Random
Cardio
GI
Respiratory
Newborn
100
Newborn child with ambiguous genitalia. One month later has vomiting, ↓Na, ↑K, and acidosis. Best lab test for diagnosis?
What is congenital adrenal hyperplasia? Most commonly due to 21 hydroxylase deficiency. Elevated 17 hydroxyprogesterone.
100
Newborn with Type 1 diabetic mother is cyanotic @ birth and does not improve with O2. CXR shows "egg on a string." What else would you be worried about in this kiddo? http://images.radiopaedia.org/images/850963/0fba5117e2a32fa8c7831512fb2ae3.jpg
What is transposition of the great arteries? Tx PGE1 to keep PDA patent until surgery. Maternal type 1 DM also associated with placental insufficiency/IUGR, Congenital heart dz, NTD, Caudal regression syndrome, Small left colon syndrome
100
1 wk old baby w/ bilious vomiting, draws up his legs, has abdominal distension.
What is malrotation and volvulus? Doesn’t rotate 270 ccw around SMA. Ladd’s bands can kink the duodenum.
100
Baby is born w/ respiratory distress, scaphoid abdomen, and stomach bubble seen in left thorax. http://img.medscapestatic.com/pi/meds/ckb/58/43758tn.jpg
What is congenital diaphragmatic hernia? Biggest concern = pulmonary hypoplasia
100
Upon examination of newborn baby girl born via SVD, you notice cone-shaped head with edema that crosses her suture lines. Ddx?
What is caput succedaneum? Reassurance--evens out in a few days. Cephalohematoma does NOT cross suture lines. Takes longer to resolve. Increased risk of hyperbilirubinemia.
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2y/o with a low grade fever, lacy reticular rash on cheeks and upper body (spares the palms/soles). https://s3.amazonaws.com/healthtap-public/ht-staging/user_answer/avatars/719365/large/open-uri20121205-12189-1oh3pm.jpeg?1354667978
What is fifth disease/erythema infectiosum? Parvovirus B19. Keep away from pregnant women! As opposed to Roseola (HHV6): fever resolves --> rash. http://www.huidziekten.nl/afbeeldingen/exanthema-subitum-1.jpg
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2y/o child who gets cyanotic and hyperpnea while playing, resolves with squatting down. CXR shows "boot-shaped heart." http://www.learningradiology.com/radsigns/radsignsphotos/boot_shaped_tet_chop.jpg
What is tetralogy of fallot? VSD + RV hypertrophy + over riding aorta+pulmonary stenosis. Tx O2 and knee-chest position, surgical correction.
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Newborn with defect to the right of the midline, no sac. During pregnancy, high maternal AFP.
What is gastroschisis? As opposed to omphalocele - defect in midline, covered by sac, associated w/ Edwards & Patau, Beckwith Wiedemann syndrome
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32 wk premie has dyspnea, RR of 80 w/ nasal flaring. CXR shows groudxnd glass appearance with air-bronchograms and atelectasis. Dx? Tx? http://www.learningradiology.com/caseofweek/caseoftheweekpix2007-1/cow284lg.jpg
What is respiratory distress syndrome? Surfactant deficiency --> can’t keep alveoli open. Artificial surfactant, nasal CPAP. Lecithin:Sphingomyelin<2, give antenatal betamethasone if <36 weeks to prevent.
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Newborn baby girl on the 2nd DOL presents with firm, yellow-white papules/pustules on an erythematous base. Upon examination under microscope, filled w/ eosinophils. http://img.medscapestatic.com/pi/meds/ckb/32/28932tn.jpg
What is erythema toxicum?
300
A 3 y/o child is brought in with petechiae, abdominal pain, vomiting and lethargy. He had bloody diarrhea 5 days ago after eating hamburgers at a family picinic. Labs reveal thrombocytopenia and ↑creatinine. Diagnosis? What do you NOT want to give?
What is hemolytic uremic syndrome/thrombotic thrombocytopenic purpura? E. Coli O157H7, Shigella, Salmonella, Campylobacter. Don’t give antibiotics!
300
Bipolar woman gives birth to a child w/ holosystolic murmur worse on inspiration.
What is Ebstein's Anomaly? Tricuspid insufficiency due to TV displacement into RV (lithium).
300
4 wk old first-born male w/ projectile, non-bilious vomiting and palpable “olive.” Dx? Electrolyte abnormalities?
What is pyloric stenosis? Worry about hypochloremic, metabolic alkalosis. Tx myotomy.
300
38 wk LGA infant born by C/S to an A2GDM has dyspnea/grunting. CXR shows air-trapping, fluid in the fissures, perihilar streaking. Dx? What else should you be worried about? http://learningradiology.com/images/chestimages1/ttn-ann.jpg
What is transient tachypnea of the newborn? Lung fluid not squeezed out. Minimal O2 needed. Self-resolves in hours to days. Gestational or maternal type 2 diabetes puts baby at increased risk for hypoglycemia since maternal hyperglycemia --> fetal hyperglycemia --> fetal hyperinsulinemia. Also respiratory distress syndrome since ↑insulin interferes w/ cortisol surge prior to birth that normally stimulates lung maturation.
