Pediatrics Review Session

Growth and Development

Emergency Care

Dermatology

Hematology

Malnutrition

GI, Fluids, Electrolytes

Genetic Disorders Grab Bag

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200 200 200 200 200 200 200 200

300 300 300 300 300 300 300 300

400 400 400 400 400 400 400 400

500 500 500 500 500 500 500 500

Neurology

Endocrinology Oncology Infectious

DiseaseNeonatol

ogyCardiolog

yNephrolo

gyGrab Bag

II

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400 400 400 400 400 400 400 400

600 600 600 600 600 600 600 600

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1000 1000 1000 1000 1000 1000 1000 1000

Growth and Development 100

What is the average weight of a 6 month-old child? A one year-old child?

6 months: 6 kgOne year: 10 kg

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.

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.

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.

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

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

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.

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.

Emergency Care 400Name five of nine signs of respiratory distress in children.

GruntingFlaringRetractions/Chest wall indrawingTachypneaHyperpneaHead bobbingCyanosisStridorWheezing

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

Dermatology 100

What is the correct treatment?

Tinea corporis: topical clotrimazole

Dermatology 200

What is the correct treatment?

Tinea capitis: oral griseofulvin

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.

Dermatology 400This newborn’s mother had a cold during pregnancy. What congenital syndrome is he likely to have:

Congenital rubella is classically associatedwith a blueberry muffinrash.

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.

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

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.

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.

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.

GI Fluids and Electrolytes 500

Name 4 treatments for hyperkalemia.

Calcium gluconateAlbuterol/salbutamolBicarbonateInsulin/GlucoseKayexalate (sodium polystyrene sulfonate)Dialysis

Hematology 100

Daily Double I

Name three hemoglobinopathies associated with protection from infection with P. falciparum.

Sickle cell traitThalassemiaHereditary Persistence of Hemoglobin FG6PD deficiency

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.

Hematology 300

Name two causes of microcytic anemia.

Severe lead poisoningIron deficiency anemiaThalassemia syndromesSideroblastic anemia

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.

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.

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

Malnutrition 200

List the criteria for diagnosing malnutrition.

Weight-for-height < 70% or <-3 SDBilateral pedal edemaClinical signs of severe malnutrition

Malnutrition 300

Match the vitamin with the manifestation of deficiency:

Malnutrition 400Which is the most reliable sign of dehydration in a

malnourished child?a. Sunken eyesb. Tachycardiac. Poor skin turgord. 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.

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.

Genetic Disorders 100

What is the mode of inheritance of cystic fibrosis?

Autosomal recessive

Genetic Disorders 200

Name the cardinal features of DiGeorge Syndrome?

Cardiac anomaliesAbnormal faciesThymus absentCleft palateHypocalcemia

Genetic Disorders 300

Name three health problems that pose a specific risk to patients with Down Syndrome.

Atlantoaxial instabilityCardiac defects (ASD, VSD, endocardial cushion defects)CryptorchidismDuodenal atresiaEye anomaliesHirschsprung’s diseaseHypothyroidismLeukemia

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.

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.

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.

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.

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.

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.

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.

Neurology 200

Name four common causes of neonatal seizures.

Birth asphyxiaCNS malformationsHypoglycemiaIntracranial bleedingMetabolic abnormalitiesSepsis/meningitisToxin

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.

Neurology 600

Name the three elements of Cushing’s triad suggesting increased intracranial pressure.

BradycardiaHypertensionAbnormal respiration

Neurology 800

What EEG abnormalities is classically associated with absence seizures?

3 Hertz spike and wave pattern is classic for absence seizures.

Neurology 1000

Name four health complications associated with cerebral palsy.

Frequent (aspiration) pneumoniaMental retardationSeizure disorderContractures/orthopedic problemsHearing lossVision abnormalitiesGERDFailure to Thrive

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.

Endocrinology 400

Name 3 clinical symptoms of hypercalcemia?

