Term
2 year old healthy girl with 2 weeks nocturnal perianal and perineal pruritus.
Next step and treatment? |
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Definition
Most likely Enterobius Vermicularis (pinworm)
1) Cellophane tape test in early morning
2) Mebendazole, Albendazole or Pyrantel Pamoate single dose |
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Term
4 year old from southeastern US with bloody stools and rectal prolapse.
Next step and treatment? |
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Definition
Likely Whipworm (Trichuris trichina)
1) Stool for ova and parasites
2) Albendazole or Mebendazole |
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Term
What type of hemorrhage is associated with each of the following?
1) <1 year old, seizures, retinal hemorrhages
2) >1 year, no seizures, high acute mortality, no retinal hemorrhages |
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Definition
1) Subdural bleed
2) Epidural bleed |
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Term
4 year old with difficulty walking. He exhibits a "waddling gait " and has recently experienced increasing difficulty arising from a sitting position of the floor.
Next step and treatment? What are common complications of this disease? |
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Definition
Most likely muscular dystrophy (Duchenne). X-linked (only in males). Older presentation and preservation of distal muscles instead suggests Becker's MD.
*Look for calf pseudo hypertrophy*
1) Get Serum CK (screening), DNA peripheral blood analysis and/or IHC detection of dystrophin on muscle biopsy (if DNA non-diagnotic)
2) Medical therapies to slow down disease progression
3) Cardiomyopathy and respiratory failure. Wheelchair dependent by age 10-12 |
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Term
10-d old infant with 12h of fever and decreased PO intake, with one episode of seizure-lie activity. LP shows elevated WBCs and blood shows thrombocytopenia
Next Step and Treatment? |
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Definition
Likely Congenital Herpes
**any sign of herpes infection leads to hospitalization of neonate regardless of CNS involvement**
1) Get cell culture of samples from various body sites and PCR or CSF
2) Parenteral Acyclovir. |
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Term
11 month old with persistent facial rash with nocturnal restlessness. Dry, red, scaly areas on cheeks, chin and mouth. Diaper area is spared.
Next step and diagnosis |
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Definition
Atopic Dermatitis (Eczema)
1) Serum IgE elevated and culture of skin if superinfection suspected (otherwise labs not useful)
2) Avoid fluorinated CS on face, genitalia and intertriginous areas (Depigmentation).
- Emmoliants, Steroids and Anti-histamines (itch) |
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Term
Recurrent infections, thrombocytopenia and eczema in 4 month old.
Diagnosis? |
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Definition
| WAS: X-linked noted in first 6 months of life. |
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Term
3 year old female with abdominal pain, abdominal mass not crossing midline and hypertension.
Patient has Aniridia and Hemihypertrophy of left side as well.
Next Step and Treatment |
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Definition
Wilm's tumor
1) Get urinary VMA and homovanillic acid levels to rule out Neuroblastoma. Get UA and CT.
2) Immediate surgical excision followed by multi-agent chemo |
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Term
Toddler with odynophagia, fever and posterior pharyngeal swelling. Patient refuses to passively move neck
What is on the differential?
Next step and treatment? |
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Definition
Likely Retropharyngeal Abscess.
1) DDX includes retropharyngeal (potential for mediastinal spread) PTA and parapharyngeal space (potential for neuromuscular invasion (infection
2) Start with lateral cervical x-ray
3) Either antibiotics and watchful waiting or surgery |
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Term
FT infant develops cough, choking and cyanosis shortly after birth. ET tube fails to pass.
Next Step and Treatment? |
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Definition
T-E fistula with Esophageal Atresia (VATER syndrome also)
Association with DiGeorge (thymic hypoplasia with 3rd and 4th pharyngeal pouch formation issues)
1) NPO, admitted to NICU, decompress esophagus
2) Surgery- post-op GERD is common |
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Term
FT male born with uncomplicated pregnancy develops tachypnea, nasal flaring, grunting, fret rations and cyanosis immediately after birth. Chest auscultation reveals right-sided heart sounds and abdomen is scaphoid.
