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Pediatrics Questions

Pediatrics Questions

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Published by: ce195364 on Feb 16, 2011
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Pediatrics SectionCongenital Heart Disease is included in the Angio-Interventional SectionThe following are True/False questions:1995, 1992Regarding croup and epiglottitis:1. croup characteristically narrows the supraglottic airway (95, 92)2. croup patients tend to be younger (92)3. croup is more urgent (92)4. croup is caused by H. influenza (92)5. subglottic tracheal narrowing is seen in up to 25% of patients with epiglottitis (95, 92)6. viral infection is the most common etiology of croup (95)7.
Staphylococcus aureus 
is the most common cause of membranous croup (95)*Epiglottitis narrows the epiglottis and aryepiglottic folds. Epiglottitis occurs in children older than 3 years,with the peak at 6 years. Epiglottitis is caused by bacteria -usually H. influenze, type B (less likely pneumococcus orStreptococcus Group A). The patient is in mortal danger of suffocation secondary to complete airway closure.Patients often require intubation. Edema can be so severe that it extends to the subglottic area in 25%Croup usually narrows the subglottic airway. Croup thickens the glottis and vocal cords. Croup occurs inchildren older than 6 months, with the peak at 2-3 years. Croup (acute laryngotracheobronchitis or acute viralspasmodic laryngitis) is usually caused by a virus(parainfluenza, respiratory syncytial virus) and is usually self-limiting. Bacterial croup is possible (called pseudomembranous croup, membranous croup, or bacterial tracheitis)and this can be severe, with the patients often needing tracheostomy. Staphylococcus aureus is usually thecausative organism.*Answer: 1. False 2. True 3. False 4. False 5. True 6. Tru 7. True1995, 1994, 1992Regarding necrotizing enterocolitis:8. it results in 60% mortality(95)9. it most commonly affects the descending colon (95)10. an air fluid level in the peritoneum indicates perforation (95)11. air in the portal venous system is always fatal (95)12. strictures occur in 10-25% of patients (95)13. term infants have better prognosis than premature infants14. barium enema can be helpful to exclude other diagnoses15. finding often confirmed by plain film16. pneumotosis indicates impending death*Necrotizing enterocolitis is a disease of bowel in infants subjected tohypoxic stress. Splancnic ischemicevents lead to indirect mucosal injury, which, in immature gut, allows bacterial overgrowth.Approximately 80% of patients with necrotizing enterocolitis are premature. Term infants or older infantswho develop necrotizing enterocolitis usually have severe underlying disease such as congenital heart disease orHirschsprung disease (do they do worse??)The most common finding in necrotizing enterocolitis is dilated bowel (due to ileus). Pneumatosis is thesecond most common findingAccording to Dahnert, barium enema is contraindicated, but “may be used judiciously in selected caseswhere there is radiologic and clinical doubt.”The Merck manual reports that 2/3 of patients with necrotizing enterocolitis will survive(33% mortality).Gore, Levine, and Laufer reports that the “majority survive.” The terminal ileum is the most common site. An air fluidlevel in the peritoneum indicates perforation, which is an indication for emergent surgery. However, air in the portalvein is not (necessarily) a preterminal event (unlike adults). In fact, it is not necessarily an indication for emergentsurgery. Strictures occur in 6-33% according to Gore, Levine, and Laufer.References: Kirks, pp. 869-876; Dahnert 1993, p. 530*Answer: 8. False 9. False 10. True 11. False 12. True 13. False? 14. Fals 15. True 16. False1995Regarding tracheoesophageal fistula:17. oligohydramnios18. greater than 90% present with a fistula19. ???*
 
