Peds NBME Form 1 77 terms chris_spates

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J-wave hypothermia

refers to a sudden, adam strokes attack

transient episode of
syncope, occasionally
featuring seizures.

cause of recurrent impaired humoral immunity

infection
mixed metabolic salicylate poisoning
acidosis and respiratory
alkalosis

patchy irregular uptake Multinodular goiter

of radioisotope
What is another name lymphocytic thyroiditis/ infiltration
for multinodular goiter

14 day fever headache Sinusitis

and green nasal
discharge in a 14 year
old. Post pharyngeal
wall is erythematous
and covered with thin
gray mucous

SCID has an abscence T cells - leads to B cell impairment too. Both are low
of what cells

recurrent infection - SCID

bacterial, fungal and
viral

Patient has foreign bronkoscopy - take it out

body, next step

kid has fever and right Pseudomonas - because he has fever.

foot pain. itching rash
started between the Keep in mind that athletes foot, Trikofyton rubrum, is a
second and third toes fungus that is the most common cause of athletes foot,
of both feet. Plays jock itch and ringworm but IT DOES NOT HAVE FEVER or
sports in highschool. TENDER LYMPH NODES
Lymphnode in groin is
tender

2 days after delivery, a Posterior urethral valves

male newborn has
dribbling. on physical
exam he has a 6
centimeter round
midline suprapubic
pelvic mass

Hep A antibody positive Hep A - immune

Hep B core antibody
positive Hep B - not immune with acute infection
Hep B surface antigen
positive
Hep B surface antibody
negative

2 year old boy with led poisoning, not iron deficiency

anorexia, poor
coordination, and
sporadic vomiting over
the last month. Lab
shows hypochromic
microcytic anemia.

ashleaf spots - Skin Tuberous sclerosis

hypopigmentation, four
periventricular nodules
- cortical tubers

what can TMP-SMX neutropenia - low segmented neutrophils

Bactrim cause on labs

14 year old girl patient impreforate hymen - do cruciate incision of the hymen
with suprapubic
tenderness for 6
months. She has a
smooth red bulge
between the labia. What
is the next step?

patient with anorexia is osteoporosis

at risk for what bone
morphology?

A low pitched vibratory Venous hum - when he turns his head left it cuts it off.
murmur is heard Venous hum is when the blood goes through the internal
through the cardiac jugular vein
cycle and is most
prominent at the left
upper sternal border
when the child is in the
sitting position. The
murmur dissapears
when his neck is rotated
in the sitting position
suspected G6PD from look at blood for heinz bodies and bite cells - thick and
antimalarial medications thin blood smears
or moth ball exposure.
what is the next step?

14 year old girl with Pulmonary artery Hypertension

down syndrome is
evaluated for poly cy
theemia vera. she has
cyanosis and clubbing.
There is an increased in
intensity second heart
sound. she has a large
ventricular septal
defect and a dilated
main pulmonary artery.
What is causing the
poly cy theemia?

fundoscopic increased intercranial pressure, papil edema, cerebral

examination shows an edema etc.
abscence of venous
pulsations

appropriate therapy for 6 week course of oral AZT within 12 hrs after delivery
a kid born to a mother
with HIV

"click" or more precisely "developmental dysplasia of the hip" (DDH) to "congenital

"clunk" in the hip may be dislocation of the hip" (CDH)- include subluxation,
detected. Ortolani dysplasia, and dislocation
maneuver and the
Barlow maneuver Ultrasound until 3 months - then you can do an x ray.
Ultrasound because calcifications are not visible until after
main types are the 3 months
result of either laxity of
the supporting capsule
or an abnormal
acetabulum.

16 year old male with a Physiologic pubertal development

painless lump in his
right breast. 1
centimeter smooth firm
mass under right nipple.
no nipple or skin
retraction or
lymphadenopathy

diarrhea with chicken salmonella - cook meat properly to prevent transmission

18 month old at daycare strict handwashing techniques at the day care center
center with diarrhea has
RSV. what could have
prevented this?

