Show:
Have a Heart
Take a Deep Breath
Confusing Kidneys (and electrolytes)
A Bloody Business
Purple Potpourri
100
The ED calls you about a 16 year old with chest pain and fever they would like you to admit. On entering the room the patient appears uncomfortable and is leaning forward. When you listen to his heart you hear what you believe is a friction rub. You pull up his chart - what do you believe the diagnosis is and what are you looking for on the EKG?
-pericarditis -elevation of ST segments in most leads followed by a return to normal of ST segments with Twave flattening and inversion
100
Match the pulmonary infectious disease with the geographic area: Histoplasmosis / Coccidiodomycosis / Blastomycosis / Southwest and San Joaquin Valley / Central + Southeast + Mid-Atlantic / Mississippi and Ohio River Valleys
Histoplasmosis -- Mississippi and Ohio River valleys Coccidioidomycosis -- Southwestern USA, San Joaquin Valley Blastomycosis -- Central, Southeastern, Mid-Atlantic USA
100
One of your patients was incidentally found to have protein on her UA. You are an excellent doctor and decided the next step is to get a first morning voided sample. A urine protein to creatinine ratio of greater than ___ in a first morning sample is abnormal and requires evaluation by a pediatric nephrologist.
0.2
100
What is the most common malignancy in childhood?
Acute Lymphoblastic Leukemia
100
What characteristics define a febrile seizure as COMPLEX?
- > 15 minutes - more than one seizure in 24 hours - focal seizure
200
You are seeing an infant in the ED who has unrepaired tetrology of fallot. He has been doing great but is here with a fever. He has had appropriate weight gain and has never had any cyanotic episodes. The nurse draws a blood culture and the infant cries. He becomes cyanotic and his oxygen drops from 80% to 60%. He becomes tachypnic. What is the best next step of action?
-Knees to chest position -with fever and crying, systemic vascular resistance drops and the L-->R shunt suddenly becomes R-->L, leading to cyanotic tet spell. Increase vascular resistance by placing knees to chest.
200
You admit a patient with an asthma exacerbation. During your history, you find out that the patient is 4 years old. She tries to run and play with her friends but sometimes has to stop due to heavy breathing and wheezing. Mom gives her albuterol usually once per day. She wakes up about once a week coughing. How would you classify her asthma severity?
Moderate Persistent
200
What electrolyte abnormalities are associated wtih hypertrophic pyloric stenosis?
Hypochloremia Hypokalemia Metabolic alkalosis
200
Define Acute Chest Syndrome
A new infiltrate on chest x-ray with one or more NEW symptoms: fever, cough, sputum production, dyspnea, or hypoxia.​
200
You are taking care of a 3 year old patient who is having repetitive episodes of hypoglycemia. She does fast for prolonged periods. You have consulted endocrinology and they have recommended checking an insulin level. Your gut tells you that there is something "off" about mom so you decide to check a C-peptide level. If your patient's repeated episodes of hypoglycemia are due to Munchausen syndrome by proxy (medical child abuse), what would you expect the C-peptide level to be (high or low)?
low
300
You admit a 3 year old Asian boy for fever of 6 days. You suspect Kawasaki's disease. What other criteria will you look for to diagnose TYPICAL Kawasaki disease?
Fever of 5+ days plus 4 or more of the criteria below: 1. changes in extremities - erythema of palms/soles, edema of hands/feet, periungal peeling of fingers/toes (week 2-3) 2. Polymorphous exanthem 3. Bilateral bulbar conjunctival infection without exudate 4. Changes in lips and oral cavity - erythema, lips cracking, strawberry tongue, injected OP mucosa 5. Cervical Lymphadenopathy (> 1.5 cm), usually unilateral Associated labs = high ESR and CRP, leukocytosis with neutrophilia, anemia, abnormal lipids, hypoalbuminemia, hyponatremia, thrombocytosis after week 1, sterile pyuria, high LFTs, high GGT
300
You admit a 10 yo for asthma exacerbation. During your physical exam you note bilateral wheezing. On HENT exam you note a nasal polyp. You treat his asthma effectively. What other recommendation do you have for his PCP other than optimizing his asthma management and education?
CF testing
300
You admit a 5 yo patient from with nausea and vomiting. Mom says symptoms started with diarrhea. Work up in the ED shows low platelets, WBC 17,000, and Cr 1.5. Mom is concerned about her tea colored urine as well. She denies recent travel but did go to a petting zoo recently. What is the diagnosis and the etiology?
Hemolytic Uremic Syndrome E coli O157:H7 -Bonus --> Treatment --> dialysis needed in many. Antimotility agents and antibiotics are contraindicated
300
You admit a patient who has developed symptoms of malaise, weakness, abdominal pain, and back pain after eating fava beans. He appears jaundiced on exam. His urine sample on the counter looks dark as well. You manage his condition like a pro and he's doing much better. This is the family's first child. How do you counsel the family about how the condition is inherited?
