PEDIA

 Suggest TOF  ECG will show right axis deviation and right ventricle hypertrophy

 10y.o petechiae on buttock and low extremities, abdominal pain, arthralgia, hematuria,
suffered from URTI 1w ago, lab show normal platelet count  vasculitis “HSP”

 Square  4y

 Recurrent hematuria + sensorineural deafness + fx of renal failure  Alport syndrome

 11 y.o left knee pain + worse with activity and better with rest + no trauma  Osgood-
schlatter disease “more common in adolescent boys active in sports”

 Nosebleeds and bleeding from gums, recently recovered URTI  idiopathic

thrombocytopenia pura pura(?)

 Most likely explanation for familial occurrence of Angelman syndrome  maternally

inherited UBE3A mutation “its inherited from fathers, but they give birth to silent
carriers women, and when these women give birth, mutation becomes active again”

 Which syndrome is not associated with craniosynostoses  (crouzon, apert, carpenter,

Pfeiffer, cleidocranial dysplasia)

 Child born with/ bilateral microtia + colobomata of lower eyelids + absent zygomata +
micrognatia + high but intact palate  treacher Collins dyndrome

 Number of descendants produced by a person possessing a given genotype or

phenotype  fitness! (fertility= ability to become or father a pregnancy, genetic drift=
population-level random fluctuations in gene frequencies, reproducibility= ability to
recreate a particular outcome, zygosity= multiple gestation)

 Child brought to clinic by father, was diagnosed recently with von hippel-lindau
syndrome, want to know wether his daughter is also affected  you need to know
results of his mutation analysis

 A case about NEC, whats correct  this condition puts the infant at increased risk for
neurodevelopmental impairment

 Infant highest risk of developing germinal matrix intraventricular hemorrhage  female

infant born at 26w by precipitous vaginal delivery who develop hyperoxia and
hypocarbia after intubation and surfactant administration (there’s a 24w boy but he’s
already 20d old, its less likely to develop it after 5d of delivery)
 Premature baby has cranial US at 4d, hemorrhage limited to right germinal matrix.
Which is true about management cranial US should be repeated within 1st week, as
the hemorrhage may extend into THE VENTRICLES!

 True about cardiorespiratory transition from intrauterine to extrauterine is correct 

surfactant is released into alveolar space via lung inflation and increased blood
catecholamine levels

 True about currently available about prevention of NEC  exposure to antenatal

steroids is associated with a decreased risk of NEC in premature infants

 True about NEC in near term infant  NEC typically occur sooner after birth in near-
term infants when compared to premature infants!

 Patent ductus arteriosus pathophysiology  elevated serum concentration of

prostaglandin E2 “a decrease of PGE2 and receptors= closure”

 Diabetic mom gave birth to an infant with shoulder dystocia, 3h later infant develops
respiratory distress and needs supplemental oxygen, on exam= shallow resp but clear
bilateral breath sounds, baby has limited movement of left arm and moro reflex, what
will you see on cxr  elevation of left hemidiaphragm by 3 intercostal spaces (relative
to right) “erb’s palsy and brachial plexus injury”

 3y.o + hx of autism + delayed language development + paroxysmal laughter and tongue

thrusting + prognathism and abnormal gait, no rash  angelman syndrome

 Child with micrognathia + glossoptosiss + u-shaped cleft palate, combination of findings

is classified as  SEQUENCEEEE! Pirre robin sequence

 New born non-disjunction tri21 causing down syndrome, mother is 28y.o, her risk of
having another child with down syndrome in next years  “1/100, general risk is 1 in
800”

 For autosomal dominant disorder, recurrence risk decrease by ½ for each successive
degree of relationship. Comparably, recurrence risk for multi factorial disorders  falls
off more rapidly as genetic distance increases

 Regarding inheritance of genetic conditions, concept of penetrance refers to 

proportion of individuals with the genotype who manifest any part of the phenotype
“other: expressivity= degree of variation or severity among people who express the
phenotype”

 True about mitochondrial genetics at fertilization, all mitochondrial DNA is derived
from oocyte
 Most effective rx of hematologic complication for gaucher disease  enzyme
replacement therapy “biweekly infusion of recombinant human glucocerebrosidase”

 6y.o + primary dyslipidemia + elevated cholesterol + FIRST therapy is  diet with

decreased fat, cholesterol and simple sugar, but increased amount of COMPLEX carbs
with NO DECREASE in total protein

 A genetic condition caused by repeated triple base pair sequence (CAG), with each
generation in a family, the repeated segment enlarges, leading to earlier sx onset, this
phenomenon known as  anticipation “disease with triple base repeat= myotonic
dystrophy, huntingtons”

 Hereditary condition are  can be transmitted during reproduction from the parent to
the offspring

 Microbrachycephaly and micrognathia + low hairline + synophrys, arched eyebrows,

long eyelash, thin upper lip, low set ears, spade like hands, 2-3 syndactylyl of toes 
cornilia de lange syndrome

 Ashkenazi Jewish carrier testing panels  tay sachs disease

 Lipoprotien lipase deficiency, elevated TGs > 1000 mg/dl!!!!, most important acute
medical concern  recurrent episodes of pancreatitis

 5m + 2-3 previous episodes of fasting hypoglycemia, labs= hypoketotic hypoglycemia

with mild acidosis, mild hyperammnemia + elevated liver transaminases during episodes
of hypoglycemia, best dx modality to establish  plasma acylcarnitine profile “hepatic
presentation of fatty acid oxidation disorder (FAODs)

 3m infant +loss of developmental milestones, hypotonia, seizure, and failure to thrive +

short, sparse and twisted hair, metal metabolism defect  copper deficiency “menkes
disease, mutation in ATP7A”

 7m previously healthy female + 2d hx of poor oral intake along with n/v + she was
lethargic and limp + glucose was found to be 25 mg/dL + no hepatosplenomegaly +
electrolytes- bicarb 18 + ammonia is normal + urine specific gravity= 1030  fatty acid
oxidation disorder

 3m persistent diarrhea + severe periorificial dermatitis, metal def  zinc “SLC30A2

transporter, rx= high dose zinc sulfate”

 6m male increased anion gap, metabolic acidosis and seizures + alopecia and
periorificial skin rash  BIOTINdase deficiency, rx is large dose of biotin

 Rx of diaper dermatitis  (all, zinc and castor oil, topical steroid, topical clotrimazole)
 Correct management for DKA  fluid, insulin, k

 1st line for child with uncomplicated UTI  oral amoxicillin/ clavulanate (augmentin)

 DKA  hypokalemia

 A 2y.o brought for thumb sucking  reassure mother

 Auscultation in a barking cough child  inspiratory/ ex stridor

 APGAR= HR 101, cyanotic body and extremities, no response to stimulation, no flexion

of extremities, strong cry  4

 10d male + cyanotic episodes + recurrent generalized convulsions + odor of burned

sugar from body and urine +marked increase in branched chain amino acids  maple
syrup sugar disease “aminoacidopathy 2ndry to enzyme defect in catabolic pathway of
branched chain amino acids: leucine, isoleucine, and valine”

 Not a component APGAR  LOC “CRIME= color, rate, irritability, muscle tone, effort
(resp)”

 Grade 1 stridor  cool mist from a humidifier

 Not a cause of painful breast during breastfeeding  (mastitis, cracked nipple, clogged
duct, pituitary gland adenoma)

 Child with scaling and hair loss of scalp, several children in his class have same condition
 tinea capitis “superficial dermatophytosis”

 All are rx tinea capitis except  (grisefluvin, fluconazole, terbinsfine, hydrocortisone)

 Upon birth, babies must begin breathing on their own, if they fail= they may suffer brain
damage caused by  anoxia “oxygen deprivation, aka asphyxia”

 Boy playing, suddenly coughs and turns blue  foreign body

 Child developed influenza after flu vaccine, whats the cause  antigenic drift may be
responsible

 APGAR= 5 at five minutes, whats the intervention  resus with oxygen and rubbing
baby’s back then reassess APGAR

 Child with bloody diarrhea and tenesmus + pain and fever + feces was scanty with
mucus blood tinged  iv fluid and antibiotics

 Most serious adverse effect of isotretinoin  teratogenicity

 Child with multiple, discrete, skin colored, 1-3 mm dome shaped smooth papules on
face with central umbilication  molluscum contagiosum

 2d newborn of DM mom has hypotonia, tachycardia, apnea, poor feeding, jitter and
seizures  hypocalcemia

 Child with unusual skin hyper elasticity and joint hypermobility, skin snaps back when
pulled  ehlers- danlos syndrome

 Not a complication of sickle cell  (priapism, ACS, gallstones, dacrycystitis)

 12 y.o hx of ptosis and diplopia which worsen after activity and improves after rest 
myasthenia gravis

 2y.o w/ symmetric psoriasiform lesions in perioral, acral, perineal areas + cheeks, knees,
elbow, also mild alopecia and chronic diarrhea  acrodermatitis enteropathica

 Black teenager with sharply demarcated, dense, firm, rubbery growth on face in site of
PREVIOUS smaller laceration that occurred long ago  keloid

 8y.o, LARGE café-au-lait spots with irregular borders and precocious puberty + xray=
polyostotic fibrous dysplasia of bone  McCune Albright syndrome

 Incontinentia pigmenti is ass/ with all except  (seizures, alopecia, hypodontia, lethal in
female)

 14m + hx of 2m 2-6 loose, non-foul watery stools per day, extensive workup is negative
for everything  toddler’s diarrhea