16 year old girl from Treponema pallidum

africa has a painless
lesion on her vulva. she
is sexually active. 10
milimeter nontender
sharply demarcated
elevated round lesion
on the right labium
majorum. base of the
lesion is smooth and
non purulent

bowing of legs outward Rickets

in a kid

anterior bowing of the hereditary syphilis

tibia caused by

9 year old with bowing Tibia Vara

of her right leg - right
knee bowed outward
on walking. X ray of
patient standing shows
collapse of the medial
aspect of the
metaphysis of the
proximal tibia

next step in caustic fiberoptic endoscopy

ingestion after
stabilization of airway

newborn is getting decreased excretion of bilirubin

jaundiced. stools are
light in color. Total
bilirubin is 14 and direct
bilirubin is 6. what is the
mechanism?

holosystolic murmur VSD

with mid-diastolic
murmur at the apex.

rickets mechanism of metabolic

deformity

12 year old boy is the determination of bone age

shortest boy in class but
has a tall father. how do
you confirm the
diagnosis?

next step in diazepam Treatment required for prolonged seizures

management in a febrile involves medication and monitoring.
seizure for 35 min (
complex partial) in 7 mo After a simple febrile seizure, most children do not need to
old. stay in the hospital.

After the seizure has stopped, treatment for the fever is

started.

when do you give penecillin until 5 years old and

penicillin or pneumococcal vaccination after age 5
pneumococcal vaccine
for a-splenia?

absent cremestaric torsion of testis

reflex on right

14 year old, frequently Hypothyroidism

tired with longer,
heavier menses. thyroid
gland is easily palpated.

3 year old has fever and acetaminophen only because there are no abonormalities
sore throat. What of pharynx, no exudate of white count
treatment do you
reccomend?

What treatment is decrease insulin dosage by 10-15% on exercise days

reccomended for a
diabetic who does
intense exercise to
reduce diabetes related
complications

outcome for post strep recovery without renal sequelae - post strep GN is usually
glomerulonephritis self limiting

3 month old has e coli renal Ultrasound to rule out pyelonephritis

100,000 and White
Blood Cells on
urinalysis. What is the
next step?

chronic lung disorder bronchopulmonary dysplasia

that is most common
among children who
were born prematurely,
with low birthweights
and who received
prolonged mechanical
ventilation to treat
respiratory distress
syndrome.

14 year old girl with perform a karee o type analysis to diagnose Turner's
high blood pressure in syndrome XO
upper extremities and
weak femoral pulses.
What is your next step?

18 month old with fever, Systemic Lupus Erythematosus

painful swelling of the
left knee. anemia,
leukopenia,
thrombocytopenia,
combs test positive and
protein in urine

which one is in Strawberry hemangiomas get bigger before they

INFANTS and which spontaneously regress and they BLANCH in INFANTS.
one blanches? Cherry hemangiomas DO NOT blanch.
strawberry hemangioma
vs cherry hemangioma

suspected adrenal increased ACTH

insufficiency LOW CORTISOL

30 month old kid with Most likely a Neuroblastoma

left flank mass, normal
bone marrow, and Neuroblastomas present as an extra renal mass that
normal kidneys on crosses midline and occurs in 1 to 2 year olds, up to 36
ultrasound months

Wilm's tumor presents as an intra renal mass and does not

cross midline. Presents in 3 to 4 year olds

6 week old baby is Soy formula is made with hydrolyzed kaesin

having stools with
blood and mucus. she
was changed from cows
formula to soy formula.
Why is she having these
symptoms?

36 hour old baby has If bilirubin is approaching 25, do an exchange transfusion.

jaundice. Total bilirubin
is 22. What is your next If it was closer to 12, then do phototherapy
step?

2 year old boy with Croup presents with subglottic edema, airway narrowing
rhinorrhea, coryza, and "barking cough"
noisy breathing when
he inhales, inspiratory
stridor and difficulty
breathing

15 year old girl has Tinea versicolor

multiple areas on her
chest and upper back
that are lighter than the
rest of her skin. she has
mild itching over these
areas when she plays
volley ball. physical
exam shows multiple
flat oval,
hypopigmented lesions.

8 year old boy with 9 spirometry

month history of
productive cough that is
worse at night and
Shortness of breath
during physical activity.
colds seem to go to his
chest and linger. Chest
X RAY shows mild
hyperinflation. next
step?

newborn 12 hrs of life, Esophageal atresia

excessive oral Attempt to insert a nasogastric tube
secretions and cough
after first feeding.
Polyhydramnios
diagnosed at 35 weeks
gestation. Next step in
management?

