At least tangentially related to GI
Mostly ID related
AAP 1
AAP Too
AAP3
100
When can someone with Mono be cleared to return to sports?
What is the timing of blood work for testing for Mono?
Avoid strenuous activity/contact sports for at least 21 days after onset of symptoms, then limited non-contact aerobic exercise allowed
Clearance for full participation 4-7 weeks after the onset of sx if asymptomatic and no splenomegaly
Dx: Serology
Heterophile- 25% false negative in the first week of illness (and high false negative in children <4yo)
VCA IgM and IgG turn positive very early on.
IgM disappears 4-6 weeks after onset of infection.
EBNA turns positive 2-4 months after infection.
100
What blood test is done to diagnose Lyme disease?
MTTT- modified two tiered test= 2 ELISA tests (no longer western blot)
Do NOT test:
●Screening of asymptomatic patients who live in endemic areas
●Patients who present only with nonspecific symptoms (eg, subacute or long-standing myalgias/arthralgias or fatigue)
●Asymptomatic patients after a tick bite
●An obvious single EM lesion: Grows to 2-12 inches over days, resolves over 2-3 weeks, clinical diagnosis only
DO NOT test if only have non-specific symptoms.
100
Name an indication for ordering food panels?
NONE! Only test for something that a child has possibly reacted to.
IgE only gives information on the possibility of an allergy. If they test positive and they avoid the food they could develop an allergy to it.
+ IgE≠allergy!!!
100
Instead of using BMI %ile for Faltering Weight (formerly known as FTT), what should you use?
Z score.
Z= standard deviations away from the mean (50%).
100
What common fractures don't need to be referred to ortho?
Salter I and II fibula fx, avulsion fx of distal fibula.
Brace or Boot x 4 week, Use pain as a guide. Usually back to full activity after 6-12 week.
Buckle fracture- Splint x 3-4 weeks.
Pubis avulsion fx separated by <3 cm
200
What are the 4 most common presenting symptoms of HSP?
What do you have monitor as a follow up and for how long?
Rash, Arthritis/arthralgia, Renal, Abdominal Pain
Monitor with UA and BP for 1 year for development of kidney disease
200
What is the Hair Pull Test?
Hair pull test: grab ~50 hairs at the scalp, gently pull. If 6 hairs come out there is active hair loss.
Anagen (90%): active growth (0.3 mm/day, ~1cm/month)
Catagen (<1%): hair production stops, separates from the hair follicle (takes 10 days)
Telogen (10%): rest phase
Lasts 2-3 months
Exogen: old hair is pushed out by new hairs growing in that hair follicle, (50-150 hairs fall out/day)
200
In what way are seborrheic dermatitis and pityriasis versicolor similar?
Both caused by Malassezia which is stimulated by increased sebum caused by increased androgens (perinatal and peripubertal)
200
What is FGID (functional GI disorder) now known as?
DGBI: Disorder of the Gut Brain Interaction
200
What inhaler should all kids ≥12yo be on for rescue and preventive asthma?
What medication should a 10 yo with EIB use?
ICS-formoterol
SABA + ICS
300
Name 3 of the dirtiest and 3 of the cleanest foods?
Dirty Dozen:
Strawberries, Spinach, Kale, Nectarines, Apples, Grapes, Bell Peppers
Cherries, Peaches, Pears, Celery, Tomatoes
Clean Fifteen:
Avocados, Sweet Corn, Pineapple, Onions, Papaya, Sweet peas (frozen), Asparagus, Honeydew
Kiwi, Cabbage, Mushrooms, Cantaloupe, Mango, Watermelon, Sweet Potatoes
300
What is the most serious longer term effect of this disease?
Immune suppression effects can last up to 3 years
Mortality- 1-3/1000 cases, higher in < 5 yo
Starts with fever (up to 105), cough, conjunctivitis and coryza (runny nose)
May have Koplik spots during this time (pathognomonic)
Rash: Starts 3-5 days after the prodrome sx, starts on the face, spreads down the body and outward to the extremities. Usually spares the palms and soles
Following exposure, approximately 90 percent of susceptible individuals will develop measles.