 Scabies  permethrin 5% cream

 15y.o + started on carbamazepine 4w ago, now has diffuse erythematous macular rash,
fever, lymphadenopathy, eosinophilic leukocytosis, elevated LFTs  hypersensitivy
syndrome

 Kasabach-merritt syndrome  (all, hemangioma, thrombocytopenia, microangiopathic

hemolytic anemia)

 ADHD rx  methylphenidate

 Social smile  2m

 Child is able to steer, pedal, control the tricycle(?)  4y

 Anion gap occurs in all except  (RTA, salicylate poisoning, ethylene glycol poison, DKA)
 Diabetes insipidus may be due to all except  (adrenal deficiency, pituitary adenoma,
hypokalemia, hypercalcemia)

 6m + tonic clonic seizure for 30min + hypothermic and lethargic looking child + diet hx=
dilute formula  hyponatremia

 Congenital heart disease least ass/ with infective endocarditis  (ASD, VSD, TOF, mitral
regurgitation)

 Increase risk of infective endocarditis  (TOF, VSD, mitral regurgitation, all)

 Heart complication related to marfan syndrome  AORTIC ANEURYSM

 Despite parents fear  no connection btw vaccines and autism

 10m + vomiting, diarrhea, tachycardia, normal bp, dry mucous membrane, capillary refill
of 2sec, deep respiration, and irritability, % of dehydration  6-9% “tachycardia reflect
iv volume loss, deep respiration= metabolic acidosis”

 Hypernatremia dehydration complication  cerebral edema

 School girl diagnosed with measles, had rash today, how many days to keep her off
school to prevent infection spread  4d “4days before rash, and 4days after”

 Cyanosis with pleothora is not seen in which of the following  (TOF, TGA, TAPV,TA)

 13 y.o overdosed on TB meds and developed seizure and high anion gap, whats the
antidote  pyridoxine (INH overdose)

 Premature baby  born before 37 completed weeks (more than 3w before due date)

 True about flu vaccine in asthma  (doesn’t reduce or shorten asthma exacerbations,
IM vaccine is safe and beneficial for children with asthma)

 Xray= bat wing  cardiogenic pulmonary edema

 True about TOF  spells ass/ with hypoxia and cyanosis

 Child with vomiting and diarrhea, unresponsive and BP is unrecordable  child is in

shock and requires IV bolus of normal saline at 20 ml/kg

 Notching or ribs is radio sign associated with  coarctation of aorta “inferior rib
notching”

 Child ingested 3 bottles of ferrous gluconate 4h ago  IB deferoxamine

 Child with ADHD, cannot get involved in anything for a long time, keeps looking for
something to occupy him, what type of ADHD  inattentive-distractible

 c/I of circumcision  (all, hypospadias, chordee of penis, premature infants)

 1d neonate with bilious vomiting starting 5h after birth, exam= scaphoid abdomen 
duodenal atresia

 14y.o + 5d hx of fatigue, sore throat, not getting better despite use of antibiotics, fever,
swollen nodes in neck and armpit, generalized body rash  infectious mononucleosis

 2m with creamy white plaques in mouth, when he was 1w he developed conjunctivitis

treated with erythromycin  rx is oral nystatin (caused by candida due to use of abs)

 Osler’s nodes are seen in  acute staphylococcal endocarditis

 Pott’s shunt  descending aorta to left pulmonary artery “TOF”

 Which condition will worsen with prolonged infusion of prostaglandin E  obstructed

TAPVC (other answers are ductal dependent lesions= pulmonary atresia w/o VSD,
hypoplastic left heart syndrome, interrupted aortic arch syndrome…) (in TAPVC patent
ductus will increase pulmonary flow, which is already increased in this condition= worse)

 7d infant was well when discharged, present with respiratory distress and shock 
hypoplastic left heart syndrome “after PDA is closed”

 Cardiopulmonary resus result in  (recovery from cyanosis, recovery of respiration,

normal sinus rhythm) NO RIB FRACTURE OR RETINAL HEMORRHAGE AFTER CPR

 Acute epiglottitis  hemo influenza

 7d child + redness, warmth, swelling, pain around umbilical stump, infant has fever,
tachycardia and hypotension  omphalitis!

 True regarding 1y.o child with PDA  chance of spontaneous closure is high
“indomethacin helps PRETERM babies only”

 Most common cardiac anomaly ass/ with coarctation of aorta  bicuspid aortic valve

 Ductus depended flow is in all except  (persistent TA, left hypoplasyia, pulmonary
stenosis, TGA with ventricular septum)

 Infantile myocarditis and pericarditis is not caused by  (echovirus, coxsackie A & B,

rotavirus)
 8 AND A HALF y.o has breast buds + sparse pubic hair + mild pigmentation of labia 
NORMAL DEVELOPMENT! (precocious is before 8)

 1st exposure of violence in children  domestic violence

 1st step in DKA  bolus NS

 Mental retardation + microphthalmia + microcephaly + chorioretinitis + rash  TORCH

infection

 In infants, congestive cardiac failure is diagnosed by  liver enlargement “poor feeding,

labored breathing, poor weight gain, tachypnea and subcostal retraction, sweating,
flaring, irritability, hepatosplenomegaly”

 1st week death in congenital heart disease  hypoplastic left ventricle syndrome

 2ndry HTN in children is most commonly due to  renal disease “75-90% due to
underlying renal parenchymal diseases, primarily GN”

 Newborn has tetany after delivery, calcium=1 (normal 2-3) + 1y later has recurrent URI +
Hib, HSV, pneumocystis jirovecii, aspergillus  22q11 .2 deletion “DiGeorge syndrome!”

 Snoring and FTT  OSA

 2y.o boy + weakness of lower limbs, CSF= no cells, normal glucose, high protein  GBS
“albumin cytologic dissociation, elevation of protein w/o wbc”

 Feature not present in neonate with PDA  (CO2 wash out, bounding pulse, pulmonary
hemorrhage, NEC!)** “they have normal respiration”

 Most common sequelae to periventricular leukomalacia  cerebral palsy

 2y.o + fever, cough, respiratory distress + cxr= consolidation in RL lobe, improved with
abs, but came 8w later with increasing consolidation, next dx  bronchoscopy

 1m + pansystolic murmur + echo show 2ml open in muscular interventricular septum 

watchful waiting (VSDs have high closure rate esp smaller ones within 2y)

 14 y.o came to take second dose of varicella vaccine, his 1 st one was taken a year ago 
give the 2nd dose “it should be given at least 28d apart”

 Tripod position, roll and reach for objects  6m

 Not helpful in rx of enuresis  (punishment, demopressin, imipramine, bell and pad

apparatus)
 PENTALOGY of fallot  TOF + ASD (trilogy of fallot= TOF w/o overriding aorta)

 Poor speech + tantrum like rages + rocking + repetitive ritual like behavior  autism

 Swallowed caustic material + drooling  protect airway

 GERD patho  (all, weak low esophageal sphincter pressure, poor esophageal motility,
delayed gastric emptying)

 Spine stops growing after onset of menarche by  30m

 13m brought for developmental delay, which is considered delay at his age  crawling

 4m + congestive cardiac failure + infant has bulging fontanel with bruit + CT= mid-line
lesion with dilated lateral ventricle  vein of galen malformation

 Mom of diabetic child tells you that he lost consciousness, initial management  IM
glucagon

 13y.o boy delayed puberty + fair hair on groin  wait

 3y.o, missing from mom house after 1m of divorce  searching for his father??! (other
answers: sleep walking, anxiety reaction)

 False regarding impending Eisenmenger  normalization of size of left and right

ventricle

 After divorce, children will demonstrate all but  (expect that parents will never go
back together, withdrawal, academic deterioration, indifference at times of reunions)

 1st line for early neonatal sepsis  ampicillin and gentamicin

 Munchausen syndrome by proxy characterized by all except (use of meds or toxins,

multiple hospitalization, induced manifestation by caregiver, ready admission of abuse
by parents)

 True about reye syndrome  (all, hepatitis and encephalopathy, unknown cause but
begins after recovery from viral infection, 90% ass with aspirin use)

 Rheumatic fever prophylaxis in penicillin allergic patient  erythromycin

 All are habit disorder except  (stuttering, thumb sucking, tics, trichotillomania)

 A case that will prompt you for further evaluation for possible underlying metabolic
disorder  3w with feeding intolerance, increased anion gap acidosis, significant
ketosis (urinary ketosis 4+) ketonuria should always be considered abnormal in neonate
 3d.o comatose neonate + ammonia level 550 micromol, next step to provide best
neurocognitive outcome  immediate hemodialysis “same q with 200 amonia= same
management”

 5m previously healthy, sudden hypotonia and dystonia adter intercurrent illness, she
was born with macropcephaly, brain MRI= degeneration of caudate and putamen with
frontal atrophy, a test that will reveal dx  urine organic acids “glutaric acidemia type
1, from glutaryl- CoA dehydrogenase, born with macrocephaly then develop sudden
hypotonia and dystonia)

 Inborn errors of metabolism can be ass with odor/smell, which is a correct association
 isovaleric acidemia and smell of sweaty feet “episodic encephalopathy” (other=
MSUD: maple syrup smell, carnitine supplement which is used in management of
organic acidemia= cause fishy odor)

 5d term neonate, 2-3d of poor feeding, 1d of lethargy, increased anion gap acidosis,
glucose= 24, urine ketones  for dx do urine organic acids

