Peds NBME Questions

Study online at quizlet.com/_3v96ns

1. 22mo old boy with

-easy fatigability
-SOB with mild physical activity
-can't keep up with peers during play
-holosystolic murmur
-diastolic rumble over diardiac apex
-no cyanosis, clubbing, peripheral edema: VSD!!
-diastolic rumble = increased flow through mitral valve

*increased pulmonary circulation

--> can result in Eisenmenger syndrome (L --> R shunting!!)
2. ASD presentation: -Wide splitting A2, P2
-Fixed S2

*Also have increased pulmonary circulation

3. 2yo with
-rhinorrhea, congestion, cough
-stridor that worsens when he cries
-dry, harsh cough
-no tonsillar enlargement/asymmetry: CROUP!!!
-parainfluenza virus
4. 17yo African American boy gets gross hematuria that resolves spontaneously, no other abnormalities; has RBCs in urine; Dx?:
Renal papillary necrosis!!!
-Sickle cell trait!!
5. Renal papillary necrosis
-presentation
-associations: Presentation
-gross hematuria
-proteinuria

Associations = SAAD
-Sickle cell TRAIT (normal RBCs, reticulocytes, etc)
-Acute pyelonephritis
-Analgesics (NSAIDs)
-DM
6. Glomerulonephritis signs: Glomerular injury
-HTN
-proteinuria
-dysmorphic RBCs
-RBC casts
7. Acute interstitial nephritis
-presentation
-associations: Presentation = "rash in the kidney"
-rash
-eosinophilia
-costovertebral tenderness

5 P's
-Pee (diuretics)
-Pain-free (NSAIDs)
-Penicillins + cephalosporins
-PPIs
-RifamPin
8. Kartagener vs. CF
-both
-Kartagener-specific
-CF-specific: Both
-chronic sinopulmonary infections
-nasal polyps
-bronchiectasis
-digital clubbing

Kartagener
-situs inversus (heart on wrong side of chest)
-infertile (immotile spermatozoa)
-normal growth

CF
-pancreatic insufficiency
-infertility (absent vas deferens)
-failure to thrive
9. When is Churg-Strauss (eosinophilic granulomatosis with polyangiitis) diagnosed?: ADULTHOOD (vs. CF --> childhood)
10. 18mo boy with
-blood in stool
-history of recurrent otitis media, pneumonia, herpes labialis
-itchy, red, scaly patches on trunk and extremities
-scattered petechiae
-low platelet count
-normal WBC count: WISKOTT-ALDRICH!!!
-XR
*Impaired cytoskeleton changes in leukocytes (can't migrate), platelets (can't replicate)
11. Wiskott-Aldrich
-presentation
-treatment: WATER
-Wiskott-Aldrich
-Thrombocytopenia
-Eczema
-Recurrent infections

Tx
-stem cell transplant
12. Reye syndrome
-pathology
-labs: Pathology
-microvesicular fatty infiltration
-hepatic mitochondrial dysfunc

Labs
-high AST/ALT
-high PT, INR, PTT
-high ammonia
13. 3yo girl has
-severe oral pain
-2 sinus infections, numerous episodes of cellulitis (S. aureus, GAS)
-periodontal inflammation, necrosis: LAD (leukocyte adhesion deficiency)
-defect in LFA-1 (CD18) on phagocytes --> impaired migration, chemotaxis
14. LAD presentation: 1. Recurrent skin + mucosal infections
-NO PUS!!!
-poor wound healing --> necrosis

2. Delayed umbilical cord separation

3. Increased neutrophils in peripheral blood

-no neutrophils at the site of infection
15. Complement deficiency presentation: Disseminated bacterial infections
-S. pneumo
-H. flu
-N. meningitidis
16. Eczema triggers: Excess bathing
Dry environments
Stress
Overheating
Irritating deteregents
17. Kawasaki disease features: CRASH and burn
-Conjunctival injection
-Rash (polymorphous --> desquamating)
-Adenopathy (cervical)
-Strawberry tongue
-Hand, foot changes (edema, erythema)
-fever
18. Kawasaki dx treatment: Aspirin + IV Ig
19. 6yo boy comes in with pallor + fatigue, recently had abdominal pain + diarrhea, treated with antibiotics; pale child with multiple
petechiae
Labs
-low Hb
-low MCV
-low platelets
-high indirect bilirubin
-helmet cells on peripheral blood smear: TTP/HUS!!! --> Microangiopathic anemia
-shearing of RBCs as they pass through vessel lumen --> HELMET CELLS!!

Presentation
-preceding bloody diarrhea
-fatigue
-pallor
-bruising, petechiae
-oliguria, edema

Labs
-hemolytic anemia
-thrombocytopenia
-kidney damage (high Cr, high BUN)
20. Microangiopathic anemia
-causes
-labs
-tx: Causes
-DIC
-TTP/HUS
-SLE
-Malignant HTN

Tx
-fluid, electrolyte management
-blood transfusions
-dialysis
*ANTIBIOTICS NOT USEFUL in HUS!!
21. Tracheo-esophageal defect presentation: -Choking, drooling, vomiting with 1st feeding
-Polyhydramnios
-Air enters stomach (gas from GI tract goes into trachea)
--> can see on CXR
*Failure to pass nasogastric tube into stomach
22. Mesodermal defects mneumonic: VACTERL
-Vertebral defects
-Anal atresia
-Cardiac defects
-Tracheo-esophageal fistula
-Renal defects
-Limb defects
23. vWF labs
-BT
-PT
-PTT: BT- high
PT- nl
PTT- high (because need vWF to stabilize Factor 8!!)
24. vWF
-genetics
-tx: AD

Tx
-desmopressin --> releases vWF stored in endothelium!
25. 3wk Asian girl born with breech presentation, L inguinal fold extends beyond orifice; seems to have leg-length discrepancy; Dx?
Next step? Diagnostic tests?: DHH = developmental dysplasia oif hip
-dislocation of femoral head from acetabulum

Risks
-breech presentation
-female
-white
-family history

Next step = ULTRASOUND OF HIP!!!

Diagnostics
-Barlow maneuver = abduction with anterior lifting of hip
-Ortolani maneuver = adduction with posterior pressure on hip
26. Nursemaid's elbow tx?: Nursemaid's elbow = radial head subluxation
-annular ligament gets caught in between humerus + radius

Tx
-Hyperpronate arm (preferred)
-Supination of forearm + flexion of elbow (less successful, more painful)
27. 9yo boy has fever, hives, joint pain; started 2 days ago + started to cover trunk and arms; currently taking penicillin for
streptococcal pharyngitis that began 9 days ago; has palpable lymph nodes in cervical, axillary, inguinal regions; Dx? Tx?: Serum
sickness-like reaction!!
-Type III hypersensitivity = immune-complex to foreign proteins

Presentation
-fever
-hives
-polyarthralgia
-headache
-edema
-lymphadenopathy
-splenomegaly

Tx
-remove offending agent
-steroids if severe
28. 4yo girl has "itchy private parts" at bedtime but not at night for past week; vulva erythematous but no discharge; Dx?:
PINWORM!!!
-itchy butt, worse at night

*If girl, vulvovaginitis = inflammation of vagina --> itchy, redness, discharge

29. Lichen sclerosis presentation: "Parchment paper" skin- thin, white skin of genital area
Cause- unknown (autoimmune, infection?)

2 age ranges
-7.6yo
-60yo
30. What are bitot spots?: Keratin deposits in conjunctiva
--> sign of Vit A deficiency!
31. 6yo boy with Down's has
-difficulty swallowing (dysphagia)
-refusal to feed
-vomiting
Dx?: Foreign body ingestion!
-swallowed a coin
32. 10yo white male with swollen, painful knee; no trauma; X-ray shows central lytic region, onion skinning, moth-eaten appearance
with some extension into soft tissue; Dx?: Ewing's sarcoma!!
-lytic
-onion-skin periosteal reaction
-moth-eaten, mottled appearance
33. X-ray shows fusiform defect with scalloping: Chondrosarcoma
34. Cause of osteomyelitis in Sickle Cell patients?: SALMONELLA!!!
35. 6yo boy has leg pain mostly at night; no other changes; able to run, walk, etc normally; no changes in weight, night sweats,
fever; last few hours; improve with massage and NSAIDs; Dx?: GROWING PAINS
-mostly at night, resolves by morning
-bilateral legs (usually)
-normal physical exam, activity

Tx
-massage
-stretching exercises
-heat + analgesics
36. Physiological jaundice causes: 1. Elevated RBC --> high RBC turnover
2. Low hepatic uridine diphosphoglucuronate = UGT (Asian babies have especially low UGT); normalizes in 2 weeks
3. Sterile newborn gut --> can't metabolize bilirubin yet
37. Tx for neonatal jaundice > 20-25mg/dL?: Exchange transfusion
38. 2yo girl has rash, fever, cough, rhinorrhea, "pink eyes"; rash started on her rash, moved to the rest of her body, sparing
palms/soles; blanching, erythematous rash; Dx? How to prevent spread in hospital?: MEASLES!!!
-Prodrome
-cough
-coryza (rhinorrhea)
-Koplik spots
-conjunctivitis
-fever
-Blanching, erythematous rash
-starts on face, moves downward
-spares palms/soles

*Airbourne --> airbourne precautions!!

-negative pressure room
-N59 mask for staff
39. Tx for measles?: Vitamin A --> helps mature cells
40. Long-term sequelae of vesicourethral reflux?: Renal scarring!!!
-Vesicourethral reflux --> UTIs --> Renal scarring!
41. Long-term sequelae of pyelonephritis?: Renal abscess --> renal scarring
42. Gold standard for diagnosing VUR?: VCUG = voiding cystourethrogram
43. Caustic ingestion management steps: 1. ABCs
2. Decontaminate body- remove contaminated clothing, irrigate contaminated skin, etc (avoids reexposing patient to this chemical
right after)
3. CXR if have respiratory symptoms
4. Endoscopy in 24hrs

*don't neutralize with vinegar, or nasogastric lavage!!

-both- increases risk of vomiting!
-vinegar- can cause exothermic reaction --> burns mucosa
44. 6yo boy with R shoulder pain for past 2 weeks
-localized swelling in R shoulder
-lytic lesion in R humeral head
-mild hypercalcemia: Langherhans cell histiocytosis = proliferative dendritic cells --> metastasize to lymph nodes
-lytic bone lesion
-skin rash
OR recurrent otitis media w/ mass involving mastoid bone
-birbeck granules
-S-100
-CD1a
45. 52yo girl has vomiting, abdominal distension; hasn't passed meconium; no stool in rectal vault, normal tone; free air in liver;
viscous meconium irrigated from ileum, some from colon; colon much narrower than usual; Dx?: CF!!!
-meconium ileus (meconium at level of ileus)
-microcolon = narrow, underdeveloped colon
-sinopulmonary disease

*free air = intestinal perforation --> surgical emergency!!

46. 15yo girl hasn't started menstruating, no breast development, no pubic hair; ultrasound shows presence of uterus; next step?:
Primary amenorrhea
-get FSH!! --> can tell whether it's central/peripheral

*Don't get estrogen level- we already know it's low because no breast development!
47. 15yo boy has unstable gait, progressive speech difficulty, nystagumus, scoliosis, pes cavus, hammer toes, dysarthria, dysmetria,
lack of plantar reflexes on ankles; Dx?: Friedreich's ataxia
-ataxia
-scoliosis
-nystagmus
-dysarthria
-pes cavus
-hammer toes
-DM
-hypertrophic cardiomyopathy
48. 7yo girl was bitten by cat; cleaned wound with hydrogen peroxide; no debris, no active bleeding; wound copiously irrigated with
saline; Next step?: Prophylax with amoxicillin + clavulanate

Cat bite management

1. Irrigate + clean
2. Prophylactic amoxicillin + clavulanate
3. Tetanus booster as indicated
4. Avoid closure (could get infected, so keep open so we can work on it)
49. 5yo boy has fatigue, scrotal swelling, low grade fever + cough 2 weeks ago, dry mucus membranes, 3-sec capillary refill,
palpable nonblanching rash on buttocks, abdominal tenderness; Dx? Labs? Tx?: Henoch-Scholein purpura = IgA-mediated
vasculitis
-palpable purpura
-arthritis, arthralgia
-abdominal pain
-INTUSSUSCEPTION!!! --> target sign on ultrasound!!!
-renal disease

Labs
-normal platelets + coag
-nl to high Cr
-hematuria +/- RBC casts +/- proteinemia

Tx
-hydration + NSAIDs
-steroids if severe
50. target sign on ultrasound?: INTUSSUSCEPTION!!!
51. 6yo boy has pain in L hip and L knee; pain present for 2mo; limping for past few days; 3 weeks ago, had fever and runny nose
that resolved within few days; internal rotation and abduction of hip difficult; Dx?: LCP (Legg-Calve-Perthes disease) = avascular
necrosis of femoral head (disruption of blood flow)
-boys 4-15yo
-chronic hip pain OR insidious pain
-ataxic gait (shorter time weight-bearing on affected side)
-as disease progresses, difficulty with internal rotation + abduction of hip
52. 25hr baby has 'bright green' vomiting; no bowel movement; family history significant for CF; markedly distended abdomen; no
stool in rectal vault; X-ray shows dilated loops of bowel with no free air; Next step?: CONTRAST ENEMA!!
-can distinguish between micro/megacolon
-microcolon --> CF
-megacolon --> Down's

*don't do CT abdomen because don't want to expose young children to lots of radiation
53. Baby born with respiratory distress + excess drooling
-Dx?
-Best diagnostic step?
-What do you look for?: TE fistula

Best diagnostic step

1. Place feeding tube
2. Take Xray --> ends up in thorax

Look for VACTER

-vertebral
-anal atresia
-cardiac
-renal
-radial
54. Baby cyanotic when feeding but pinks up when crying; Dx? What else do you look for?: Choanal atresia = back of nasal passage
blocked, because of failed recanalization of nasal fossa during fetal development
--> CAN"T BREATHE THROUGH NOSE!!!
-can only breathe through mouth!!

