophy of some nails is seen. What is the diagnosis and tx?
onychomycosis terbinafine
___ toxidrome presents with presents with miosis (pinpoint pupils) and central nervous system depression.
opioid
A 14-year old boy comes to your office with complaints of gradual onset of pain just below his right kneecap over the past month. He has just started playing basketball for the junior varsity team at his school and he is very excited for the season to begin. Unfortunately, the pain in his knee is exacerbated by all the jumping he has to do during practice. He feels the same type of pain when he is going up and down the stairs. He denies any preceding injury to the knee. Physical examination shows full range of motion of his knee, but the pain is reproducible when he extends his knee against resistance. What is the most likely diagnosis and tx?
osgood schlatters rest, ice, nsaids, stretching
A 22-year old college student comes to the office because of a 3-week history of progressive back pain. The patient is currently taking aspirin. His medical history is noncontributory. When asking the patient about symptom description, he mentions that his pain is worse at night and he has no relief with aspirin. Upon further interrogation, the patient denies history of trauma, fever or any other disease. Physical exam shows limited range of motion of his spine and spinal tenderness at C5 and C6 levels. His temperature is 36.1°C (96.9°F), pulse is 84/min, respirations are 15/min, and blood pressure is 110/70 mmHg. A plain spine radiograph shows a 3 cm, well-circumcised radiolucent area surrounded by rim area of sclerosis at C5. What is the most likely cause of this patient's current condition?
osteoblastoma ( > 2 cm, worse at night but NOT better with NSAIDS, common in the spine)
A 12-year-old boy comes to the clinic with his mother because of severe pain in his right leg for the past month. He says that the pain is mostly located in his thigh and that it was initially mild but now the pain is so bad that he cannot walk on his leg. His mother says that aspirin relieves his pain temporarily. Physical examination shows some localized pain over the area of the proximal femur. There is no palpable joint deformity, redness or swelling. He also walks with a visible limp. Neither increasing nor decreasing activity alleviates the pain, which tends to be worse at night. He has not had any recent trauma to the leg. An MRI of the leg shows a 1cm lesion within the femur.
osteoid osteoma (worse @ night, relieved with NSAIDS, < 2 cm)
A 13-year old boy comes to the clinic because of a 6-week history of pain in his right shoulder. His pain is aggravated by the recent start of football practice and associated increased activity, but it persists after practice as well. He has no prior history of trauma. He denies fevers, weight loss and night sweats. His temperature is 37.1°C (98.8°F), pulse is 70/min, respirations are 16/min, and blood pressure is 120/82 mm Hg. Physical examination shows a hard immobile mass on the right proximal humerus which is slightly tender. His range of motion in the shoulder is minimally restricted. A radiograph obtained of his right upper extremity shows a sunburst pattern. What is the most likely diagnosis?
osteosarcoma (sunburst pattern, no systemic sx, waxes and wanes)
A 14 year-old patient presents after a recent vacation. He complains of left ear pain. Physical examination reveals left tragal tenderness, an inflamed external auditory canal, and the tympanic membrane can not be visualized. Diagnosis, MC causative agent, tx?
otitis externa pseduomonas Topical steroid/antibiotic drops (cipro dex)
An 8-year-old boy presents to the emergency department with a five-day history of low-grade fever, runny nose, and hacking cough. Yesterday, he started complaining of some chest pain that is worse with lying flat on his back. The patient appears non-toxic, and you note that while seated on the exam table, he is leaning forward in a tripod position. Physical exam reveals a pericardial friction rub on auscultation, and a chest radiograph shows a slightly enlarged heart. What is the most likely diagnosis? What is the MC cause? Tx?
pericarditis coxsackie virus NSAIDs
a 22-year-old female complaining of a rash around her mouth. She describes a feeling of mild burning or tension but denies pruritus. Examination reveals papulopustules on erythematous bases; the vermillion border is spared. A culture is negative. What is the diagnosis and tx?