 Barking cough, red epiglottis, thumb sign, best initial  endotracheal intubation “acute
epiglottitis”

 Baby with large anterior fontanelle, low ears, bifid thumb, imperforate anus,
undescended testes, which are the defects that are associated  bifid thumb and
imperforate anus

 2y.o, 2 episodes of unsteady gait after a viral illness, intermittent sweet caramel odor to
skin, dx  evaluation for a branched amino acid disorder (MSUD)

 Mom gives birth to infant who’s growth restricted, microcephalic, has congenital heart
defect, she had 1 miscarriage, and her 3y.o son has mental impairment, she says her
child was on a special diet, what most likely maternal condition - PKU

 Inborn error of metabolis with x-linked recessive + significant variability of phenotype 

ornithine transcarbamylase deficiency

 Cellulitis in infants 6-24m with purple discoloration caused by  hemophilus

influenza!!! “distinctive bluish discoloration”

 15y.o w/ osteosarcoma complains of sharp stabbing pain at site of tumor  somatic

nociceptive pain

 Child most likely to have intussusception  1y.o toddler (6m-36m)

 13y.o + ewing sarcoma + his pain is so severe and needs opioid which should be
AVOIDED in children  (codeine, morphine, fentanyl, hydromorphone, oxycodone)
 Vaccine c/I in eczema, psoriasis and contact dermatitis  smallpox

 Which method is effective dor a long time in enuresis  alarm

 Which is true about current newborn screening  new technology allow for detection
of over 40 differen metabolic disorders

 Intervention has the BEST evidence base suggest potential benefit for 10y.o with severe
cerebral palsy from hypoxic brain injury at birth  tracheostomy

 Infant with lung disease is being discharged because O requirement now decreased to
35% to maintain O, at home, 100% is delivered by nasal cannula, as a general rule, FiO2
likely reach 35% when oxygen flow through a nasal cannula exceeds how many kiter per
minute in infants  2L per minute “3-4 per minute in older children”

 1y was breastfeed till 6m and developed normally, then mother gave him fruit juice and
he started to have delays, which substance should be avoided  fructose

 Doc. Asks child to bend forward with feet together, arms hanging and knees in
extension with doctor inspecting from back  adam’s test “search for abnormalities of
spinal curve

 Principal method of physiologic heat elimination  evaporation

 3y.o with diaper rash with no satellite lesion  barrier cream with frequent change of
diaper

 True about burns in children  modified Lund-Browder surface area chart should be
used to approximate the burned surface area

 Mom with 4m came to vaccinate, he’s having diarrhea for 3 days  give all vaccines as
per schedule

 3w found in a car on a hot summer day, temp41, hr 170, rr8, minimally responsive and
hot dry skin, which is true  ice water immersion may not be the ideal form of cooling
because shivering and peripheral vasoconstriction may increase heat production

 True about inborn errors of metabolism  inborn errors of metabolism are a group of
varying disease that have different physical exam and lab result

 True regarding trauma management  bag-valve mask ventilation is often sufficient to

maintain oxygenation and ventilation and is preferred to endotracheal tube placement
when a difficult airway is anticipated or providers have little experience with intubatiob
 True regarding alteration in level of consciousness  careful hx may help guide the
choice of diagnosing testing in patients presenting with altered mental status

 1y.o male diagnosed with UTI, what to do before rx  enal us

 What should be give to children with malignancy as prophylaxis  varicella ig

 Prompt you to suspect underlying inborn error of metabolism in a critically ill child 
patient whose sx present after their first prolonged fast

 True about regulation of respiration in children  change in PCO2 have more influence
than change in PO2 in causing compensatory changes during respiratory distress

 11m chocked on hotdog  back blows face down “<1” (in >1 = Heimlich maneuver)

 Rx for post-streptococcus GN in children with edema and HTN  diuretic for edema

 Most common cause of nephrotic syndrome in children  minimal change disease

 Child with hip pain, lab= high ESR and CRP  urgent incision and drainage

 18m tool Hib, MMRV, PCV13 vaccine one week. Came for HAV was not available, when
to give HAV  immediately

 4m came for vaccine + has 2d hx of watery diarrhea, abdominal pain and vomiting 
give all vaccines except for OPV “if the child doesn’t have a significant fever and is not
hydrated  give OPV”

 Measure obesity in children, including BMI and gender, what else to add  skin fold
thickness

 Man HIV+, told him he should tell his wife but he refused, what to do  inform her
regardless***

 Down syndrome is associated with (conductive hearing loss, speech delay, narrow ear
canals, all)

 Best way to treat entamebeoa  boiling

 What organ is responsible for 1st response to changes to BP  aorta “carotid sinuses”

 Otitis externa  (commonly related to swimming, treated with topical antibiotic drops,
caused by pseudomonas most commonly, all)

 Poor growth and low muscle tone + kinky hair + increased joint laxity and thin skin 
low serum copper
 1y + runny nose + wheezing  broncholitis

 2m FTT + seizure + severe hypoglycemia + hyperlipidemia + lactic acidosis and ketosis +

PE= hepatosplenomegaly, CT= renomegaly  von gierke disease “glycogen storage
disease type1”

 Paradoxic irritability is a finding helpful in diagnosing  meningitis “increase of

fussiness”

 Aniridia + genital malformation, which condition to screen for  wilms tumor

 Walk distance of 10 ft + climb stairs + cannot yet form a full sentence + but can speak
few words  15m

 “down syndrome case”, whats most common cause of this syndrome  maternal
meiotic nondisjunction

 All are features of prader-willi syndrome except  (FTT in infancy!!, hypotonia,

hypogonadism, large feet)

 7y.o used antibiotic, when stopped developed diarrhea and abdominal pain  C.
DIFFICILE!

 Child starring and non-responding with eye twitching for 4-5min, he looks frightened
and pale after that and goes to sleep  occipital epilepsy “gastaut type”

 8y.o following URTI developed maculopapular rash on jaw, spreading into trunk which
cleared on 3rd day without desquamation + tender post auricular & suoccipital
lymphadenopathy  rubella “three days measles!”

 Tetracycline  tooth discoloration tetragenocity

 3y,o white girl + elevated liver enzymes + total and direct bilirubin + hx of RTA and
peripheral pulmonic steonis + exam= broad forehead and deep set, widely spaced eyes
+ scratch marks 2ndry to itching, liver biopsy will show  bile duct paucity “algaille
syndrome”

 8y.o + chest pain 1d + 5d before onset, she had FEVER, chillds and MYALGIA + exam=
uncomfortable, anxious, afebrile with tachycardia, nor murmur + cxr= cardiomegaly w/o
pulmonary edema + paradoxical pulse= 22mmHG  pericarditis! “patient feel better
sitting”

 Wbc count and differential is most helpful SCREENING test in  bacteremia

 Whats used to determine the maturity of fetal in utero  amniotic fluid analysis
 Infant failed to pass meconium for 3d + everything normal except for barium enema
which shows large dilated segment of transverse colon  lack of ganglion cells in distal
colon

 2.9 kg term + prenatal dx of congenital diaphragmatic hernia since 19w + delivery

uneventful + mild tachypnea and retraction developing 24h of age + cxr= multiple lucent
areas in left lower thorax  congenital cystic adenomatoid malformation** “classic
description= echogenic lung mass that gradually disappear over subsequent us”

 Child returned from developing country + 2w illness characterized by gradually

increasing fever, temp reaching 104, associated headache, malaise, cough and
abdominal pain  typhoid fever

 20m + hemolytic anemia + anuria + azotemia + thrombocytopenia after febrile bloody

diarrhea  enterohemorrhagic E.coli “HUS” (they mentioned all bloody bacteria but this
is the most common)

 Most common complication of mumps in children  meningitis

 4y.o child + 3m of fever! Fatigue + generalized lymphadenopathy + CNS involvement +

hepatosplenomegaly + bleeding + plt count= 80,000  ALL!

 9y.o + fever >39 for 4d + myalgia + watery diarrhea + conjunctival infection + diffuse
ertyhrodema + strawberry tongue + bp85/52 + moderately elevated hepatic
transaminases  toxic shock syndrome TSLS***

 Bee bite  INTRAMUSCULAR epi

 Most common lysosomal storage disease  gaucher’s disease

 Fever + wt loss + night sweats + anterior mediastinal mass  non-hodgkin’s lymphoma

 Most common sequel of bacterial meningitis  impaired hearing

 Hemodynamically STABLE 2m + supraventricular tachycardia  vagal stimulation

 Testicular pain 2h + tender red left testis  torsion

 2d of sore throat + fever + erythematous pharynx with white creamy exudate on tonsil +
tender submandibular LN + culture= beta hemolytic colonies on blood agar + growth is
inhibited by bacitracin  streptococcus pyogenes “scarlet fever”

 5y.o + increasing pallor since birth + hepatosplenomegaly  hb electorophoresis

 Wilm’s tumor is ass/ with all except  (polycystic kidney, aniridia, beckwith, denys
drash)

 All complication of pertussis except  (encephalopathy, apnea, pneumothorax,

cerebellar ataxia)

 Girl with turner, cardiac ass  coarctation of aorta

 When 7y.o fails to cooperate with care in hospital, one should suspect  fearfulness

 2d infant + copis amount of blood in stool + tachycardic, what embryonic structure is

responsible  vitelline duct

 What a turner syndrome girl is at risk of developing  osteoporosis “think ovarian

failure”

 3y.o + umbilicated + flesh colored papules on trunk  poxvirus! “molluscum

contagiosum”

