Confluent erythema of the cheeks; lacy reticulated rash of extremities/trunk; [late] petechial erruption of hands/feet - diagnosis?
Erythema infectiosum (5th disease); Parvovirus B19
Erythema of sun-exposed skin after taking drugs like: tetracylcines, quinilones, phenothiazines, or NSAID - diagnosis?
Phototoxic (drug) reaction
Delayed hypersensitivity reaction to UV light manifesting in erythematous papules/vesicles on sun-exposed skin - diagnosis?
Polymorphous light eruption
What are specific characteristics of the rash found in scarlet fever?
Fine, rough feeling erythematous papules (usually concentrated on flexural areas)
What are specific characteristics of the rash found in systemic lupus erythematosis?
Erythematous, scaling malar eruption
Children raised on vegan diets are at risk for which vitamin deficiency?
Vitamin B12 deficiency
Children who are exclusively fed goat's milk are at risk for which vitamin deficiency?
What are 2 clinical manifestations of vitamin E deficiency?
- 1) Neuropathy
- 2) Hemolysis
What lab test is used to determine vitamin D status?
What serum level of 25-vitamin D is considered "insufficient?"
Less than 20 ng/ml
What serum level of 25-vitamin D is considered "deficiency?"
Less than 15 ng/ml
What are 3 biochemical complications of vitamin D deficiency?
- 1) Reduced calcium & phosphorus absorption
- 2) Increased PTH secretion
- 3) Phosphaturia
Name 2 risk factors for vitamin D deficiency other than lack of sun exposure?
- 1) Poor intake (i.e. exclusive breastfeeding)
- 2) African American ethnicity
What are 3 key advantages of preterm infant formula over term formula or soy-based formula?
- 1) Higher calorie density
- 2) Greater protein content
- 3) Enriched vitamins/minerals (i.e. Ca & P for bone mineralization)
When can an infant be switched from formula to cow's milk? Why?
After 12 months - inadequate iron content and protein/lytes content overwhelming to infant kidneys
Besides Ortolani & Barlow sign, what are 4 signs of developmental hip dysplasia?
- 1) Asymmetry of the thigh folds (additional skin fold on affected side)
- 2) Leg length discrepancy
- 3) Waddling gait
- 4) Difficulty abducting affected hip
What is the typical age range when Legg-Calve-Perthes manifests?
2-12 years (mean age 7)
Which type of kids get SCFE?
Fat preadolescents (4-11 years)
What are the 3 lab findings of citrullinemia?
- 1) Hyperammonemia
- 2) Prolonged PT & PTT
- 3) Respiratory alkalosis
What are the 4 lab findings of propionic acidemia (organic acidemia)?
- 1) Hyperammonemia
- 2) Large urine ketones
- 3) Bone marrow suppression
- 4) Metabolic acidosis
What is the drug of choice for treatment of trichomoniasis?
Metronidazole 2g single dose OR 500mg bid x7 days
In the setting of premature adrenarche, when is clinical follow-up without medical intervention is justified? (3)
- 1) No height acceleration
- 2) No bone age advancement
- 3) No other pubertal changes (i.e. acne, clitoromegaly)
Delayed puberty in boys is defined as no secondary sex traits by what age?
Delayed puberty in girls is defined as no secondary sex traits by what age?
Precocious puberty in boys is defined as appearance of secondary sex traits earlier than what age?
Precocious puberty in girls is defined as appearance of secondary sex traits earlier than what age?
- 6 years in white girls
- 5 years in black girls
For kids with constitutional pubertal delay, hormonal therapy may be considered under what circumstance?
Only if there is significant emotional distress
What is the most accurate lab test for diagnosing mycoplasma pneumoniae?
Mycoplasma pneumoniae titers (IgM & IgG)
Contact with farm animals (i.e. pigs, cows, chickens, horses); high daily fevers; lymphadenopathy; splenomegaly; severe malaise - diagnosis?
Urine continues to be dilute & copious despite administration of desmopressin suggests which type of DI? Central or nephrogenic?
Nephrogenic diabetes insipidus
(T/F) Protein composition of formula has no effect on renal solute load.
False! Protein gets metabolized to urea, which contributes greatly to the renal solute load
(T/F) Both carbohydrates and fat contribute significantly to renal solute load.
False! They so don't!
What is the mainstay of treatment for nephrogenic DI?
