Let's take a Breather
The most common viral cause of croup
What is the parainfluenza virus?
A 14-year-old boy is admitted for evaluation of diarrhea, which has recently become bloody. Dr.Dhana evaluates him and nods-- he'll be getting an endoscopy. During his post-procedure examination, his he ask about the side effects of possible long-term therapies. What is considered a first-line therapy for ulcerative colitis?
What is Mesalamine (5-ASA) ?
sulfasalazine(also a 5-ASA) gets point too :)
A previously healthy 8-year-old girl presents to the ED with red-tinged urine. Her parents report that she has had increased urinary frequency and burning with urination since yesterday.
Color: yellow Appearance: cloudy Glucose: negative Bilirubin: negative Ketones: negative Blood: 1+ Protein: negative Nitrite: positive Leukocyte esterase: 2+
What antibiotic would you like to provide?
What is Kaflex (cephalexin)?
≥24 months: cephalexin 25 mg/kg TID for 3-5 days
A 3-year-old boy presents to the emergency department after a high-speed motor vehicle collision. appeared apneic requiring bag-mask ventilation for a few minutes. However, he improved. Your primary and secondary surveys are normal. He has normal head and cervical spine CTs. But with more detailed MRI you see evidence of acute injuries to what parts of his cervical spine ?
What are c3 to c5?
Pediatric patients are at an increased risk of spinal cord injury without radiographic abnormalities (SCIWORA) on CT and X ray as compared to adults.
which comorbid condition aare boys with attention-deficit/hyperactivity disorder at his age 7 years old are most likely to have?
hint: his favorite word would be no to authority figure...just because
Oppositional defiant disorder
A 3-month-old was hospitalized with a left lower lobe pneumonia at the age of 2 months. Having gained gained about 10 g/day since discharge (on a proper feeding schedule), with daily loose stools and a new cough she may have what disorder? Accompanied by absorption of what vitamins?
What is cystic fibrosis and vitamins A,D,E,K?
A 2-month-old infant presents to the emergency department due to lethargy and vomiting. The mother reports he has been previously healthy and was in his normal state of health until about 2 hours ago, when he started vomiting. He was born full term with no complications and has been exclusively breastfed since birth but she has started supplementing feeds with cow’s milk-based formula last week. This infant likely has what illness?
What is Food protein-induced enterocolitis syndrome or hypersensitivity to cow’s milk protein?
A non-immunoglobulin E gastrointestinal food hypersensitivity
An 8-year-old boy presents to the office for new concerns of recurrent gross hematuria. He has no significant past medical or surgical history. Renal biopsy is performed. The pathologic specimen shows splitting of the glomerular basement membrane and abnormal immunostaining for type IV collagen. Name another finding associated with this X linked diagnosis?
What is Hearing loss ?
(You can get points for hematuria or anterior lenticonus - this is Alports )
A 5-month-old male infant presents to clinic. Family shares he had been episodes of jerking for the past few weeks. During these episodes, he pulls his arms towards his torso and seems startled and sometimes cries afterward. They happen a few times every hour but are becoming more frequent. What are you concerned for and what can you order to confirm?
What are Infantile spasms and an EEG (for hypsarrythmia)?
A 15-year-old girl presents with intermittent headaches for the past 6 months. The headaches are bilateral, pounding, and are worse in the morning. She has occasional dyspepsia and nausea. She also reports difficulty sleeping and tight muscles. She has had no fever, neck pain, or respiratory symptoms. Her physical examination is normal. A CT scan obtained at an outside Emergency room last week showed no evidence of mass. What is is she experiencing that may be contributing to her headaches?
What is Anxiety Disorder?
A 12-year-old boy with cerebral palsy, neuromuscular scoliosis, and a seizure disorder is admitted to the pediatric floor with respiratory distress secondary to an asthma exacerbation. What risk associated with his clinical history would generally contradict the use of NIV( noninvasive ventilation) in his care?
What is a high risk of aspiration?
A 5-year-old boy presents with a one-day history of crampy abdominal pain and vomiting. His mother reports the boy has had intermittent, diffuse abdominal pain for the past two years. She describes the pain occurring more often after meals. There's been no associated fever or diarrhea. He had an episode of pancreatitis about 2 years ago. On examination, the boy is uncomfortable but feels better sitting up and has diffuse abdominal pain on palpation. Complete blood count and comprehensive metabolic panel are normal except for elevated amylase to 225 units/L and lipase to 700 units/L. What is the best diagnostic test for the suspected diagnosis?
What is an Magnetic resonance cholangiopancreatogram?
A 10-year-old boy is brought to the emergency department by his parents. He has a history of chronic kidney disease. They say he has been feeling weak and fatigued for the past few days, with occasional episodes of palpitations. His ECG shows peaked T waves. Laboratory results reveal a serum potassium level of 6.5 mEq/L. What treatment for hyperkalemia is mainly intended to prevent dysrhythmias by stabilizing myocardial membrane potential?
What is Calcium gluconate (10% solution) ?
A 5-month-old girl presents to the emergency room with her mother for increased work of breathing and poor oral intake for the past week. She has no runny nose, cough, fever, vomiting, or diarrhea. On examination, she is lying in a frog leg position and is in moderate respiratory distress with nasal flaring and grunting. Her chest appears bell shaped. When she inhales, her chest contracts and belly protrudes. When she sticks her tongue out, tongue fasciculations are present. You start her on CPAP. What condition does her clinical picture suggest?
What is spinal muscular atrophy (with diaphragm paralysis)?