 Most common ig in breast milk  IgA

 Birth normal hr  110-150

 3y.o + FTT + confluent macules on scalp + skull xray= multiple irregular osteolytic lesions
on skull, fibia, and tibia  histiocytosis X “hallmark is lytic lesions”

 5m girl with bilateral retinoblastoma + parents= no hx + involve chromosome 13 

tumor-suppressor gene loss “mutation in RB1”

 2y.o + 6d of fever and limp + erythematous macular exanthem over body + ocular
conjunctivitis + dry cracked lips + red throat + cervical lymphadenopathy + grafe 2-4
systolic ejection murmur at lower left sternal border, wbc= neutrophils, increased plt 
Kawasaki disease

 Infant + mild cyanosis + diaphoresis + weak pulses + hepatosplenomegaly +

cardiomegaly + rr 60 + hr 250, CHF is most likely due to  paroxysmal atrial tachycardia

 Not a risk factor for OSA  (retro mandible, long/soft palate, small triangle chin)

 8y.o boy + progressive corneal vascularization + notched incisors + flat nose  T.

pallidum!! Syphilis

 Case of cushing’s disease  ACTH secreting pituitary adenoma

 Most common cause of preload disorder in children  hypovolemia from vomiting and
diarrhea

 Meningitis acquired during passage through birth canal  L. monocytogenes

 1y.o + passage of several maroon colored stools + everything else normal  meckel’s
diverticulum

 3y.o + difficulty walking + increased inward curvature of lower spine + waddling gait +
large calves  muscular dystrophy

 7y.o + urinalysis 2+ protein, 2.5 g of urinary protein in 24h, which med he’s on 
trimethadione “drug induced nephrotic syndrome”

 10y.o + 2y hx of abdominal pain + mostly at night!! + vomiting after pain + occult blod in
stools + father also has stomach aches  peptic ulcer

 10m + persistent cough, poor weight gain + multiple episode of pneumonitis + passing
foul stool  sweat chloride test

 Mva + no LOC + alret + blood behind tympanic membrane, what will you see on CT scan
 basilar skull fracture (hemoytpanium)

 Most common cause of CONGENITAL nephrotic syndrome  finnish type of congenital

NS “mostly in finnish descent”

 Not a criteria for HSP admission  (severe joint pain, control severe abdominal pain,
rehydration, monitor renal function, age younger than 2)

 Pastia’s lines often seen in  scarlet fever! (red lines formed confluent petechiae are
found in skin creases, esp antecubitalfossa)

 Infant born at 43w + thin pale limp and breathing difficulty + amniotic fluid has pea
soup, 1st resus  suction of trachea under direct vision

 Premature infant 950g + breast fed exclusively which provide 120 cal. Which condition
baby will most likely develop  hypocalcemia “he requires 200mg/kg|

 10-15% dehydration  NS

 Hypernatremia caused by all except  (HYPERGLYCEMIA!, nephrogenic DI,

gastroenteritis, adipsia)

 14m + chronic TPN! Due to short gut syndrome, which complication is most likely to
develop  SEPSIS!!! Esp in central line cath
 Hx recent onset inspiratory sound + chest retraction nasal flaring and barking cough + 2d
hx of mild URTI  VIRAL CROUP!

 Microcytic anemia + hb electrophoresis= increase Hb A2  B-thalassemia trait “in

sickle= HbS, HbSC predominanct”

 12h + deep jaundice and lethargy + mother AB -ve, father O +ve, peripheral smear=
anisocytosis, coombs= +ve  rhesus incompatibility** (ABO?)

 African American boy + 7cm mass in jaw + intermediate-sized lymphoid cells, nuclei
have coarse chromatin and several nucleoli, and many mitoses, t(8; 14)  Burkitt

 13 y.o + fever + tender swelling BEHIND ear + hx of acute otits media treated with amoxi
+ tympanic membrane= opaque and light reflex absent + saggong of deep part of post
meatal wall  acute mastoiditis

 Brusies over body + xray= multiple post rib fracture + metaphyseal corner fracture +
spiral fracture of humerus  battered baby syndrome

 Dehydration after 2d of vomiting and diarrhea + urinary sediment= epithelial + dirty

brown cast  ATN! Tubular necrosis

 8y.o + severe pruritic rash on both legs + rash worse at night + afebrile + patches of
erythematous papule with several streaks of vesicles on legs only  SCABIES! **

 10y.o + freckles on her face, neck, hands + unusually sensitive to sunlight, exam=
ulcerated nodule beside nose= which was basal cell carcinoma, underlying cause is 
defect in DNA repair mechanism

 9y.o + early sings od puberty + exam= hirsutism and voice harshening + high
testosterone  Leydig cells increased activity!

 13 y.o, referd to geneticist for muscle weakness, easy fatigue, mental retardation, heart
failure + fx mother died after this delivery with undiagnosed heart problem, what’s the
cause  mitochondria

 4y.o + voice change and progressive dyspnea for 3m + exam= mild stridor and
suprasternal retraction + multiple soft growths were removed from glottis, advised
parents to bring child 6m later for recurrence  HPV! Laryngeal papillomatosis

 Most likely cause of chest pain in previously healthy child  MSK

 Hypotonia, poor feeding, flat face blab la, which is helpful in dx  karyotyping

 Asthma  check proper use of inhalers

 Infant erythematous diaper dermatitis with sharp demarcated edge + satellite lesions on
lower abdomen and thighs  antifungal “candida diaper rash”

 Kawasaki rx  IVIG

 Dark colored urine + periorbital edema  GN

 Sickle cell boy + chest pain and SOB, swelling of hands and feet + cxr= infiltration  iv
fluids

 Girl with recurrent episodes of boils on scalp + subside with ab but recur  (primary ID,
HIV, pediculosis capitits, NONE!) **DX IS RECURRENT FURUNCULOSIS**

 All cause of neonatal menigitis except  (e. coli, streptococcus, listeria, N. menigitis)

 6m + enlarged liver + increased con. Of hepatic glycogen + no detectable increase in

serum glucose after fructose administration  enzyme defective= glucose 6-
phosphotase

 Bloody diarrhea + blood on stool  amoeba

 3 y.o boy + polyuria + specific gravity of 1.003 + decrease urine osmolality + deficiency of
what hormone is expected  (aldosterone, vasopressin, calcitonin, none)

 Gingival swelling, blisters and drooling  herpetic gingivostomatitis

 7y.o recurrent pulmonary infection and chronic diarrhea, mutation in  CFTR

 Petechie on buttocks and low extremitis, abdominal pain, arthralgia, and hematuria 
hydration and pain control with NSAIDS (HSP)

 Most common abdominal tumor in children  wilms

 Most common cardiac lesion in down syndrome  endocardial cushion

 Most common cause of 2ndry HTN in children  fibromuscular dysplasia

 Short, wide spaced nipple  turner

 Most common malignancy in INFANTS  neuroblastoma

 Most common cause of primary hypogonadism  Klinefelter syndrome

 2m normal development  recognize parents

 1w general edema, fatigue, and abdominal pain + periorbital edema on exam, what is
seen on kidney biopsy  normal finding!!! “minimal change disease”

 FFT + rectal prolapse!!!  cystic fibrosis

 7y.o + sore throat and poor appetite + malaise for 4d + intermittent cough + WITHOUT!!
Rhinorrhea or congestion + temp 37.6 + swollen tonsils covered with thin, whit exudate
+ anterior cervical lymph nodes!  BACTERIAL pharyngitis  same case  do throat
culture

 Rash in groin area  diaper dermatitis

 Most likely organism to cause dental caries in a child  streptococcus mutans

 Most infants are able to sit w/o support  7m “in answers there’s 5m, don’t choose it”

 Given to prevent hemorrhage in newborn  vit k

 Most common cause of gastroenteritis  rotavirus

 c/I to breastfeeding  active untreated TB

 6y.o + seizures + hx= mental retardation + glaucoma + exam= red flat lesion covering left
eye area + adjacent facial skin which is present since birth + hemianopia, hemiparesis +
hemisensory disturbance  sturge-weber syndrome

 Intellectual disability + large hands and feet + long face with large ears and large testicle
 fragile x syndrome

 Ass/ with TOF  pulmonary valve obstruction

 2w + white adherent coating of his tongue and buccal mucosa + erythema and lesion
bleeds when you try to remove white coating  oral candidiasis

 High grade fever for 9d + brick red maculopapular rash first appeared on face and
spread to his trunk and extremities + before rash she had non-productive cough, tearing
eyes, runny nose  measles

 Recurrent respiratory tract infection + ABSENT TONSILS + normal T lymphocyts + very

low B lymphocyte  x-linked agammaglobulinemia

 Oral candida  oral nystatin

 HSP  vasculitis

 Right to left shift  TOF

 Kawasaki disease  aspirin and IVIG

 15y.o + 1y of fatigue + multiple area of pain, tenderness + labs= normal  fibromyalgia

 High fever + cough, coryza, conjunctivitis + maculopapular rash spread from head and
down + splenomegaly and lymphadenopathy  measles

 2d old with rash, not ill everything normal  erythema toxicum neonatorum

 No head lag when pulled to sit  4m

 10y.o + obese and hyperphagia, small hands and feet, small penis, cryptorchidism and
cognitive deficiency  prader willi syndrome

 TOF  VSD, right ventricular outflow and pulmonary valve obstruction + over riding of
aorta

 Best test for diagnosing lactose intolerance  hydrogen breath test

 12 y.o + rrash bilaterally on trunk + proximal e + lesions are 1-2 cm + oval + ring of fine
scale along edges + one lesion is 4cm  pityriasis rosea

 1y + low grade fever + ulcer on buccal mucosa and tongue + exam= maculopapular eash
on hand, feet, butt, and groin  hand-foot-and mouth disease “coxsackievirus”

 Recurrent ear infections + eczema + profuse bleeding during circumcision and

thrombocytopenia  wiskott-aldrich syndrome

 Mode of inheritance in Fanconi anemia  autosomal recessive

 12y.o + sudden onset dyspnea and swollen face + exam= edematous swelling of face
including lips, hands, arms, legs, and genitals + w/o rash  hereditary angioedema!

