Success: These questions come from objectives

 Try to do all the CLIPP cases; at least read pdf summary, also case quizzes are good

 Try to answer objectives on your own

 Just read word doc for OMM

Questions:

1. Describe the rationale for childhood immunizations and list the immunizations currently
recommended from birth through adolescence?

 One question discusses 11yr-old and asks what vaccine is needed…Tdap

2. Describe physical signs and symptoms of shaken baby syndrome (questions asks indirectly
about abuse)?

 Retinal hemorrhages?

3. Describe the age appropriate differential diagnosis and key clinical finding: PAINLESS
bleeding at 2yrs old

 Meckels diverticulum

4. Clicking sound during hip exam

A. + ortolani/barlow

5. Boy with Mental retardation (family hx in males), long face and big ears, what’s dx?

 Fragile X

6. Parents are letting their baby sleep on their stomach, what do they need to change?

 Baby needs to sleep prone

7. Mom breast feeds for 6 months

 Supplement with vitamin D; after 6months need iron

8. Development at 24 months:

A. Puts 2 words together; brushes teeth; copies line.

B. Make sure to be able to distinguish between 18months as well

9. Presentation of color change, muscle tone, chocking

 ALTE

10. 12yr old obsess child has a limp?

 SCFE

11. Sickle cell pt with fever, rashes, pleurtic chest pain, infiltrates on x-ray, dx?

 Acute chest syndrome

12. Airway obstruction with hunched forward position and drooling?

 Croup

13. Pt with abdominal pain, rash on lower extremities, butt and trunk, also has bilateral swollen
knees with pain.

 Henoch-Scholen Purpura (NSAID for pain and watch; STEROIDS use controversial)

 ITP: asymptomatic purpura; oral corticosteroids use, IVIG

14. Tx for uncomplicated AOM (3-5days after URI).

 OBSERVE for nonsevere illness (fever less 39 degrees C), most other cases use ampicillin

 Also make sure to look at the age bc there is a breakdown in one of the cases for age
<>2yrs old and tx

15. Test performed in DS?

 Thyroid screen; have macroglossia.

16. Pt with bilious vomiting

 Volvulus (also small bowel obstruction)

 Non-bilious vomiting (pyloric stenosis; GERD; metabolic derangements and increased

ICP)

17. Know the difference in the 4 domains and what makes up each

 Gross motor (raising head, sitting), fine motor (pincer grasp, copies circle), language
(cooing, babbling), social development (social smile, gender)

 Question asks what domain is wrong, think language and fine motor; there are 2 domain
questions
18. Pt is irritable, hypothermic, +tremors, hypotonia, poor feeding and seizures?

 Hypoglycemia

19. Seizures greater then 15 minutes?

 Complex seizure

20. Question about 4 domains about childhood

 Again asking about which domain is affected

21. Obese child has papilledema

 Pseudo tumor cereberi - p. 611

22. Question about growth?

Belief it deals with failure to thrive <3 rd percentile growth curve

 Low birth weight, low SES

23. Pt had headaches with vomiting, what is the cause? I think it was migraines.

 Tension type HA’s have posterior/frontal pain origin which feels like a rubber band

24. Lab studies to order in physical abuse?

 Skeletal survey Xray

25. Patient presents with abdominal pain

 Belief this was clear case of appendicitis (RLQ pain)

26. Viral exanthems after fever?

 Roseola

27. Clinical case of adolescent who losses interest in things he liked previously

A. Depression

28. Risk of epilepsy in febrile seizures?

 Slightly higher than baseline population 0.5-1.0%; seizure before 12months has 50%
recurrence risk

 Management: NSAIDS; for bacterial cause provide AB

29. Question about a kid who is losing weight even though he eats milk, cereal and drinks lots of
juice?

 Kid is getting too much carbohydrates thus not gaining weight

30. Kid who has chocolate milk in his bottle-question about nutrition management?

 Not sure about it… it was between just giving the kid water in his bottle or other answer
states that chocolate milk will cause increased desire for sweets (I picked this)

