Testables 2d

  1. For kids being treated for hypothyroidism, what would cause both TSH and fT4 to be elevated?
    Not taking thyroid hormone (as directed); disconcordance between thyroxine and TSH suppression causes elevated TSH (missed a dose) and then elevated fT4 (extra synthroid was taken)
  2. Target pattern lesions in the form of erythematous papules or plaques with central VIOLACEOUS discoloration; no mucosal involvement - diagnosis?
    Erythema multiforme
  3. Prodrome of fever, headache, malaise, cough, sore throat x1-14 days followed by eruption of nontargetoid erythematous or violaceous macules/patches that blister and rupture; mucosal involvement at conjunctiva, mouth, urethra, and rectum - diagnosis?
    Stevens-Johnson syndrome or toxic epidermal necrolysis
  4. What is the difference between SJS and TEN?
    • Less than 10% epidermal loss is SJS
    • 10-30% epidermal loss is TEM
  5. Neonate with h/o IUGR, microcephaly, seizures, hepatopathy, bone marrow suppression should make you think of what diagnosis?
    TORCH infection (in utero infection)
  6. What TORCH stand for?
    • 1) Toxoplasmosis
    • 2) Other (Syphillis, VZV, parvovirus, HIV)
    • 3) Rubella
    • 4) Cytomegalovirus
    • 5) Herpes simplex virus
  7. What is the risk of transmission of HIV to an infant from an infected mother who breastfeeds?
    Approximately 20% to 45%
  8. What category of bacteria does pseudomonas sp. fall under?
    Gram-negative bacilli
  9. In a sick patient (i.e. cystic fibrosis) with suspected pseudomonal sepsis, what is first line empiric therapy?
    • 1) 2 antipseudomonal agents
    • PLUS
    • 2) Aminoglycoside
  10. Name 3 beta-lactams that are effective against pseudomonas?
    • 1) Cefipime
    • 2) Ceftazidime
    • 3) Pipericillin +/- tazobactam
  11. Furosemide usage leads to urinary loss of what 3 electrolytes?
    • 1) Sodium
    • 2) Chloride
    • 3) Potassium
  12. How does furosemide work?
    Blocks Na+/K+/2Cl- transporter in the loop of Henle
  13. How does furosemide cause sensorineural hearing loss?
    Inhibition of the Na+/K+/2Cl- transporters in marginal cells of cochlear duct of inner ear leads to reduced endocochlear potentials
  14. How does chronic furosemide increase risk for kidney stones?
  15. In a person with history of allergy to beta-lactams, which cephalosporin is MOST likely to elicit cross-reaction?
    First generation cephalosporins
  16. (T/F) Negative skin testing to major (penicilloyl) and minor (penicilloate) determinants of penicillin can exclude almost all IgE-mediated reactions to penicillins
  17. What is the best thing you can do for a person with an avulsed tooth?
    Reimplant tooth gently back into socket and have the patient hold in place during transport
  18. What are good liquid solutions for preservation of an avulsed tooth?
    • 1) Balanced salt solution
    • 2) Milk
    • 3) Saliva (in buccal vestibule)
  19. Neonatal lupus erythematosis is caused by transplacental passage of what 3 maternal antibodies?
    • 1) Anti-Ro (SSA)
    • 2) Anti-La (SSB)
    • 3) Anti-U1 RNP
  20. What do the skin lesions of neonatal lupus erythematosis (NLE) look like?
    Erythematous annular plaques located in sun-exposed areas (face)