 First sign of sexual development in girls  breast buds

 Copy triangle  5years!!!!!

 Crusting golden-colored lesion and erythema around his nares + onset occurred in ass
w/ URI, its resolving now, and its tender to touch  impetigo

 Kallman syndrome  46 XX

 Rheumatic fever + heart murmur + fever and joint swelling  penicillin

 Drug of choice for ADHD  methylphenidate

 9d + breastfed well + jaundice  breast milk jaundice

 Painful, erythematous nodules on anterior leg + hx of ulcerative colitis  erythema

nodosum

 High fever + poor feeding, pain with swallowing and ulcers on both tonsils 
herpangina!

 Bilateral bulbar palsies + symmetric descending paralysis and constipation in infants 

infant botulism  IVBIG

 True about Osgood  exact cause in unknow, although overuse and trauma play an
important role

 Sudden face swelling and stridor + NO pruritus and urticaria  hereditary angioedema

 Herpangina cause  coxsackie A virus

 15 y.o female + pericarditis + pleurisy + recurrent oral ulcers + hemolytic anemia + RBC
in urine  SLE

 UTI + recurrent since birth + ill child and temp40  vesicoureteral reflux

 4m + fever and lethargy + LP= WBC and gram +ve  vancomycin and ceftriaxone

 High arched palate + pectus carinatum + aortic dilatation  marfan syndrome

 Copy a circle  3y

 Hr=130 (2) + irregular respiration (1) + active muscle movement with good tone (2) +
cough in response to stimulation (2) + pink body and blue hand and feet (1), APGAR is 
8

 Most common cause of bronchiolitis  respiratory syncytial virus

 Most specific test for congenital heart disease  echocardiography

 Inheritance in adult polycystic kidney disease  autosomal dominant

 Inheritance in neurofibromatosis  autosomal dominant

 Most common CNS tumor in children  astrocytoma

 2y.o reluctant to move his arm + mom pulled his arm to prevent a fall + exam= tender at
radial head  radial head subluxation
 Low grade fever + headache and sore throat + no vaccine + PE= rash and posterior
auricular and suboccipital lymphadenopathy  rubella

 String of beads sign  fibromuscular dysplasia

 Poor feeding and constipation + jaundice + scleral icterus + large tongue and hoarse cry
+ normal tone but decreased activity + hypothermia and large anterior fontanelle 
congenital hypothyroidism

 11y.o boy + recurrent jaundice + elevated indirect bilirubin + everything else normal 
gilbert’s syndrome

 Confirm pertussis  nasopharyngeal culture and PCR testing

 Most common defect ass/ with carbamazepine and valproic acid  spina bifida

 Bilious emesis + upper GI= double bubble + 1m  volvulus

 True about moro reflex  disappears by 3-6m

 Worng about breath-holding spell  (confused with seizure, episodic apnea in children
ass with LOC and change in postural tone, cyanotic is most common, most common in
2-5m) “they are most common 6-18m and unusual before 6m”

 6y.o normal development  draw a diamond shape

 6w progressive jaundice and high bilirubin  biliary atresia

 Associated with sickle cell disease  Howell-jolly bodies

 24m normal development  builds a tower of 4 cubes

 Most common malignancy in childhood  acute lymphocytic leukemia

 2y.o + purulent, malodorous, bloody discharge from left nostril  foreign body

 Low grade fever + joint pain + enlarged cervical lymp nodes + splenomegaly and
petechiae  ALL

 2d diarrhea + progressing ascending weakness and loss of deep tendon reflexes with
CSF= high protein  guillian barre syndrome

 Excessive cow mil consumption in infants  iron deficiency anemia

 10y.o hx of headache for 3m + no nausea, vomiting, chills or fever + fx of HTN, bp156/90

+ angiography= string of beads  fibromuscular dysplasia
 Inheritance in cystic fibrosis  autosomal recessive

 Fever + drooling + thumb sign  epiglottitis

 Most common cause of meningitis in infants  group B streptococcus

 Ass/ with atopic dermatitis  asthma

 Café au lait  neurofibromatosis

 Hyperventilation, metabolic acidosis high anion gap + tinnitus and confusion  he

ingested aspirin

 Developmental delay + deafness + cataract + purapura  congenital rubella syndrome

 Most common cause of epistaxis in children  self-induced

 Most common cause of hearing loss in children  otits media

 Most common cause of short stature and pubertal delay in adolescent  constitutional
growth delay

 Inheritance in progressive familial intrahepatic cholestasis  autosomal recessive

 Coin + EXCESSIVE DROOLING  removeeeeeee

 True about polio vaccine  IPV uses inactivated poliovirus, OPV uses weakned
poliovirus

 4m is being exclusively breastfed requires ALL of these supplement except  (zinc, iron,
vit D, calcium!)

 A disease that requires a specific chart for assessing growth and development  down
syndrome

 Breastfeeding is c/I in all except  (herpes in breast, TB, varicella zoster, hep b)

 Hospital baby friendly initiatives  provide counseling and info to pregnant, document
desire to breast-feed, document method of feeding, skin to skin contact, initiate breast
feeding within 1h of birth

 True about collection of breast milk  expressed breast milk can be frozen and used up
to 6m

 Normal child  WHO growth chart

 True about formula  safe and nutritionally adequate in first 4-6m

 Indication for using soy protein formula except  (infantile colic, galactosemia, 2ndry
lactose intolerance, hereditary lactase deficiency)

 FALSE regarding protein hydrolyzed formula  (partial hydrolyzed formula can be fed
to infants who are allergic to cow’s milk, “EXTINSEVLY IS THE ONE PREFERRED”,
extensively are preferred for infants intolerant to cow and soy milk, hydrolyzed=
oligopeptide <5000 while extensive contain peptides < 3000, extensive ma be more
effective than partial in prevention of atopic disease)

 Rx of choice for anaphylaxis  aqueous epinephrine (1:1000) IM

 ALL can be given to SCID except  (measles, DTaP, salk poliovirus, hep B)

 Not a prevention for listeria  vaccine (prevention methods= avoid unpasteurized dairy
foot, handwashing, TMP-SX for immunocompromised patients)

 % of poliovirus that are asymptomatic  90-95%

 Recommended rx for active pulmonary TB in children  isoniazid and rifampin for 6m,
with pyrazinamide during first 2m

 MOST COMMON mode of TB transmission  person-to-person spread by infected

airborne droplet

 1m + fever and bloody diarrhea  nontyphoidal salmonella “most common cause of

febrile gastroenteritis in early infancy”

 Which contacts should receive rifampin prophylaxis after N. meningitides  all children
and adults in same house of daycare regardless of immunization hx

 All about c. difficle are true except  (ab ass diarrhea, newborn and infants are
commonly colonized by it, most children with it will improve w/o specific ab rx, most
common causing ab is gentamicin) “clindamycin is!”

 True about 5u PPD skin test for TB  person with TB meningitis do not react to PPD skin
test

 Ass/ with infantile hypertrophic pyloric stenosis  erythromycin administered during

first 2w of life

 Which of infants born to HIV infected mom should receive prophylaxis for
pneumocystitis carinii  all 6w to 1y born to HIV moms
 Gold standard for diagnosis of malaria  thick and thin blood smears

 Most severe form of malaria ass/ with highest fatality rate  P. falciparum

 Feature distinguish paralytic polio from GBS  paralysis is usually ASYMMETRIC in

paralytic polio

 Advantage of inactivated poliovirus over live poliomyelitis vaccine  no ass with vaccine
paralytic poliomyelitis

 All are findings in paravirus b19 except  (slapped cheek, lacy rash in trunk and hands,
arthritis, transient reversal of CD4:CD8)

 Congenital infection ass with cats  toxoplasma gondi

 HPV  laryngeal papillomatosis, conylomata, cervical cancer

 All true about HIV rx except (suppression of HIV is best done by rotating drugs,
therapy can reduce HIV burden to undetectable levels, viral burden predicts
progression, CD4 reflect risk of opportunistic infections)

 Not associated with EBV  (Kaposi sarcoma, leiomyosarcoma, Burkitt,

lymphoproliferative disease in immunocompromised person)

 Diagnostic of HIV in 1y child EXCEPT  (+ve p24 antigen, +ve HIV DNA, +ve HIV RNA, +ve
HIV western immunoblot) “ELISA & western are only reliable after 18m”

 Role of c/s in preventing perinatal HIV  effective and selectively recommended

 WHO recommends zinc supplements for  children with severe malnutrition and
diarrhea

 All true about malnutrition except  (malnutrition- under and overweight, greatest risk
for undenutrition occur during pregnancy and 2y of life, weight for height or wasting is a
measure of acute malnutrition, height for age reflect acute malnutrition)

 Not a complication of severe acute malnutrition  (hypoglycemia, hypothermia.