Decreasing the renal solute load in formula helps to reduce polyuria and polydipsia
IgE-mediated reaction to milk products with symptoms including: urticaria, angioedema, atopic dermatitis, and anaphylaxis - diagnosis?
Milk protein allergy
Non-IgE-mediated reaction to milk products with symptoms including: hematochezia, abdominal distention within first few postnatal months - diagnosis?
Gastrointestinal milk protein allergy
Chronic reflux, dyspepsia, and dysphagia after food ingestion +/- weight loss or failure to thrive; no improvement with formula switches - diagnosis?
Allergic eosinophilic gastroenteritis (esophagitis)
Immediate oral pruritis and swelling after eating certain raw fruits or vegetables; occurs in 10-40% of patients with allergic rhinitis - diagnosis?
Oral allergy syndrome
Ingestion of what household chemical is most likely to present with drooling, dysphagia, odynophagia, and intraoral burns?
Ingestion of ethylene glycol is associated with this LATE finding on urinalysis.
Crystalluria - calcium oxalate crystals
What are the 2 main organ systems affected by hydrocarbon ingestion?
- 1) Lung: pulmonary aspiration
- 2) CNS: depression, seizure, coma
Ingestion of what chemical is most likely to present with cholinergic symptoms of: salivation, lacrimation, urinary incontinence, diarrhea, abdominal cramps, bronchospasm, muscle weakness, miosis?
List 6 factors that predispose children to the development of vulvovaginitis
- 1) Absence of labial fat pads
- 2) Absence of pubic hair
- 3) Poor toileting hygiene
- 4) Anus and vagina are close
- 5) Thin vulvar skin
- 6) Vaginal environment favors bacterial growth
At what value is stool reducing substance assay considered significant?
0.5% or greater
Which section of the bowel is responsible for the absorption of most fats?
Terminal ileum - reabsorbs bile acids that are secreted in proximal intestine by liver
Which type of dietary fat is absorbed by lipase and bile acid-independent pathway?
Adolescent with the "worst headache of her life," pain exacerbated by Valsalva, stiff head/neck - diagnosis?
Subarachnoid hemorrhage (SAH)
Infant presents in shock 2-3 days after discharge from MBU; birth & neonatal course unremarkable; declining activity/feeding at home - which type of congenital heart disease is this?
Left-sided obstructive (gray baby)
What lab is diagnostic for Hashimoto's thyroiditis?
Antithyroid antibodies against thyroid peroxidase (TPO) or thyroglobulin
Adolescent female with primary amenorrhea; no breast developmen but some pubic hairt; short in stature - you should definitely consider what diagnosis?
Turner syndrome: ovarian dysgenesis, single X chromosome (XO)
What are 3 hematopoietic manifestations of intrapartum asphyxia?
- 1) Anemia
- 2) Thrombocytopenia
- 3) Coagulopathy
(T/F) Most infants who have seizure develop cerebral palsy.
Goats milk is lacking in what 3 nutrients?
- 1) Folate ***
- 2) Vitamin D
- 3) Iron
At what age can you consider screening audiometry?
Cyanotic congenital heart disease generally presents at what age?
Within hours of birth
Left-sided obstructive congenital heart disease generally presents at what age?
Days AFTER discharge from MBU
What are the 3 etiologies of inheritance of Down syndrome?
- 1) Nondisjunction
- 2) Unbalanced translocation
- 3) Mosaic pattern
What is the recurrence risk of Down syndrome inherited by nondisjunction?
1% plus mother's age-related risk
What is the recurrence risk of Down syndrome inherited by familial translocation carried by the father?
What is the recurrence risk of Down syndrome inherited by familial translocation carried by the mother?
What is the definition of primary amenorrhea?
No menstrual period by age 16 years
What is the incidence of Turner syndrome?
1 in 2,000 to 1 in 5,000 live female births
What is the incidence of Hashimoto's thyroiditis?
1 in 600 children
Name 4 infectious organisms that require AIRBORNE precautions
- 1) Mycobacterium tuberculosis
- 2) Aspergillus sp.
- 3) Measles virus
- 4) Varicella virus
Name 6 infectious organisms that require DROPLET precautions
- 1) Haemophilus influenzae b
- 2) Influenza virus
- 3) Paramyxovirus (mumps)
- 4) Mycoplasma pneumoniae
- 5) Bordetella pertussis
- 6) Streptococcus pyogenes
Name 10 infectious organisms that require CONTACT precautions
- 1) Clostridium difficile
- 2) Enteroviruses
- 3) Escherichia coli
- 4) Shigella sp.