perioral dermatitis topical metronidazole
A 15-year-old boy returns to the clinic complaining of left eyelid pain, swelling, and itching for four days with no relief from gentamicin drops. He has recently been camping. Physical exam reveals an edematous, erythematous upper and lower left lid with the patient recoiling from touch. Extraocular motilities are normal without pain or diplopia and the bulbar conjunctiva is white. What is the most likely diagnosis?
periorbital cellulitis
a 7-year-old boy is brought to his pediatrician for evaluation of a sore throat. The sore throat began 4 days ago and has progressively worsened. Associated symptoms include subjective fever, pain with swallowing, and fatigue. The patient denies cough or rhinorrhea. Vital signs are as follows: T 101.4 F, HR 88, BP 115/67, RR 14, and SpO2 99%. Physical examination is significant for purulent tonsillar exudate; no cervical lymphadenopathy is noted. What is the diagnosis, MC cause, diagnostics, tx?
pharnygitis group A strep rapid strep and throat culture amoxicillin to prevent rheumatic fever
condition present at birth, in which the infant has a smaller than normal lower jaw ( micrognathia ), a tongue that is placed further back than normal (glossoptosis), and an opening in the roof of the mouth ( cleft palate )
pierre robin sequence
A 15-year-old boy is brought into the office for a rash that appeared on his neck and trunk yesterday. He had been treated for tinea corporis due to a lesion on his back about two weeks ago, but the lesion has not resolved. Upon physical examination, he has a diffuse maculopapular rash that is bilateral and symmetrical following the lines of cleavage of the skin. The rash is not pruritic. The patient is otherwise healthy with no chronic illnesses and has no other complaints. What is the diagnosis and tx? Most likely causative agent?
pityriasis rosea (herald patch mistaken for ringworm, christmas tree rash), supportive care HHV 7
Fever, cough, focal findings on auscultation
pneumonia
patient presents to the ED with increasing dyspnea and pleuritic chest pain of sudden onset after getting hit in the left side of the chest. examination reveals moderate respiratory distress with absence of breath sounds and hyperresonance to percussion on the left, with tracheal deviation to the right.
pneumothorax
joint pain in children that affects > 5 joints, can have + RF, and is typically symmetrical is defined as
polyarthritis (JIA)
A 10-year-old boy presents with gross hematuria, hypertension, and edema. His throat was sore two weeks ago, but he was not seen by his pediatrician. His sore throat resolved one week ago. He has been well until two days ago when he noticed some blood in his urine. His face and extremities are puffy this morning. Laboratory studies show elevated antistreptolysin titers and low serum complement levels. What is the most likely explanation for these findings?
postinfectious glomerulonephritis
A 3-year-old boy presents to the clinic with generalized edema and foamy urine. There have been no complaints of dysuria or other notable symptoms. Urinalysis is notable for proteinuria. Subsequent workup confirms a serum albumin of 2.7 g/dL and a protein/creatinine ratio of 2.3 mg protein/mg creatinine. What is the best initial treatment?
prednisone (MCD)
Perioral dermatitis is associated with
prior hx of topical steroid use
a 3-week-old infant with decreased appetite and a rash in her mouth. On physical exam, you note white plaques on her tongue that scrape off with a tongue depressor and bleed slightly. Potassium hydroxide (KOH) preparation of the scrapings demonstrates budding yeasts with hyphae. Diagnosis and tx?
thrush nystatin
classic finding of epiglottis on x-ray
thumbprint sign
if patient presents with a febrile UTI, what should you order and why?
renal and bladder US (looking for hydronephrosis) if abnormal, then order VCUG
occurs when infants are born before the lungs are producing adequate amounts of surfactant.
respiratory distress syndrome (hyaline membrane dz)
An infant born at 30 weeks' gestation begins to have respiratory difficulty shortly after birth. Examination reveals rapid, shallow respirations at 80 per minute with associated intercostal retractions, nasal flaring and progressive cyanosis. Chest x-ray reveals the presence of air bronchograms and diffuse bilateral atelectasis. What is the most likely diagnosis and tx?