The illness may be transmitted in public spaces, even in the absence of person-to-person contact. (droplet and airborne- remains in the air for 2 hours)
Primary vaccine failure is the reason for a 2 dose schedule
-7% failure rate with just 1 vaccine
300
What is a technique to get an intranasal FB out of the nose (that we could advise over the phone)?
"Parent's kiss"- blow into mouth, occlude other nostril
300
Should we run a strep test on:
2 years old with fever, no obvious other symptoms/source?
5 year old with fever and cough x 2 days?
8 year old with 5 days of fever and ST?
10 year old with 2 days of fever, ST, no cough?
Centor criteria (only valid for ≤ 3 days of sx)
Test for score ≥2
3-14 yo: +1
Temp > 100.4 (38): +1
Cough: -1
Exudate or swollen tonsils: +1
Tender/swollen anterior cervical lymph nodes: +1
300
What are a few ways to decrease nanoplastic and chemical exposure of a 6 month old?
Glass bottles
Give your baby fresh foods (minimize pouches)
Don't put plastic in the microwave.
If you put plastic in the dishwasher have it in the upper rack.
Avoid plastic bottles (especially single use), cutting boards, Tupperware, etc.
400
How should H Pylori be diagnosed in the pediatric population?
ENDOSCOPY!
There is no evidence that H. pylori infection causes functional abdominal pain in children [nor] that treatment improves functional gastrointestinal pain-related symptoms
Who to test:
Child with peptic ulcer disease, Mucosa-associated lymphoid tissue (MALT) lymphoma, first-degree relative with gastric cancer
Noninvasive testing is not recommended for the initial diagnosis of H. pylori in children.
Do NOT test with serology
400
Name 3 of the 5 criteria for diagnosing PANDAS?
Definition:
OCD or tic disorder
Acute onset of symptoms, episodic course (saw tooth pattern- abrupt onset, resolution over weeks to months)
Starts between 3 years and puberty
Temporal relationship of GAS infection and symptoms
Hyperactivity, tics, anxiety or choreiform movements during exacerbations.
Treatment: azithro or cephalosporin, Standard therapy for tics or OCD, Naproxen
Prophylaxis: Amox 250 mg BID; Azithro 5mg/kg/d (for amox allergy)
Could trial for a few months/during the winter. If has sx while on prophylaxis, it is not PANDAS.
If sx decrease on prophy then it could be PANDAS
400
What instructions should we give patients on how to deliver/take intranasal steroids?
Angle toward the ipsilateral ear, do not inhale (the med will then end up in the throat)
400
What is the definition of Primary Amenorrhea?
No period by 15 yo,
no period 3 years after thelarche.
400
What test/imaging should you order in a 14 year old, BMI Z score 1.89, presenting with subacute knee pain?
AP and Bilateral hip frog leg X-ray
SCFE
Slipped Capital Femoral Epiphysitis
500
What is the new name for MPA?
What in mom's diet are the 3 most common triggers?
When should you retest a guaiac for proof of success of treatment?
Food protein-induced allergic proctitis/proctocolitis (FPIAP)
Triggers: ●Cow's milk (76 percent) ●Egg (16 percent) ●Soy (6 percent)
Do not retest guaiac because can stay positive for many weeks
*Some (Europe?) will reintroduce as early as 6 months old, or 6 months after elimination
Can reintroduce milk after a month to see if sx recur
500
What percentage of rabies cases caused by bats in the United States had a known bat bite?
17 percent had a known bat bite,
41 percent had unprotected physical contact with a bat
5 percent had bats in the residence, but no known contact;
37 percent had an unknown exposure type
500
What to do for a 9 month old whose eczema is exacerbated by eating nuts?
Increase eczema treatments and continue with nut exposure. If you stop the food they could develop an allergy to it.
500
What advice/action/activity is most associated with improved concussion symptoms?
Light aerobic exercise, 20-30 minutes per day
500
What works best for Migraine prophylaxis?
Anything! Nothing better than placebo, but need to use something (low dose cyproheptadine; nutraceuticals- coenzyme q10, mag, riboflavin)