Look for CHARGE

-coloboma
-heart defects
-retarded growth
-GU anomalies
-ear anomalies + deafness
55. Ground glass opacities on CXR?: RDS!!!
-Respiratory Distress Syndrome
56. 5yo girl has bedwetting; for past week, wet the bed nightly and has trouble sleeping from needing to go to the bathroom
multiple times/night; more thirsty than usual, going to the bathroom during the day more than usual; has fatigue + 'crankiness';
previously met all developmental milestones; last month, family moved to new house; PE- tired, dry mucus membranes; Dx?:
DM 1!!!
-polyuria
-polydipsia

*Psychological stressor
-enuresis (BUT NOT GOING MORE FREQUENTLY)
-behavioral regression
-mood lability
57. What is trichophagia?: Eating hair
-often after trichotillomania
-can produce hairballs
58. What is alopecia areata?: Autoimmune condition --> immune system attacks hair follicles
-hair loss in multiple areas
-hair growth unpredictable, cyclical
59. 1 day old newborn girl has swollen labia, blood-tinged vaginal discharge, bilaterally enlarged mammary glands; Dx? Next step?:
Maternal estrogen effects in newborn
-Breast hypertrophy
-Swollen labia
-Leukorrhea- whitish vaginal discharge
-uterine withdrawal bleeding
60. Pregnant mom brings 3yo son to ED because of vomiting and abdominal pain; vomit is coffee-ground; low Hb, low HCO3;
imaging shows radioopaque tablets in stomach; Dx? Tx?: Ingestion of prenatal vitamins!!
-Prenatal vitamins rich in Fe --> show up as radioopaque on imaging!!
--> free radial production + lipid peroxidation

Tx = deferoxamine
61. Tx for aspirin toxicity?: BICARB!!
62. Tx for acetaminophen toxicity?: N-acetylcysteine
63. Tx for severe Li toxicity?: Hemodialysis!
-most dialyzable ion
64. Tx for moderate Pb toxicity?: Calcium EDTA
65. 5yo obese Hispanic girl has precocious puberty; source of her hormones?: Adrenal gland!!
-generates steroids --> testosterone --> estradiol (peripheral tissue)

*Increased adipose tissue can stimulate central production of hormones AND peripheral conversion
66. 5yo boy has L hip pain; no recent injury; hurts when he walks or moves; had runny nose and congestion for past 3 days; L hip
flexed, abducted, externally rotated; ESR = 30; CRP = 9 (nl = 8); Dx? Tx? Prognosis?: Transient synovitis
-boys 3-10yo
-hip pain
-following viral infection, mild trauma
-affected hip flexed, abducted, externally rotated (maximizes joint space --> relieves pain)

Tx
-Ibuprofen
-Rest, follow up in 1 week

Prognosis
-usually recover in 1-4 weeks
67. Septic arthritis
-presentation
-management: *More severe!!
-fever > 101F
-can't bear weight
-WBC > 12,000
-ESR > 40
-CRP > 2

Management- arthrocentesis
68. Why are most male CF patients infertile?: Congenital bilateral absence of vas deferens!!
-NOT BECAUSE OF BLOCKAGE OF TUBES!!!

*Women infertile because

-malnourished
-pubertal delay
-amenorrhea
69. 6wk old boy has pyloric stenosis; labs all normal; has been projectile vomiting nonbilious vomit for last 2 weeks; next step in
management?: 1. IV hydration, K+ replacement
--> decreases risk of postop apnea
*Pyloric stenosis tends to cause hypochloremic, hypokalemic metabolic alkalosis

2. Surgery
70. Clinical phases of pertussis: Catarrhal (1-2wk)
-mild cough
-rhinnitis

Paroxysmal (2-6wk)
-cough with inspiratory "whoop"
-posttussive emesis

Convalescent (wks to month)

-gradually gets better
71. Pertussis
-diagnosis
-treatment: Dx
1. PCR of Pertussis
2. Lymphocyte-dominant leukocytosis (WEIRD SINCE IT"S A BACTERIA!!)

Tx
-Macrolides
72. Cardiac exam
-Single S2
-may have VSD murmur

Imaging
-X-ray shows "eggs on a string" heart- Dx?: Transposition of the great vessels!
73. X-ray shows
-pulmonary edema
-"snowman" sign = enlarged supracardiac veins + SVC: Total anomalous pulmonary venous return with obstruction
74. 1wk old baby has fever and irritability; intermittently apneic and hypoxic; mom is 16, not married to dad; dad not involved in
baby's care; exam concerning for meningitis; doctor wants to intubate baby; mom refuses; who do we get consent from?: DON"T
NEED CONSENT FOR EMERGENT LIFE-SAVING PROCEDURES!!
-management of time-sensitive procedures (managing airway) don't need consent
75. 6yo boy stepped on rusty nail, never vaccinated; parents are divorced and have joint custody; mom consents to vaccination but
dad refuses; how to proceed?: PROCEED WITH VACCINATION!!
-parents with joint custody can both consent, but only need consent from 1 parent to proceed (esp if in child's best interests)

*If both parents refuse to consent, then need court order to give vaccine
76. How does neonatal chlamydial conjunctivitis present?
Best way to prevent?
Best way to treat?: Bilateral chemosis = thickened, injected conjunctivae
Eyelid swelling
Watery or mucopurulent discharge

Prevent
-treat maternal chlamydia

Treat
-Erythromycin ointment on eyes
77. Patients with asplenia at risk for which organisms?: Please SHINE my SKiS
-Pseudomonas
-S. pneumo
-Haemophilus Influenza
-Neisseria
-E. coli
-Salmonella
-Klebsiella
-Group B strep
78. Sickle cell patient has
-fever
-chills
-hypotension
-leukocytosis
-bandemia
Dx?: SEPSIS!!!
79. Most common cause of sepsis in sickle cell patients (esp those who have been vaccinated)?
Prophylaxis?: Strep pneumo
*H.flu, Neisseria less common because have vaccines for them

Prophylaxis- penicillin until age 5

80. 2yo boy with cough, difficulty breathing; playing with toys until 2 hours before presentation; has brother with peanut allergy;
nasal flaring + grunting with subcostal and intercostal retractions; wheezing in R lung; chest x-ray shows hyperinflation of R
lung; Dx? Next step?: FOREIGN BODY ASPIRATION!!!
-sudden onset
-coughing
-unilateral wheezing
-unilateral lung hyperinflation
-kids 1-3yo
*most objects end up in R bronchus

*NOT asthma because would be bilateral/diffuse!!!

81. 2-day old boy has jaundice, scleral icterus, large tongue, hoarse cry; breastfeeding poorly, weak latch; high total bilirubin (high
indirect ), high TSH, low T3; Dx? Cause? Tx?: Congenital hypothyroidism
*Thyroid dysgenesis (most common)
-Lethargy
-Hoarse cry
-Poor feeding
-Constipation
-Jaundice
-Dry skin
-Large fontanelles

Tx- levothyroxine
82. 2yo child has easy bruising, nosebleeds, decreased activity over past week; had URI last week that was treated with antibiotics;
well-developed, anicteric, pale; small palpable posterior cervical lymph nodes; sinus tachycardia; systolic ejection murmur;
ecchymoses on L shoulder + both LEs; low Hb, Hct, WBC, reticulocytes; bone marrow biopsy shows hypocellular marrow,
decreased megakaryocytes + precursors of erythroid + myeloid lineages; Dx?: Acquired aplastic anemia
-decrease in all cell lines
-fatty infiltration of marrow

Causes
-radiation
-drugs
-chemo
-Abx (chloramphenicol)
-insecticides
-toxins
-benzene
-CCl4
-infections
83. Fanconi anemia presentation: Bone marrow failure
Short
Increased tumors/leukemia
Cafe au lait spots
Thumb/radial defects
84. Diamond-Blackfan anemia presentation: -Rapid-onset anemia within 1 year b/c of intrinsic defect in erythroid progenitor cells
-high HbF
-low Hb
-short
-craniofacial abnormalities
-upper extremity malformations (triphalangeal thumbs)
85. Most common cause of osteomyelitis in normal infants, kids?: S. aureus!
86. 17yo girl has purging habits, weight loss, syncope; started on NG feeds; on 2nd day of admission, has severe SOB, current
sustained episodes of ventricular tachycardia, low BP, high RR, BMI = 14, jugular venous distension; Dx? Hormone that's causing
her presentation?: Refeeding syndrome!
-increased insulin --> increased glycogen synthesis, protein synthesis, intracellular uptake of PO4, K+, Mg2+, B1
--> decreased serum PO4, K+, Mg2+, B1; high Na+, H2O

-Arrhythmia
-CHF
-Seizures
-Wernicke encephalopathy
87. 2yo boy has microcytic anemia; drinks 900mL of cow's milk each day; what additional abnormal findings should we see?: Fe
deficiency from excess cow's milk!
-Fe not bioavailable

Distinguishing factors (from thalassemia)

-increased RBC distribution width
-low Fe + ferritin, high TIBC
-microcytosis + hypochromia (vs. thalassemia- target cells)
*Hb electrophoresis only used to distinguish alpha vs beta thalassemia
88. "Sail sign" on CXR?
-triangular shape
-scalloped border
-uniform density: THYMUS!!!
-visible in kids <3yo on CXR
*normally atrophies, replaced by fat as child matures
89. Previously healthy 13yo comes in with delayed puberty; has been tracking at bottom 5th percentile all his life (from 3yo); parents
are taller than he's projected to be currently; Dx? Next step?: Constitutional growth delay
-drops to bottom at 3yo
-tracks at bottom level until hits puberty (late)
-most common cause of delayed puberty

Next step- followup in 6mo

90. 7yo girl has budding breasts, coarse axillary and pubic hair; high LH levels; grandma and mom both went through puberty at age
9; Next step? Tx?: Central precocious puberty (high LH --> central)

Next step- MRI brain

--> rule out pituitary/hypothalamic tumor

Tx- GnRH agonist

--> maximize adult height
91. 1mo boy has blood-streaked stools for past 24hrs; nurses every 2-3hrs but regurgitates a lot of it up; mom recently completed
antibiotic course for mastitis; infant has diffuse eczema; Dx? Tx?: Milk-induced gastrocolitis!!!
-onset 2-8 weeks
-regurgitation or vomiting
-may have painless bloody stools
-may have eczema

Tx
-remove milk, soy from mom's diet
-hydrolyzed formula in formula-fed babies

*Spontaneously resolves by 1yo

92. Meckel's diverticulum
-cause
-presentation
-tx: Cause- persistence of vitelline duct
*May contain ectopic acid-secreting mucosa

Presentation
-melena (blood stools)
-LUQ pain
-intussusception
-volvulus
-obstruction near terminal ileum

*Less common than milk-induced gastrocolitis

93. 4yo girl has vaginal bleeding, foul-smelling vaginal discharge for 1 week; labia look normal; no fever, abdominal pain, dysuria;
visual inspection shows white foreign body inside vaginal introitus; Dx? Next step?: Vaginal foreign body --> vulvovaginitis!!!
*Most likely toilet paper
-foul-smelling vaginal discharge
-intermittent vaginal spotting
-urinary complaints (sometimes)

Management
-external examination of genitalia
-irrigation with warmed fluid
*NEVER DO BIMANUAL ON PREPUBERTAL CHILD- VERY PAINFUL!!!
94. 8yo with painful, non-itchy rash for past 3 days; no fevers, chills, sore throat, other symptoms; erythematous papules, pustules,
honey-colored crust around mouth, nose, neck; Dx?: Nonbullous impetigo!!!
-honey-colored crust
-not itchy
-no systemic symptoms (fever, cough,

Causes
-S. aureus
-GAS
95. What is eczema herpeticum?: HSV superinfection on top of severe eczema
-rash- progresses rapidly
-fever
96. What is herpangina?: Coxsackie pharyngitis --> painful vesicles or ulcers on soft palate
97. Erysipelas presentation: Small erythematous patch --> red, indurated, tense plaque
Raised, sharply demarcated border
Fever
Regional lymphadenopathy
98. Impetigo vs. erysipelas: Impetigo
-UPPER DERMIS