  21. What is the initial work-up for an infant with neonatal lupus erythematosis? (3)
    • 1) EKG: evaluate heart block
    • 2) CBC: eval heme issues
    • 3) LFT: eval for hepatopathy
  22. Early-onset (neonatal) GBS infection occurs within what time frame?
    First 24 hours of life
  23. Late-onset (neonatal) GBS infection occurs within what time frame?
    First 7 days of life
  24. What are 4 clinical manifestations of early-onset GBS infection?
    • 1) Pneumonia
    • 2) Pulmonary hypertension
    • 3) Septic shock
    • 4) Meningitis (<10%)
  25. What are 3 manifestations of late-onset GBS (that are less likely in early-onset GBS)?
    • 1) Meningitis
    • 2) Cellulitis
    • 3) Septic arthritis
    • 4) Osteomyelitis
  26. How does GBS bacteremia cause pulmonary hypertension?
    GBS toxin can mediate pulmonary vascular constriction
  27. Hypertensive crisis should be suspected in the face of markedly elevated BP PLUS any of the 3 following clinical manifestations:
    • 1) CNS symptoms (HA, vision changes, seizure)
    • 2) Epistaxis
    • 3) Congestive heart failure (HSM, pulm edema)
  28. What are 3 likely causes of hypertensive crisis?
    • 1) Drug ingestion (sympathomimetics)
    • 2) Renal disease
    • 3) Unrecognized progressive hypertension
  29. For all women capable of becoming pregnant, what is the CDC's recommendation for prevention of neural tube defects?
    0.4 mg of folic acid daily
  30. For women who had a previous pregnancy affected by neural tube defect, what is the CDC's recommendation for prevention of future neural tube defects?
    4 mg folic acid daily from time of trying to get pregnant through first trimester
  31. (T/F) Research indicates that adolescents are more likely to disclose sensitive information if clinicians make explicit statements about confidentiality.
  32. (T/F) State laws mandate that adolescents in all states may receive confidential treatment for alcohol and other drugs.
    False - state laws vary in extent to which they protect confidentiality of minors; can't cover every situation
  33. (T/F) Billing policies of an outpatient or inpatient facility are always confidential in regard to STI testing in adolescents.
    False - EMR may not always have safeguards for confidentiality
  34. What are the 3 most common side effects of methimazole and propylthiouracil?
    • 1) Rash
    • 2) Arthralgia
    • 3) Arthritis
  35. What are rare but serious side effects of methimazole and propylthiouracil?
    • 1) Hepatitis
    • 2) Neutropenia
    • 3) Agranulocytosis
    • 4) Vasculitis (more for PTU)
  36. What 3 treatment options for people with hyperthyroidism?
    • 1) Antithyroid medication
    • 2) Ablative therapy with radioactive iodine
    • 3) Surgical thyroidectomy
  37. Regarding treatment of skin abscesses, beyond what size do most experts recommend starting antibiotics?
    5 cm or greater (start abx after I & D)
  38. What is recurrent (functional) abdominal pain syndrome?
    Unexplained abdominal pain severe enough to interfere with school; can be precipitated by stress
  39. What does the palpation of a prominent precordial lift indicate?
    Right heart volume overload
  40. Loud systolic ejection murmur over LUSB indicates what heart lesion?
    Pulmonic stenosis
  41. What are antibiotic choices for outpatient treatment of Lyme disease?
    • Less than 8 yo: doxycycline
    • 8 yo and older: amoxicillin
    • Penicillin-allergic: cefuroxime
  42. What are antibiotic choices for inpatient treatment of Lyme disease?
    Ceftriaxone or penicillin
  43. What are 3 indications for parenteral antibiotics for Lyme disease?
    • 1) Persistent/recurrent arthritis after trial of oral abx
    • 2) Carditis
    • 3) Meningitis/encephalitis
  44. What are beta-lactamases?
    Enzymes produced by gram-negative bacilli that hydrolyze beta-lactam ring
  45. Extended spectrum beta-lactamases (ESBL) confer resistance to which 4 antibiotics?
    • 1) 3rd gen cephalosporins
    • 2) Monobactam (aztreonam)
