In a Heartbeat
17yo M with new onset HF. He presents with hepatomegaly, pitting edema of lower extremities and SOB. Negative prior medical history except for viral URI10 days ago. PE, CXR and EKG are non-specific. Endocardial biopsy shows inflammatory infiltrates. What is the most likely cause of patient's new onset HF?
A. coronary artery aneurysm
B. myocardial infarction
C. Hypertrophic cardiomyopathy
D. Myocarditis
E. Pericarditis
D. Myocarditis
Myocarditis is inflammation of the myocardium and is often a clinical diagnosis. Infectious cause ( particularly viral) are most common in children. Therefore, a child with a history of URI or GI illness within the previous 2 weeks
Myocarditis presents with symptoms of heart failure including dyspnea, tachycardia, tachypnea chest pain, hepatomegaly and rales
Clinical evaluation: EKG, CSR, echo, BNP and troponins. If dx is unclear after initial eval, cardiac MRI can be used to assist with dx.
Niacin deficiency will result in
A. Dysphagia
B. Diaphoresis
C. Disarticulation
D. dysarthria
E. Diarrhea
E. Diarrhea
3 Ds: dermatitis, dementia, and diarrhea)
By what age can the majority o children walk up a few strains with or without help?
A. 18mo
B. 15 mo
C. 30mo
D. 2yo
E. 5yo
D.2yo
By age 2, majority of children can walk up a few stairs but are not able to climb
At 18mo majority of children walk well without holding on to anyone or anything
A 6mo previously healthy boy presents to ED with a very rapid heart rate. He had a cold a few days ago and today his mother is concerned that he "doesn't look right." HE has not been feeding well since being ill. He is febrile and his pulse is extremely rapid and baby appears uncomfortable. An Echo showed a regular rate of 262bmp with a narrow QRS complex. P waves are not discernible.Which of the following is most likely in this patient?
A. Hypertrophic cardiomyopathy
B. ASD
C. Ebstein Anomaly
D. Normal heart
E. VSD
D. Normal heart
rrhythmias can arise in children with normal structured hearts or with CHD or existing cardiomyopathy
An infant with SVT- can be triggered by illness
Tachycardia is sufficiently high to narrow QRS complexes and obscure P waves of EKG.
Most children with SVT has no underlying CHD and normal structured hearts. The abnormality is with the electrical pathway between atrium and ventricle
However, children with CHD has an increased risk for SVT.
Accessory conduction pathways are present in up to 36% of patients with Ebstein anomaly predisposing to a variety of arrythmias.
Which of the following individuals would require the highest protein requirement?
A. adolescent
B. 6yo
C. newborn
D. average adult
E. 6-12 mo
c. newborn (1.5-2g/kg/day)
6-12mo 1.5g/kg/day
early childhood 1g/kg/day
adolescent 1g/kg/day
adult 0.8g/kg/day
By what age should the majority of infants be able to reach for and grab a toy?
A. 12mo
B. 4mo
C. 6mo
D. 2mo
E. 9mo
C. 6mo
-2mo- can briefly open their hands
4mo- hold a toy if placed in front of them and brings hands to their mouth
9mo- rake food with their fingers
12mo- mature pincer grasp (thumb and pointer)
An EKG demonstrates an upright T wave in V1. For which of the following is this EKG finding abnormal?
A. 13yo
B. 18yo
C. 3yo
D always abnormal
E. 1 day old
C 3yo
-Newborns have upright (positive T waves for up to 7 days after birth. T waves then become inverted after first week of life
T waves typically remain inverted in V1 until age 9-10. Suavely becomes positive around this time. May remain inverted after this time in some kids which does not necessarily indicate heart disease
A 4yo girl presents for a well child visit. r Height is 70% for age and BMI and weight in 96%. Which of the following is the most appropriate advice to offer the parents regarding beverage consumption for the patient?
A. Limit sugary drinks to 8oz/day
B. offere only non-flouride water
C. limit caffeine to 45mg/day
D. Limit 100% fuit juice of 16oz/day
E. Offer up to 24 oz of unflavored skin mild per day
E. Offer up to 24oz of unflavored skin milk per day
Sugar sweetened beverages not recommended for < 5yo
100% fruit juice should be limited to 4oz/day 1-3yo and 4-6oz/day for 4-6yo
At a well child visit is asked to drawn a person. The drawing has 2 eyes, a mouth and 2 legs. The child can also name a few colors of items but cannot count to 10. Which of the following is the estimated age of this child?
A.4yo
B. 5yo
C. 24mo
D. 30 mo
E. 3yo
A. 4 yo
most children are able to drawn a person with 3 more more body parts at age 4.
A 1 day old in nursery is evaluated for an irregular heart rate and intermittent difficulty with feeding. HR 80-130. ECG showed QT interval of 0.56 seconds. The infant is stable but slightly irritable. Family hx is significant for prolonged QT syndrome in father. Which of the following do you recommend
A. Ablation
B. no treatment
C. Amiodarone
D. Propranolol
E. Bretylium
D. propranolol
prolonged QT >0.45sec
Which of the following is the approximate potential energy available from dietary fat?
A. 2kcal/g
B. 3kcal/g
C. 4kcal/g
D9kcal/g
E. 5kcal/g
d. 9kcal/g
-carb and protein= 4kcal/g
A. 9mo
B. 15mo
C.4mo
D. 6mo
E. 12 mo
A. 9 mo