Pediatrics Review Session

1. Pediatrics Review Session

4. Growth and Development 100 What is the average weight of a 6 month-old child? A one year-old child? 6 months: 6 kg One year: 10 kg

5. Growth and Development 200 What are Ebstein pearls and where are they located? Ebstein pearls are keratin containing cysts located in the midline of a neonate’s palate. They are benign.

6. Growth and Development 300 • At what age do children usually begin to walk and use a few words specifically? Most children walk at 12 months (range 10-15 months). Most children will begin to use words at 9 months, but will begin to use them correctly at 12 months.

7. Growth and Development 400 What is the most common inherited cause of mental retardation? The most common inherited cause of mental retardation is Fragile X syndrome. The most common genetic cause of mental retardation is Down Syndrome.

8. Growth and Development 500 What is the correct sequence of pubertal development in females: adrenarche, growth spurt, menarche, thelarche? Female: thelarche, growth spurt, adrenarche, menarche Male: testicular enlargement, penile enlargement, growth spurt, adrenarche

9. Emergency Care 100 A 6 year-old male child is brought in after a road traffic accident. He is bleeding profusely from an open leg fracture. What is always the initial step in emergency management? AIRWAY, BREATHING, CIRCULATION

10. Emergency Care 200 What is the difference between a second- and third- degree burn? First degree burns involve only epidermis. Second degree burns extend into the dermis. Third degree burns extend through the dermis (full-thickness) Fourth degree burns involve fascia, muscle, bone and joint tissue.

11. Emergency Care 300 A child presents with respiratory distress and a hives shortly after eating peanuts for the first time. What is the most important drug to give and how? This child is likely having an anaphylactic reaction. Give epinephrine (adrenaline) IM first. You may also give steroids, chlorpheniramine, salbutamol, and ranitidine.

12. Emergency Care 400 Name five of nine signs of respiratory distress in children. Grunting Flaring Retractions/Chest wall indrawing Tachypnea Hyperpnea Head bobbing Cyanosis Stridor Wheezing

13. Emergency Care 500 A 4 year old child presents with fever and altered mental status. After your initial assessment, you note that the child is tachycardic, dilated pupils and red, flushed skin. The mother tells you she thinks the child took some pills laying around the neighbor’s house. What class of drug did the child take? This child is exhibiting the anticholingeric toxidrome: fever, mydriasis, flushing, dry skin, hypertension, tachycardic, urinary retention, convulsions, urinary retention

14. Dermatology 100 What is the correct treatment? Tinea corporis: topical clotrimazole

15. Dermatology 200 What is the correct treatment? Tinea capitis: oral griseofulvin

16. Dermatology 300 What is the causative agent for fifth’s disease? Fifth’s disease (erythema infectiosum) is caused by parvovirus B19. Classically, there is a slapped cheek rash which progressed to a erythematous maculopapular rash that spreads from the arms to the trunk.

17. Dermatology 400 This newborn’s mother had a cold during pregnancy. What congenital syndrome is he likely to have: Congenital rubella is classically associated with a blueberry muffin rash.

18. Dermatology 500 This child recently started bactrim and nevirapine. What’s the diagnosis? Stevens Johnson Syndrome. Common causative agents include: antibiotics, anticonvulsants, and sulfa drugs. Treat these patients as burn patients.

19. GI Fluids and Electrolytes 100 What is the hourly maintenance fluid rate for a 26kg child? Use the 4-2-1 rule: 4 x 10 = 40 2 x 10 = 20 1 x 6 = 6 Total = 66 cc/hr

20. GI Fluids and Electrolytes 200 A 9 year old female presents with two days of fever, vomiting, and anorexia. She complains of periumbilical tenderness and had mild abdominal distention. What is the diagnosis and first step in management? This child is highly concerning for appendicitis. Call surgery immediately.

21. GI Fluids and Electrolytes 300 An 8 month-old male presents with intermittent fussiness and drawing up of his legs. You palpate a mass in the right lower quadrant during one of these episodes. How would you manage him? This case is suggestive of intussusception. Consult surgery to assist with an air enema.

22. GI Fluids and Electrolytes 400 What electrolyte abnormalities would you expect to find in a child with pyloric stenosis? (Name 3 changes) Hypochloremic metabolic alkalosis and hypokalemia. The child is vomiting gastric contents (HCl) and driving potassium intracellular.

23. GI Fluids and Electrolytes 500 Name 4 treatments for hyperkalemia. Calcium gluconate Albuterol/salbutamol Bicarbonate Insulin/Glucose Kayexalate (sodium polystyrene sulfonate) Dialysis

24. Hematology 100 DAILY DOUBLE!!!

25. Daily Double I Name three hemoglobinopathies associated with protection from infection with P. falciparum. Sickle cell trait Thalassemia Hereditary Persistence of Hemoglobin F G6PD deficiency

26. Hematology 200 A one week old neonate presents with blood in the stool. What is the treatment for the most likely disorder? Hemorrhagic disease of the newborn can present with bleeding in the first 2 to 10 days of life. Give vitamin K IM, especially if it was not given at birth.