    • 3) Aminoglycosides
    • 4) Fluoroquinolones
  46. Which organisms typically develop ESBL?
    • 1) Klebsiella sp
    • 2) E. Coli
    • 3) Proteus mirabilis
    • 4) Pseudamonas sp
  47. What is the study of choice to evaluate for UPJ obstruction?
    MAG-3 radioisotope scan - shows delayed "washout" with lasix infusion
  48. What is the study of choice to evaluate for duplex collecting system with ureterocele?
    VCUG - filling defect in bladder
  49. What are 6 clinical manifestations of Jimson weed exposure?
    • Anticholinergic effects:
    • 1) Bizarre behavior
    • 2) Tachycardia
    • 3) Hypertension
    • 4) Dry skin
    • 5) Flushing
    • 6) Dilated pupils
  50. What are 2 clinical features of hand-foot-and-mouth disease?
    • 1) Cutaneous findings: erythematous papule/vesicle on palms or soles
    • 2) Oral-mucosal findings: ulcers on soft palate, uvula, tonsillar pillars and tongue
  51. What are clinical features of herpangina?
    Ulcers or vesicles in posterior pharynx including: tonsillar pillara, soft palate, uvula
  52. In a term infant, when does physiologic anemia occur?
    6 weeks to 3 months (you can reassure parents that anemia will resolve by 4 months)
  53. In preterm infants, when does "physiologic" anemia occur?
    As early as 3-6 weeks
  54. In term infants, how low does hemoglobin get at nadir?
    Usually no less than 9 g/dl
  55. In preterm infants, how low does hemoglobin get at nadir?
    Down to 7 g/dl
  56. Normal MCV in kids 6 month and older?
    70-75 fl
  57. What are the 5 major Jones criteria for the diagnosis of rheumatic fever?
    • 1) Carditis
    • 2) Erythema marginatum
    • 3) Syndenham chorea
    • 4) Polyarthritis
    • 5) Subcutaneous nodules
  58. What are the 4 minor Jones criteria for the diagnosis of rheumatic fever?
    • 1) Fever
    • 2) Arthralgia
    • 3) Acute phase reactants up
    • 4) Prolonged PR interval
  59. What counts as evidence of prior GABHS infection? (2)
    • 1) Throat culture+
    • 2) Rising ASO titer
  60. How do you make the diagnosis of rheumatic fever?
    • 1) 2 major Jones criteria
    • 2) 1 major + 2 minor Jones criteria PLUS evidence of past GABHS infection
  61. What is the number 1 cause of death in teenagers?
    Motor vehicle crash
  62. For a child with first-time unprovoked seizure, what is his recurrence risk in the next 12 months if he is otherwise healthy?
    1 in 3
  63. For a child with first-time unprovoked seizure, what is his recurrence risk in the next 5 years if he has a history of developmental delay, MR, CP, or other CNS problem?
  64. What the 3 key factors in preventing/delaying complications of diabetes?
    • 1) Glycemic control
    • 2) Blood pressure control
    • 3) Smoking cessation
  65. Yersinia enterolytica infection is associated with meat product?
  66. Escherichia coli O157:H7 infection is associated with meat product?
  67. Which diarrheal pathogen is associated with consumption of raw seafood, ice, salads, and cruise ships?
    Norovirus (Norwalk virus or Norwalk-like virus)
  68. What differentiates adenoviral diarrhea from rotaviral diarrhea?
    Adenovirus associated with ingestion of contaminated foods, while rotavirus is not (both occur in kids <4yo)
  69. How long does it take to develop diarrhea from ingesting food contaminated with Staph aureus or Bacillus cereus?
    1 to 8 hours (FAST ONSET!); other pathogens take days to develop symptoms
  70. What is the MOST common explanation for a palpable abdominal mass in a newborn?
    Multicystic dysplastic kidney
  71. Using the 4 clinical features of describing asthma severity, what are the cut-offs for diagnosing persistent asthma?
    • Daytime symptoms >2 times/wk
    • Nighttime symptoms >2 times/mo
    • FEV1 >80%
    • Peak flow variability >20%
  72. For infant CPR, which method of chest compressions is superior: 2 thumb-encircling hands technique or 2 fingers on sternum technique?