respiratory distress syndrome (hyaline membrane dz) antenatal steroid, surfactant
A 10-month-old boy presents to the emergency department with a widespread maculopapular rash. His mother states he had a fever for three days that suddenly resolved prior to the development of the rash. What infectious exanthem is the most likely cause?
roseola
A 12-month-old girl presents to her pediatrician with a sudden-onset rash. She had a high fever up to 104°F for the last three days. She was seen at an outside urgent care two days ago and started on amoxicillin due to concern for erythematous tympanic membranes. This morning, she woke up happy and afebrile but with a pink rash all over her trunk. It now seems to be spreading to her face, neck, arms, and legs. Her immunizations are up to date. On exam, she is playful and nontoxic with mild nasal drainage, erythematous tympanic membranes without dullness or bulging, and a rosy-pink maculopapular rash over her trunk, extremities, and face. What is the most likely diagnosis? Cause?
roseola HHV6
a mother who brings her 14-month-old daughter for evaluation of a rash. The mother describes the rash as beginning on the face and subsequently spreading to the rest of her body over 1 day. She has not been vaccinated per her parents' preferences. Temperature is 100°F (37.8°C). There is postauricular lymphadenopathy and petechiae on the soft palate and uvula. Pink maculopapules are found in the face, neck, trunk, and extremities. The rash disappears in three days.
rubella
An 8-year-old girl comes to the emergency department with her mother because of right ankle pain. Her mother states that the pain started two weeks earlier and subsequently became worse. She also reports fever for the last week, and pain around the joint. Physical examination shows the right ankle is erythematous, warm, swollen and tender to palpation over the lateral malleolus. Radiographs of the ankle show soft tissue edema and a large radiolucency in the distal fibula. What is the most likely organism involved?
s. aureus (osteomyelitis)
MC cause of meningitis and pneumonia in kids
s. pneumo
patient presents with fever and pharyngitis. ON PE, patient has a sandpaper rash that starts in groin and axillae, strawberry tongue, pastias lines (petechial lesions in axilla, inguinal areas). What is the diagnosis and MC causative agent
scarlet fever strep pyogenes
"fall fragment" of "fallen leaf" sign on XR
simple bone cyst
An 8-year-old boy presents for his annual physical with complaints of night-time cough and intermittent wheezing. What diagnostic study would confirm a diagnosis of asthma? What will it show?
spirometry Reversibility - increase in FEV1 by 12% after a bronchodilator
17 y/o with a severe drug-induced reaction on both lower limbs with few lesions elsewhere (< 10% body surface) in addition to mucosal involvement of the mouth of two days duration. The insulting drug was sulfonamide and the onset of the rash was within 48 hours of taking the drug. The rash comprised of bilateral symmetrical bullae on a background of erythematous macules and patches in addition to erosions and peeling
steven johnson syndrome
A 3-year-old girl comes to the pediatrics department because of "on-and-off fevers" for the past week. Her mother reports that her daughter will look very sick in the morning, but later in the day, she appears normal and has a normal body temperature. Her mother also reports that the child has a "salmon-colored rash" that is most prominent when she is having a fever. Physical examination confirms that the patient is currently febrile and has a macular, pink rash mainly present over the axillae and waist. Hepatosplenomegaly and several swollen joints that are not particularly tender are also noted. A complete blood count shows leukocytosis and thrombocytosis. What is the most likely diagnosis in this child? Tx?
stills disease (fever, salmon pink rash, hepatosplenomegly, polyarthalgia) NSAIDS
A 6-year-old boy presents to the clinic with hair loss and scaling of his scalp. Examination reveals two areas of hair loss with black dots. Potassium hydroxide preparation supports the diagnosis of ___. What is the recommended treatment?
tinea capitis oral griseogulvin
___ toxidrome presents with mydriasis, agitation, hypertension/hyperthermia, sweating and tachycardia.
sympathomimetic
absent cremestaric reflex and decreased blood flow on doppler. what is the diagnosis and tx?