Infection. Hyperkalemia)

 Most useful dx of neurocysticercosis  CT

 Not a fat soluble vit  vit c

 Introduction of complementary feeds except  (introduction of multiple nutrient

ingredient food at time is recommended, complementary foods are combined with
 milk, practice vary among cultures, should not occur before 4m and not delayed after
6m)

 False about formula feeding  protein and energy content of infant formulas is 4.1
g/100kcal and 90 kcal/dL

 Growth period has highest energy nutritional requirement  infancy

 Highest energy per gram  fat

 Defects cannot be traced to dysfunction of CFTR gene  (sweat and serous secretions
containing REDUCED salt content, inability to clear mucous secretions, mucus
secretions with reduced water content, chronic respiratory tract infection) “ITS
ELEVATED SALT”

 FALSE about vit A  water soluble vit (ITS FAT SOLUBLE) “correct facts= essential for
normal vision, organ meats are very rich in vit A, chronic intesetinal or lipid
malabsorption= vit A def”

 NOT a clinical feature of vit A def  (night blindness, xerophalmia, increased

susceptibility to infections, vomiting and diarrhea)

 LEAST LIKELY to be seen in chronic anemia  (jaundice, calcium gallstones, erthyrocyte

destruction, hemoglobinuria)

 Cause of hypopituitarism  subarachnoid hemorrhage, irradiation, craniopharyngioma,

all

 Chronic urticaria  6w

 Dx of urticaria  hx and description of rash

 Evaluate for latex sensitization  2y w/ hx of spina bifida undergoing

ventriculoperitoneal shunt revision “18%-73%”

 Allergic rhinoconjunctivits exam  pale, enlarged nasal turbinates and clear rhinorrhea

 Egg allergy  give MMR only “don’t give influenza”

 Montelukast  leukotriene receptor

 16y.o + heel pain, morning back pain and stiffness, left knee swelling, progressively
worse on several months + lumbar lordosis decreased + tender at achille’s tendon,
DEFINITIVE TEST  sacroiliitis on dedicated radiographs of SI joints
 17y.o + progressive SOB, fever, malaise over last 2w + exam= tachypnea, diffuse rales
and ronchi, cxr= diffuse nodular infiltrates in all lung, lab= high WBC + CRP,
urinalysis=protein and blood cells & casts, what ab is +  anti- neutrophil cytoplasmic
antibody “pulmonary renal syndrome, probably wegner, +ANCA”

 Pain should raise suspicion for a disorder OTHER than inflammatory arthritis  (pain in
mornings, pain after cold, after car ride, during viral illness, awakens with pain during
night)

 Patient with Kawasaki disease, received IVIG, now he’s back to normal activity, with
exception of swelling of knee bilaterally  reassure, it will resolve

 True about HSP  rash may come and go for weeks to months following initial
presentation “IT DOES NOT INCREASE RISK OF VASCULITIS AS AN ADULT”

 MIXED CONNECTIVE TISSUE DISEASE, with overlapping features of several rheumatic

disease, SLE, SD, JIA, dermatomyositis, all have specific antibody  anti- U1RNP

 Mechanism of joint stiffness after rest  low temp

 15 y.o painful recurrent mouth sores occurred 6x last year + 1p of geniral ulcer 2m ago,
culture was negative, exam= synovitis in ankle bilaterally and pustular rash on arm 
pathergy test “Bechet disease”

 Girl with SLE, decreased school grade  LP to eliminate infection

 IBD patient w/ related arthritis, complains of knee pain, swelling, warmth and erythema,
next  refer back to gastroenterologist urgently

 10y.o + fever for last 10d + fever occur 2x daily and feeling well btw episodes + salmon
colored rash! + hepatosplenomegaly, no arthritis, negative culture + today= patient is
dizzy and has SOB + cxr=enlarged heart silhouette and increased interstitial markings 
large pericardial effusion “systemic onset JIA”

 13y.o + finger and foot pain progressing for several months + 2 of her fingers on right
hand are swollen and painful she is not able to make a complete fist… blab bla there are
several NAIL PITS!! On thumbs bilaterally, what info would you ask about  fx of skin
disease “juvenile psoriatic arthritis”

 Newly dx of polyarticular JIA + feels better on anti-inflammatory + negative ANA, +RF &
+anti-CCP  given her +RF 150, anti-CCP, her course will be more similar to those with
adult onset arthritis
 5y.o + swollen left wrist + warmth erythema and decreased range of motion + dx=
oligoarticular JIA, in addition to starting therapy, what should you do  refer to
ophthalmology

 Feature suggest chronic rather than acute arthritis  leg length discrepancy in a child
with a swollen left knee

 Skeletal radiograph in JIA  normal radiograph!

 SLE + which treatment is used as a long-term maintenance  hydroxychloroquine

 9y.o with dx of polyarticular JIA, 6m ago she started NSAI, 4m ago she started subQ
methotrexate + she says she improved but still has 60-120m of morning stiffness daily
interfering with school, best thing to do  continue current therapy for 3m to evaluate

 Child with Kawasaki, what would you see on lab  a CSF pleocytosis

 What would lead to artificial low ESR  18 Y.O with chronic lung disease and
polycythemia

 5y.o + dx= juvenile dermatomyositis + takes prednisone 2mg/kg/d and methotrexate +

weakness of legs and arms didn’t progress + his voice is changed + has heliotrope rash
and gottron papule and rash on face + weakness in hips and is unable to rise from floor
+voice sound nasal and hoarse  admit patient to hospital!!! “palatal involved”

 Juvenile systemic sclerosis is associated with  Raynaud phenomenon

 True about chronic fatigue syndrome  some patients have autonomic dysfunction
including tachycardia and orthostasis

 JDM presentation can be very subtle until significant muscle weakness, which is a late
complication of JDM associated with a delay in dx  dystrophic calcification

 5y.o + for past months has been having severe abdominal pain and fever + lasting for 1-
3d and accompanied by rash on legs and swelling in knee + 2 of uncles on father side
who are middle eastern had similar illness, there’s a mutation in MEFV, next  start
colchicine 1-2mg/day “familial Mediterranean fever”

 6y.o + progressive weakness on arms and legs + difficulty climbing stairs + GOWERS
SIGN!!!!!!!!!!!! + unremarkable skin exam + CPK 15,000 + you consider juvenile
polymyositis, what other dx should be considered  muscular dystrophy

 3y.o + irritable and limping + mild swelling and tenderness in midtibia on left + child is
avoiding bearing weight on extremity xray= negative  toddler’s fracture
 Mass on dorsal surface of wrist + FROM + nontender and cystic when transilluminated
 observation w/o intervention

 Obese fell and has excruciating hip pain, he’s holding his hip in abduction  acute
slipped capital femoral epiphysis

 Torticollis ‘congenital’  tight sternocleidomastoid muscle on left

 12y.o under chemo for leukemia + developed severe abdominal pain and profuse
diarrhea and vomiting + viral culture= non-polio enterovirus, most at risk for developing
chronic enteroviral infection  acquired B-cell def

 14y.o develop fever + hypoxia + require oxygen + occasional hemoptysis + recovering

from recent BM transplant and has profound neutropenia + CT= halo sign “haziness
surrounding nodule” best to confirm  lung biopsy “aspergillosis

 Low viral count mom who’s on antiretroviral therapy deliver via c/s, infant is give
monotherapy of zidovudine, what’s the optimal schedule for HIV testing  HIV
DNA/RNA assays 4x during 4-6m “if placentally= test PCR at birth, 14-21d, 4-6w, 4-6m”

 Asymptomatic exposed to hep A boy + didn’t receive vaccine  hep a vaccine  Same
case but had vaccine  IM IG!!!

 Ex-28w infant now on day of life 14 + fever + increased o requirement + cxr= bilateral
interstitial pulmonary infiltrate + high wbc and thrombocytopenia + receives TPN & IV
LIPID!! + no nec  discontinue the IV lipid infusion “characteristic sx of malassezia
furfur infection which happens to infants getting iv lipids”

 Homeless, unvaccinated seeks you 3w after exposure to hep b, labs would be  +HBV
DNA, -IgM, -HBsAg “IgM IS FOR ACUTE”

 Child after ksasi procedure develops fever and modest rise in bilirubin, most likely 
eneterococcus

 4y.o + 1w of watery diarrhea + dx is cryptosporidium  treat with nitazoxanide

 18m + fever and refusal to walk + hip is flexed, abducted and externally rotated + high
ESR & CRP + WBC is 6000 on joint aspiration  recommend arthrotomy

 Teenage on antileukemia therapy + cxr show bilateral, diffuse alveolar with granular
opacities, dx  by bronchoalveolar lavage

 14y.o + periorbital cellulitis of rt eye + has hx of sinus and allergies, he was given
clindamycin but no improvement + he now developed proptosis and chemosis that
wasn’t there on admission  obtain imaging of orbit\
 6y.o + intermittent fever of 40 and chills, sweats, and nausea + visited southern new
England which is endemic with deer tick + no rash and no tick bites  test for babesiosis
“ixodid tick”

 Loose stool with mucous and blood + positive for blood with guaiac testing  stool
enzyme immunoassay for shigella would be affective

 Infant with oropharyngeal candidiasis “scraping tongue bleeds”  cleaning bottles

nipple and pacifier by boiling after use!

 West nile virus CSF finding  lymphocytes, elevated protein, and normal glucose

 Dx in CMV for newborn  viral culture!!!!!!!