31. Recognize factors in the perinatal and newborn hx that may put a neonate at risk for
medical problems?

 Not sure what this question is asking

32. Sickle cell: 3 questions

 One deals with ACS (describes it, question asked), other with needing 23 pneumococcal
vaccine at 2yrs (also meningococcal) booster for both is at 3-5yrs (question); providing
1.5 maintenance bolus for hydration; most common microbe is S. pneumoniae (also a
question, Salmonella not a choice)

33. Genetic basis for autosomal trisomy’s? Not sure if having to identify trisomy 21 or if it talks
about inheritance pattern (nondisjunction during meiosis; karyotype)

34. Symptoms of a kid who has rickets and I think questions asks for vitamin D deficiency (also
note fluoride is found in drinking water and is good for teeth).

35. Somatic complaints of recurrent abdominal pain

 Functional abdominal pain: no alarming symptoms, - for occult blood; also have HA and
problems with sleep

 IBD: +blood, weight loss

36. Order correct lab and radiology studies for shaken-baby syndrome (this follows the last
questions were it asked about symptoms [retinal hemorrhage, broken femur, ribs ] know
that you would do full body xray)
37. Describe components of health supervision visit for newborn, infant, toddler, school aged

 Question could be nutrition based (see previous); also there was one about a child not
speaking as well and it asked about what test should be done (I picked hearing test)

38. Same as #37; similar question description; not sure what this one was except the previous

39. Newborn exam findings (red reflex-retinoblastoma or glaucoma; scalp swelling is indicative
for ICP; heart murmurs-there is one question about systolic murmur around sternal border
on left side –answer is ASD

40. Description of wheezing, cough with sputum, worse at nights

 Asthma (also question about possible triggers such as SMOKING,)

41. Know components of pre-participation sports exam.

 Question describes DS pt who wants to try out special Olympics; BEFORE PT CAN PLAY
SPORTS CHECK atlantoaxial instability

42. Pt with persistent asthma, what rescue med should be used?

 Short term beta agonists

43. Symptoms of sepsis, shock, severe dehydration, DKA

 Know symptoms sepsis and shock

44. Fluid replacement (3 questions): only one question required calculation (asked for amount
needed to be replaced, answer with three same values in the answer choice is correct value
I calculated (the two other answers choices with the value can be eliminated; question
requires the correct amount in it and saline %); most questions ask about the correct
replacement fluid (.3%, .45% and .9% saline replacement depends on hypo or hypernatremic
dehydration; 2nd QUESTION; kid has diarrhea and vomiting for 24hrs what fluid is correct;
NOT sure what I picked); in general 0.45% saline with 5% dextrose is used to provide
maintenance fluids; it would be good to know holliday-segar method and presentation of
different types of dehydration (mild, mod,severe); alert and irritable or consolable, pulse is
age appropriate or slightly elevated, moist or tacky buccal mucosa, moist eyes, tears,
 decreased urine output, good skin turgor, <2 sec cap refill; describes 5% is a mild
dehydration with <50 mL/kg water loss; Moderate loss : 50-90 mL/kg water loss. Severe loss
> 100 mL/kg; last question ask about oral replacement

 DKA: only questions deals with effects of insulin on K+; I picked that insulin
administration in DKA will cause K+ to shift inside the cell

45. Recognition of congestive heart failure in infant (diaphoresis, tachypnea, failure to thrive,
hepatomegaly) use digoxin or furosemide

46. Differentiate normal and abnormal findings on exam lymph nodes, liver, spleen

 One question I think describing lymph nodes in size and asked what to do next

47. Understand the management of septic shock in pediatric patient

 See question #43

48. Know tanner stages (I only remember one Q); girl with breast buds and sparse hair
distribution; I was between stage 2/3

49. Know age appropriate diff for fever w/o cause

 Remember few questions (at least 2) asking/describing meningitides and asking for
causative agent; viral or bacterial; one provides high WBC pointing towards viral
other provides high neutrophils; also remember central rash is seen with N.
meningitis