Erysipelas
-involves DERMAL LYMPHATICS!!!
99. Orchiopexy complications: Subfertility- even if successful, sperm count still suboptimal
Inguinal hernia
Testicular torsion
Testicular cancer- decreases but doesn't eliminate risk
100. 3yo with epiglottitis, blue lips, drooling, inspiratory stridor, tripod positioning, suprasternal retractions; Next step?: 1.
ENDOTRACHEAL TUBATION!!!
2. Antibiotics
101. Larayngomalacia vs. vascular ring: Laryngomalacia
-worse when supine
-better when prone
-INSPIRATORY stridor

Vascular ring = aorta has another piece of skin, chokes trachea

-better when supine
-worse when prone
-INSPIRATORY + EXPIRATORY STRIDOR!!
-improves with neck extension
*Also have esophageal symptoms
-vomiting
-dysphagia
-difficulty feeding
102. 3yo girl with lethargy, fever; hasn't taken fluids in 12hrs, hasn't urinated, 60/20 BP; poor skin turgor, cap refill = 5sec bilaterally;
Dx? Next step?: SEPTIC SHOCK!!!
-Intraosseous cannulation!
*Don't transfer to ICU for central venous cath because it takes too long --> need immediate attention!!!
*Central caths also take longer to place, more skill to place
103. If someone in household gets pertussis, who should get macrolide prophylxis?: ALL CLOSE CONTACTS!!!
-even if already vaccinated (immunity wanes over time)
104. Edwards syndrome presentation: -IUGR
-Microcephaly
-VSD
-Closed with w/ overlapping fingers (2nd over 3rd, 5th over 4th)
-Micrognathia
-Prominent occiput
-Rocker-bottom feet
105. Pathophysiology of coarctation of aorta?
-Complications?: Thickening of tunica media!!
-near junction of ductus arteriosis + aortic arch

Complications
-shock
-prolonged cap refill
-metabolic acidosis
-decreased renal perfusion --> decreased urine output!!!
106. 15-day-old boy has bilious vomiting; no interest in feeding for past 24hrs; normal stools; normal pregnancy + birth; dry mucous
membranes; Dx? Next step?: VOLVULUS!!!
-neonate <1mo
-bilious vomiting
*If have signs of ischemia (bloody stools, bowel perforation, abdominal distention), systemic decompensation, EMERGENCY
LAPAROTOMY!!

Next step- upper GI series

*Ligament of Treitz on R side of abdomen--> MALROTATION!!!
*Contrast in "corkscrew" pattern --> VOLVULUS!!!
107. 5yo boy has fatigue, well until 2wks ago when had URI; poor appetite, lost 2.2lbs in 3 wks; 103F temp, low BP, high HR, high RR;
pale conjunctiva + skin, petechiae on extremities; hepatosplenomegaly; CXR- widened mediastinum; CBC- low Hb, low Hct, low
Plts, high WBC; Dx? Next step?: ALL- acute lymphoblastic leukemia
-most common childhood cancer
-peaks 2-5yo

Presentation
-nonspecific systemic features
-bone pain
-lymphadenopathy
-hepatosplenomegaly
-pallor (anemia)
-petechiae (thrombocytopenia)

Next step- bone marrow biopsy

108. 7yo boy has severe acne, growth, pubic and axillary hair, bone age 2 standard deviations above normal, normal testicular
volume; LH levels low at baseline, don't increase after GnRH stimulation; Dx?: CAH!!! (in boys)
-premature adrenarche/pubarche
-severe cystic acne resistant to treatment
-accelerated linear growth
-advanced bone age
109. Leydig cell tumors presentation: -GnRH-independent precocious puberty
-UNILATERAL TESTICULAR ENLARGEMENT
-OR testicular mass
110. 12hr girl with
-bilious emesis
-abdominal distension
-mom had no prenatal care, used cocaine during pregnancy
-no stool yet
-35wks gestation
-minimal subcutaneous fat
-CXR- triple bubble, gasless colon: JEJUNAL ATRESIA!!!
-bilious emesis
-abdominal distension
-CXR- triple bubble (stomach, duodenum, jejunum), gasless colon (air can't reach there because atresia of jejunum)

Cause
-Vascular incident in utero

Risk Factors
-mom used cocaine, tobacco (vasoconstrictors)
-poor fetal gut perfusion
-
111. CXR finding- pneumotosis intestinalis = extravasation of gas into damaged bowel wall: NECROTIZING ENTEROCOLITIS
112. CXR finding in Hirschsprung's?: Distended loops of bowel
113. 5yo boy has
-3 days fever, sore throat
-nontender cervical lymph nodes palpable bilaterally
-multiple 1mm vesicles on anterior tonsillar pillars
-grayish, ulcerated lesions on posterior pharynx
-no lesions on tongue, lips, buccal mucosa
-grandma has "cold sores"
-supposed to start school in 5 days

Dx?: HERPANGINA = COXSACKIE A VIRUS!!!

-3-10yo
-summer/early fall

Presentation
-Fever
-Pharyngitis
-Gray vesicles/ULCERS on POSTERIOR PHARYNX
114. 3yo boy has 3 days of fever
-painful swelling in R groin
-4 previous episodes of cutaneous abscesses and lung abscesses from S. aureus
-maternal uncle died from recurrent infections
-areas of scarring over drainage sites
-Gram stain of aspirated fluid shows numerous organism-filled neutrophils

Dx? Best test?: CGD!!!

-Recurrent infections in
-lungs (ABSCESSES)
-soft tissue (ABSCESSES/lymphadenitis)

Test
1. Dihydrohordamine blue
2. Nitroblue tetrazolium test
115. Medical options for acute abnormal uterine bleeding?

Common causes?: 1. High dose IV/oral estrogen --> promotes regrowth of endometrium
2. High-dose OCP
3. High-dose progestin
4. Transexamic acid

Common causes
-ovulation dysfunc
*In adolescents, usually immature hypothalamus-pituitary-ovary axis
116. 5yo boy with fatigue, abdominal pain, generalized edema; periorbital edema; 1+ pretibial edema; scrotum swollen, mildly tender;
proteinuria in urinalysis; Dx? Pathophys?: MCD = Minimal Change Disease!
*80% of pediatric nephrotic syndrome cases!!

Pathophys- T-cell-mediated injury to podocytes

117. Infant has
-mild atrophy of L foot
-equinus (can't bend ankle up) + varus (bowlegged) of calcaneum, talus
-varus of midfoot
-adduction of forefoot
-limited dorsiflexion and plantarflexion of ankle

Dx?
Tx?: CLUBFOOT = congenital foot defect (talipes equinovarus)
-equinus + varus of calcaneum, talus
-varus of midfoot
-adduction of forefoot

Dx- Stretching, manipulation, serial casting

*NEED TO START TREATING IMMEDIATELY!!
118. RDS risk factors: -Prematurity
-Maternal DM --> causes fetal hyperglycemia --> fetal hyperinsulinemia --> blocks maturation of sphingomyelin!!
-Male
-Perinatal asphyxia
-C-section without labor
119. Risk factors for childhood constipation?
Tx?: Risk factors
-initiation of solid food
-initiation of cow's milk
-toilet training
-starting school

Tx- oral laxatives

120. Torticollis causes: URI
Minor trauma
Cervical lymphadenitis
Retropharyngeal abscess
Atlantoaxial subluxation
121. 20day girl has jaundice, difficulty feeding, sleepier than usual; 96F; high RR; decreased muscle tone; Dx? Next step?: NEONATAL
SEPSIS!!!!
-temp instability (fever, hypothermia)
-poor feeding
-irritability/lethargy
-jaundice (25-50%)
-respiratory distress (25-50%)
-seizures (25-50%)
-vomiting (25-50%)

Next step- Bacterial cultures + ABX!!!

122. Tx for clavicular fracture in newborn?: NONE!
-resolves spontaneously in 7-10 days
*can maybe pin arm down to decrease movement
123. Newborn girl in delivery room born at 37wks develops respiratory distress; polyhydramnios on prenatal ultrasound; nasal flaring,
grunting, barrel-chest, absent breath sounds on L; heart sounds loudest on R chest; abdomen appears scaphoid; Dx? Next step?:
CDH = Congenital Diaphragmatic Hernia
*Allows abdominal viscera to herniate into chest
-pulmonary hypoplasia
-pulmonary HTN
-85% cases occur on L
-polyhydramnios (from esophageal compression)
-concave abdomen
-barrel-shaped chest

Tx- emergency endotracheal intubation!!

124. 6yo boy has abdominal pain; severe, intermittent abdominal pain; drawing up legs in pain; episodes last 15-20min; appetite
decreased, last bowel movement was 2days ago; had ileocecal intussusception that was reduced with air enema; palpable
cylindrical mass on R side of abdomen; Dx? Cause?: INTUSSUSCEPTION!!
*Likely to recur if have 1st incident

Risk factors
1. Recent gastroenterovirus infection OR rotavirus vaccination
2. Pathological lead points
-Meckel's diverticulum
-Henoch-Scholein purpura
-Celiac
-Intestinal tumor
-Polyps
125. Cause of intussusception in 2yo (very young child)?: Hypertrophied Peyer's patches
126. Cause of inspissated stool?: CF!!
127. 15yo girl comes in for annual exam; normal BMI, good socially; sexually active with 1 boyfriend but takes oral contraceptives
daily; grandfather died of MI; doesn't use tobacco or alcohol; Next step?: Test for Chlamydia, gonorrhea!!
*Test all sexually active women <24yo for these!!
*Cervicitis often asymptomatic --> leads to PID!!!
128. 13yo boy has limp; fell off bike today, BMI = 31; leg rotated externally; decreased range of motion; Dx? Tx?: Slipped capital
femoral epiphysis
-obese patients 10-16yo
-adolescent boys
-endocrinopathies (hypothyroidism, GH def)
-renal failure
-radiation

Tx- immediate surgical screw fixation!!!

129. Impetigo tx?: Topical abx- eg. mupirocin!
130. 7yo has erythema migrans after hiking, malaise + fever; Tx?: Amoxicillin OR Cefuroxime!!

Tx for localized, early Lyme disease (all have equal efficacy)

-Doxycycline = TETRACYCLINE!! --> DON"T USE IN KIDS <8yo!!! (slows bone growth in fetuses, enamel hypoplasia + permanent teeth
stains in kids)
-Amoxicillin
-Cefuroxime
131. 7yo boy fell on outstretched hand; pain in L arm, refuses to move it; L arm swollen, pale, slightly erythematous; radial pulse
intact; gets analgesics but continues to complain of increasing pain; What are you most concerned about? Tx?: COMPARTMENT
SYNDROME!!!

*Supracondylar humerus fractures complications

1. Neurovascular injury
2. Compartment syndrome
-pain
-pallor
-poikilothermia
-paresthesias
-pulselessness
-paralysis

Tx
-Remove bandages
-Measure compartment pressure
-Ortho eval for fasciotomy
132. 15yo girl from China has periorbital and pretibial edema; facial puffiness, fatigue, decreased appetite for past few days; elevated
ALT/AST; 4+ proteinuria; Dx? Further workup?: MEMBRANOUS NEPHROPATHY!!!
-associated with HepB!!!

Further workup
-24hr urine (protein >3)
-Serum C3
-ANA
-Renal biopsy
133. Most common congenital heart defect in Down's babies?: Complete atrioventricular septal defect
-ASD + VSD combined!!

ASD --> systolic ejection murmur

VSD --> holosystolic murmur
134. 16yo boy has 2mo history of L leg pain
-dull, aching pain over L thigh
-worse at night
-improves with ibuprofen
-no trauma, fever, pain in other joints
-pain not related to physical activity
no redness, deformity, tenderness
Dx?: OSTEOID OSTEOMA!!!
*Benign bone-forming tumor that occurs most often in adolescence
-common in males

Symptoms
-nighttime pain
-improves with ibuprofen
-central nidus
135. Difference in sound, management of small + large VSDs in kids?: Small VSDs
-close spontaneously by 2yo in 75% kids
-turbulent sound, grade III/IV

Large VSDs
-need surgical repair
-soft sound!!
136. Most common complications of bronchiolitis (RSV)?: Apnea
Respiratory failure
137. Celiac presentation: -Weight loss
-GI symptoms (vomiting, diarrhea, abdominal pain, flatulence, bloating)
-Fe deficiency anemia (duodenal villous atrophy --> decreased Fe absorption)
-Dermatitis herpetiformis
138. 2yo child had strep pharyngitis 2 weeks ago, treated with full course of antibiotics (amoxicillin); now has R knee pain, refuses to
walk on that leg; knee swollen + tender to palpation; elevated WBC, elevated ESR; Dx? Next step?: SEPTIC ARTHRITIS!!!
-acute onset fever, joint pain
-fatigue, malaise
-refusal to bear weight because of pain

Next step- arthrocentesis (diagnostic + therapeutic)

139. Tx for septic arthritis
-birth --> 3mo
- >3mo: Birth --> 3mo
*Causes
-Staph
-GBS
-Gram (-) bacteria
Tx- Nafcillin or vancomycin AND gentamicin or cefotaxime

>3mo
*Causes
-Staph
-GAS
-S. pneumo
Tx
-Nafcillin
-Clindamycin
-Cefazolin
-Vancomycin
140. 3yo has abdominal swelling, recently had strep pharyngitis treated with abx; firm, nontender, palpable mass on abdomen; Dx?:
WILM'S TUMOR!!
-Asymmetric abdominal mass that doesn't cross midline
*Most common renal malignancy in childhood
*Peak time 2-5yo

Associated syndromes
-WAGR (Wilm's, Aniridia, GU abnormalities, mental Retardation)
-Beckwidth-Widemann
-Denys-Drash
141. 5yo boy with mild fever (101F), L-sided neck swelling; no recent trauma, no sick contacts; dentition normal; Pathogen causing
this?: S. aureus!!
-unilateral cervical lymphadenopathy
142. Baby born to mom who was found to have active HepB infection; Next step?: 1. Give HepB immunoglobulins
2. Give HepB vaccine right after!!
143. 3yo from refugee camp
-hungry all the time
-malnourished with minimal subcutaneous fat
-scaling and fissures at the corners of his mouth
-tongue, oropharyngeal mucous membranes swollen + hyperemic
-erythematous scaly patches on eyebrows, cheeks, nose; extends to scrotal skin, medial aspect of both thighs
-skin, conjunctiva pale
-hair kinky

What vitamin deficiency?: B2 = riboflavin!

