Miscellaneous
At what age can parents give free water to their infant?
6 months
A 4 week old infant is seen in the ED for projectile vomiting. An abdominal ultrasound is obtained that is diagnostic of pyloric stenosis. What is the pattern of electrolyte derangement you are likely to see?
Hypokalemic, hypochloremic, metabolic alkalosis
Medical emergency!!! Not a surgical emergency
What are the three most common organisms that cause neonatal sepsis? What are the empiric antibiotics of choice?
Group B Strep, E. coli, listeria monocytogenes
Ampicillin and Gentamicin
You are seeing a 6 month old child for routine well child exam. What vaccines should the child receive at this visit?
Hep B, DTaP, Rotavirus, H. flu, IPV, Pneumococcal conjugate
What is the congenital heart defect classicaly associated with Down Syndrome?
An atrioventricular canal defect or endocardial cushion defect? (What murmur would you hear?)
This a cause of hip pain, usually unilateral, in an overweight adolescent. What is the condition and what is the classic x-ray finding?
What is SCFE (Slipped Capital Femoral Epiphysis)
Described as a melting ice cream cone
An 8 year old boy is seen in clinic with several days worth of diarrhea, the last few of which have had some blood streaks in it. You send a stool sample that returns positive for Shigella. How should you treat this infection?
Supportive care!
What is the most common infectious agent in osteomyelitis?
What is staphylococcus aureus. (What other infectious agents are on the differential?)
Put these shapes in order from youngest to oldest that a child should be able to copy: Square, line, triangle, circle
Line: 2 years old
Circle: 3 years oldSquare: 4 years old
Triangle: 5 years oldYou diagnose a child with Noonan Syndrome. What is the most common congenital heart defect associated with this syndrome?
Pulmonic stenosis (Describe the murmur)
A 4 year old male presents with hip pain and limp 1-2 weeks after a URI. What is the most likely diagnosis?
What is Transient Synovitis. (Must think about septic arthritis)
A newborn male is seen in the NICU. His intestines are noted to protrude from his abdomen lateral to the umbilicus and are not covered by a membrane. What is the diagnosis and how did this occur embryologically?
Gastroschisis (bad bowel good baby)
Failure of lateral body wall folding
What are three most common bacteria that cause otitis media in children?
Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
At what age should children be screened for familial dyslipidemia?
Age 9-11 and gain after puberty. Do not send once puberty has started as results are likely not interpretable
You are seeing a newborn child in your clinic. You hear a murmur and are suspicious it is coming from a VSD. Describe the murmur.
Holosystolic murmur heard best at LLSB. Usually heard first around 2-4 weeks of age.
Name that syndrome: Elf-like facies, cocktail party personality, supravalvar aortic stenosis
Williams Syndrome. Elastin gene mutation on chromosome 7
A 1 week old baby born at 28 weeks develops abdominal distension and feeding intolerance. You suspect a diagnosis of necrotizing enterocolitis so you order an abdominal xray. What is the pathognomonic finding to confirm the diagnosis?
Pneumatosis intestinalis (air in the bowel wall)
A 10 day old infant presents to your clinic with watery discharge from both eyes. What is the likely diagnosis?
Chlamydia conjunctivits (not prevented by erythromycin ointment)
Within 24 hours: Chemical irritation
2-5 days: Gonococcal
5-12 days: Chlamydia
A one year old comes to your clinic for his one year well child check. At this visit, he should be transitioned off of infant formula and recommended to start what type of milk?
Whole milk, alternatively pee protein milk or hemp milk
At 2 year visit, transition to low fat milk
A 6 month old infant presents to the emergency department with irritability and lethargy. Heart rate is 250. EKG shows a narrow complex tachycardia without identifiable P waves. What is the diagnosis and how do you treat it?
Supraventricular tachycardia (most likely AVRT). Treat with vagal maneuvers (ice to the face) or adenosine
What are the diagnostic criteria for Kawasaki Disease?
An 18 month old girl comes to the emergency department with episodic abdominal pain. You witness an episode where the child draws up her legs and inconsolably cries. An ultrasound shows a target sign. What is the diagnosis and how do you treat it?
Intussusception. Treat with air enema.
You are seeing a 14 year old boy in clinic with left lower leg cellulitis that has failed to get better on Keflex. You suspect this may be due to MRSA. Name 2 of the 3 oral antibiotics you can use for empiric MRSA coverage.
Clindamycin
Trimethoprim-Sulfamethoxazole
Doxycyline
An 18 year old comes to your clinic for well visit. During your HEADSS assessment, she tells you that she is sexually active with her boyfriend and uses condoms for contraception. You should counsel her that condoms are what precentage effective at preventing pregnancy with typical use?
85% with typical use
98% with ideal use
What are the four components of Tetrology of Fallot?
1. Anterior malalignment VSD 2) pulmonary stenosis 3)overriding aorta 4) right ventricular hypertrophy (Describe a "Tet spell" and what can you do for it).