Anticipate the future
Funny metabolism!
Save me!
Don't go breaking my heart


At what age specifically does the AAP recommend initial Autism Screenin?
What is 18mo ?

The AAP recommends universal screening for autism (eg. MCHAT) at both 18 and 24 month visit or whenever parental concerns are raised.


What infection are children with galactosemia at greater risk of having?
What is E. coli sepsis?


A 6 month old infant presents with a large, unexplained swelling over the parietal area. 

What should you do?

CT scan

Infants < 2 years of age with non frontal scalp hematomas are at risk for intracranial injuries. While some physicians would choose observation rather than CT for traumatic scalp hematomas in a well-appearing child, the injury in this infant is unexplained and the possibility of abuse should be explored. 


A 2 year old child has had repeated episodes of wheezing during viral upper respiratory infections but neither parent has asthma. The child does not have eczema, allergic rhinitis, wheezing apart from colds, or eosinophilia.

How likely is it that this child will develop asthma by age of 6?

What is Unlikely?

If the child has a negative API, it is unlikely that the child will develop asthma by 6 years of age


A 6 year old girl presents with



Elevated CRP


What is the most likely diagnosis?

What is Rheumatic Fever


A 3-month-old with SCID presents for his first set of immunizations.

Which routinely recommended immunization is contraindicated in this patient?

What is Rotavirus ?

Rotavirus vaccine is a live attenuated virus vaccine and is contraindicated in children with SCID.


A patient presents with:

Marfanoid habitus

Developmental delay

Lens dislocation, which is downward and medial

What is the most likely diagnosis?

What is Homocystinuria?

Homocystinuria is an AR disorder that results in elevated levels of homocysteine. 

IQ low + lens dislocation downward


Tachycardia, HTN, Widened QRS, Prolonged QT, Drowsiness, Lethargy, Seizures

Which drug, if ingested, results in these findings?

Tricyclic Antidepressant Ingestion


You diagnose a child with transient hypogammaglobulinemia of infancy.

What therapy do most children with this disorder require?

What is No therapy?

Most do not require any therapy, but you can consider IVIG in those with recurrent infections or markedly low IgG levels. Most have normal IgG levels by 3-4 years of age


A newborn presents with delay of the femoral pulse compared to the radial pulse

What cardiac condition does this indicate?

What is Coarctation of the Aorta?


What supplements should be given to exclusively breastfed babies?
What is Vit D and Iron?

Vit D (400IU/day) should begin in all exclusively breastfed infants in the first few days of life and continue until the infant is weaned to at least 33oz a day of vit D fortified formula or milk.

Full term, healthy breastfed babies should receive daily supplementation with 1mg/kg of elemental Iron starting at 4-6mo.


What skeletal defects are you most worried about  in a child with Mucopolysaccharidosis type I ( Hurler synd)?
What is Atlantoaxial subluxation?


You are seeing a 18 month old child with multiple bruises concerning for child abuse. What radiologic study should be performed?
What is Skeletal Survey?

Skeletal survey should be done in children <2 years of age in whom physical abuse is known or suspected.  These include quality views of the skull, chest/ribs, spine, and extremities. A "babygram" is not detailed enough to see subtle fracture. A follow-up skeletal survey in approx 2 weeks may detect additional injuries not seen on initial survey.


 A 5 year old presents with

Difficulty walking

Chronic sinus infections and several hosp for pneumonia

Elevated a1 fetoprotein

what is the most likely diagnosis?

What is Ataxia-Telangiectasia?

Is an AR disorder with the ataxia occurring early in life, but telangiectasia not become noticeable until after 5 years of age. These children have elevated a1 fetoprotein.


An infant fails the newborn hearing screen and on ECG has a very prolonged QT interval

What is the likely diagnosis?

What is Jervell and Lange-Nielsen syndrome

Is an AR disorder with deafness at birth and prolonged QT interval


At what age should a child be able to sit with support; with no support?
What is 6 months; 7months?

A child should be able to sit with support at 6months of age and with no support by 7 months of age.


Menkes disease is caused by impaired uptake of what mineral?
What is Copper ?

"Kinky hair disease" 

X linked recessive


A 16 year old boy sustains a concussion playing football. He is anxious to get back in the game. 

When should he be allowed to play?

What is Once Asymptomatic and Progresses  through Concussion Rehab stages

No return to play the same day! He must have physical/cognitive rest until he is asymptomatic without medication. Then he may attempt gradual resumption of activities, with cessation if symptoms return.


A 2week boy with eczema, profuse bleeding that is difficult to stop, and found with thrombocytopenia. On peripheral smear, you note small platelets.

What is the most likely diagnosis?

What is Wiskott Aldrich synd?

X linked disease with a classic triad: thrombocytopenia, eczema, and susceptibility to encapsulated bacterial and oportunistic infections. 


A 10 year old boy with crescendo-decrescendo harsh systolic murmur best at the RUSB that radiates into the suprasternal notch and neck, apical ejection click and suprasternal notch thrill

What is the most likely diagnosis?

Aortic Stenosis


What is the cut-off age for giving a DTaP?
What is >7y

Tdap is routinely recommended at 11-12 years of age. After this, a Td booster every 10y is recommended unless a dirty wound has occurred. 


Homozygous children with this disorder develop plantar xanthomas from birth to 5 years of age. Tendon and tuberous xanthomas occur in children 5-15years of age. What is the disorder?
What is Familial Hypercholesterolemia (FH)

Is AD, achilles tendonitis or tenosynovitis may be the first clue in a teenager. Angina and symptomatic coronary disease occur in the 2nd decade.


A 6 year old is seen after an ankle injury. He is tender over the distal fibula. Xray do not show a fracture

What do you suspect? 

What is Salter-Harris type I fracture

Young children are more likely to have a fracture than sprain. If tender over the distal fibular growth plate, it is likely to be a Salter-Harris type I fracture even if the x-ray is normal.


Children with spina bifida or congenital urogenital problemas have an increased risk of having allergy to which common hospital substance?
What is Latex ?

Due to sensitization to proteins primarily hevein. Cross reactivity can occur with papaya, kiwi, banana, potato, avocado and chestnuts.


A 7 year old boy presents for a camp physical. Found with systolic ejection murmur with a vibratory character, it decreases with positional changes that decrease venous return. 

What is the most likely murmur?

What is Still's murmur

Very common in childhood. Usually has a musical quality. It is the most common innocent murmur in children beyond the newborn period.