obinno59's version from 2015-12-08 18:11


Question Answer
Cyclic vomiting syndrome (CVS) is an idiopathic disorder that typically presents in children 4-7 years old, with the classic history described in the question stem. It is associated with_________ usually tx with______1.A family (or personal) history of migraines.
2. Antimigraine(Amitriptyline)
This 5-week-old healthy male infant is crying for at least 3 hours a day, at least 3 days a week, without evidence of a condition that would provoke crying which is most likely_________. It usually begins between___________ of age and should resolve by_________1. Infantile colic
2. 2 and 6 weeks
3. 4 months of age
A two-year-old should a_______ word vocabularySeveral hundred
Potty training occurs between________. If the child is not motivated to stay dry, the best advice is to______1. 2-4 years of age
2. wait for a few months then reassess.
Neonatal jaundice DDx
Within 24 hours
Within 48 hour
After 48 hours
1. Hemolysis (ABO/Rh isoimmunization or HS)
3. Infection,Hemolysis,Breast Milk,Congenital malformation (biliary atresia),Hepatitis
Physiologic jaundice
occurs________ and is clinically benign
1. between days 3-5
Pathologic jaundice
The presence of the following factors in an infant is indicative of pathologic jaundice and warrants evaluation for an underlying etiology:
1) Jaundice in the first 24 hours of life is always pathologic
2) Total serum bilirubin > 12 mg/dL in a term infant
3) Conjugated bilirubin > 2 mg/dL or > 20% of total bilirubin level
4) Total serum bilirubin rate of rise > 5 mg/dL/day
5) Persistence of jaundice beyond 10-14 days
6) Presence of any additional signs or symptoms indicative of potential underlying diseasedirect (conjugated) bilirubinemia
Bilirubin levels > 20 mg/dL can lead to kernicterus and associated________Neurotoxicity
Results from the irreversible deposition of billirubin in the basal ganglia, pons, and cerebellum
Breast milk
infant liver is not mature enough to process ____ and presents _____ day of life
indirect bilirubin as high as 27 mg/dl during the 3rd week of life
1. lipids
presents between 4th and 7th day of life
2. No intervention needed (mother does not need to stop breast feeding)
if breast feeding stops, bilirubin levels fall rapidly
if breast feeding continues, bilirubin levels will fall slowly
Breast milk vs Breast feeding jaundiceBreast milk jaundice: does not typically become apparent until 6-14 days of life
Breast feeding= Mcc of jaundice in the 1st week of life
Conjugated (direct) hyperbilirubinemia occurs in___(7)Infections
alpha-1-antitrypsin deficiency
congental causes include
extrahepatic biliary atresia
Dubin-Johnson syndrome
Rotor syndrome
Is CAH genetic?AR
~CAH vs Androgen-producingAndrogen-producing tumor: > 30 years old and often presents with a ~ pelvic mass.
When does CAH show up?Usually birth to childhood(salt waste, ambig clit)
But rarer form can show up anywhere from childhood to adulthood(Mc sx: male precocious pub=short and hirsitism in women)
CAH vs PCOSAdrenal corticotropic hormone challenge, which will reveal elevated levels of 17-hydroxyprogesterone, with different cut-offs for classic and nonclassic CAH
Bronchiolitis DxELIZA= Rapid antigen test of nasal aspirate
.RSV-Asthma correlationSevere RSV bronchiolitis within the first year of life requiring hospitalization carries a significantly increased risk of developing asthma by the age of 7, with some estimates as high as 50%
At what age should a child be hospitalized for Bronchiolitis?Age < 3 months
Measle presentationSymptoms
low grade fever
followed by 3C's
coryza (erythematous mucous membranes, nasolabial usually)
erythematous, maculopapular rash develops with fever
starts on face and spreads downward, fading from top to bottom with progression
excludes palms and sole
Measle mgmtMedical management
immunoglobulin administration indicated for use in exposed individuals to alter clinical disease
vitamin A (200,000 U daily for 2 days) reduces mortality in children < 2 y
symptom management
tylenol for fever
moisturizing lotion for rash
maintain hydration
Measles complicationsComplications
otitis media is the most common complications
others may include giant cell pneumonia and larygnotracheitis
most severe complication is subacute sclerosing panencephalitis in 1:2000 case
EKG findings that help dx Tricuspid Atresia1. Tall P-waves (due to right atrial enlargement)
2.Left-axis deviation (due to hypertrophy of the left ventricle), 3.Small/absent R-waves in precordial leads V1–V3 (due to a hypoplastic right ventricle).
If a infant is cyanotic and has decreased BF how do you distinguish Tricuspid Atresia vs Pulmonary Atresia on EKG?Both will have LVH and Decre RV forces
TA: Left up axis deviation(-90-0)
PA: Left down deviation (0-90)

gray membrane on tonsil and throat + High fever
respiratory distress

Pathognomonic gray membrane on tonsil and throat for
Membranous Pharyngitis (Diphtheria

Tx: STAT antitoxin

Sore throat
Red eye
Pharyngoconjunctival Fever (Adenovirus
Tx: Supportive
Strep throat tx.
What if allergic ex rash? What about anaphylaxis?
1st generation cephalosporin for 10 days is used in those who are not anaphylactically sensitive.

Otherwise, treatment with 10 days of clindamycin or clarithromycin, or 5 days of azithromycin, is recommended.
When to tx strep throat vs cxage 3-14, absence of cough, swollen cervical lymph nodes, tonsilar exudate, and fever > 100.4. Patients with a score of 4 or above can be given empiric antibiotic therapy. Patients with a score of 2-3 should be evaluated with a rapid strep test or throat culture
Intussusception sxabdominal distention and tenderness
positive stool guiaic indicative of intestinal bleed
sausage-shaped abdominal mass may be palpated in RUQ
signs of shock may be evident
What part of the bowels dues Intussusception affect?Large bowels
What is the tx for Intussusception?Air-contrast barium enema =both diagnostic and therapeutic in many cases. If that fails then surgery.
After successful reduction, child should be admitted for 24 hrs to monitor for recurrence or complications.
Pyloric stenosis assoc and risk factorsRisk factors
maternal history of pyloric stenosis
Associated with transesophageal fistulas

A 45-year-old women with polyhydramnios delivers a male infant with Down syndrome. Shortly after birth, the infant vomits greenish-yellow fluid. Imaging reveals two distinct pockets of air in the abdominal region. Ddx? Tx?
Duodenal atresia(double bubble) vs Pyloric stenosis, tracheoesophageal fistula

On diagnosis, intravenous fluids should be initiated and a nasogastric tube should be placed for gastric decompression. Surgery is not immediate and is typically performed between 24 and 48 hours after diagnosis. The standard procedure is a duodenoduodenostomy
PE on PKU pt'shyperactive deep tendon reflexes
If a girl puts a foreign body in her vag and it's there for months: it stinks, bloody, fever what do you do?The best initial management is warm fluid irrigation in an attempt to expel the foreign body; if this fails, an examination under general anesthesia should be pursued.
RF for Hirschsprung dzDown syndrome
Chagas disease
MEN type 2
Waardenburg's syndrome(''DIL For MEN''
D- deafness (cngenital).
I- heterochromic Irides.
L- lateral displacement of inner canthi nd of lacrimal puncta.
For- white forelock.
M- macules (hypomelanotic)
E- eyebrows.(p
N- nasal root. (Prominence))