October 5, 2016

1) In a kid with acute otitis media, if bulging of TM is bilateral or high

fever of 39C , suspect bacterial infection and prescribe amoxicillin on
the spot.
2) Otitis media with conjunctivitis is probably caused by H. flu, not strep.
pneumo. So tx is cephalosporin, not amoxicillin.
3) Otitis media is mostly viral-caused. Viral pathogens are RSV,
parainfluenza, influenza, adenovirus.
4) Group B Strep and E. coli are the most common causes of meningitis in
neonate. This is a classic pediatric test question.
5) Pregnancy infection, baby born with blue berry muffin.
6) Roseola buzz words: abrupt rash and high fever greater 40 C
7) Live pediatric vaccine: oral Polio, rota, MMR, varicella, influenza, BCG.
8) Moro reflex is when primitive reflex up to 3 or 4 month where loss of
support results in baby spreading their arms.
9) Macrosomia = gigantism
10)
Pathognomonic sign of osteogenesis imperfect is blue sclerae,
but other signs are loss of teeth and deafness. Mutation of collagen
type 1 affects the skin, bone, teeth, sclerae, tendon, ligament, and ear
bones.
11)
Celiac Disease is associated with autoimmune diseases such as
type I diabetes and thyroiditis. Symptoms include iron deficiency
anemia (duodenum absorption difficulty) and dermatitis herpetiformis.
12)
Whopping cough is pathognomonic for Bordetella Pertussis. Tx is
macrolides such as erythromycin or azithromycin. Prophylaxis
macrolide is given all the household members in contact with infected
patient.
13)
Contact dermatitis from poison ivy is a delayed response, which
is type 4 hypersensitivity. MOA is T cell and macrophage mediated.
14)
Primary amenorrhea defined as lack of menarche by 15 yo could
due to Turner Syndrome or Androgen Insensitivity Syndrome or others.
First step in differential and diagnosis is detecting the presence of
uterus using ultrasound.
15)
A girl suspecting of Turner Syndrome, the best way to confirm it
is via karyotype analysis.
16)
A 8 yo girl already going through puberty and a mass in an ovary
= Granulosa cell tumor that secretes excessive estrogen.
Presentation is precocious puberty. Tx: surgical removal.
17)
Neonatal polycythemia is defined as > 65% hematocrit. Usually
is asymptomatic but can cause tachypnea from blood viscosity. Most
common cause is delayed clamping of umbilical cord. Other causes are
from intrauterine hypoxia from maternal HTN, maternal diabetes, and
smoking. Tx is just hydration to reduce the viscosity.
18)
What is the most common brain tumor in children? Pilocytic
astrocytoma.

19)
Teenager boy with recurrent nosebleeds, visible nasal mass,
nasal obstruction = juvenile angiofibroma. Its a benign growth but
can invade and erode locally.
20)
Edema, hypoalbuminemia, no urine RBC, and fatigue are signs of
nephrotic disease. Most common cause is minimal change disease in
children and FSGS and membranous nephropathy in adolescence and
adults. Hepatitis infection is associated with increased risk for
membranous nephropathy.
21)
Suspect Alports Syndrome in patients with recurrent
hematuria, sensorineural deafness, and family history of renal failure.
Dx shows splitting of GBM.
22)
Iron deficiency is the most common nutritional deficiency in
children. It is at risk with babies under 2 who drink mostly cow-milk
(low iron) than breast milk. Tx is oral iron therapy
23)
In patient with type I diabetes, acute infection can precipitate
DKA due to increased glucagon increases hyperglycemia. As a result,
depletion of total body potassium storage even though serum K+
may be elevated.
24)
Neonate with jaundice, light-colored stool, hepatomegaly, and
direct (conjugated) hyperbilirubinemia requires prompt evaluation for
biliary atresia. Dx is ultrasound to show absence or abnormal
gallbladder. Dont pick Crigler-Najjar or Gilberts syndrome (CG) both
resulting in unconjugated hyperbilirubinemia.
25)
Chest CT scan isnt the best option for foreign bodies stuck in
right bronchus because some foreign bodies dont show up in CT scan
so the best diagnosis is immediate bronchoscopy.
26)
Gynecomastia can occur up to 2/3 pubertal boys but
reassurance that it most likely will dissolve.
27)
For sickle-cell patients with recurrent vasooclusive pain,
hydroxyurea is indicated with its effect to increased fetal
hemoglobin.
28)
Pathophysio of Hirschsprungs disease could be in RET gene that
is responsible for movement of nerve cell, which this disease lacks
myenteric plexus. A mutation in RET gene is associated with Downs
Syndrome.