Answer: 17. Prob False 18. True 19. ???1993, 1992vRegarding intussusception:20. the most common site of perforation is the intussusceptom21. ileocolic is the most common type22. a lead point is more likely in a recurrent intussusception23. it most commonly occurs in 18 m/o -5 y/o.24. a lead point is found in 50% of recurrent intussusceptions*The most common site of perforation is the place which is most ischemic within the intussusception(intussusceptom centrally or intussuscepiens peripherally?). Perforations have also been reported to occur at therectum upon reduction no matter where the intussuception resides.Intussusception occurs more in children (94%) than adults (6%). In children, ileocolic is the most commonby far (90%) followed by ilioileal (4%) and then colocolic. In adults, ilioileal is most common (40%) followed byileocolic.In most cases of infantile intussusception, no lead point is identified. A lead point is most likely (5%) innewborns (Meckel’s, polyp, tumor) and in recurrent intussusception. There is an increased incidence in cysticfibrosis patients -the meconium ileus equivalent syndrome.Most intussusceptions occur between the ages of 6 months to 4 yrs with a peak incidence between 18months and 3 years.References: J. Meyer; Swischuk, 2nd ed., p. 418; Rumack, p. 1210*Answer: 20. False 21. True 22. True 23. True 24. False1993, 1991, 1989Which of the following are causes of gall bladder hydrops in a young child?25. Kawasaki’s disease26. sepsis27. TPN28. neonatal hepatitis29. extrahepatic biliary atresia30. prolonged fasting*Hydrops of the gallbladder is defined as massive distention of the gallbladder without evidence of acongenital malformation, stone, or inflammatory etiology. Most cases are idiopathic.The following are all causes of GB hydrops:-Kawasakis-Sjogrens-Systemic sclerosis-nephrotic syndrome-leukemia-familial Mediterranean fever-TPN-scarlet fever-leptospirosis-ascariasis-typhoid-staph/strepAtresia of the bile duct occurs in about 1 of 15,000 live births. 20% of patients with extrahepatic biliaryatresia will have a remnant GB. Types of biliary atresia:I -atresia of CBDII -atresia of CHDIII -atresia in the portal right and left ductsTreatment of biliary atresia is with the Kasai procedure in which hilar dissection and adjacent placement ofa bowel conduit is performed.Treatment of GB hydrops is conservative with percutaneous drainage if necessary. Avoid surgery.References: Caffey’s, p.452; Walker (Ped GI), p. 1167*Answer: 25. True 26. True 27. True 28. False 29. False 30. Prob False, should be normal1993Which of the following are causes of pancreatitis in a child?31. choledochal cyst32. parathyroid adenoma (hyperparathyroidism)33. cystic fibrosis34. Henoch-Schonlein purpura35. L-asparaginase therapy*Reference: Kirks, pp. 785-786, 840
 
*Answer: 31. True 32. True 33. True 34. True 35. True1992Renal agenesis is associated with:36. typical facies37. agenesis of the bladder38. lung hypoplasia39. oilgohydramnios40. club foot*There are two main categories of renal aplasia -unilateral and bilateral.Bilateral renal agenesis is also called Potter’s disease and has an incidence of 1:3000-1:10000. It has atypical facies (low set ears, redundant skin, and a parrot beak nose), and is associated with lung hypoplasia,oligohydramnios, and club foot.Unilateral renal agenesis has an incidence of 1:600-1:1000. It has no typical facies and is not associatedwith agenesis of the bladder, lung hypoplasia, oligohydramnios, or club foot. It does have agenesis of the ipsilateralhemitrigone of the bladder and renal artery, however.*Answer: (unilateral) 36. False 37. False 38. False 39. False 40. False(bilateral) 36. True 37.False 38.True 39. True 40.True1992Which of the following organisms commonly affect patients with cystic fibrosis?41. Klebsiella42. Staphylococcus43. Stretococcus viridans44. Haemophilus45. Pseudomonas*Answer: 41. True 42. True 43. False 44. True 45. True1993Regarding lung development:46. tracheal development is finished around 20 weeks47. development of alveoli continues after birth48.pulmonary arterial muscle extends down to the alveoli level49. the pulmonary artery and bronchial tree develop in parallel50. the trachea is a foregut structure*Tracheal development from the foregut is finished at approximately 30-32 days.Alveoli develop after birth*Answer: 46. False 47. True 48. False 49. True 50. True1994, 1991Regarding cystic fibrosis:51. it is an autosomal recessive disease52. there is atresia of the vas deferens in males53. there is a higher incidence of gastroesophageal reflux54. the right upper lobe is most commonly affected55. meconium plug syndrome is the presenting feature in 10-20% of cases*Cystic fibrosis is an autosomal recessive disease with approximately 5% of Caucasians as carriers. Thereis atresia of the vas deferens (Harrison’s) with poor development of other Wolffian structures. Although the upperlobes are more commonly affected in the lungs, we could find no reference stating that the right was more common.5% of patients with cystic fibrosis are born with meconium ileus. Patients can also develop meconium ileuslater in life (undigested food and motility problem). This is completely separate from the meconium plugsyndrome,which is not related to cystic fibrosis. This isa functional obstruction of the left colon -it is treated with a watersoluble enema. It is often seen in infants of diabetic mothers.Other findings in cystic fibrosis: biliary/hepatic cirrhosis (which is rarely clinically significant), rectal prolapse,pancreatitis/pancreatic dysfunction, malabsorption, and gallstones. Interesting fact -if you see gall stones in kids -think cystic fibrosis, sickle cell disease, or TPN!

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