300
Newborn baby boy with cataracts, deafness and VSD in the NICU. Ddx?
What is rubella? Syphillis: Maculopapular rash on palms and soles, snuffles, periostitis. Toxoplasmosis: Hydrocephalus, intracranial calcifications and chorioretinitis. CMV: Microcephaly, periventricular calcifications, deafness, thrombocytopenia and petechiae.
400
14 y/o lanky male w/ nagging knee pain and decreased ROM of the hip on exam. Differential?
What is slipped capital femoral epiphysis? Surgically close and pin the epiphysis to avoid osteonecrosis. NOT always obese kids. Legg-Calve Perthes Disease: initially painless limp, then thigh pain due to avascular necrosis, usually presents at younger age ~5 years old Osgood-Schlatter: Usually athletes with knee pain and swelling of the tibial tubercle. Overuse injury from repetitive movements.
400
Female with PMH of Turner's syndrome presents with decreased femoral pulses, CXR with “notching” @ inferior rib border due to increased collaterals. Diagnosis? What else should you be worried about in this gal?
What is coarctation of the aorta? Turner's also commonly associated with bicuspid aortic valve and horseshoe kidney. Presents as primary amenorrhea, lack of breast development, short stature, high FSH. Tx estrogen replacement for secondary sex characteristics and to prevent osteoporosis.
400
2 month old baby has colicky abd pain and currant jelly stool w/ a sausage shaped mass in the RUQ. Dx and tx?
What is intussusception? Dx and tx with air contrast enema.
400
A 5 y/o child returns to clinic for follow up after a recent URI and now presents with purpura on his legs and buttocks, abdominal pain, joint pain, current jelly stool. His peripheral smear appears normal, as are his coagulation studies and electrolytes. IgA and C3 are deposited in the skin. http://www.dermnetnz.org/doctors/quizzes/15/img/case4-s.jpg
What is Henoch Schonlein Purpura? Tx symptomatically. Can use steroids for GI or renal dz.
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Baby girl presents DOL 3-5 with bilateral purulent conjunctivitis. Mom had no prenatal labs done. Ddx? What labs would you want if she had a fever of 100.6?
What is gonococcal conjunctivitis? Tx w/ topical erythromycin and IV 3rd gen ceph. Worry about corneal ulceration. As opposed to chlamydia conjunctivitis - presents DOL 7-14, red conjunctiva w/ mucoid discharge & lid swelling, tx w/ oral erythromycin. Complication is chlamydial pneumonia - staccato cough, nasal drainage, scattered crackles + bilat infiltrates on CXR. Neonatal fever 100.4 or greater: CBC, blood culture, urine culture, CSF
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Child presents for well child check. Walks downstairs, copies a circle, can jump with both feet, knows age and sex. Mom worried child is developmentally delayed.
What is normal development for 36 months of age? Provide reassurance.
500
15 year-old athlete complains of occasional palpations angina and dizziness. Last week, he fainted during the 1st inning of his baseball game. Physical exam reveals SEM, softer w/ squat and handgrip, louder w/ valsalva and standing.
What is hypertrophic obstructive cardiomyopathy? Only murmur that improves with ↑ preload and worsens with ↓ preload.
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3 day old newborn has still not passed meconium. What are you worried about? Differential? How to treat?
What is meconium ileus? Dx and tx with gastrograffin enema. Get family history for CF. What is Hirschsprung’s disease? DRE --> explosion of poo. Gold standard = bx showing no ganglia in distal colon due to failure of neural crest cells to migrate properly.
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2 y/o w/ fever to 104 & drooling w/ intercostal retractions and tripod position. CXR shows "thumbprint sign." Ddx? http://pediatricimaging.wikispaces.com/file/view/Picture1.jpg/153527569/Picture1.jpg
What is epiglottitis? HIB only in unimmunized, Strep pyo, strep pneumo, staph. Do not attempt oropharynx exam. Go to OR in case you need to intubate! As opposed to croup: “barking” cough and inspiratory stridor, most commonly parainfluenzae, CXR with "steeple sign," tx with racemic epi nebs and steroids. http://www.learningradiology.com/radsigns/radsignsphotos/steeple%20sign.jpg
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7 day old male, bili @ 12, direct is 0.5. dry mucous membranes, not gaining weight. Ddx?
What is EARLY Breast feeding Jaundice? ↓feeding = dehydration = retain meconium (glucuronidase - reduces bilirubin back to unconjugated) --> intestinal mucosa re-absorbs unconjugated bili. As opposed to LATE Breast milk Jaundice--breast milk has glucuronidase --> unconjugated bili. Onset around ~2 weeks of age and re-gained birthweight already. Hypothyroidism Sepsis
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