-angular cheilosis
-stomatitis = inflammation of mouth, lips
-glossitis
-normocytic anemia
-seborrheic dermatitis
144. Superficial hemangioma aka ...?: Strawberry hemangioma!!!
145. Nevus simplex aka ...?: Stork bite, angel kiss, macular stain, salmon patch
146. When do ASO titers peak?: 1mo after strep infection!
-used to test for rheumatic fever
147. Congenital varicella syndrome: -Limb hypoplasia
-Scarring (dermatomal)
-CATARACTS!!!
148. Best way to prevent long-term morbidity in septic arthritis patient?: Surgically drain hip!!
*Debridement + drainage
149. Treatment levels for asthma?: 1st
-Albuterol (inhaled)
-Mg sulfate (IV)
-Terbutaline (IV)
-Steroids

2nd
-biPAP = positive airway pressure

3rd
-endotracheal intubation
150. Use of racemic epinephrine?: Croup!
151. 14yo girl with irregular periods; gets withdrawal bleed when give oral progesterone; Cause of irregular periods?: Insufficient
GnRH --> not enough LH, FSH for ovulation!
-sometimes have breakthrough bleeds because endometrium needs to shed
152. 12mo baby dehydrated; what do you give them?: 20mL/kg normal saline IV
*Don't use D5 --> not for initial flush (but can use for maintenance fluids)
*1/2, 1/4 saline hypotonic --> don't use for resuscitation
153. Signs of child abuse in burns: 1. Sparing of flexor surfaces!!!
2. Uniform depth, with sharp demarcation of burned/nonburned skin
154. 2yo boy has fever 100.4F, respiratory distress, nasal congestion, muscle aches, grade III/IV heart murmur, liver palpable at 3cm
below costal line; Dx? Tx?: Viral myocarditis
-viral prodrome
-heart failure- dyspnea, syncope, tachycardia, nausea, vomiting, hepatosplenomegaly (from passive congestion of RH failure)
-CXR- cardiomegaly, pulmonary edema

Tx
-Inotropes
-Diuretics
155. 8yo has low grade fever, then persistent cough; occasionally has severe coughing precipitated by eating; doesn't resolve with
antitussive meds; extensive subcutaneous emphysema over anterior chest observed; Next step?: CXR!!!
*Coughing can lead to subcutaneous emphysema = air leaks out from chest wall intoi subcutaneous tissues from high intraalveolar
pressure provoked by cough
*Can also be caused by pneumothorax!! --> so need to rule out pneumothorax!
156. 23mo girl has E. coli UTI; started on antibiotics; fever and abdominal pain resolve; Next step?: Renal + bladder ultrasound!
*Kids <2yo have higher risk of complications
**Only do repeat CBC, urine culture if abx don't work
157. 8yo boy has abdominal pain, dark urine; scleral icterus, abdominal mass in RUQ; ultrasound shows extrahepatic cystic mass; high
direct + indirect bilirubin; amylase normal, lipase high; Dx? Tx?: Biliary cyst
-extrahepatic
-single cystic dilatation of biliary duct
-Classic
-jaundice
-pain
-extrahepatic mass

Tx- surgical excision

158. 2yo has painful limp for 3 weeks; unable to bear weight on that leg; no history of trauma, serious illness; decreased flexion,
internal rotation; muscle strength 4/5 on abduction of R hip; x-ray of pelvis shows dense, contracted R femoral capital
epiphyses; Dx?: Legg-Calve-Perthes!!
-chronic/insidious hip pain
-can't bear weight on that leg
159. Newborn girl has palpable clunk when hip abducted, flexed, lifted forward; Dx? Mechanism of disease?: DHH- developmental
dysplasia of hip
CDH- congenital dislocation of hip

Mechanism
1. Laxity of supporting capsule
2. Abnormal acetabulum
160. 13yo girl has 6wk history of abdominal pain, breast tenderness, weight gain; never had period; normal weight, height; breast,
pubic development are Tanner 3; nontender mass below umbilicus; Next step?: urine hCG
*ALWAYS GET PREGNANCY TEST FOR YOUNG GIRL WITH ABDOMINAL PAIN!!
-even if never had period, not sexually active
*It's a can't miss!!
161. Previously healthy 17yo girl found lying on the street; outside temp was 40F; ECG shows J-wave pattern; temp = 86F, RR =12, BP
= 90/60; odor of ethanol on her breath; Cause of cardiac findings?: J-wave --> HYPOTHERMIA!!!
162. Previously healthy 2mo boy has 3-day history of vomiting; been taking cow's milk-based formula well but vomits after every
feeding; vomiting increasing in amount and force; vomitus = nonbloody, nonbilious undigested formula; infant seems mildly
dehydrated; Labs- low Na, nl K, low Cl, high HCO3-; Dx?: PYLORIC STENOSIS!!!
-hypokalemlic, hypochloremic metabolic acidosis
*Here, not hypokalemic yet, but hypochloremic yes (maybe just takes time to affect K?)
163. 12yo girl with DM1 (diagnosed today) has headache and changed mental status; 3 IV boluses of saline delivered, glucose 800 -->
400; fundoscopic exam shows absence of venous pulsations; most likely cause of patient's altered mental status?: Cerebral
edema
164. 2yo boy has 5-day history of fever (104F), 3/6 systolic murmur at L lower sternal border, splenomegaly; Next step?: Serial blood
cultures

-myocarditis?
-rheumatic fever?
165. 13mo girl has abdominal pain, bloody stools, fever (101F); malaise, fever; no nuchal rigidity; slightly decreased skin turgor; Dx?:
Shigellosis!!
-bloody diarrhea
-fever

*SHIGA TOXIN CAUSES HUS!!!

-hemolytic anemia
-acute kidney failure = uremia
-thrombocytopenia
*Often happens after Shigella, but different syndromes/symptoms
166. 12yo boy recently began to snore loudly; history of URIs, steatorrhea; cause of his new symptoms?: CF --> NASAL POLYPS!!!
167. 11yo boy has 2wk history of fever, headache, yellow-green nasal discharge, nocturnal cough; posterior pharynx covered with thin
gray mucus, erythematous; Dx?: Sinusitis!!!
-yellow-green discharge
168. 2yo boy has 2-day history of fever, persistent cough, abdominal pain; decreased breath sounds at lower lung base; abdomen
shows diffuse tenderness without rebound or guarding; CXR- RLL density; Dx?: Bacterial pneumonia
169. 4yo girl has intermittent muscle cramping over past 2mo; last from few seconds to few minutes; relieved by gentle massaging,
comfort measures; mild developmental motor delay from birth; dad also has similar muscle cramping, esp after lifting heavy
objects; mild distal muscle weakness; difficulty relaxing her fingers after physician grips them; Dx?: Myotonic dystrophy
*NOT CEREBRAL PALSY!

-myotonia
-muscle wasting
-cataracts
-testicular atrophy
-frontal balding
-arrhythmia
170. Aplastic anemia presentation: Fatigue
Malaise
Pallor
Purpura
Mucosal ulcers/bleeding
Petechiae
Infection
171. 16yo boy has high cholesterol, high LDL, obese; family history of HTN, premature CAD, hyperlipidemia; Next step in
management?: Reduced calorie diet!
*Try nonpharmacological before medicine (statin)!
172. 3yo comes in for rapid breathing and cant catch his breath. pulse = 100, RR = 30, BP=120/80. lungs clear. slight hyperresonance
on right chest. decreased breatah sounds on right. x-ray shows slight overexpansion of right lung compared with left. no
infiltrates or effusions. Best management?
a. hyperbaric Oxygen
b. CT of chest
c. bronchoscopy
d. Thoracotomy (Wrong)
e. Tube thoracostomy: PNEUMOTHORAX --> TUBE THORACOSTOMY!!!
173. 3yo girl on trimethoprim-sulfamethotrate for UTI prophylaxis; has low WBC (low neutrophils); cause for neutropenia?: BACTRIM -
-> NEUTROPENIA!!
-inhibits DNA synthesis
174. Kallman's syndrome heritability?: XR!
175. 2yo boy has 2day history of fever, facial swelling; initially had R earache, then developed pain in his R and L cheeks with
overlying swelling; had 2 episodes of otitis media as a child, croup last year; tympanic membranes flat, gray, immobile to
inflation; Dx? Most at risk for what?: MUMPS!!
-parotitis
-aseptic meningitis
-orchitis
-school-age kids

*Most at risk for aseptic meningitis!

176. 6mo boy has progressive facial rash that starts from eyebrows, go to scalp; not painful or pruritic; mom started using mild,
unscented shampoo and that made it better; yellow-greasy appearance; Dx?: Seborrheic Dermatitis
-yellow, greasy scales
-scalp, face, umbilicus, diaper area
-associated with Malassezia
177. 4mo infant has progressive lethargy, poor feeding, fatigue, increasing pallor over past month; diet = mostly breastmilk; webbed
neck, cleft lip, shield chest, triphalangeal thumbs, pale mucus membranes + conjunctivae; low Hb, low Hct, low retics; Dx? Tx?:
Diamond-Blackfan anemia = congenital hypoplastic anemia
*Intrinsic defect of erythroid progenitor cells --> increased apoptosis!
-1st year of life (usually)
-macrocytic anemia
-low retic count
-congenital abnormalities
-triphalangeal thumb
-cleft lip
-webbed neck
-shield chest

Tx
-corticosteroids
-transfusion if unresponsive to steroids
178. When is having imaginary friends normal?: 3-6yo
179. Waterhouse-Friedreich syndrome pathophys?: Adrenal GLAND failure!!!
-NOT RENAL FAILURE!!! ><
180. 15yo girl with confusion, rapid breathing, abdominal pain; developed dry cough, runny nose, fever 3 days ago; now has urinary
frequency, somnolence, progressive fatigue; dry mucus membranes, abdominal tenderness without rebound; Dx? What's
elevated? What's decreased?: DKA!!

Elevated
-liver gluconeogenesis
-RAAS system because of decreased body volumes (this drives out K!!)
-solute excretion
-increased free fatty acids (because increase in glucagon: insulin ratio)

Decreased- total body K stores (insulin drives K in; without insulin, K comes out)
181. Gold standard diagnostic test for DMD?: Genetic testing!!
*NOT MUSCLE BIOPSY!! (Could look like Becker's Dystrophy)
182. 3yo girl has UTI; 3 UTIs in past; has history of constipation after starting cow's milk at 1yo; exam shows suprapubic tenderness,
anal fissures, normal anal wink and tone, hard stool palpated in rectal vault; culture shows 100,000 colonies of E. coli; most
likely mechanism of UTI?: Constipation --> urinary stasis --> UTI!!
*sits on urethra, doesn't let urine out!

Complications
-anal fissures
-hemorrhoids
-encopresis = involuntary defecation
-enuresis/UTIs
-vomiting
183. 9mo boy has lethargy, tachypnea; started having fever and vomiting 4 days ago; lost 1.4lbs since last visit 2 weeks ago; only had
1 wet diaper in past 24hrs; high Na, high Cl, low HCO3-, high BUN; Dx? Next step?: Hypovolemic hypernatremia
*Renal losses
-diuretic use
-glycosuria
*Extrarenal losses
-Diarrhea
-increased sweating

*Next step = resuscitate with 0.9% saline!

ALWAYS resuscitate/stabilize with isotonic saline!!!
-never use hypotonic- need to SLOWLY return Na to normal
184. 3week old boy born at 28wks; has increased gastric residual volume and vomiting; has been advancing on nasogastric feeds,
gaining 30g/day; lethargic neonate with abdominal distension; what should we see on CXR?: NEC!!!
Causes
1. Gut immaturity
2. Exposure to bacteria from enteral feeds
--> damage to bowel wall, inflammation

CXR
1. Air in bowel wall = "double-line"/"train-track" = pneumatosis intestinalis
2. Portal venous air = linear, branching areas of lucency over liver (bacteria in portal veins make gas OR transmigration of gas from
bowel wall --> mesenterium veins)
185. Tx for intussusception?: Air enema --> pressure reduces obstructions
186. Technieticum-99m pertechnate scan used for what?: Meckel's diverticum!!
187. 4yo boy still has bedwetting; next step?: Reassurance!
*Only prescribe bedwetting alarm if >5yo (pathologic at that point)
188. 13yo has intermittent L knee pain that started 3mo ago, no trauma to knee, worse after basketball games; some relief with
NSAIDs; edema and tenderness over proximal tibia at site of patellar tendon insertion, no effusion; knee pain reproducible by
extending knee against resistance; Dx? Tx?: Traction Apophysis = Osgood-Schlater
-13-14yo in M, 10-11yo in F
-Quads tendon puts traction on apophysis where patellar tendon inserts
-pain when extend knee against resistance

Tx
-Reduce activity
-Stretching exercises
-NSAIDs
189. Most common cause of acute, unilateral cervical lymphadenopathy?: Bacterial --> S. aureus!!