Respiratory distress due to progressive weakness of the intercostal muscles and diaphragm leading to paradoxical breathing, which is the inward rib cage movement with outward movement of the abdomen with inspiration.positive pressure can reduce the paradoxical breathing by splinting the diaphragm, allowing spontaneous respiration.
What class of antihypertensives is contraindicated in patients with hypertension and tachycardia in amphetamine intoxication?
What are Beta-blockers?
A 24-month-old girl has been evaluated for a chronic cough. The cough has been present since birth with occasional periods of worsening. She has received multiple rounds of antibiotics with concern for pneumonia. When she is not ill, the cough primarily occurs during and after eating. Chest radiograph reveals bronchiectasis of the right middle and lower lobes of the lung. Newborn screening and sweat tests were negative for cystic fibrosis. Developmentally, she is able to walk with assistance and say 20 words. What diagnostic study can help identify the cause of her focal right sided bronchiectasis?
What is a Swallow study?
A 10-month-old boy has failure to thrive, chronic diarrhea, and two prior episodes of pneumonia. He undergoes multiple tests and is found to have an elevated sweat chloride level. What pathophysiologic mechanism is responsible for his disease?
What are Hyperviscous secretions?
points for going big
A 7-year-old girl presents with dark urine. Last month, she was diagnosed with streptococcal pharyngitis and received 1 week of amoxicillin. She has been well since that time. Today she developed dark urine but no other symptoms. Blood pressure is 119/77 mm Hg. She has mild bilateral pedal edema. Urinalysis: hematuria, proteinuria, and pyuria. Urine microscopy: RBCs, RBC cast, WBCs. Serum chemistries: Elevated creatinine of 0.6. What is the most appropriate management of this child’s condition?
What is supportive care ( fluid and salt restriction)?
Post poststreptococcal glomerulonephritis resolves over several weeks to months. In the meantime, the mainstays of supportive care are fluid and salt restriction. This child will also need monitoring of her serum creatinine and blood pressure. Steroids & albumin arent needed. Consider concurrent furosemide if edema and hypertension are present
A 6-year-old girl presents with difficulty walking. She reported tingling in her feet yesterday and today she cannot bear weight on either foot. Achilles reflexes are absent, and patellar reflexes are 1+ bilaterally. She did experience a bout of diarrhea 2 weeks ago. What is her likey diagnosis?
What is Guillain-Barré syndrome?
Hospitalized due to the risk of progression to the diaphragm. First-line therapy for Guillain-Barré syndrome is intravenous immune globulin
A 12-year-old girl continues to struggle with impairing symptoms of obsessive-compulsive disorder in spite of an adequate trial of cognitive behavioral therapy. Her parents are opposed to a fluoxetine trial due to negative press. Which is another SSRI medication they can try for ocd?
What is sertraline or fluvoxamine?
Fluvoxamine, sertraline, and fluoxetine are first-line medications for the treatment of obsessive-compulsive disorder in children and adolescents. F
A 16-year-old girl with asthma presents with intermittent difficulty breathing for the past few months. It seems to occur when she is exercising, especially when she is pitching on her varsity softball team. She has been taking her albuterol inhaler prior to pitching with little improvement. Her teammates say they can sometimes hear her breathing loudly. She has no fever, vomiting, or weight changes. She has begun to feel anxious that she will feel short of breath whenever she pitches. Her vital signs are normal with respiratory rate of 22 breaths per minute. On exam, she is generally well appearing. Heart exam is normal. Lungs demonstrate some transmitted upper airway sounds with no wheezing or other sounds. Abdomen is soft. Neurologic exam is normal. She is referred for spirometry, which shows no change with albuterol administration. She likely has what airway disorder?
What is Vocal cord dysfunction?
This gene is mutated in 80% of cases of autosomal dominant hereditary pancreatitis?
What is the PRSS1 gene mutation?
everyone gets points*
A 10-year-old boy with pancreatic insufficiency is admitted following passage of multiple large-volume, oily stools. He develops muscle cramps and weakness. Physical examination demonstrates a heart rate of 86 bpm and moist mucous membranes. Lab results show a potassium of 1.9 mEq/L. ECG show's T wave flattening and a prolonged ST segment. Potassium is given, but abnormal findings persist. What can you provide to help his body metabolize and respond to your attempts at potassium repletion?
What is magnesium sulfate (25 to 50 mg/kg given by slow intravenous infusion)?
Steatorrhea causes hypomagnesemia though the excretion of magnesium-bound lipid salts through the stool.
Low Mg -> loss of potassium through the urine.
Low Mg -> hypocalcemia through inhibition of PTH release and responde.
Low Mg EKG: T wave flattening & prolongation of the ST segment.
A 17-month-old girl underwent placement of a ventriculoperitoneal shunt 8 months ago for the management of obstructive hydrocephalus.Her parents ask what will be done moving forward to ensure her shunt is continuing to function well. What is a non invasive exam that can help with surveillance management?
What are routine ophthalmologic exams for fundoscopic evaluation?
A 3-year-old boy presents to the emergency room after ingesting 20 tablets of his 15-year-old sister’s amphetamine medication that she uses to treat her attention-deficit/hyperactivity disorder. The boy is agitated and excessively sweating. His vital signs are HR 200 beats/minute, BP 150/70 mm Hg, T 106℉, and RR 50 breaths/min. A dose of lorazepam is administered with minimal improvement in his agitation. At this point, what can you provide to eliminate excessive muscular activity?
What is Rocuronium?
Done in conjunction with intubation, especially in severe presentations. Benzo can get points as well in less severe cases.