 Recommend prophylaxis when undergoing dental procedure  hx of infective

endocarditis

 Ate freshly caught salmon and mackerel, developed pain, nausea, vomiting a small
worm which was anisakid larva  endoscopic retrival

 4y.o with bacterial meningitis +has hx of amoxicillin and cephalexin allergy 

vancomycin and chloramphenicol “gentamicin used in infants= GBS”

 Bacterial vaginosis  metro 500mg oral, twice for 7d

 3y.o + wheezing and rhonchi and fever for weeks + eosinophilia + high ESR + tested for
anti-hemagglutinin and has high anti-B + family has several dogs, and baby has been
seen eating dirt outside  rx is albendazole “toxocariasis, visceral larva migrans”
common by dog ascarid

 High risk of UTI in neonate  being a male!!! Shocking

 Girl with peripheral cath + has induration that’s mildly painful + no fever or any other sx
+ culture negative  IV vanco and cefepime* “if theres sx remove and give abs”

 11y.o + hardening over time neck mass + afebrile + no lymphadenopathy + biopsy=

gram+ filamentous acid fast negative + he had molar tooth extraction before math 
actinomycosis israelli  SAME CASE, RX  penicillin

 Epiglottitis  consult anesthesia 3la 6ol\

 Best strategy of otitis externa  use alcohol ear drops before and after swimming lower
pH and helps preventing infection

 Pertussis in 15d infant  droplet isolation

 Otitis externa, no surrounding cellulitis  systemic abs to cover pseudomona

 3y.o + unilateral anterior cervical neck mass in setting of URI + erythematous and sof
w/o fluctuance, no animal exposure  staph aureus “cervical lymphadenitis”

 16y.o with cat scratch disease + right axillary mass for 2w  treatment of CSD is
supportive

 Best rx for L. mono in infants  ampicillin

 17 with cough, cxr= patchy infiltrates throughout + vaccine + no animal exposure, most
likely dx  Chlamydophila pneuminae, M. pneumoniae  RX OF C PNEUMONIAE 
azithromycin

 1y.o infant with pertussis + difficult breathing and fits of coughing for 2d  initiation of
rx with ab once paroxysmal phase has started will not have an effect on patient’s course
of illness “aggressive suction should be avoided cuz it may trigger paroxysms, abs are
helpful during cararrhal phase, macrolids are 1st line, TMX-SMA is 2nd line”

 17y.o + toxigenic vibrio cholera + watery diarrhea & abdominal pain, most common
complication  shock!

 1d premature + birth was induced due to maternal septic like features + baby suddenly
became septic + CSF= 120 nucleated cells, 75% neutrophils, glucose= 39, protein= 160
 listeriosis

 16y.o + back pain and dysuria + urine culture +ve for staph, what staph is it  staph
saprophyticus

 Botulism rx  admit baby and administer BIG-IV

 Pertussis “fits of cough”, what do you expected on CBC  lymphocytosis (>10,000)

 RICE WATER STOOL  toxigenic v. cholera

 14d + difficulty breathing and grunting + PCR and NP swab confirmed pertussis, plan for
prophylaxis  household and daycare should receive abs prophylaxis for 14d after last
contacts

 Most common complication of pertussis  pneumonia (22%) and otitis media, seizures,
and encephalopathy

 12y.o + severe earache for 1d + initially ear was pruritic then became painful + exam=
severe pain when auricle is pulled superiorly + otoscope= edematous ear canal, cannot
see tympanic membrane, most likely organism  pseudomonas
 Healthy term infant born to woman with untreated syphilis, initial management  full
exam, RPR or VDRL, CSF, CBC, long bone radiograph “no FTA-ABS!!”

 17y.o cough for 3w + her 3y.o brother had recovered from similar sx with posttussive
emesis, there’s a newborn in the house, what to do  NP swab for pertussis PCR, Tdap
booster to patient and to rest of unimmunized family

 19 y.o + paraplegia 2ndry to transverse myelitis + now has a large swelling on right butt
7x7 + pet hx + recurrent UTI  incise and drain and send culture for organism
identification “CA-MRSA”

 True about acute viral meningitis  HSV cause over 90% of cases

 When a cath-related infection is suspected, which situation would immediately remove

cath in is recommended  (coagulase -ve staph spp infection in 1-2 blood culture,
candida infection, s. aureus in short term cath, bloodstream w/o signs of sepsis, exit site
infection)

 10y.o suspecting Lyme disease  doxycycline (>8= doxy, <8= amoxi)

 Poor oral intake + ulcers in oropharynx  IV acyclovir

 Ear infection, treated with amoxicillin, hasn’t improved, why rx failed  alteration of
outer membrane proteins of bacteria causing infection**

 CORRECT about rotavirus  spread via fecal-oral route

 Recovered from meningitis, came for follow up after 2w, what to do  hearing test

 7y.o + 2w of progressive scalp itchiness and irritation +she like to wear TIGHT pigtails +
noted small bald patches 2 + bilateral posterior cervical lymphadenopathy 
griseofluvin po for 6w “tinea corpois”

 Looks at familiar objects and people when named + participates in two communication
 7-9m

 Rickets in infancy is characterized by all except  (crainotabes, wide open fontanelle,

rachitic rosary, bow legs)

 Draw straight line and stack few cubes on each other  24m

 Raise head slightly when prone and smiles, turn his head 180 and has head lag when
pulled to sit  8w

 Most. Typically seen in 4y baby  toilet trained

 Set w/o support + cruise around furniture + use chair to stand, say dada, crawl stairs 
10m

 Not associated with craniosynostoses  (apert syndrome, crouzon syndrome, Pfeiffer,

sathre-chotzen, carptner, cleidocranial dysplasia)

 Bilateral microtia, colobomata of low lids, absent zygomata, micrognatia, high but intact
palate  Treacher Collins syndrome

 Best evidence available about prevention of nec  exposure to antenatal steroids is

ass/ with decreased risk of nec

 Large PDA  due to high prostaglandin E2

 Milestone = looks at familiar objects when named, participates in 2 way communication

 7-9 month

 Milestone = draw straight line, stacks cubes  24m

 Milestone = in 4y  toilet trained
 New
 +ve Gower’s and Trendelenburg, next  muscle biopsy
 Sign of duchenne  gower’s
 Why give both activated and inactivated polio  to increase IgA at GIT at entry of virus
 s/e of DTP vaccine  (fever & erythema at site, A & B)
 sickled parasite, chronic diarrhea  giardia
 best way to examine dehydration  (hx & pe, A & C)
 limping with persistent pain on knee, destructed femur head with high WBC  legg
calve perthes disease

 blisters in trunk  varicella

 2y.o, acute abdominal pain, febrile, VCUG= one of the kidney with dilated ureter, renal
pelvis and calyces  ureterocele

 15y.o can’t take BCG vaccine due to  high level of interferon gamma

 Sickle cell w/ recurrent vaso occlusive, best rx for future  hydroxyurea

 Character in fragile x syndrome  macrogonadism

 Most common parotid neoplasm in pedia  hemangioma Or benign mixed tumor

 Young boy, diarrhea sometime bloody, wt loss, arthralgia, anemia  UC

 Recurrent UTIs, initial dx  US

 Baby missed a vaccine, later developed bi parotid swelling  orchitis “missed mumps”

 After 5m, HR120 (2), breath irregular and grasping(1), acrocyanotic 1, cough and
grimace 2, flex all limbs not moving 1  7

 GCS= crying 3, withdraw from pain 4, open eye to talking 3  10

 Bleeding and erythema & vesicle in mouth, multinucleated giant cell  HSV

 PALS  15 comp 2 breath

 Croup, dx by  (nasal, nasopharyngeal, pharyngeal. A & B)*

 NOT in fragile x syndrome  (autism, absence of speech, large ears, microorchidism)

“they have large testes”

 Most common site for mumps  parotid

 PSGN, confirm dx  complement level

 Cystic fibrosis  ch7 long q arm

 Cyanotic lip & cold extremities, dx  echo

 Child is having rhinorrhea then multiple episodes of coughing followed by vomiting,

what vaccine could’ve prevented it  DTaP

 TOF  VSD, PS, OOA, RVH

 ASD  fixed wide S2 splitting

 Rheumatic fever prophylaxis  IM pen monthly

 11y.o r fever with cardiac involvement, how long prophylaxis  10y

 Unilateral nasal foul smelling for 2w, rx  removal of forigen body/ x-ray??
 Red eye and fever, pink rash on face, spreads to up and low limbs & white papule in
mouth  measles

 Gradual cyanosis and ejection systolic murmur of left upper sternal  TOF

 Bi periauricular enlargement, tenderness and fever  periauricular lymphadenitits

 7d abd distention & constipation since birth, next  rectal exam

 Bilious vomiting & constipation since birth, initial  plain xray

 GBS, CSF= high protein, ft u’ll find  cranial nerve involvement

 Alert & depressed fontanelle  6-9% dehydration

 Child w/ convulsion after GI sx  shigella

 Baby smile at  2m

 Newborn w/ congenital adrenal hyperplasia, presentation  dehydration

 Milestone = in 4m  complete head fixation

 Adolescent with recurrent swelling of lip, gene affected  SERRING1 gene

“angioedema”

 Screen for fetus for thalassemia  amniocentesis @ 15w

 Milestone = draw a square  4y

 Wave bye-bye  10m

 15y no period, slight breast bud, wide spaced areola, fine pubic hair  stage 2

 Purulent discharge from 13 d in newborn  chlamydia trachomatis “first 24h= chemical

cause, 24-48= bacterial causes like gono and staph, 5-14d= chlamydia)

 Milestone = tripod, rolls prone to supine, reaches for objects  6m

 Milestone = can’t sit w/o support, coos and laughs  3m

 Neonate w/ leukocoria bilaterally, dx  congenital cataract “can be seen in

hemorrhage, retinoblastoma”

 Hematuria & aniridia  nephroblastoma “wilms tumor!!!”