X-linked dominant (G6PD)
300
Crohn Disease vs Ulcerative colitis. Which disease goes with each of the below symptoms? Terminal ileum / Contiguous progression / Transmural thickness / Fistulas / Toxic megacolon / Lead pipe colon on barium xray / String sign on xray / Marked risk of colon cancer / Often has complications from surgery
*Terminal ileum - Crohn *Contiguous progression - UC *Transmural thickness - Crohn *Fistulas - Crohn *Toxic megacolon - UC *Lead pipe colon on barium xray - UC *String sign on xray - Crohn *Marked risk of colon cancer - UC *Often has complications from surgery - Crohn
400
What are the major Jones criteria? What disease are they used to diagnose?
Rheumatic fever Most often affects the mitral and aortic valves 1. Migratory Polyarthritis 2. Carditis 3. Chorea 4. Subcutaneous nodules 5. Erythema marginatum (Mitor criteria = Arthralgia, High ESR, Prolonged PR interval, Fever, Increased CRP) Diagnosis is via evidence of recent or concurrent Strep infection and 2 major or 1 major and 2 minor criteria
400
You admit a patient who is coughing up blood. You are not 100% sure if the blood is pulmonary or GI in origin. You consult pulmonology and they perform a bronchoscopy and bronchoalveolar lavage. What finding on this test would indicate a pulmonary source of bleeding. Hint - they usually appear 3 days after bleeding onset.
Hemosiderin-laden macrophages
400
How is nephrogenic diabetes insipidus treated?
-Hydrochlorothiazide -Exact mechanism of action is unknown. HCTZ will decrease distal convoluted tubule reabsorption of Na and water --> diuresis. This decreases plasma volume, which lowers the GFR and enhances the absorption of sodium and water in the proximal nephron. Less fluid reaches the distal nephron, so overall fluid conservation is obtained
400
What test is used to screen for risk of stroke in sickle cell patients?
Transcranial Doppler Ultrasound --do this on all HbSS and HbSBO patients starting at 2 yo
400
You direct admit a baby from ECU Pediatrics for hypotonia. Per chart review, the baby was normal at birth and was developing appropriately. They were lost to follow up for a few months. Mom and dad brought the baby back with concern for weakness. You note that the baby has low muscle tone, absent reflexes and tongue fasciculations. What diagnosis are you concerned about?
Spinal Muscular Atrophy
500
You are admitting an 8 yo boy from the ED. He just came from overseas and on the flight he become very dizzy. PMH includes a heart murmur as an infant that needed surgery but he could not get it done. The murmur went away when he was 4 years old though. He is cyanotic, SpO2 78%. He has hepatomegaly and distended jugular veins. You hear a loud P2 and a 3/6 systolic murmur at the left sternal border. What is his defect?
-VSD --> Pulmonary Hypertension --> possible Eisenmenger syndrome
500
Bronchiolitis obliterans occurs when small bronchi and bronchioles are obstructed by intraluminal masses of fibrous tissue. This can be caused by many disorders but in children, it commonly follows a lower respiratory tract infection with what virus?
Adenovirus
500
You are rounding with Dr. Dibas. She shows you some labs and asks you to calculate the anion gap. She already calculated a urine anion gap and let you know that it is greater than 0. Na = 135 K = 4 Cl = 108 Bicarb = 17
Anion gap = Na - (Cl + Bicarb); normal range is 10-12 **135 - (108 + 17) = 10 = Normal anion gap metabolic acidosis *To decide whether the patient has diarrhea or RTA, calculate the urine anion gap. In this case the patient would have RTA. *A positive UAG suggest low urinary NH4+ (example: RTA) *A negative UAG suggest a high urinary NH4+ (example: diarrhea)
500
An immunocompromised patient needs a blood transfusion. You order it and she develops a fever. What could you have done to most likely prevent the fever? A - pretreat with Benadryl B - Irradiate the blood C- Leukoreduce the blood
Answer: - leukodepletion removes granulocytes via filtration, thereby reducing risk of febrile transfusion reactions. ---Irradiation of blood products makes the lymphocytes that could not be filtrated out replication incompetent, thereby preventing GVHD.
500
You are seeing a 5 day old newborn on the floor that has just been transferred from an outside hospital for vomiting and lethargy. You find out that the infant was born at home and has never seen a doctor. He does not appear well and has become less responsive during transport. An ABG obtained at the OSH shows respiratory alkalosis. CMP shows normal bicarb and bilirubin is reassuringly normal for age. Lungs are clear bilaterally and infant is afebrile. He has low tone. Exam is nonspecific otherwise. As you are calling the PICU attending to transfer the child, the admitting nurse getting ready to draw blood asks you if there is anything you want. Want next best blood test will point you in the direction of the diagnosis and disease severity?
-Ammonia -Most likely has a Disorder in the Urea Cycle -In classic form, by 5 days of age ammonia has elevated to the point that it causes lethargy, hypotonia, vomiting and poor feeding. They progress rapidly to coma and death if hyperammonemia is not quickly identified and treated. -Ammonia > 200 or coma = need for dialysis -Chronically, must restrict dietary protein