*EBV = bilateral
190. 11yo boy with sickle cell disease has SOB, weakness, fatigue over past 3 days; no fever, cough, chest pain; many prior
hospitalizations for acute pain, one hospitalization for acute chest syndrome; pale, tired-looking boy with III/IV systolic murmur
throughout pericordium; abdomen soft and nontender with no palpable spleen or liver; low Hb, low retics; Dx?: APLASTIC
CRISIS!!!
*transient erythropoietic arrest
*2ndary to infection (parvovirus B19)
-not same thing as aplastic anemia (all cell lines down)
191. Most common complications of sickle cell trait?: 1. Hematuria (sickling in renal medulla --> impaired renal function)
2. Isosthenuria = decreased ability to concentrate urine
-nocturia
-polyluria
3. Increased UTIs, especially in pregnancy
192. How do we time vaccines, according to chronological or gestational age?: CHRONOLOGICAL AGE!!
*Exception- weight should be >2kg for HepB
193. 4yo girl has painful inguinal swelling in groin; started 2 weeks ago, gradually become red and tender; attends school 3x/wk,
returned from family trip to China 2 weeks ago; has cat, 2 dogs, turtle; small, nontender papule on anterior L thigh; 4cm, tender,
soft, freely mobile L inguinal lymph node with overlying erythema; Pathogen?: Bartonella
194. Reservoir for rabies?
Tx for rabies?: BATS!!! (most common)
*Also raccoons, skunks, foxes

Tx
1. Soap + water
2. Rabies immunoglobulin
3. Rabies vaccine
195. 13yo girl from China has heart murmur; 1 yr ago, had sore throat, joint pain and swelling; has loud 1st heart sound and mid-
diastolic rumble at apex; didn't have murmur 2yrs ago; Dx? Tx/: Rheumatic fever with carditis

Penicillin!!
196. 15yo boy has sudden difficulty breathing, nausea, colicky pain, swollen face; suffered from bronchitis 4 yrs ago; PE- edematous
swelling of face including lips, hands, arms, legs, genitals; this happened last time when he had a tooth extracted; cause?: C1-
inhibitor deficiency --> HEREDITARY ANGIOEDEMA!!!

*noninflammatory edema of face, limbs, genitalia

*NO HIVES!!

*Triggers
-dental procedures
-infection
-trauma
197. 12yo boy has several month history of back pain; recent bedwetting; 98F, 110/60, PE- palpable "step-off" in lumbosacral area,
decreased perianal pinprick sensation; Dx?: Spondylolisthesis = 1 vertebrae slips over another
-palpable step-off in back!!
198. 6yo girl with 10day history of thick, purulent nasal discharge, nasal congestion, cough; yellow, purulent mucus all over posterior
nasopharynx; maxillary sinuses tender to palpation; bilateral expiratory wheezes in lungs; Dx? Bug that causes this?: Acute
bacterial rhinosinusitis
-S. pneumo- 30%
-H. flu- 30%
-Moraxella- 10%

*Persistent symptoms for 10days without improvement

OR severe symptoms, fever, nasal discharge, face pain for >3 days
OR worsening symptoms after initially improving from viral illness >5days
199. What causes tet spell (physiologically)?
What does knee-chest do (physiologically)?: Tet spell- agitation/exertion --> infundibular spasm (in lung track) --> increased
pulmonary vascular resistance --> increased RVOT occlusion --> blood shunts into aorta

Knee-chest --> increased systemic vascular resistance --> increased RV blood into pulmonary circulation
200. 18yo woman comes in for fever, throat pain, malaise for 3 days; pain with swallowing, erythematous tonsils that are 3+ bilaterally
with exudates, diffuse bilateral cervical lymphadenopathy; polymorphous, maculopapular rash across body; Dx?: EBV!!!
-can have maculopapular rash!!!!
201. 6yo with abdominal pain, hematuria, joint pain, lower-extremity purpura; Dx?: Henoch-Scholein purpura!
202. Goodpasture's syndrome features: Pulmonary hemorrhage
Glomerulonephritis
203. Vocal cord paralysis associated with: 1. Birth trauma
2. CNS insults
204. 4wk old, full term baby has vomiting; always had spit-up but not more forceful emesis; emesis is nonbilious and nonbloody;
excellent appetite, always seems hungry; sunken anterior fontanelle, decreased skin turgor; abdomen soft, nondistended; Dx?:
PYLORIC STENOSIS!!!
-olive mass only palpable in <50% of patients!!
-abdomen soft, nondistended because minimal air can pass through!
205. 4yo boy has fever, pain, rhinorrhea, nasal congestion, sore throat for past week; developed fever, neck pain in past day; can't
eat or drink because painful to swallow, drooling because painful to swallow saliva; vaccinations up to date; tired and
uncomfortable; bilateral cervical lymphadenopathy, can't extend neck but can flex neck laterally; bilateral tonsillar exudates; XR
shows widened prevertebral space but no other abnormalities; Dx?: Retropharyngeal abscess
-fever
-odynophagia/dysphagia
-drooling
-neck stiffness with EXTENSION
-muffled voice
-trismus = can't open mouth completely
-widened prevertebral space
206. Ringworm
-presentation
-Tx: Presentation
-Round
-Scaly
-Erythematous
-Patch
-Centrifugal spread
-Central clearing with raised borders

Tx
1. 1st line= topical antifungals
-clotrimazole
-terbinafine
2. 2nd line = oral antifungals
-terbinafine
-griseofulvin
207. 13day full term boy has mild swelling of eyelids with conjunctival injection, mucupurulent discharge; Tx?: ORAL erythromycin!!!
*topical only used for prophylaxis against GONOCOCCAL conjunctivitis
208. 5.5lb newborn born at 37 weeks to HIV-positive woman who didn't take any meds during pregnancy; newborn tested to be
HIV-positive; what regimen should they be started on?: 6-week course of AZT (zidovudine) within 12 hours!!!

*NOT triple antiretrovirals within 24hrs!!

209. 8yo boy has a murmur; no cyanosis, decreased exercise tolerance, rheumatic fever; split S1 widens with inspiration; PE-
pronounced sinus bradycardia, low-pitched vibratory murmur heard throughout cardiac cycle- disappears when child in supine
position and when head rotated in sitting position; Dx?: VENOUS HUM
*benign
*when blood flows through internal jugular veins
--> makes vein walls vibrate --> humming noises
*cuts off when turn head to side
210. 12 month-old African American girl with sickle cell disease is brought to the emergency department because of the sudden
onset of high fever, irritability, and tachypnea 6 hours ago. Her diet consists of iron-fortified formula and pureed fruits and
vegetables. Her mother states that she only misses an occasional dose of her penicillin prophylaxis. She appears ill. Her
temperature is 39°C (102.2°F), pulse is 180/min, and respirations are 48/min. Examination shows conjunctival pallor. A grade 2/6
systolic murmur is heard best at the left sternal border. Laboratory studies show a hematocrit of 23%, leukocyte count of
23,000/mm3, and platelet count of 250,000/mm3. The most appropriate initial step in management is administration of which of
the following?"

Oral penicillin
Intravenous cefotaxime
Intravenous corticosteroids
Intravenous immune globulin
Intravenous nafcillin
Intravenous penicillin: IV Cefotaxime --> BROAD SPECTRUM!!
211. Newborn has decreased urinary output, urinary dribbling; PE- 6cm, round, midline, suprapubic pelvic mass palpated; normal labs;
Cause of oliguria?: Posterior urethral valves!!
*Tissue blocking urethra in bladder!!! --> oliguria --> POTTER SYNDROME!
212. A 17-year-old girl comes for a precollege physical examination. She is not sexually active. Her menses occur at regular 28-day
intervals. She has smoked one-half pack of cigarettes daily for 3 years and drinks 1 oz of alcohol weekly. Her 50-year-old
mother was diagnosed with breast cancer 1 year ago. Her father and grandfather died of heart disease during their 30s. Her
blood pressure is 130/70 mm Hg while sitting. Which of the following is the most appropriate screening test?"

Serum lipid studies

UA (wrong)
Mammo
CXR
Stress Test: SERUM LIPID PANEL!!!
*Ffamilial hyperhcolesterolemia = early heart disease!!
213. 16 yo boy. 3-d hx pain and press left cheek. Hx S. pneumo 6 and 10 yrs and X2 sinusitis past 2 yrs. T-100.5 F. P-88, RR-20,
Bilateral tender maxillary sinuses and boggy turbinates. Sputum H. influenzae+. Cause infections?
A-Combined deficiency
B-Complement
C-cell-med immunity
D-chemotaxis.
E-humoral immunity: Humoral immunity.
*CMI? --> bronchiectasis, sinopulmonary disease?
214. A 2-year-old boy has a 5-day fever of up to 104 F. He appears ill. Temp = 102.2 F, pulse = 130, BP = 90/60.Has had recurrent
thrush and diarrhea, failure to thrive, hepatosplenomegaly present; CXR- diffuse interstitial infiltrates
-sputum cultures
-blood cultures
-VDRL
-silver stain of bronchoalveolar fluid
-CT scan of chest: BLOOD CULTURES!!!
-likely HIV/SCID --> need to be concerned about bacteremia!!
-blood more important than throat cultures!!
215. 3yo boy has anorexia, irritability, decreased play activity, decreased concentration, sporadic vomiting; microcytic, hypochromatic
anemia; Dx?: Pb poisoning!!! --> neuro symptoms!
216. 9mo child can only sit up with support; can bang 2 blocks together but doesn't scribble; says "mama", "dada" but not specifically
to parents; Gross motor, fine motor, speech development?: Gross- delayed (should be able to sit up by 6mo, walk with assistance
at 9mo)
Fine- normal
Speech- normal
217. 16mo girl with Down's has polycythemia; Hb = 16.8; mild/moderate cyanosis, digital clubbing; S2 increased in intensity; large VSD,
dilated main pulmonary artery; Cause of polycythemia?: Eisenmenger's --> PULMONARY HTN!!! --> need more RBCs to
218. Previously healthy 16 yo boy comes to doctor 6 hours after onset of fever and right foot pain. He ahs a 1 week Hx of
progressive itching rash that started between 2nd and 3rd toes of both feet. Has an active lifestyle and plays baseball and
football. Temp 101.1. Exam of right foor shows erythema and induration from the interdigital spaces to the medial malleoulus.
Exam of left foot shows dry scaly skin between toes. A tender lymph node is palpated in right side of groin. Which organism is
most likely?
A) E. coli
B) Mycobacterium tuberculosis
C) Pseudomonas aeruginosa
D) Staph aureus
E) T. rubrum: Tinea pedis (athlete's foot)/trichophyton rubrum --> break in skin --> S. aureus superinfection!!!
219. TdT = marker for what kind of cells?: Pre B, T-lymphocytes!
220. Peroxidase positive material = marker for what kind of cells?: Myeloblasts!
221. When do we do gonadectomy for complete androgen insensitivity?: AFTER puberty
*Keep gonads until then so can reach maximal height (and risk of dysgerminoma = 1-5%)
222. Where are VSDs best heard>: TRICUSPID valve area
223. PE findings in PDA?: Mildly accentuated peripheral pulses
224. Williams syndrome cardiac defects?: Supravalvular aortic stenosis
Pulmonary stenosis
Septal defects
225. Complication for frequent transfusions in sickle cell patients?: Fe toxicity!!
Tx- Fe chelators (eg. deferoxamine)
226. Panner's disease
-mechanism
-risk factor
-presentation: Osteochondrosis of capitellum