18 month old, vomiting, Drain cleaner is caustic and will cause ulcers.
drooling, ULCERS on
lips and tongue. What is Organophosphates cause vomiting, drooling and diarrhea
the most likely without ulcers.
ingestion?

4 year old, 6 hour Give intravenous dopamine to increase BP and renal

history fever, decreased perfusion.
alertness, and rash over
chest and extremities.
Purple macular rash.
Edematous face and
extremities. IV
ceftriaxone &
vancomycin. Patient
intubated for apnea. BP
70/30. Markedly
decreased urine output,
hazy lung fields,
cardiomegaly,
BUN/Creatinine > 15
What is the next step in
management?

5 year old, increasing Malignant pleural effusion

difficulty breathing,
jugular venous
distension, Chest X ray
shows superior
mediastinal mass and
pleural effusion.
Thoracocentesis yields
SEROSANGUINOUS
fluid. What is the most
likely cause of the
pleural effusion?

8 week old, 48 hours Low Chloride

continuous, nonbilious, Low Potassium
projectile vomiting. High pH
Palpable "olive". What is hypochloremic alkalosis
his electrolyte status?

18 month old, 2 week Serous otitis media

history upper
respiratory tract
infection. Over last 15
months, several
episodes acute otitis
media. Unilateral AIR
FLUID LEVELS behind
tympanic membrane.
Membrane blue/grey
with visible landmarks.
What is the most likely
diagnosis?

3 year old African Nephroblastoma

American girl, 1 month Wilms Tumor, likely associated with Denys-Drash syndrome
history abdominal pain due to wrist symptoms.
and loss of appetite.
Firm nodular midline
upper abdominal mass.
X ray shows mass with
multiple calcifications.
What is the most likely
diagnosis?

Itching head, several Tinea capitis caused by Trichophyton tonsurans

small oval areas of
alopecia with broken
hairs close to scalp.
What is the most likely
diagnosis and causal
organism?

1 month old, 12x8 cm Thrombocytopenia from platelet sequestration

red, raised, well-defined Kasabach-Merrit phenomenon is a giant
lesion overlying hemangioendothelioma vascular malformation in
buttocks. Multiple NEONATES that traps circulating platelets
petichiae and bruises.
What is the most likely
explanation?

Recurrent episodes of Measurement of serum C1 esterase inhibitor concentration.

ASYMMETRIC Hereditary Angioedema
SWELLING of face,
chest, and arms.
Occasional additional
abdominal pain and
diarrhea.

2 month old, 10 day Pertussis

history worsening Whopping Cough
coughing spells with
post-tussive emisis.

1 year old, 2 weeks Iron supplementation

pallor. drinks 2% cows Deficiency causes all of stated symptoms
milk and table food.
Hematocrit 26%. Wright
stain smear shows few
reticulocytes and
increased red cell
distribution width. What
supplementation could
have prevented this?

6 month old, difficulty Larynx

breathing, low grade upper airway
fever, nasal congestion,
runny nose, inspiratory
stridor. Where is the
pathology?

3 year old, 3 month Normal growing pains

history night time leg
pain that wakes her Most often seen in preschool and school aged children
from sleep. Resolved
with acetaminophen
and massage

5 year old, left hip pain IV Vancomycin

and limp for four hours.
Watery stools a week
ago. Erythrocyte
sedimentation rate 28.
Ultrasound shows small
effusion. What is the
appropriate treatment?

2370g 37 week Trisomy 18

gestational age baby. Edwards Syndrome
Mother drank two beers
a day. Prominent
occiput, narrow
palpebral fissures, small
mandible, short
sternum, clenched
hands, hypertonia. What
caused baby's low birth
weight?

Episodic hematuria I g A Nephropathy

following non-specific
upper respiratory
infections

What is the most Thyroid dysgenesis

common cause of
congenital
hypothyroidism?

Henoch-Schonlein IgA Nephropathy

Purpura Abdominal Pain
Purpura caused by ELEVATED Platelets!

Absent P waves and Supraventricular Tachycardia

Tachycardia

Supraventricular Beta blockers like propranolol and/or digoxin.

Tachycardia treatment Adenosine should be avoided.
in infants and children

Acute Lymphoblastic High WBC

Leukemia Low Hemoglobin, RBC and Platelets