testicular torsion detorsion/fixation (Orchiopexy)
A 20-year-old male with no significant past medical history presents complaining of patchy tanning. He states that he has been out in the sun without a shirt several times. Areas on his chest and back just don't tan, and he is becoming self-conscious. KOH prep shows hyphae with spores. What is the diagnosis and cause? Tx?
tinea versicolor malassezia furfur selenium sulfate shampoo
A 14-year-old boy presents with a common wart on his hand. What is the most appropriate treatment?
topical salicylic acid, cryotherapy, topical imiquimod
a 3-day-old boy is evaluated in the newborn nursery for a neck contortion. He was born at 38 weeks gestation and was noted at birth to have bilateral clubfeet. On exam, the top of his head is tilted to the right and his chin is rotated to the left. His left sternocleidomastoid muscle is dystonically contracted. An ultrasound of his neck demonstrates no masses or cysts. What is the most likely diagnosis and tx?
torticollis stretching
17 y/o presents with a severe drug-induced reaction with extensive skin involvement covering > 30% of her body surface area. The insulting drug was anticonvulsant medication and the onset of the rash was within 10 days of taking the drug. The rash comprised of bilateral symmetrical bullae on a background of erythematous macules and patches in addition to erosion and peeling. On examination, her skin peels away in sheets when pressure applied and rubbed.
toxic epidermal necrolysis
A 1-day-old female newborn is being evaluated in the neonatal intensive care unit for severe respiratory distress and cyanosis. The patient was born at 38 weeks gestation via vaginal delivery to a 30-year-old woman who had minimal prenatal care. Temperature is 36.4°C (97.5°F), pulse is 150/min, blood pressure is 87/55 mm Hg, and respiration rate is 60/min. An electrocardiogram reveals left axis deviation with a superior axis and chest x-ray shows decreased pulmonary markings and a hypoplastic right ventricle. What is the most likely diagnosis?
tricuspid atresia
T OR F: In scoliosis, Most curvatures are to the right in the thoracic spine, causing the right shoulder to be higher than the left
true
gold standard for dx of obstruction
upper GI
A 5-year-old boy presents to the clinic with a diffuse vesicular rash that occurred two days after the onset of fever and pharyngitis. On exam, lesions are seen on the boy's face, trunk, and extremities, and the lesions are noted to be in different stages. He is diagnosed with what? What is the cause?
varicella HHV3
acute onset unilateral erythema of conjunctiva, copious watery discharge, tender preauricular lymphadenopathy, scant mucoid discharge. Diagnosis and MC cause?
viral conjunctivitis adenovirus
MC etiology for pneumonia in 1-5 y/o
viruses (followed by s. pneumo)
a severe paroxysmal cough followed by an high-pitched inspiration
whooping cough
A 4-year-old boy is sent home from day care for a severe cough following one week of cold symptoms, including sneezing, conjunctivitis, and nocturnal cough. He presents with paroxysms of cough followed by a deep inspiration, and occasional post-tussive emesis. During severe paroxysms, he exhibits transient cyanosis. Dx and Tx?
whopping cough, azithro (abx prophylaxis to close contacts)
A 3-year-old boy is brought to the clinic because of irritability, vomiting, fever, and abdominal pain for the past month. His temperature is 39.2°C (102.56°F), pulse is 110/min, respirations are 25/min, and blood pressure is 110/70 mm Hg. Physical examination shows an upper right quadrant abdominal mass on palpation
wilms tumor
A 2-year-old, previously healthy patient presents to the clinic with an abdominal mass. The child's mother noticed the mass two months ago and states it has been steadily growing in size. Upon physical exam, the mass is firm, minimally-mobile, nontender, and located to the left of midline, extending from the costal margin to the level of the umbilicus. Physical exam is otherwise normal. Family history is unremarkable. The patient has no fever, no hematuria, and no weight loss. Vitals are within normal limits except for a blood pressure of 130/90 mm Hg
wilms tumor (HBP, unilateral abdominal mass)