50. Child with pigmented genitals and I think hyperK; what is increased: choices are cortisol, 17-
hydroxylase or 21-hydroxylase

51. Remember one question about different blood types AB, O and it asked which would cause
an severe reaction in child (not sure if it deal with Rh- or blood transfusions in general); I
think I selected the one that would cause coagulation if administered

52. Understand the basis and description of fetal alcohol syndrome?

  Short palpebral fissure, smooth philtrum thin upper lip, hypotonia, developmental
delay, congenital heart disease and renal abnormalities

53. Pt with chronic abdominal pain, bloody stools, dx?

A. IBD

54. Know differential diagnosis for cough/wheeze in pediatric patients?

 Common cold (rhinosinusitis), know bronchiolitis, foreign body aspiration (one

question about the imaging, usually impacts only one side); transient synovitis of hip
occurs after URI

55. What is the metabolic panel/symptoms in a pt with pyloric stenosis?

A. Hypochloremic metabolic alkalosis

56. Know presentation of turner syndrome?

 Webbed neck, short stature, cognitive impairment, ovarian dysgenesis; XO

57. There was a second milestone question about rolls front to back, raking grasp (4 months) or
rolls over in both directions (6 months)

58. Know stuff on febrile seizures: do not influence intelligence or learning, do not lead to
disabilities like MR. Occur in kid’s b/t 6 mo and 7y/o. risk factors: < 12 mo old with initial
seizure event, family h/o febrile seizure or epilepsy.

59. Pt is irritable with coryza and 103.4 fever, what will the culture show?

A. Strep pneumonia

60. What do you do with a child b/t 12-18mo and their first seizure and fever?

A. Lumbar Puncture

61. Understand patent ductus arteriosus and the manifestation of it?

 Closed with indomethacin (NSAIDs), loudest at S2

62. Know benefits of breast milk?

 Question answer: mother should not stop breast feeding; breast feeding helps
infants recover faster, higher mental development, protect from becoming
overweight; only in severe cases stop breast feeding

63. Know symptoms of lead intoxication?

64. Rapid and labored respirations can lead to?

A. Difficulty feeding

65. Boy with one joint affected, inflamed

A. aspiration of the joint shows inflammatory cells, see gram + cells, if fever > 100.4
need to rule out septic arthritis.

66. What are some increased risks of DDH? (developmental dysplasia of the hip)

A. Breech delivery

67. Question about a rash starting on the neck and going down to the belly and the arms, non
blanching and erythematous rash (2 questions).

A. Chicken pox (varicella)

68. Kawasaki’s s/s:

A. Prolonged high fever, big red tongue, rash on hands

69. Results of Kawasaki’s dz?

A. Coronary artery aneurysm

70. 2nd step after a renal U/S with a child with a UTI?

A. VCUG (voiding cystourethrogram)

71. What do you do with an infant who has had a fever and seizure for 24 hours>

A. LP
72. Q on physiologic jaundice, know bili <15 mg/dL, peaks at 3-4 days.

73. Q on breastfeeding and the fact that it has a perfect balance of fats (50%), CHO and
proteins.

74. What are the risk factors for TTN (transient tachypnea of the newborn)

A. C-section, male, macrocosmic

75. What is dx if ground glass is seen on x-ray in infant?

A. RDS

76. Age of mother and risks on infant

A. DS, age greater then 35yrs

77. Know treatment of IBS

 Diagnosis made with colonoscopy and barium enema

 Tx includes: steroids, AB, monoclonal AB, mesalamine

78. 4 Questions on immunization

 Two were already discussed (see tdap, other sickle cell PCV)

 2 others: these describe symptoms and asks what vaccine would have prevented it

o One was botulism and other whooping cough

79. Know microbes involved (scarlet fever, impetigo, meningitis)

80. There were few questions for labs/diagnostic tool needed for abuse, IBS, urinary problems,
and fever (do not remember)