    2 thumbs-encircling hands technique
  73. What is the depth you should achieve for chest compressions on an infant?
    One third to half the AP diameter
  74. When do you need to pause between breaths and chest compressions?
    When definitive airway has not been established - 15:2 for 2 person CPR, 30:2 for 1 person CPR
  75. Why is it important to allow full chest recoil after each compression in CPR?
    To enable cardiac refilling
  76. What is the treatment for labial adhesions?
    Estrogen cream (followed by zinc oxide paste or petrolatum)
  77. What level of direct (conjugated) bilirubin do you consider cholestasis or biliary obstruction?
    2 mg/dl or 20% of TSB
  78. The following should make you think of what diagnosis?
    • -Intrahepatic cholestasis
    • -Posterior iris embryotoxin
    • -Vertebral anomalies
    • -Peripheral pulmonic stenosis
    • -Big forehead, pointed chin, hypertelorism
    • Allagille syndrome
  79. What is the most common brachial plexus palsy in newborns?
    Erb-Duchenne palsy
  80. Which palsy affects the upper arm?
    Erb-Duchenne palsy
  81. Which palsy affects the lower arm?
    Klumpke palsy
  82. Which brachial plexus palsy has poorer prognosis?
    Klumpke palsy - affecting lower arm
  83. Aside from arm weakness, what are 3 other clinical manifestations of brachial plexus palsy?
    • 1) Diaphragmatic weakness
    • 2) Shoulder drop
    • 3) Horner syndrome
  84. For brachial plexus palsy isolated to the arm, what is he mainstay of management?
    • 1) Occupational therapy
    • 2) Physical therapy
    • 3) Surgical repair for severe
  85. (T/F) Hemolysis due to ABO or Rh incompatibility can persist for weeks?
    True - maternal IgG has a long half-life
  86. What is the main cause of "intoeing" during early infancy?
    Metatarsus adductus: incurving of the forefoot
  87. What is the main cause of "intoeing" during toddlerhood?
    Tibial torsion
  88. What is the main cause of "intoeing" during early childhood?
    Femoral anteversion
  89. What are clinical signs of femoral anteversion?
    • 1) Reduced external hip rotation
    • 2) Sitting in the "W"'position"
  90. What are classic findings on radiograph that would suggest Blout disease?
    Downsloping of the medial metaphysis of the proximal tibiae (leading to bowed legs)
  91. Late systolic ejection murmur heard best at the apex in a tall teenager - what's the heart lesion?
    Mitral valve prolapse
  92. Ejection click best heard at the right upper sternal border - what's the heart lesion?
    Aortic valve stenosis
  93. What is the first-line anti-seizure medicine is used for treatment of partial epilepsy?
    Carbemazepine or valproic acid
  94. What is the first-line anti-seizure medicine is used for treatment of generalized primary absence seizure?
    Ethosuximide or valproic acid
  95. What is the first-line anti-seizure medicine is used for treatment of status epilepticus?
    • 1) Diazepam to abort seizure
    • 2) Phenobarbital or phenytoin for maintenance
  96. Why should power lifting and body building be discouraged in children and young teens?
    To prevent injury to an immature skeleton
  97. Poor weight gain (or weight loss) in a kid with adequately controlled diabetes mellitus type 1 should make you think of what diagnosis?
    Celiac disease (DM1 has higher risk for autoimmune disease)
  98. Poor weight gain (or weight loss) is a kid with POORLY controlled diabetes mellitus type 1 should make you think of what 2 diagnoses?
    • 1) Mauriac syndrome (associated with hepatomegay and very high glucose concentrations; HgbA1c 12-14%)
    • 2) Diabetic ketoacidosis (in the setting of acidosis)
  99. When should a child be starting to sleep through the night?
    6-15 months
  100. How can parents promote better nighttime sleeping for their infant? (3)
    • 1) Limit daytime naps to 3-4 consecutive hours
    • 2) Allow infant to calm self
    • 3) Limit nighttime feeding
Card Set
Testables 2d
Fourth 50