Immediate oral pruritis and swelling after eating certain raw fruits or vegetables; occurs in 10-40% of patients with allergic rhinitis - diagnosis?
Oral allergy syndrome
Ingestion of what household chemical is most likely to present with drooling, dysphagia, odynophagia, and intraoral burns?
Drain cleaner
Ingestion of ethylene glycol is associated with this LATE finding on urinalysis.
Crystalluria - calcium oxalate crystals
What are the 2 main organ systems affected by hydrocarbon ingestion?
1) Lung: pulmonary aspiration
2) CNS: depression, seizure, coma
Ingestion of what chemical is most likely to present with cholinergic symptoms of: salivation, lacrimation, urinary incontinence, diarrhea, abdominal cramps, bronchospasm, muscle weakness, miosis?
Organophosphates
List 6 factors that predispose children to the development of vulvovaginitis
1) Absence of labial fat pads
2) Absence of pubic hair
3) Poor toileting hygiene
4) Anus and vagina are close
5) Thin vulvar skin
6) Vaginal environment favors bacterial growth
At what value is stool reducing substance assay considered significant?
0.5% or greater
Which section of the bowel is responsible for the absorption of most fats?
Terminal ileum - reabsorbs bile acids that are secreted in proximal intestine by liver
Which type of dietary fat is absorbed by lipase and bile acid-independent pathway?
Medium-chain triglycerides
Adolescent with the "worst headache of her life," pain exacerbated by Valsalva, stiff head/neck - diagnosis?
Subarachnoid hemorrhage (SAH)
Infant presents in shock 2-3 days after discharge from MBU; birth & neonatal course unremarkable; declining activity/feeding at home - which type of congenital heart disease is this?
Left-sided obstructive (gray baby)
What lab is diagnostic for Hashimoto's thyroiditis?
Antithyroid antibodies against thyroid peroxidase (TPO) or thyroglobulin
Adolescent female with primary amenorrhea; no breast developmen but some pubic hairt; short in stature - you should definitely consider what diagnosis?
Turner syndrome: ovarian dysgenesis, single X chromosome (XO)
What are 3 hematopoietic manifestations of intrapartum asphyxia?
1) Anemia
2) Thrombocytopenia
3) Coagulopathy
(T/F) Most infants who have seizure develop cerebral palsy.
False
Goats milk is lacking in what 3 nutrients?
1) Folate ***
2) Vitamin D
3) Iron
At what age can you consider screening audiometry?
3 years
Cyanotic congenital heart disease generally presents at what age?
Within hours of birth
Left-sided obstructive congenital heart disease generally presents at what age?
Days AFTER discharge from MBU
What are the 3 etiologies of inheritance of Down syndrome?
1) Nondisjunction
2) Unbalanced translocation
3) Mosaic pattern
What is the recurrence risk of Down syndrome inherited by nondisjunction?
1% plus mother's age-related risk
What is the recurrence risk of Down syndrome inherited by familial translocation carried by the father?
1%
What is the recurrence risk of Down syndrome inherited by familial translocation carried by the mother?
10-15%
What is the definition of primary amenorrhea?
No menstrual period by age 16 years
What is the incidence of Turner syndrome?
1 in 2,000 to 1 in 5,000 live female births
What is the incidence of Hashimoto's thyroiditis?
1 in 600 children
Name 4 infectious organisms that require AIRBORNE precautions
1) Mycobacterium tuberculosis
2) Aspergillus sp.
3) Measles virus
4) Varicella virus
Name 6 infectious organisms that require DROPLET precautions
1) Haemophilus influenzae b
2) Influenza virus
3) Paramyxovirus (mumps)
4) Mycoplasma pneumoniae
5) Bordetella pertussis
6) Streptococcus pyogenes
Name 10 infectious organisms that require CONTACT precautions
1) Clostridium difficile
2) Enteroviruses
3) Escherichia coli
4) Shigella sp.
5) Hepatitis A virus
6) Herpes simplex virus
7) Respiratory syncytial virus
8) Rotavirus
9) Scabies
10) Staphylococcus aureus
What does "contact precautions" entail?
Donning gown & gloves before entering patient's room
What does "droplet precautions" entail?