“Bones, stones, groans, psychiatric overtones”NephrolithiasisAbdominal pain/constipationMental status changes/seizuresBone pain

Endocrinology 600

What is the initial step in management of a child in DKA?

Patients with DKA are frequently dehydrated. It is important to slowly rehydrate first, before giving insulin.

Endocrinology 800

Your patient is admitted with encephalitis. Despite constant maintenance IV fluids, the child is becoming dehydrated. What hormonal abnormality might you suspect?

SIADH: syndrome of inappropriate antidiuretic hormone secretion. SIADH is associated with brain injuries.

Endocrinology 1000

A 3 week old female infant presents with vomiting and dehydration. His initial laboratory studies are notable for hypernatremia and hypokalemia. You also notice that her clitoris seems enlarged. What hormonal abnormality should you suspect?

Congenital adrenal hyperplasia can present in the newborn period with ambiguous genitalia (in the female), dehydration, and shock. It is most commonly due to 21-hydroxylase deficiency, which causes overproduction of DHEA, and decreased mineralocorticoid and glucocorticoid.

Oncology 200

What TWO viruses are commonly associated with Burkitt’s lymphoma?

EBV (Ebstein Barr virus) and HIV (Human Immunodeficiency virus) and both associated with Burkitt’s lymphoma.

Oncology 400

Describe three clinical findings associated with Beckwith Wiedemann sydrome?

Wilm’s tumorMacrosomiaMacroglossiaHemihypertrophyOmphalocele

Oncology 600

What lab abnormalities are associated with tumor lysis syndrome?

HyperkalemiaHypocalcemiaHyperphosphatemiaHyperuricemia

Oncology 800

A two year old child with an abdominal mass develops dancing eyes and dancing feet. What type of tumor might you suspect?

Opsoclonus-myoclonus is a paraneoplastic syndrome associated with several tumors, most commonly neuroblastoma. The symptoms do not always resolve with treatment of the tumor.

Oncology 1000

Daily Double II

Name two potential life threatening side effects of cyclophosphamide.

Hemorrhagic cystitisBone marrow suppressionTransitional cell carcinoma of the bladder

Infectious Disease 200

What are the most common causative agents for neonatal sepsis?

Group B StrepE. ColiListeria(In developing countries, other gram negatives and

staph species are also common)

Infectious Disease 400

Name three common complications of measles infection.

Pneumonitis/pneumoniaEncephalitisDiarrheaKeratitis

Infectious Disease 600

What is the diagnosis and what are the cellular inclusions called?

P. Falciparum malaria with trophozites visible in the red blood cells

Infectious Disease 800

After what age can you reliably obtain an HIV antibody level on a child with perinatal exposure?

Infants with perinatal exposure can have maternal antibodies through the first year of life. Typically, if antibodies persist beyond 18 months, they are believed to be from the child.

Infectious Disease 1000

What clinical signs might you expect in someone taking isoniazid for tuberculosis without taking pyridoxine?

B6 deficiency manifests as peripherial neuropathy and seizures.

Neonatology 200

A one week old presents with jerking movements of his extremities, decreased tone, and inability to suck. What infection should you suspect?

Neonatal tetanus

Neonatology 400

What lab test should you check if you see this on the first day of life.

Oral thrush on the first day of life is highly suspicious for HIV.

Neonatology 600

A 4.5kg newborn is found to have an asymmetric Moro. His left arm is held in a extended and internally rotated position. What nerve injury might he have sustained?

This is suggestive of a Erb’s palsy, an injury to the fifth and sixth cervical nerves. This injury results from excessive traction to the arm during delivery.

Neonatology 800

What laboratory abnormality would you expect from the infant of a diabetic mother and why?

Infants of diabetic mothers are often born hypoglycemic due to increased insulin production while in a hyperglycemic intrauterine environment.

Neonatology 1000

Name four causes of pathologic jaundice in the newborn.