27. Hematology 300 Name two causes of microcytic anemia. Severe lead poisoning Iron deficiency anemia Thalassemia syndromes Sideroblastic anemia

28. Hematology 400 What is the genetic mutation associated with hemoglobin S? In the beta globin gene, there is a glutamic acid (GTG) to valine (GAG) substitution. Many other mutations exist, causing a variety of abnormal hemoglobins.

29. Hematology 500 A 3 year-old child presents with a petechial rash. The mother reports that the child had a diarrheal illness 2 weeks before. On the CBC, everything is normal except for the platelet count of 35. What is the treatment? This child likely has Idiopathic Thrombocytopenic Purpura (ITP). Observe the child clinically.

30. Malnutrition 100 What is the WHO recommendation for when to transfuse a child with malnutrition? WHO recommends blood transfusion when the hemoglobin drops below 4g/L or Hb 4-6g/L AND child is showing signs of life-threatening heart failure or respiratory distress

31. Malnutrition 200 List the criteria for diagnosing malnutrition. Weight-for-height < 70% or <-3 SD Bilateral pedal edema Clinical signs of severe malnutrition

32. Malnutrition 300 Match the vitamin with the manifestation of deficiency: Vitamin A Vitamin D Zinc Vitamin C Dermatitis Night blindness Stomatitis Rachitic rosary

33. Malnutrition 400 Which is the most reliable sign of dehydration in a malnourished child? • Sunken eyes • Tachycardia • Poor skin turgor • Dry mucus membranes B. Tachycardia is the most reliable of the choices. Most malnourished children have limited subcutaneous tissue, therefore will often have sunken eyes and poor skin turgor. They can also have atrophic salivary glands, and therefore dry mouth.

34. Malnutrition 500 Which electrolyte abnormality can be most deadly as you start to feed a severely malnourished child? Children who have been starved are at risk for refeeding syndrome. In this occurrence, there are rapid shifts of electrolytes into deprived cells. Hypophosphatemia can cause sudden death, as can hypokalemia and hypomagnesemia less commonly.

35. Genetic Disorders 100 What is the mode of inheritance of cystic fibrosis? Autosomal recessive

36. Genetic Disorders 200 Name the cardinal features of DiGeorge Syndrome? Cardiac anomalies Abnormal facies Thymus absent Cleft palate Hypocalcemia

37. Genetic Disorders 300 Name three health problems that pose a specific risk to patients with Down Syndrome. Atlantoaxial instability Cardiac defects (ASD, VSD, endocardial cushion defects) Cryptorchidism Duodenal atresia Eye anomalies Hirschsprung’s disease Hypothyroidism Leukemia

38. Genetic Disorders 400 During your newborn exam, you notice that a female infant has a webbed neck, widely spaced nipple, and swollen feet. What physical exam maneuver should you pay particular attention to? Turner’s syndrome (45, XO). These women may also coarctation of the aorta, so checking the femoral pulses is critical.

39. Genetic Disorders 500 What enzyme is often mutated in oculocutaneous albinism? There are multiple gene defects associated with albinism. Two types of albinism are associated with defects in the tyrosinase gene.

40. Grab Bag I 100 At what age should a child be vaccinated for measles? Most children should receive measles vaccine at 9 months of age. During a outbreak , the vaccine can be given as early as 6 months.

41. Grab Bag I 200 What is the common age range during which autism presents? Autism usually presents between 18month and 3 years of age with verbal and motor delays and poor attachment.

42. Grab Bag I 300 A 13 year old male presents with painless hematuria and lethargy. What pathogen should you look for under the microscope? Urinary schistosomiasis can present with dysuria, or with painless hematuria. Eggs can be visualized in the urinary sediment.

43. Grab Bag I 400 What is the most common cause of urinary tract obstruction in the newborn? Posterior urethral valves is the most common cause of urinary tract obstruction in the newborn. It is associated with renal dysgenesis in utero, and progression to renal failure if untreated.

44. Grab Bag I 500 What is the most appropriate feeding option for an HIV infected mother? Breastfeeding remains the best option for HIV-infected mothers, despite the risk of transmission.

45. Neurology 200 Name four common causes of neonatal seizures. Birth asphyxia CNS malformations Hypoglycemia Intracranial bleeding Metabolic abnormalities Sepsis/meningitis Toxin

46. Neurology 400 What are the common vital sign changes associated with subclinical status epilepticus? Commonly, patients with seizures will have tachycardia, hypoxia, and appear to have respiratory distress.

47. Neurology 600 Name the three elements of Cushing’s triad suggesting increased intracranial pressure. Bradycardia Hypertension Abnormal respiration

48. Neurology 800 What EEG abnormalities is classically associated with absence seizures? 3 Hertz spike and wave pattern is classic for absence seizures.

49. Neurology 1000 Name four health complications associated with cerebral palsy. Frequent (aspiration) pneumonia Mental retardation Seizure disorder Contractures/orthopedic problems Hearing loss Vision abnormalities GERD Failure to Thrive

50. Endocrinology 200 What is the total body potassium status of a patient presenting in DKA (low, normal, high? Regardless of what the laboratory values suggest, all patients with DKA are potassium depleted (LOW). It is critical to replace potassium as you fix their acidosis.