Risks
-athletes engaged in throwing sports

Presentation
-chronic dull pain
-crepitation
-loss of pronation, supination
227. Systemic carnitine deficiency
-mechanism
-presentation: *Inherited defect in fatty acid oxidation
-hypoglycemia
-hyperammonia
-acute encephalopathy episodes
-increased acyl-carnitine levels!!
228. 7yo boy has bleeding gums, easy fatigability, pounding sensation in ears, 5th percentile for height, 25th percentile for weight,
thumbs slightly bent, areas of hypopigmentation in skin; low WBCs, low RBCs, low plts; Dx?: Fanconi anemia = DNA repair defect
-aplastic anemia
-progressive bone marrow failure
-short
-microcephaly
-abnormal thumbs
-hypogonadism
-hypo/hyperpigmentation
-cafe au lait spots
-large freckles
-strabismus
-low-set ears
-middle ear abnormalities (hemorrhage, incomplete development, chronic infections, deafness)
229. When does Babinski disappear in kids?: 12mo-2yo
*primitive reflexes disappear cephalic --> caudal, proximal --> distal
230. 9mo African-American baby has swelling of hands and feet, poor feeding, fussiness, 101F, pale; PE- dorsal sides of hands and
feet are swollen + tender, with restricted range of motion; radiography shows soft tissue swelling; Dx?: VASOOCCLUSIVE
CRISIS!!
*Hand-foot syndrome = dactylitis
--> swelling of dorsal hands, feet
231. Newborn boy 3rd percentile for weight, 5th percentile height, 50th percentile head circumference, hepatosplenomegaly; mom
received no prenatal care but had no pregnancy complications; over next 48 hrs, develops jaundice, rhinorrhea, maculopapular
rash on feet and buttocks that desquamates; Infected with what?: SYPHILIS!!!
-rhinorrhea
-abnormal long-bone x-rays
-desquamating, bullous rash
232. What do you do when mom refuses vaccinations for kids even after you explain risks and benefits?: Document in chart that you
explained risks/benefits
*Can't force them to get vaccinated, also don't report to public health department
233. 4mo boy has FTT, recurrent diarrhea, poor weight gain, pneumonia that reveals PCP; WBC = 18000, 50% neutrophils, 40%
lymphocytes; Dx?: HIV!!!
-normal lymphocyte number, but low CD4+ count

*SCID- very very low lymphocytes

234. 5mo girl has poor weight gain even though consistently increasing caloric intake in formula; no diarrhea or vomiting; family
history of nephrolithiasis; hypokalemia, hyperchloremia; low serum pH, low serum CO2, low serum HCO3-, alkalotic urine; Dx?:
Type 1 Renal Tubular Acidosis!!
-failure to thrive (poor cellular growth and division in acidic environments)
-low serum bicarb
-hyperchloremia --> normal anion gap acidosis!
235. 15yo boy with L shoulder pain, swelling for past 3mo, getting progressively worse; no fever, night sweats, chills, weight loss; lifts
weights, plays basketball 5 days/wk; taken NSAIDs but no relief; PE- tender mass at L proximal arm; labs- elevated alk phos,
ESR, lactase dehydrogenase; Dx?: Osteosarcoma!
-often have no constitutional symptoms
-ages 13-16
-metaphysis of long bones like distal femur, proximal tibia, proximal humerus
236. Complications of SGA (small for gestational age)?: Hypoxia
Perinatal asphyxia
Meconium aspiration
Hypothermia
Hypoglycemia
Hypocalcemia
Polycythemia (hypoxia --> increased EPO)
237. 8yo girl has history of bone fractures, moon facies, pubic hair, raised breast areolas, 2 light-brown spots with irregular contours;
Dx?: McCune-Albright = defect in G-protein cAMP kinase
-precocious puberty
-cafe au lait
-multiple bone deformities (polyostotic fibrous dysplasia)
*May have Cushing symptoms from adrenal hypercortisolism (cAMP activates ACTH too!)
238. 3wk infant with hypoplastic L heart syndrome has difficulty feeding, 1 episode of vomiting 24hrs after cardiac surgery; had
palliative heart surgery shortly after birth; cyanotic, small for his age, muffled heart sounds; Dx?: Pericardial effusion --> cardiac
tamponade!!
-Pleuropericardial disease that occurs days to months after cardiac surgery or injury

CXR
-cardiomegaly (increased pericardial fluid)
-pleural effusion
239. Beck's triad: Distant heart sounds
Distended jugular veins (or scalp veins in infants)
Hypotension
240. 10yo boy has sudden-onset nausea, vomiting, abdominal pain over last 2 hrs; ate barbequed chicken and potato salad at
community lunch 4hrs before; also swam in community pool and played with pet turtles; What bug responsible?: S. AUREUS!!!
-food poisoning!!! --> VOMITING!!

*Salmonella causes DIARRHEA not vomiting!!

241. 6yo female with Down's has been refusing to do her normal activities; feels dizzy, has urinary incontinence; PE- hypotonic,
hyperreflexic, positive Babinski's, ataxic gait; Dx? Cause? Presentation? Tx?: Atlanto-axial instability
*Increased laxity in posterior transverse ligament --> increased mobility between C1, C2
*10-15% of Down's patients!

Presentation
-behavioral changes
-torticollis
-urinary incontinence
-vertebrobasilar symptoms (vertigo, dizziness, diplopia)
-UMN (leg spasticity, hyperreflexia, positive Babinski, clonus)

Tx
-Surgical fusion of C1 to C2
242. 15yo boy has hematuria, lower abdominal pain, mild bilateral sensorineural hearing loss; urinalysis- hematuria, proteinuria; labs-
BUN = 50, Cr = 3.1, normal serum complement; renal biopsy- foam cells; EM- alternating areas of thinned and thickened capillary
loops with wire splitting of GBM; Dx?: ALPORT'S!!!
*Can't see, can't pee, can't hear a bee
-sensorineural hearing loss
-nephritic syndrome
-alternating areas of thin, thick capillary loops with GBM splitting
243. 6yo boy comes in with sudden appearance of "pinpoint" bruises throughout body; recently had URI that resolved; cooperative,
well-appearing boy with scattered petechiae over trunk and extremities; normal Hb, low plts, normal WBCs; Dx? Tx?: ITP!!!
*Only skin manifestations, well-appearing --> observe!!
244. 16yo girl has fever, joint pain, rash that started on her face and spread down her body; 1 male partner, uses condoms
intermittently; hasn't received many vaccinations; blanching, erythematous maculopapular rash that spares palms, soles;
posterior auricular, suboccipital lymphadenopathy present; Dx?: Rubella!!
*adults- same presentation in kids + arthralgias/arthritis
245. Lab findings in hereditary spherocytosis?: High MCHC
Spherocytes
Negative Coombs
Increased osmotic fragility on acidified glycerol lysis test
Abnl eosin-5-maleimide binding test
246. 1yo girl with Turner's has pedal edema; Mechanism of edema formation?: Dysgenesis of lymphatic system
*If severe, turns into cystic hygroma!!!
247. Hydrocele tx?: Reassurance + observation
*Most resolve by 12mo
248. 9yo African American boy has high fever, irritability, poor appetite; hospitalized several times before for poorly localized
abdominal pain; hasn't had routine vaccinations; history of hematuria; Hct = 22%, retics = 12%; dies several hours after admission;
what could have prevented death?: Vaccine with conjugated capsular polysaccharide
*Sickle cell patient! More at risk for
-S. pneumo
-H. flu
-N. meningitidis
249. When do we supplement breastmilk with formula?: When lose >7% birth weight!
250. When do we see uric acid crystals?: Common after birth --> NORMAL!!! (NOT SIGN OF DEHYDRATION!!!)
*esp high at birth, decreases until adolescence
-when mom's milk 1st coming in
-in later months with morning void when infant starts to sleep through night
251. 5yo with battery stuck in esophagus; Next step in management?: Endoscopic removal!
*If distal to esophagus, observe, should pass by itself into stool
*Don't blindly push battery further into GI tract
*Don't induce emesis- causes mucosal damage, ulceration
252. 6yo boy has purulent nasal discharge, fever, epistaxis; has had daily fever and nasal discharge for past 10 days; easy bruising for
past 2mo, recurrent pulmonary infections requiring hospitalization for parenteral abx therapy; positive sweat chloride testing;
Which clotting factor likely to be low?: CF --> ADEK deficiency --> Vitamin K deficiency --> lose Factors 2, 7, 9, 10, C, S!!!
253. Cause of pneumonia in CF
- <20yo
- >20yo: <20yo --> S. AUREUS!!! (DON"T FORGET THIS!!!)
>20yo --> Pseudomonas
254. Coffee bean sign indicates...?: Sigmoid colon --> torsion of sigmoid colon
-abdominal pain
-distension
-constipation
-elderly patients
255. 4mo boy has poor feeding secondary to macroglossia, hypoglycemia, 99th percentile for weight/height/head circumference;
enlarged tongue, reducible umbilical hernia; R upper and lower extremities significantly larger than L; Next step in
management?: Abdominal ultrasound!!

BECKWITH-WIEDEMANN!!
-fetal macrosomia
-omphalocele OR umbilical hernia
-macroglossia
-hemihyperplasia = half of body bigger than other half
*Complications
-Wilms tumor
-Hepatoblastoma

Surveillance
-AFP
-Abdominal/renal ultrasound
256. 14day boy has spasms of whole body; poor suckling over past few days; mom never sought pre or antenatal care; swollen,
erythematous umbilical cord; Dx?: Neonatal tetanus!!
-1st 2 weeks of life
-poor suckling
-fatigue
-rigidity
-spasms
-opisthotonus = spasms of muscles --> backward arching of head, neck, spine
*UMBILICAL STUMP INFECTION!!!
-cultural practices- putting cow dung on umbilical cord
-inadequate postnatal care
257. 14yo boy comes in with fever, nasal discharge; incidental urinalysis shows 2+ proteinuria but no hematuria, pyruria, active urine
sediment; serum Cr within normal limits; Next step in management?: Repeat urine testing on 2 separate occasions!

*Urine protein can be positive in 10% of tests- can be orthostatic, intermittent/transient, persistent
*Orthostatic common in teenage boys
*Checking serum albumin useless because even if have nephrotic syndrome, many PTs have normal serum albumin
258. Mono symptoms: Fever
Cervical lymphadenopathy
Pharyngitis
Hepatosplenomegaly (sometimes)
259. Breastfeeding reduces risk of what kinds of cancer in mom?: Breast
Ovarian

*NOT ENDOMETRIAL!!
260. 5yo girl has congestion, fever, rhinorrhea that started 10 days ago, purulent nasal discharge, dry cough that worsens at night,
dripping in posterior pharynx, mild L cheek swelling; Most common predisposing factor?: Viral URI --> BACTERIAL SINUSITIS
-nasal drainage
-congestion
-cough
-10-30 days without improvement
261. 6yo girl with bloody diarrhea, pallor, decreased E, "spots" over arms and legs that developed over past 2 days; no fever,
vomiting, joint pain; swollen face and extremities; poor skin turgor; high Cr, high indirect bili, low plts; UA- WBCs- 50+, RBCs- 20-
30, hyaline casts; Dx?: HUS!!!
*Has high Cr, hematuria, proteinuria, casts, high bili
*Oliguria

*NOT HSP!! (doesn't have bloody diarrhea)

262. 12yo previously healthy girl has hair loss on scalp, itchy, just switched to new school and anxious about new teachers and
friends; lymphadenopathy in posterior auricular and occipital lymph nodes; Dx?: Tinea capitis!!
-can have lymphadenopathy!!
263. Most common cause of viral meningitis?: ECHOVIRUS!!
*Enteroviruses
264. 7wk boy born at 32wks; pale, low Hb, low Hct; normochromic, normocytic RBCs on peripheral smear; Dx?: Anemia of prematurity
-low Hb
-low Hct
-low retics
-normochromic, normocytic RBCs
265. 3yo boy exposed another child with chickenpox; 3yo boy's mom is pregnancy and is immune to VZV; Next step in management
of patient?: Give VZV vaccine!
*Varicella immunity develops after 2 doses of vaccine (1yo, 4yo)
-if incomplete immunity, give vaccine!!
*VZV Igs only for immunocompromised!
266. Colic definition: Crying for >3hrs, >3x/week, duration of >3wks
*usually at night
267. Heinz bodies seen in ???: G6PD
*Hb precipitation (oxidation of SH-Hb groups)
268. Howell-Jowell bodies seen in: Splenectomy
269. EKG findings for tricuspid atresia?: L axis deviation
Tall, peaked T-waves
Minimal R-waves
*Cyanotic infant!
270. NAS baby symptoms: Irritable
Poor feeding
Vomiting, diarrhea
Sneezing
Tachycardia
*No dysmorphic features
271. 16yo with R knee swelling, mild associated pain and fatigue, fatigue with flu-like symptoms and variable joint pain; spent summer
in camp in Maine, sexually active with girlfriend; knee aspiration- yellow, translucent fluid with 20,000 WBC (50% lymphocytes),
no organisms on Gram stain; Dx?: LYME DZ!!!
-fatigue
-malaise
-migratory arthralgias
272. Genetic defect in Prader-Willi: Usually maternal gene silenced, paternal expressed
*Here, paternal gene LOST (deleted/mutated)
273. Genetic defect in Beckwith-Wiedemann Syndrome : dysregulation of imprinted gene on 11p15
274. 11mo African-American boy has open anterior fontanelle, pliable skull bones without step-offs, bony prominences of ribs, genu
varum; Dx?: RICKETS!!!
-genu varum
-craniotabes = ping-pong ball skukll
-delayed fontanelle closure
-increased
-skull size
-costochondral wrists
-long-bone joints
275. Triad of
-sudden death
-sensorineural hearing loss
-QT prolongation: Jervell-Lange-Nielson Syndrome
276. Tx for QT prolongation
-hypocalcemia
-hypokalemia
-hypomagnesemia
-Jervell-Lange-Nielson
-Romano-Ward: Propranolol + pacemaker
277. If asplenic, at risk for which organisms?: Please SHINE my SKiS
-Pseudomonas
-S. pneumo
-H. flu type B
-N. meningitidis
-E. coli
-Salmonella
-Klebsiella
-group B Streptococci
278. HSP vs HUS petechiae difference?: HSP- PALPABLE petechiae
*Vasculitis tends to be palpable

HUS- non-palpable?
279. Behcet syndrome triad?: *Small vessel vasculitis
-Oral aphthous ulcers
-Genital ulcers
-Uveitis
280. 9 yr old with bowing of her right leg - right knee bowed outward on walking; no warmth, erythema, swelling; began walking at
10mo, 95th percentile for weight, 10th percentile for height. X ray of pt standing shows collapse of the medial aspect of the
metaphysis of the proximal tibia: Tibia vara = Blount's disease
*Weight on growth plate --> inner part of tibia fails to develop normally --> bone angulation
-Early walking
-Asymmetric leg bowing
-Heavy kid, short
-African-American
281. 3mo boy has fever, irritability, urine culture shows over 100,000 colonies of E. coli; Abx treatment begun; Next step?: Renal
ultrasound!
282. 2yo boy has infections with H. flu, S. pneumo, GBS septicemia; elevated WBC of 34,000, normal percentages; brother + 3 uncles
died in infancy of septicemia; Dx?: COMPLEMENT DEFICIENCY --> infections with encapsulated bacteria!!
*C3b activates macrophages in spleen to eat up bacteria
283. 18 mo boy. 4 hrs after lethargy. Intermit ab pain 24 hrs. Mass in RLQ. BS decreased. Stool red, occult blood+. X-ray shows no air
in ab in ascend or transverse colon. Next step? A-air-contrast enema B-upper GI series C-Meckel scan D-Upper endoscopy E-
laparotomy: Intussusception!!
-Sudden-onset, intermittent ,severe, crampy, progressive abdominal pain
-A sausage-shaped abdominal mass may be felt in the right side of the abomden.
-70% have stool that contains gross or occult blood.