ABO/Rh incompatibilityCongenital HypothyroidismDefective conjugation (Crigler-Najjar, Gilbert’s)PrematurityRed cell enzyme defects (hereditary spherocytosis, G6PD)SepsisTORCH

Cardiology 200

Name the five cyanotic heart lesions

Truncus arteriosusTransposition of the Great ArteriesTricuspid AtresiaTetralogy of FallotTotal Anomalous Pulmonary Venous Return

Cardiology 400

What are the most common valvular lesions associated with rheumatic heart disease?

Mitral regurgitation is the most common valvular lesion. Aortic insufficiency can also occur.

Cardiology 600

A 4 month old infant presents with poor feeding and weakness. You note that the heart rate is persistently 205 with good skin turgor, and moist mucous membranes. When you check again after triage, you get the exact same: 205. What cardiac arrhythmia might you suspect?

This infant might be in poorly compensated supraventricular tachycardia. Try vagal maneuvers such as rectal stimulation, ice on the face, elicit the gag reflex.

Cardiology 800

What are the classic physical exam findings associated with an ASD?

A systolic murmur audible at the left upper sternal border with a fixed, split S2.

Cardiology 1000

A child with a known murmur occasionally has episodes of cyanosis and respiratory distress relieved by squatting. What are the abnormalities of his cardiac anatomy?

Overriding aortaPulmonic atresia/stenosisVSDRVH

Nephrology 200

What constellation of (4) clinical/laboratory findings define nephrotic syndrome?

ProteinuriaEdemaHypoalbuminemiaHyperlipidemia

Nephrology 400

A 5 year old develops hematuria and swelling 2 weeks after being treated with ‘unspecified antibiotics’. What two types of infection might you suspect he had?

This history is suggestive of acute post-streptococcal glomerulonephritis, which can be caused by strep pharyngitis or strep skin infections (i.e. impetigo)

Nephrology 600

What is the most specific test of the urinalysis to detect a urinary tract infection?

Nitrites has 88% sensitivity and 98% specificity. Leukocyte esterase has 84% sensitivity, 78% specificity.

Nephrology 800A 14 year old female presents with joint pains and hematuria. On exam,

you also note an erythematous rash on her face. Her labs are further notable for normocytic anemia. She meets diagnostic criteria for what disease?

Lupus erythematosus is characterized by 4 of 11 findings:Malar rash Discoid rashPhotosensitivity CytopeniaOral ulcers ArthritisNeurologic disease NephritisSerositis Autoimmune antibodiesPositive ANA

Nephrology 1000

A 8 year old female presents with a history of bloody diarrhea one week ago, now with a petechial rash and oliguria. Name her syndrome and another associated anomaly.

Hemolytic uremia syndrome can follow infections with E. coli. It is described by thrombocytopenia, acute renal failure, and microangiopathic hemolytic anemia.

Grab Bag II 200

What is the difference between meningitis and encephalitis clinically?

Meningitis is inflammation of the meninges. This may cause pain and seizures. Encephalitis is inflammation of the cerebrum, therefore is associated with altered mental status.

Grab Bag II 400

After what age should an undescended testis be repaired?

Undescended testes place a child at risk for infertility and neoplasm. Most infants’ testes descend by 12 months. If after 12 months of age they have not descended, consider orchidopexy.

Grab Bag II 600

Name three facultative or obligate intracellular bacterial pathogens

Grab Bag II 800

What is the most appropriate maintenance medication for intermittent asthma (please name medication and route).

Inhaled salbutamol is the most appropriate maintenance medication for intermittent asthma. Children with most persistent symptoms should take an inhaled steroid. If inhaled salbutamol is not available, you may use oral salbutamol.

Grab Bag II 1000

During a blood transfusion for a Hb of 3.2, a child develops a fever and chills. What are the most important medications to administer?

This child is having a transfusion reaction. Stop the transfusion immediately and give paracetamol and chlorpheniramine or hydrocortisone.