- 5) Hepatitis A virus
- 6) Herpes simplex virus
- 7) Respiratory syncytial virus
- 8) Rotavirus
- 9) Scabies
- 10) Staphylococcus aureus
What does "contact precautions" entail?
Donning gown & gloves before entering patient's room
What does "droplet precautions" entail?
Gown, glove, and mask for anyone coming within 3' of patient; otherwise just gown & glove before entering patient's room
What does "airborne precautions" entail?
Patient requires negative pressure room; gown, glove, and mask must be worn before entering patient's room
What is the most common viral cause of asthma exacerbation in older children?
What seasons do influenza and parainfluenza strike?
When does rhinovirus strike?
September & late spring
What promotes respiratory drive in patients with chronic respiratory failure (i.e. BPD, CF)?
What promotes respiratory drive in patients with acute respiratory failure (i.e. asthma attack)?
Hypercarbia and acidosis
Recurring crops of pruritic, erythematous papules, some with central punctum - diagnosis?
Small pustules (1-2mm) with surrounding erythema - diagnosis?
Erythematous papules (clustered, coalescing) over face and extremities; usually after viral infection or immunizations - diagnosis?
Translucent or white papules with central umbilication - diagnosis?
Erythematous papules or vesicles that are generalized in infants or concentrated at flexural areas (i.e. interdigital webs, wrist flexures), at belt line, on the penis in older children - diagnosis?
Name 4 complications of parenteral nutrition
- 1) Infection
- 2) Thrombocytosis
- 3) Electrolyte derangement
- 4) Cholestasis
How do we treat TPN cholestasis?
- 1) Trophic feeds - stim's bile flow & intestinal motility
- 2) Ursodeoxycholic acid
What are 2 reasons why preterm infants have difficulty digesting fat?
- 1) Decreased pancreatic lipase activity
- 2) Decreased enterohepatic circulation of bile-acid
How does human milk aid in fat absorption?
Contains bile salt-stimulated lipase that is activated in the duodenum
At routine wellness physical, you should recommend that parents set home water heaters at what temperature?
120 degrees F
What brain processes present with bilateral progressive leg weakness and urinary incontinence? (2)
- 1) Hydrocephalus
- 2) Midline parasagittal lesion affecting cortical spinal tract fibers to both legs
Epicanthal folds, short palpebral fissures, smooth philtrum, narrow upper lip - this matches the description of what congenital disorder?
Fetal alcohol syndrome
Epicanthal folds, upslanting palpebral fissures, flat nasal bridge, macroglossia, excess nuchal skin, 5th finger clinodactyly - this matches the description of what congenital disorder?
Macrocephaly, small chest compared with abdomen, proximal shortening of upper extremities - this matches the description of what congenital disorder?
Short stature, triangular face (broad forehead + narrow chin)
What are 5 lab abnormalities in DIC?
- 1) Thrombocytopenia
- 2) Prolonged PT & PTT
- 3) Low fibrinogen
- 4) Elevated D-dimers
- 5) Burr cells on smear
What 6 vaccines do you need to be a health-care worker?
- 1) Rubella
- 2) Measles
- 3) Mumps
- 4) Hepatitis B
- 5) Influenza
- 6) Varicella
Kid with poor growth, hypertension, normocytic anemia, elevated BUN and creatinine should make you think of what disease?
Chronic kidney failure
What are 3 things that drive red cell synthesis?
- 1) Substrates (i.e. folate, B12, iron)
- 2) Bone marrow function
- 3) Erythropoietin
When should ingested foreign bodies be removed endoscopically?
- 1) Retained longer than 24 hours
- 2) Object is corrosive (i.e. button battery)
What is the typical progression of hemangiomas?
Grow rapidly during first 6-9 months of life - stabilize and involute after
What is the hallmark of involution of a hemangioma?
Appearance of gray or white discoloration on lesion surface
What are statistics of COMPLETE resolution of hemangiomas?
- 30% by 3
- 50% by 5
- 70% by 7
- 90% by 9
What is the mode of inheritance of familial adenomatous polyposis?
Autosomal dominant - mutation in APC gene on chromosome 5
At what age should children with FAP receive their first annual screening colonoscopy?
What is the mean age of developing colorectal adenomas in children with FAP?
Lentigines on the lips and oral mucosa should clue you in to which inherited polyposis syndrome?