 Pansystolic murmur  (MR, VSD, AR, A & B)

 Milestone = couple of words other than mama and baba  16m/ 12m??

 Milestone = tells a story, hop on one leg  4-5y

 Milestone = at 6m  sitting with support

 Sickler, tired within 10h, drop in hb with palpable liver and spleen, 6cm below costal
margin. Had 3 previous episode  transfuse 50% of regular blood transfusion*

 Most common abnormality to get infective endocarditis  TOF

 Petechiae in lower limb, plt 15,000  IVIG “ITP”

 Hemangioma in left eye in newborn needs to be resected so doesn’t affect vision, when
 6-8w

 1m total bili 200, direct bili 80  choledochal cyst

 Neonate high aPTT, normal PT & BT & plt, def in  (VIII, V, VII, X) “aPPT high= VIII 8, IX
9, XI 11, XII 12)

 Eczema uses topical steroid but not effective, med to add  tacrolimus

 Sickle cell, hip pain and limping, dx  leg calve perth’s disease

 IPV & OPV  formation of ab in serum which fight the virus

 Child bitten cy cat. Cause  (bartonella henselae, Pasteurella, both)

 Baby w/ deafness and rash  (rubella, CMV, both)

 Repeated infections, failure to thrive and anemia, brother has same condition 
hemoglobinopathy

 Cut umbilical cord, bleeding doesn’t stop, def in  factor x “vii, ix. X”

 Fever, maculopapular rash, auricular and occipital nodes  rubella!

 Child used steroid cream for scaly dermatological condition and got better  allergic
contact dermatitis

 Mass in flank displace collection system  wilms

 Rheumatic heart disease allergic penicillin, prophylaxis  oral azithromycin

 6m vaccine, he had anaphylaxis at 4m vacc, what to do  allergy test

 Hydrops fetalis & thalassemia  normal 2 beta and abnormal 4 alpha

 Fatigue, diarrhea and glossitis  ( folic, vit 12, both)

 Milestone = raise head slightly, smiles, turn head 180d, head lag when sitting  12w
“3m”

 Milestone = in 4y  stand on one foot briefly

 Milestone = cruise, use chair to stand, say dada, crawl stairs  10m

 Deceleration  bad prognostic factor

 Loss of gag reflex in left side, normal uvula  glossopharyngeal injury

 More in cow milk than human  protein

 pH 7.24, pco2 lower than normal, hco3 lower than normal  compensated met
acidosis

 newborn, HR 300 bt/min, clear chest  vagal message

 increase fetal hb in sickle cell  sodium butyrate

 3mm ASD  follow up

 VSD asymp  follow up after 6m

 Vomiting after juice, allergy to  fructose

 RSV can go to  liver

 Petechiae, low plt & high creatinine  hemolytic uremic syndrome

 Most common cause of infantile colic  increased gases

 15m +cocci in CSF  cef and vanco

 5y.o girl with uncomplicated cystitis  IM ceftriaxone

 Dx for coarctation of aorta  echo

 c/I in HIV  OPV

 triple therapy in peptic ulcer in a child  PPI, amoxicillin, metro

 child w/ bronchiolitis, rx  oxygen

 ambiguous genitalia, hormone to check  17- hydroxyprogesterone

 Milestone = say baby and holds furniture  10m

 Milestone = sit unsupported, laughs and turns and babbles  7m

 Fever, sore throat, pink rash, peri-carditis  Kawasaki

 Milestone = hops on 1 leg and tells a story  4-5y

 Purulent discharge 36h in newborn  gonorrhea

 Milestone = walk w/o support, build 3 cubes, points at something he’s interested at 
15m

 Milestone = ride tricycle but can’t copy square  3y

 Milestone = draw straight line, stacks few cubes  24m

 Diaper rash with satellite lesion  local antifungal

 9m, vaccine given now  MCV4

 Child w/ CP  give all vaccines

 Jaundice, splenomegaly, echo gallbladder, low hb1c  hereditary spherocytosis

 15kg, daily fluid requirement  1250

 Petechiae in leg, hx urti, low plt  IVIG

 CPR to in infant, then asystole  epinephrine

 PCV  conjugated

 Failure of 2,3,4 pharyngeal arch  brachial cleft cyst

 Constipation, few days later developed bloody urine and abd pain  UTI?

 25kg, daily fluid requirement  1600

 Most common cause of preseptal cellulitis  staph aureus

 Runny nose & watery conj  adenovirus

 Severe bronchiolitis  resp support

 Child only drinks milk, has anemia  oral vitamins and iron

 Initial rx for JIA  NSAIDS

 Red urine, constipation, low c3  APSGN

 7d vomit, fever, culture= catalase -, gram +, beta hemolytic bacteria, rx  ampicillin

 2y.o with iron def anemia, hb=9  oral correction of iron

 Milestone = pulls himself to stand, crawl  9m*

 Gray macule in mouth  measles

 Maintenance fluid for 10kg, 5%  1000

 Fluid for 3d newborn 2kg  100

 Gram- with iv insertion  pseudomonas

 Multiple osteochondroma, huge mass in left hip and calcification  chondrosarcoma

 Neonatal sepsis  ( cef & amp, amp, genta, b & c)

 Milestone = walks alone, builds 3-4 blocks  18m

 Milestone = can say few words  18m

 Epilepsy & on anticonvulsant  avoid dtp

 Child w/ hepatosplenomegaly & current infection, brother died w/ septic shock  don’t
give live vaccine

 Hb= 10, mcv= 69, mchc= 20, wbc= normal, target cells  beta thalassemia

 Bi knee swelling, blab ka high ESR  juvenile RA

 Tenesmus & abd dis  amebiasis

 PDA “continuous machinery murmur”, left upper sternal border  NSAIDS!

“indomethacin”
 Diarrhea, everything normal except low Na  congenital chloride diarrhea

 Fever, coryza, watery diarrhea  (adeno, rota, all)

 5m didn’t vaccinated for 4m  arrange for 4m vaccine*

 2w, bi conj, chest infiltration  chlamydia

 Flaccid paralysis  c. botulinum

 Rash and vesicle on trunk, chest and limbs with fever, confirm dx  VZV abs

 Bilious vomit, abd dis, poor feeding  midgut volvulus

 Wbc very high, low hb, low mcv, low rt  anemia of chronic disease

 Skating and fell on perineum, bruise over scrotum, perineum, low abd, retrograde
urethrogram extravasation of dye  anterior urethra

 Infant, fatigue, not moving or gaze  botulism

 12h w jaundice, dx  (osmotic fragility test, abo and rh, g6pd, all)

 Newborn, resp distress, left side silent heart sound on right  diaphragmatic hernia**
pneumothorax?? Both?? Dextrocardia**

 REC infections, TB, aspergillosis, what vaccine to give  flu vaccine

 Infant, high fever, irritable, anuria, petechiae  septic shock

 Proteinuria, edema, taking ACE, consume high protein, a finding  decreased serum
albumin, or increased serum TGs**
 17y, conductive hearing loss in left ear, dx  excessive wax

 Confirm dx of cystic fibrosis  CTRF gene in parent

 Mendelian mode of inheritance  (alpha tha, leber, fragile x syndrome)

 Trauma, received fluid, then have high urine output 100ml/hr  central DI

 Minimal probability for getting beta th from carrier parents  25%

 Found in auscultation in croup  wheezing*

 Abd pain, constipation, low k, na, cl  barter

 <50th percentile, polyuria, constipation, low na, k, cl  NaCl channel defect “barter”
 8y abnormal gait, Trendelenburg, +ve galeazzi  CHD/ congenital dislocation of hip

 URTI, bleeding nose and gum and bruising  IVIG

 Cellulitis in face, 6-24m, fever and purple discoloration  strept A

 Mass, -ve transillumination, not reducible  testicular torsion

 Best way to prevent tetanus neonatorum  vaccinate during pregnancy**

 Milestone = hold his head, flying hands when laughing and coos  4m

 Most common w/ infective endocarditis of following  TGA

 c/I in absence  phenytoin

 initial for croup  nebulized cool mist

 croup, what to worry abt  blue lips

 holo murmur, left 3d ic space  vsd

 problem in phagocytosis w/ normal ig, molecule ass  NADPH “chronic granulomatous”

 infant, vomit, low ph  close observation*

 bone age > choro age  (hypoth, const, ckd, CAH) “sexual precocity”

 growth retardation, what to check  (androgen, adrenal gland h, both)

 child abnormal sitting “w-setting”  internal femoral torsion

 9m cant sit, fisting and crossing leg  cp

 Hip pain and effusion, exam= flexed, abducted, externally rotated hip, nxt  nsaid,
follow up 1w later “transient synovitis”

 Stage 2 HTN in 9  >140/90

 Evaluate in case of short stature due to GH def  (IGF-I, IGFBP-3, bone age, all)

 Chew pain and headache, wt loss  TMJ disorder

 Dyspnea, parasternal heave, ECG= RBBB, echo= RVH, triangle appearance of cardiac
shadow  ASD