Next step and treatment? |
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Definition
CDH most likely. Associated with pulmonary hypoplasia and intestinal malrotation. Common in trisomy 13,18 and 21
1) Get X-ray
2) Place TG tubes. Intubate and low-pressure ventilation. ECMO often needed (involves canulation of carotid and IJ)
If no R-L shunting, can repair surgically with 24-72h. If PVR does lead to shunting, ECMO required. |
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Term
12 month old with 1d intermittent abdominal pain and vomiting and 2h lethargy. RLQ is devoid of bowel and RUQ contains sausage like mass.
Next step and treatment? |
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Definition
Likely Intussusception. Bloody stools often associated. Also associated with HSP.
1) Order air-contrast enema. US if children cannot tolerate contrast.
2) Air-contrast enema |
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Term
| Describe management strategy for acne. |
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Definition
1) First line is topical keratolytic Benzoyl Peroxide and comedolytic agent like Tretinoin (Retin-A) with mild soaps and topical antibiotics.
2) For severe pustulocystic acne, add oral antibiotics
3) For severe cystic acne, add oral retinoid (Isotretinoin). |
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Term
FT infant develops dribbling urinary stream and lower abdominal mass.
On US, bilateral hydronephrosis with bladder wall hypertrophy and enlarged urethra is noted.
Next Step and Treatment |
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Definition
Posterior Urethral Valves
1) Order renal US
2) Immediate bladder cath with small feeding tube. Follow up with endoscopic transurethral valve ablation if serum Cr is normal. Otherwise, emergent vesicostomy may be necessary. |
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Term
| What are the first-line medications for ADHD? |
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Definition
1) Stimulants like Methylphenidate and Dextroamphetamine.
2) Atomoxetine (Strattera) is a non-stimulant SNRI that can be used. |
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Term
| What are the first-line medications for ADHD? |
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Definition
1) Stimulants like Methylphenidate and Dextroamphetamine.
2) Atomoxetine (Strattera) is a non-stimulant SNRI that can be used. |
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Term
Infant with excessive unilateral tearing progressing to mucopurulent eye discharge. Normal conjunctivae and corneas are present.
Next Step and Treatment? |
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Definition
Dacryostenosis: narrowing and blockage of tear ducts due to failed canalization of nasolacrimal duct.
Usually resolves within 1 year
Nasolacrimal duct massage and Topical Erythromycin. |
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Term
| Why is prophylactic oral erythromycin for infants with mothers with untreated chlamydial infection generally not indicated? |
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Definition
| Effectiveness uncertain and link between Hypertrophic Pyloric Stenosis |
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Term
| Child with excessive tearing, photophobia and bleopharospasm is associated with what neonatal infection? |
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Definition
| Rubella: Congenital Cataract |
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Term
Name each of the following:
1) Syndrome of nephropathy, thrombocytopenia and MAHA
2) Small vessel vasculitis in young children with dermatological, renal, GI and joint involvement (purpuric)
3) Platelet destruction by circulating antiglycoprotein IIb/IIIa antibodies |
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Definition
1) HUS due to E. coli O157H7
2) HSP
3) ITP |
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Term
How do you treat ITP?
What about HSP? |
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Definition
1) Close observation and support
- Can also try IVIG and steroids
2) Hydration and pain control. |
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Term
7 month old develops pharyngitis, inspiratory stridor and tachypnea 3d after prodrome of coryza and barking cough.
What is the likely etiology? |
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Definition
Croup: Laryngotracheobronchitis (Hoarseness, inspiratory stridor, barky cough)
Aerosolized Epinephrine and Steroids are used to treat.
Winter: Parainfluenza virus
Summer: Enterovirus, Mycoplasma or parainfluenza type 3 |
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Term
| Why do patients being treated for Kawasaki disease get the Influenza vaccine? |
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Definition
Risk of Reye's with ASA treatment.
Remember, you also delay live vaccines for 11 months because of IVIG treatment |
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