Gown, glove, and mask for anyone coming within 3' of patient; otherwise just gown & glove before entering patient's room
What does "airborne precautions" entail?
Patient requires negative pressure room; gown, glove, and mask must be worn before entering patient's room
What is the most common viral cause of asthma exacerbation in older children?
Rhinovirus
What seasons do influenza and parainfluenza strike?
Winter
When does rhinovirus strike?
September & late spring
What promotes respiratory drive in patients with chronic respiratory failure (i.e. BPD, CF)?
Hypoxemia
What promotes respiratory drive in patients with acute respiratory failure (i.e. asthma attack)?
Hypercarbia and acidosis
Recurring crops of pruritic, erythematous papules, some with central punctum - diagnosis?
Papular urticaria
Small pustules (1-2mm) with surrounding erythema - diagnosis?
Folliculitis
Erythematous papules (clustered, coalescing) over face and extremities; usually after viral infection or immunizations - diagnosis?
Gianotti-Crosti disease
Translucent or white papules with central umbilication - diagnosis?
Molluscum contagiosum
Erythematous papules or vesicles that are generalized in infants or concentrated at flexural areas (i.e. interdigital webs, wrist flexures), at belt line, on the penis in older children - diagnosis?
Scabies
Name 4 complications of parenteral nutrition
1) Infection
2) Thrombocytosis
3) Electrolyte derangement
4) Cholestasis
How do we treat TPN cholestasis?
1) Trophic feeds - stim's bile flow & intestinal motility
2) Ursodeoxycholic acid
What are 2 reasons why preterm infants have difficulty digesting fat?
1) Decreased pancreatic lipase activity
2) Decreased enterohepatic circulation of bile-acid
How does human milk aid in fat absorption?
Contains bile salt-stimulated lipase that is activated in the duodenum
At routine wellness physical, you should recommend that parents set home water heaters at what temperature?
120 degrees F
What brain processes present with bilateral progressive leg weakness and urinary incontinence? (2)
1) Hydrocephalus
2) Midline parasagittal lesion affecting cortical spinal tract fibers to both legs
Epicanthal folds, short palpebral fissures, smooth philtrum, narrow upper lip - this matches the description of what congenital disorder?
Fetal alcohol syndrome
Epicanthal folds, upslanting palpebral fissures, flat nasal bridge, macroglossia, excess nuchal skin, 5th finger clinodactyly - this matches the description of what congenital disorder?
Down syndrome
Macrocephaly, small chest compared with abdomen, proximal shortening of upper extremities - this matches the description of what congenital disorder?
Hypochondroplasia (dwarfism)
Short stature, triangular face (broad forehead + narrow chin)
Russell-Silver syndrome
What are 5 lab abnormalities in DIC?
1) Thrombocytopenia
2) Prolonged PT & PTT
3) Low fibrinogen
4) Elevated D-dimers
5) Burr cells on smear
What 6 vaccines do you need to be a health-care worker?
1) Rubella
2) Measles
3) Mumps
4) Hepatitis B
5) Influenza
6) Varicella
Kid with poor growth, hypertension, normocytic anemia, elevated BUN and creatinine should make you think of what disease?
Chronic kidney failure
What are 3 things that drive red cell synthesis?
1) Substrates (i.e. folate, B12, iron)
2) Bone marrow function
3) Erythropoietin
When should ingested foreign bodies be removed endoscopically?
1) Retained longer than 24 hours
2) Object is corrosive (i.e. button battery)
What is the typical progression of hemangiomas?
Grow rapidly during first 6-9 months of life - stabilize and involute after
What is the hallmark of involution of a hemangioma?
Appearance of gray or white discoloration on lesion surface
What are statistics of COMPLETE resolution of hemangiomas?
30% by 3
50% by 5
70% by 7
90% by 9
What is the mode of inheritance of familial adenomatous polyposis?
Autosomal dominant - mutation in APC gene on chromosome 5
At what age should children with FAP receive their first annual screening colonoscopy?
10 years
What is the mean age of developing colorectal adenomas in children with FAP?
16 years
Lentigines on the lips and oral mucosa should clue you in to which inherited polyposis syndrome?
