Nephro/Uro
What is the most common pathogen of UTIs in children?
E. coli
What labs suggest Type 1 over Type 2?
Presence of pancreatic autoantibodies, normal to low insulin relative to glucose concentration, C-peptide levels (low)
A 13 y/o male c/o knee pain that gets worse throughout the day for the past several weeks. Exam reveals tenderness and swelling over the proximal anterior tibia. No bony tumors are seen on xray. What is the most likely diagnosis?
Osgood Schlatters
A 16 y/o female presents c/o fatigue and generalized weakness the past several weeks. Exam reveals mucosal pallor and an atrophic tongue. Lab data shows a microcytic, hypochromic appearance to the RBCs. What is the most likely anemia?
Iron deficiency
A 10 y/o presents with his parents who are concerned about their son's school difficulties. he has consistently been unable to stay in his seat and has great trouble focusing on his school work. He also has difficulty following direction, is easily distracted, and is often forgetful about what he is assigned to do. What is the most appropriate pharmacologic choice for this patient?
Stimulant (methylphenidate preparation)
List 2 indications to get a renal/bladder US pertaining to UTIs
<2 y/o with first febrile UTI; child with recurrent febrile UTIs; child with hx of UTI who have Fhx of renal or urologic disease, poor growth or HTN; child who doesn't respond to prophylactic abx therapy
Name 2 risk factors for neonatal hypoglycemia.
DM mother, IUGR, Preterm
A 2 y/o male presents with his father c/o elbow pain. While playing in the park, his father pulled him up by his arm to catch him from falling off the jungle gym. The child immediately cried out in pain and now his arm is hanging by his side with limited mobility. On exam, the child has limited supination and swelling is absent. What is the most likely diagnosis?
Nursemaid's elbow
A patient presents with fatigue and weakness. Exam reveals a temp of 99.4F, purpura, pallor, and traces of gingival bleeding. There is no hepatosplenomegaly. A CBC shows normochromic normocytic anemia, granulocytopenia, and thrombocytopenia. What is the most likely diagnosis?
Aplastic anemia: pancytopenia due to bone marrow failure
A patient c/o a strange motor phenomenon involving her left arm. The fingers of her left hand begin to jerk spasmodically, which progressively involves the forearm, upper arm, and shoulder, until the whole left upper extremity displays this activity. She does not lose consciousness. This is characteristic of which seizure?
Focal motor (previously called simple partial) seizure.
Involves motor sx that begin distally and progress to involve an entire limb or body. Other types of focal motor seizures will include sensory or autonomic sx. This does not cause LOC.
You are seeing a pt with a fever which you do not find an obvious source for with H&P. You get a urine which shows microscopic hematuria. You then order a urine culture which comes back negative. At this point the pt feels well and fever has resolved. What is the next best step in the management of this pt?
Follow every 3 mo with hx, physical, and urinalysis and microscopic urine
What is the treatment of neonatal cephalic pustulosis?
Most mild cases will resolve on their own. You can treat with daily cleansing with soap and water and avoid oils/lotions. If severe can use 2% ketoconazole or 1% hydrocortisone.
A 5 y/o is brought in by her parents c/o rash and swelling to her legs. The parents states the pt c/o some pain in ankles but is able to bear weight.
On exam you note palpable purpura and swelling of the lower legs and feet bilaterally. There is some mild ttp to lower legs and ankles.
CBC shows mild leukocytosis but otherwise normal. ESR is elevated. UA and BMP are neg. What is the best management of this pt?
Supportive care. Mild HSP w/o complications will resolve on its own in 3-4 wks. Can give NSAIDs for pain if needed.
A 17 y/o male presents with a persistent lump in his neck. It has been present for about 4 mo. The lump usually does not bother him, but he has experienced pain episodes intermittently, the most recent was the previous weekend after attending a birthday party. What is the most likely diagnosis?
Hodgkin lymphoma
List some characteristics of those with autism.
Socially withdrawn, trouble with eye contact, delayed communication/speech, intense interest, ritualistic behaviors, repetitive motor mannerisms, hypo/hyperactivity to environment, etc.
What is the initial evaluation in a child with asymptomatic microscopic hematuria with proteinuria?
Serum creatinine and 24 hour urine OR first am void for urine protein to creatinine ratio
List 2 of the most common pathogens in AOM?
S. pneumoniae (most common). H. influenzae, M. catarrhalis
You are seeing an adolescent for a sports physical. On exam you note a left thoracic curvature of the spine. What is the next best step in the management of this patient?
MRI of spine b/c left sided curvatures are highly associated with intraspinal pathology
What is the definitive treatment of Ewing sarcoma?
Resection
Describe some main symptoms or signs you may see in a patient with Duchenne Muscular Dystrophy
Delayed motor milestones, awkward gait (waddling gait) or run, calf hypertrophy, Gower sign, hyperlordotic
What is the risk of cryptorchidism and how is this issue treated?
Risk: infertility and testicular malignancy
Treatment: orchidopexy
What can keep the ductus arteriosus open and list at least one disorder where you would want to keep the ductus open?
Prostaglandin E and CoA, Transposition of the Great Arteries, hypoplastic left heart syndrome (essential)
A 10 y/o male presents c/o of left thigh pain x 2 days. On exam, you note the patient has a limp and holds the left leg in external rotation when he walks. What would you expect to see on xray?
Widening of the growth plate possible or the femoral epiphysis slipping off the metaphysis
You are working up an 18 mo old for ataxia, abd pain, weakness and irritability. You see basophilic stippling on the blood smear. What is the most likely diagnosis?
Lead poisoning
What are the 3 main types of spina bifida and differentiate between the 3.
Spina bifida occulta: skin of the back is intact but there is an underlying defect of the vertebrae or spinal canal
Meningocele: spinal canal and meninges are exposed but spinal cord usually intact and functional
Myelomeningocele: Spinal cord exposed and usually damaged and not functioning properly