Next step = Air-contrast enema

284. 18hr female has jaundice; born at term; mom O+; newborn urinated twice but has no bowel movements; urine dark yellow;
difficulty latching onto breast; liver edge 1cm below costal margin; spleen tip 1cm below costal margin; Total bili = 11.1, direct bili
= 0.1; Most likely diagnosis?
-Breast-milk jaundice
-Galactosemia
-Hemolytic disease of newborn
-Physiological jaundice of newborn
-Sickle cell disease: Hemolytic disease of newborn
285. 2 yo girl with 2wk history of irritability, poor appetite, occasional cough, refusal to walk, -4.4lb wgt loss in 6 mo. T100.2F P140
R24 BP145/100. Bluish under eyelids. Hgb10.5; other labs normal; Mass in posterior mediastinum. Dx?
A-Anthrax
B-congenital heart dis
C-CF
D-dermatomyositis
E-neuroblastoma
F-Pulm sequest G-thymoma
H-tuberculosis: Neuroblastoma!!
-1-2yo
-skin lesions/nodules with blue/purple patches
-mass in abdomen, chest, neck, pelvis
286. Still's murmur: Benign
-systolic
-vibratory + musical
-L lower sternal border
287. Most likely prognosis for PSGN?: Full recovery with no renal sequelae
288. How to diagnose asthma?: Tests
1. Spirometry
2. Methacholine challenge
289. 7yo boy has 1wk history of fever, fatigue; 3-day history of rash, moderate pain + swelling of ankles; rash 1st appeared on ankles,
then spread to legs; palpable petechiae on legs; ankles swollen, mildly tender; Dx?: Henoch-Scholein purpura!!
*palpable petechiae = vasculitis!
290. Reiter's syndrome
-causes?: Syndrome
-can't see (uveitis)
-can't pee (dysuria)
-can't climb a tree (joint pain)

Causes
-Chlamydia
-Shigella
-Salmonella
-Yersinia
-Campylobacter
291. 15yo boy has well-controlled DM1, worried about getting hypoglycemic during intense basketball practice; Solution?: Decrease
insulin dosage by 10-15% only on practice days
292. When should infants be able to sleep through the night?: 4mo
293. child with 3mo rash on cheeks --> eczema; Tx?: Vaseline
294. Cow's milk colitis tx?: Protein-hydrolyzed formula
295. More common after erythromycin use in 1st 2 weeks of life?: Pyloric stenosis!
296. 8yo previously healthy boy with 3wk history of fever of unknown source, fatigue, wt. loss, myalgia, headaches, heart murmur,j
petechiae, mild splenomegaly; Dx?: Endocarditis
*Causes
-dental work
-IV/needle use
-
297. 12yo girl has 1wk history of sore throat that's unrelenting; 6 days ago, developed mild rash, pharyngitis, fever, vomiting, remained
intermittently febrile and now having more difficulty swallowing; asymmetry of palate; muffled voice and malodorous breath;
Dx?: Peritonsillar abscess
-fever
-malaise
-headache
-neck pain
-throat pain more severe on affected side
-can't swallow

*Retropharyngeal abscess
-prevertebral soft tissue, lots of lymph node drainage
-young kids
298. 3yo with 103.5F fever, no other symptoms; Next step?: Urine culture!
-could have UTI (12-15% chance)
299. Roseola causes: HHV6
Enterovirus
300. DTaP contraindications?: Encephalopathy within 7 days
-coma
-changed MS
-prolonged seizures
301. An 8 year old girl brought to physician because of pallor and easy fatigability for the past 2 months. Symptoms began after URI.
She was adopted, and her family history is unknown. She appears pale, spleen tip palpated 2 cm below left costal margin. Her
HCT is 28%, retic count is 4% with 3+ spherocytes. Splenectomy is most likely to prevent which of the following complications?

A) cholelithiasis
B) esophageal varices
C) overwhelming sepsis
D) painful crises
E) pancreatitis: Hereditary spherocytosis --> increased hemolysis --> increased bili --> cholelithiasis
302. 12yo boy short; dad tall; how to determine if this is normal?: Determine bone age!
-if constitutional short stature, bone age < real age
-if familial short stature, bone age = real age
303. 2yo swallowed drain cleaner; after stabilizing airway, next step?: Fiberoptic endoscopy
304. 10yo girl has tonic-clonic seizure, 1mo history of behavioral disturbances; 2wk history of fever, weakness, painful swelling of L
knee; low Hb, low plts, low WBCs; positive Coombs; Dx?: SLE
Rash (malar A or discoid)
Arthritis (nonerosive)
Serositis
Hematologic disorders (eg, cytopenias) Oral/nasopharyngeal ulcers
Renal disease
Photosensitivity
Antinuclear antibodies
Immunologic disorder (anti-dsDNA, anti-Sm,
antiphospholipid)
Neurologic disorders (eg, seizures, psychosis)
305. Previously healthy 1mo boy has bilious vomiting, less active than usual, poor feeding, abdomen firm + distended, fever; normal
rectal tone; small amount of stool in rectal vault; positive for occult blood in stool; Dx?: Malrotation with volvulus
-bilious vomiting
-distended abdomen
-occult blood in stool
XR- corkscrew pattern
*Child typically presents with legs drawn up
306. Previously healthy 3yo girl comes in with 2mo history of limp, most obvious when she wakes, less obvious at end of day; no
recent history of fever, rash, illness, tick/spider/animal bite; R knee warm, swollen, but not erythematous or tender; holds knee
in slightly flexed position but won't extend it when she walks or stands; ESR = 64, positive ANA, negative RA/ASO/Lyme titer;
Dx? Next step?: JIA
-joint pain, swelling
-joint stiffness in morning
-uveitis
-leukocytosis
-thrombocytosis
-hypergammaglobulinemia
-ANEMIA

Next step- slit-lamp exam for uveitis!!

307. 7yo girl fainted, became progressively lethargic over past winter, complexion has darkened, BP = 80/40; Dx? Best test?: Adrenal
insufficiency (Addison?)

Best test = serum cortisol level

308. 15yo girl has multiple areas over chest, upper back that are lighter than the rest of her skin; mild itching when she plays
volleyball; multiple, flat, oval, hypopigmented lesions; Dx?: TINEA VERSICOLOR!!!
-hypopigmented lesions over chest, upper back
-itchy

*Cause = yeast overgrowth (MALASSEZIA FURFUR)

-hot, humid climates
-lots of sweating
-oily skin
-weak immune system
309. 6wk girl had murmur since 2wks old; 25th percentile for height, 5th percentile for weight, 4/6 holosystolic murmur with thrill
heard along LLSB and throughout chest; P2 accentuated; 2/6 diastolic murmur heard best at apex; liver edge palpated 3cm below
costal margin; Dx?
-aortic stenosis
-ASD
-Pompe disease
-Transposition of great vessels
-VSD : Tetralogy of Fallot!!
-holosystolic regurgitant murmur with PALPABLE THRILL (VSD)
-diastolic murmur at apex (pulmonary stenosis)
-P2 accentuated = pulmonary HTN from increased pulmonary flow (because recirculating more into lung flow)
310. Tx for febrile seizure?: 1. Diazepam --> stops seizure
2. Acetaminophen --> decreases fever
311. 6mo girl has hemangioma on side of neck, has been enlarging; raised, erythematous, blanches with pressure, no ulceration; Next
step?: Observation
*Strawberry hemangioma!
312. Strawberry hemangioma vs cherry hemangioma: Strawberry hemangioma
--> blanches with pressure

Cherry hemangioma
--> doesn't blanch with pressure
313. 6wk girl has 2wk history of persistent irritability, passing stools covered in mucus and blood, no vomiting; 2wks ago, changed
from Cow's milk formula to soy-milk based formula; weight unchanged from 2wks ago; 25th percentile for weight, height, head
circumference; Tx?: Formula with hydrolyzed casein (predigested milk protein)
314. Wilm's tumor vs. neuroblastoma: Wilm's tumor
-3-4yo (usually)
-intrarenal
-doesn't cross midline

Neuroblastoma
-1-2yo
-extrarenal
-crosses midline
315. 14yo boy has
-1yr history of learning disability, hyperacitivity
-short attention span
-generalized tonic-clonic seizure at 8yo
-9 lesions with coffee-like stain on his back
-many small skin tags on chest, back, abdomen
-small increased areas of hyperpigmentation
Dx?: NF1
316. Asymptomatic 2yo gets positive screen for TB after visiting grandmother with TB; Tx?: RIPE
-rifampin
-isoniazid
-pyrazinamide
-ethambutol OR STREPTOMYCIN
317. 14yo girl has progressive fatigue over past month, diagnosed with DM1 4yrs ago; menarche occurred at 13yo and occurs at
irregular 30-40day cycles; breast and pubic hair development = Tanner 4; thyroid gland easily palpated; HR = 60, BP = 120/75;
Dx?: Hypothyroid --> menstrual irregularities, fatigue
318. 14yo boy has L scrotal mass, feels like "bag of worms", L scrotum hangs lower than R scrotum; Increased risk for what
complication?
-distant mets
-incarceration
-infertility
-testicular carcinoma
-testicular torsion
-torsion of appendix testis: Varicocele --> increased temperature --> INFERTILITY!!!
319. Frostnip
Frostbite
Chilblain
Cold panniculitis
Trench foot: Frostnip
-firm, WHITE, cold patches of skin in exposed areas
Tx- rewarm exposed areas

Frostbite
-tissue frozen + destroyed (BLACK)

Chilblain
-small, ulcerated lesions on exposed areas
-last 1-2weeks

Cold panniculitis
*Destruction of fat cells from exposure to cold weather or cold object
Ex. area of erythematous, firm, slightly swollen, nontender skin on corner of mouth, extending to cheek during summer

Trench foot
-prolonged exposusre to cold/moisture
-cold, numb, pale, edematous, clammy
320. Irritability, convulsions, hypochromic anemia; Vitamin deficiency?: B6
321. Megaloblastic anemia
Glossitis
Pharyngeal ulcers
Impaired immunity
-Which vitamin deficiency?: B9 = folate
322. Newborn infant with
-microcephaly with sloping forehead
-cutis aplasia
-microphthalmia
-cleft lip + palate
-ASD
-VSD
-dextrocardia: Patau = Trisomy 13
323. Bushy eyebrows
Hirsutism
Limb defects
VSD
Mental retardation: Cornelia de Lange!
*unibrow
324. Tx for prenatal vitamin OD?: Deferoxamine mesylate
-complexes with Fe, secreted in urine --> red urine
325. Sickle cell anemia kids need to be supplemented with what vitamin?: B9!!
-increased erythropoiesis --> increased B9 need!
326. 16yo girl comes in for physical; had chickenpox at 3yo; immunizations UTD when started kindergarten; only immunization she
received since was diptheria-tetanus toxoid at 10yo for leg laceration; has been sexually active with 2 male partners but uses
condoms consistently; most appropriate vaccines you should give at this time?: *Needs catch-up on:
Tdap
HPV series
MCV
327. Previously healthy 4yo boy has 2wk history of head itchiness, scattered hair loss on scalp; several small oval areas of alopecia
over posterior scalp with numerous hairs broken off close to the scalp; several small, occipital, nontender lymph nodes
palpated; Organism causing symptoms?: Tinea capitus causes (head ringworm)
-Trichophyton tonsurans- US

*Microsporum audovinii- more global

328. 17yo boy has swelling of lower lip that's resolved slowly over past 2 days; 12mo history of intermittent asymmetric swelling of
face, chest, arms; during 3 of these episodes, also has abdominal pain, diarrhea; no medications, no illicit drugs, not sexually
active; Next step in diagnosis?: *C1 esterase inhibitor deficiency --> hereditary angioedema!!!
--> Measure C1 esterase inhibitor concentration!
329. 16yo boy brought to ED 20min after onset of tonic-clonic seizure lasting 5min; has HTN treated with CCB, but hasn't been taking
his meds; BP = 250/154; unarousable on presentation, proliferative retinopathy; Next step?: Give nitroprussive (for hypertensive
emergency!!)
330. 12hr old newborn had polyhydramnios; Next step in diagnosis?: Insertion of nasogastric tube

Polyhydramnios causes
-Esophageal, duodenal atresia --> can't swallow
-Buchdalek's hernia
-Renal disorders (Bartter syndrome)
-Anencephaly
-Down's, Edward's
331. 12mo girl has varicella for 4wks; Most likely immune deficiency?: Impaired T-cell function --> viral, fungal infections!
332. 5lb3oz baby boy born to 37yo woman who had no prenatal care; she drank alcohol throughout pregnancy; he has prominent
occiput, narrow palpebral fissures, small recessed mandible, short sternum, hands clenched with index finger over middle finger
+ pinkie over 4th finger; 2/6 holosystolic murmur over LLSB, no hepatosplenomegaly, hypertonia; Dx?: EDWARDS!! (hands
clenched with overlapping fingers)
333. 3yo girl with bluish-grayish L tympanic membrane with visible landmarks; air-fluid level present; minimal movement on
pneumastic otoscopy; Dx?: OM with effusion!

AOM
-red
-bulging TM
-doesn't move with insufflation

OM with effusion
-air-fluid level
-decreased TM mobility
334. 4yo girl has 6hr history of fever, decreased alertness, rash over arms + legs + trunk; obtunded; HR = 120, low HCO3-, high BUN;
given fluids, IV ceftriaxone + vancomycin; 1hr later, her urine output decreases to 0.5mL/kg/hr; CXR- hazy lung fields bilaterally
+ cardiomegaly; Next step in management?: Cardiogenic shock!!
--> IV dopamine to kickstart heart!!
*Already gave fluids, didn't work, and plus she has cardiomegaly, suggesting CHF
335. 3yo African American girl with 1mo history of worsening, diffuse abdominal pain, loss of appetite, 2lb weight loss; firm, nodular
midline mass from mid-upper abdomen; pain + swelling of R wrist; XR + US show 12cm midline mass with multiple calcifications;
Most likely diagnosis?: Neuroblastoma- midline

*Nephroblastoma (Wilm's)- usually 1 side

336. Direction of PDA flow?: Extracardiac L --> R
*NOT R --> L!!!
337. Sandifer syndrome: Infant arches back during feeding
*Tonic reaction to protect airway from refluxing gastric contents
338. Hypotonia
Emotionally labile
"Milkmaid grip"- sequential tightening _ relaxing
Darting tongue
"Spooning" of extended hand: Sydenham chorea
339. PHACE syndrome presentation: 6mo child with blindness on same side as large facial lesion
*Infantile hemangioma + malformation of eyes/heart/major arteries/brain
340. Most common causes of aseptic meningitis: Enteroviruses (Echovirus, Coxsackie A)
Mumps
Lymphocytic choriomeningitis
Herpesviruses (HSV, EBV, CMV, VZV)
Arboviruses
Influenza
341. Urethritis in male indicates...?: STI!!!
342. 4day-old newborn has 2-day hx of progressive jaundice; born at 36wks gestation; baby- O+, mom B+; breastfed since birth +
given 1-2oz supplemental soy milk; 7 wet diapers/day, stools yellow + seedy; scleral icterus + jaundice from face to abdomen;
hematocrit- 52%, bili- 12.5, direct- 0.3; Most likely explanation?
-ABO incompatibility
-biliary obstruction
-dehydation
-erythrocyte enzyme defect
-physiologic jaundice
-polycythemia: Physiologic jaundice!
*Polycythemia = Hct > 65%
343. Previously healthy 4mo girl initially had fever 100.8F (but now afebrile), mild intercostal retractions, diffuse bilateral crackles +
wheezes, pulse ox = 84%; Next best step?
-ABG
-Culture pharynx for bacteria
-Viral culture for respiratory secretions
-CXR
-Neck XR
-Give inhaled bronchodilator (nebulizer)
-Give O2
-Subcutaneous epinephrine injection: GIVE O2!!! (b/c 84% O2 too low!)
344. 16yo girl hasn't had a period, Tanner stage 1, bone age = chronological age, multiple nevi over face and trunk, height 3rd
percentile since birth; Dx?: Turner's!
-often have melanocytic nevi!
345. 5yo girl with 1yr history of chronic cough, occurs during the day and at night, not exacerbated by exercise; no chills, diarrhea,
weight loss; b-agonists, oral abx, 10d course of oral prednisone haven't relieved her symptoms; CXR- no abnormalities except
for linear consolidation on R middle lobe; Dx?
-a1-antitrypsin deficiency
-asthma
-bronchiectasis
-congenital emphysema
-CF: Bronchiectasis!
*Permanent airway enlargement --> unable to clear secretions --> fluid builds up in between --> linear consolidation
--> airway blockage + breakdown
346. A 10-month-old girl is brought to the physician because of fever and agitation for 8 hours. She had URI for 2 days. Temperature
is 38.3C/100.9F, pulse 160, respiration 40, and blood pressure is 60/P. S3 gallop present. S1/S2 normal. Scattered crackles
present B/L. Which is most likely explanation?

A. Bronchiolitis
B. Endocarditis
C. Hypertrophic cardiomyopathy
D. Myocarditis
E. Valve rupture: Myocarditis
-usually have signs of HEART FAILURE
-S3 gallop
-bilateral crackles = fluid in lungs from pulmonary edema secondary to heart failure

*Probably viral
-Coxsackie B
347. 5yo boy has 4-day history of increasingly difficult breathing; T 99.6F, P 116, RR 36, BP 116/80; jugular venous distention, mild
swelling of face and upper extremities, moderate intercostal retractions, bilateral inspiratory + expiratory wheezes; CXR- mass
in superior mediastinum, large pleural effusion in R mediastinum; thoracentesis- 400mL of reddish-brown serosanguinous fluid
with numerous RBCs; Most likely cause of effusion?
-CHF
-Malignancy
-Nephrotic syndrome
-traumatic hemothorax
-TB: Serosanguinous pleural fluid ALWAYS --> MALIGNANCY!!!
+ mass in superior mediastinum
+ swelling in face, arms (SVC syndrome?)
348. 12hr male hasn't urinated since birth; born at 36wks gestation to 15yo girl who had no prenatal care, smoked 0.5pack
cigarettes/day, drank 2 beers/weekend when pregnant; received 1oz cow's milk-based formula, passed 1 small meconium stool;
no dysmorphic features; lower abdomen distended with midline mass; Dx?
-alcohol toxicity
-CAH
-meconium ileus
-nephroblastoma (Wilm's)
-posterior urethral valves
-testicular torsion: Posterior urethral valves
-midline mass
-decreased urination
349. 17yo girl has 8mo history of facial hair growth, 12lb weight gain over this time, menses were regular when began but now at
45day intervals, has begun to be moody and depressed, BMI = 24, exam shows striae over abdomen, no clitoromegaly, Next
step?
-measurement of morning serum fasting cortisol concentration
-measurement of serum prolactin concentration
-measurement of serum testosterone concentration
-abdominal CT
-brain MRI: Cushing's syndrome --> measure serum fasting cortisol!!
-cortisol can cause psychosis!
350. 1mo infant has 12x8cm, red, raised, well-defined lesion that's lobulated and compressible overlying buttocks since birth; exam
also shows multiple petechiae and bruises; Dx?: Kasabach-Merritt
-giant hemangioma
-thrombocytopenia
-consumptive coagulopathy
*Thrombocytopenia from platelet sequestration
351. 5yo boy has L hip pain for past 2 days, associated limp for past 4hrs; had watery stools and fever 1 week ago- resolved in 2
days; hip not swollen or erythematous, but pain with movement and weight-bearing; ESR = 28; US- small hip effusion; Dx? Tx?:
Transient synovitis
-3-10yo
-after viral infection
-increased ESR, CRP
-effusion on ultrasound

Tx- oral ibuprofen

352. Mechanism behind PSGN?: Type III hypersensitivity --> Ab/Ag Immune complex
353. 16yo girl has 2mo history of mass in side of neck, progressive axillary and inguinal lymphadenopathy, generalized pruritis, 15lb
weight loss; CXR- mediastinal mass; CBC- anemia with normal differential; increased ESR, increased ferritin; node biopsy should
show what?
-CMV
-Hodgkin's lymphoma
-Sarcoidosis
-Thymoma
-TB: Hodgkin's lymphoma
354. 16yo girl sexually active with 2 male partners, uses condoms inconsistently, last menstrual period 10 days ago, pelvic exam
shows ectropion on cervix; in addition to starting convo about contraceptives and performing Pap smear, what else should we
do?
-HPV testing
-Gonorrhea, Chlamydia testing
-measure LH, FSH
-measure TSH, T3
-Colposcopy: Gonorrhea, Chlamydia testing
-
355. 9yo girl has DKA, blood glucose > 500; most appropriate step in management?
-IV D5
-IV normal saline
-IV lactated Ringer + KCl
-IV 0.1U/h regular insulin
-continuous IV 0.1U/h regular insulin: 1. NORMAL SALINE FLUIDS!
-if in DKA, already dehydrated

2. Insulin

3. Replenish K
356. 3yo boy has 1d history of fever, abdominal pain, diarrhea with blood and mucus; history of ear infections treated with abx,
completed 10-day course of amoxicillin+clavulanate 1d ago; test for occult blood in stool positive; Organism?: C. diff!!
357. 6 day-old girl has vomiting for 2 days, no fever, 5th percentile for weight, generalized jaundice, liver enlarged + firm; total bili =
14, direct = 8, test for urine reducing substances positive; Dx?: Tyrosinemia!
-FTT
-Jaundice
-Hepatosplenomegaly
-Jaundice

*Von Gierke
-increased glycogen in liver
-increased blood lacate
-increased TGs
-increased uric acid --> gout
-hepatomegaly
358. 13yo boy has cola-colored urine whenever he gets a cold for the past 2 years; UA shows 4+ blood, 3+ protein; Dx?: IgA
nephropathy
359. 16yo boy has fever 103F, malaise, pain in LE, unable to walk, looks illl; no overlying contusion or break in skin; technitium 99m
shows increased uptake in metaphysis of bone; Dx?: Acute osteomyelitis!

*If septic arthritis, would be in bone JOINT!! (epiphysis)

360. 8yo girl had 2 previous episodes of sinusitis; had S. pneumo hospitalization last year, Giardia recently; had asthma since 3yo,
height and weight are 5th percentile; Dx?: CVI- common variable immunodeficiency --> low IgG/A/M
-recurrent respiratory infections
-autoimmune disease
-chronic lung disease (bronchiectasis)
-GI disorders
361. 15mo boy turned blue, has been extremely fussy today even though mom gave him acetaminophen and a 'numbing cream' that
she used when she had a toothache; immunizations up to date, otherwise healthy child; Dx?: Methemoglobinemia
*Causes
-dapsone
-NO
-numbing meds (benzocaine, lidocaine)

Symptoms
-cyanosis
-chocolate colored blood

*Normal PaO2 because it's not that O2 lacking in blood

362. When do you treat postpartum depression?
-what do you treat with?: If lasts >2wks + cause functional impairment

Tx
-Psychotherapy
-Pharmacotherapy (SSRIs)
363. Types of conjunctivitis
-viral
-bacterial
-allergic: Viral
-unilateral OR bilateral
-1-2wks
-watery mucus discharge
-viral prodrome

Bacterial
-unilateral oR bilateral
-1-2wks
-purulent
-unremitting ocular discharge

Allergic
-ALWAYS BILATERAL
-<30min to perennial
-watery
-OCULAR PRURITIS, ocular edema
364. 4yo boy has 101F, gets some meds to alleviate but they don't work; starts to see things that aren't there like bunnies and horses;
Cause?: Medication SE!
-Antihistamines, etc

*Hyperpyrexia can cause delirium, hallucinations at high fever (103F)

365. 2yo F has L knee pain and fever that began 2mo ago; at time of onset, many children in her daycare had sore throat and cough
too, but no one developed joint pain; pain mostly in morning and improves in afternoon; has daily fevers and an erythematous
macular rash on her trunk around bedtime; swelling, erythema, edema of L knee and L hip; WBC 21,000, Plts 500,000, ESR 100;
Dx?: JIA = juvenile idiopathic arthritis
-leukocytosis
-elevated plts
-elevated ESR, CRP
-quotidian fever = >2wks fever 1x/day
-arthritis in at least 1 joint
-pink macular rash that worsens with fever
-ANEMIA --> chronic inflammation, Fe deficiency (increased hepcidin --> decreased Fe absorption)
-hypergammaglobulinemia
-hyperferritinemia