Other

Question 1

Parkland formula

Answer 1

For burns >15%
Fluid resuscitation 4mL/kg x TBSA burned = 24 hour total
-give first half over 8 hours and rest over 16 hours

Question 2

Pyloric stenosis

Answer 2

• pre repair children develop hypochloremic hypokalemic hyperbilirubinemia and metabolic alkalosis

Question 3

Bilirubin and liver disease

Answer 3

• high total bilirubin with presence of conjugated or direct bilirubin likely indicates cholestatic liver disease
• physiologic jaundice of the newborn has an associated elevated unconjugated bilirubin level

Question 4

Mallampati score

Answer 4

• an assessment of the airway prior to intubation

- score of class 3 or 4 or higher is associated with a more difficult airway and intubation

Question 5

Contraindication to lung transplant

Answer 5

• malignancy within past 2 years, immunodeficiency syndrome, hepatitis B or C with liver disease, severe neuromuscular disease, multiorgan system dysfunction.
• relative contraindications include pleurodesis, renal insufficiency, markedly abnormal BMI, chronic airway infection with specified organisms, severe scoliosis, active collagen disease, mechanical ventilation,

Question 6

Normal QTc

Answer 6

• normal value is 0.44 m/second or less

Question 7

Tumor lysis syndrome

Answer 7

• elevated potassium, phosphorus and uric acid
• elevated BUN and creatinine
• low calcium

Question 8

neurofibromatosis

Answer 8

• Type I is usually diagnosed in infancy or at least prior to age 10 and involves the presence of café au lait spots and Lisch nodules (hamartomas of the iris), the defining characteristic.
• Type II occurs in patients in adult years and findings include glioma, meningioma, and hearing loss

Question 9

SCFE ( slipped capital femoral epiphysis)

Answer 9

• obese adolescent who presents with a limp.
• pain to the hip, knee, or thigh and holding the leg in an externally rotated position are other findings.
• requires urgent intervention, and surgical correction is necessary to prevent further slippage

Question 10

Legg–Calvé–Perthes disease

Answer 10

• caused by poor blood supply to the femoral head causing avascular necrosis.
• occurs in prepubertal, immature children and it affects males more than females
• discomfort with internal rotation and abduction and no external signs
• initial therapy includes rest and slow restoration back to use. If not identified early and managed, may require surgical intervention.

Question 11

transient synovitis or septic arthritis

Answer 11

• inflammatory process often following a viral illness
• acute or gradual onset
• usually unilateral

Question 12

hypomagnesemia causes

Answer 12

-GI losses (Pancreatitis, celiac disease, short gut syndrome, and inflammatory bowel disease)

Question 13

CHARGE syndrome

Answer 13

• genetic pattern of birth defects which include coloboma of the eyes, choanal atresia or stenosis, cranial nerve involvement, outer, inner, and middle ear abnormalities, cardiac defects, cleft lip and palate, and several others that are not typically associated with other patterned abnormalities.
• includes hearing loss and outer ear abnormalities, such as the outer ear appearing wide, low, and with no earlobe.

Question 14

Iron overload following chemotherapy

Answer 14

-prolonged elevated ferritin level can lead to liver dysfunction, endocrine disorders, and altered cardiac function

Question 15

diarrhea-associated (D+) hemolytic uremic syndrome (HUS)

Answer 15

• bloody diarrhea versus non-bloody
• anemia, decreased or no urine output, and signs of bleeding (e.g., petechiae).
• anemia is normochromic, normocytic, with an elevated reticulocyte count.
• results in Hyperkalemia and hyperphosphatemia, uremia, metabolic acidosis, Fluid overload secondary to lack of glomerular filtration resulting in hemodilution and relative hyponatremia
• cause E.coli 0157 (produces a toxin and is contracted through contaminated water, meat, fruits, and vegetables).
• results in damage to endothelial cells and erythrocytes, producing a prodrome of hemorrhagic enterocolitis.
• Endothelial swelling of the glomerular arterioles in the kidneys results in decreased glomerular filtration rate, proteinuria, and hematuria with hemolytic anemia, thrombocytopenia, and acute renal failure.

Question 16

Diamond–Blackfan anemia

Answer 16

-increased percentage of fetal hemoglobin (Hgb F)

Question 17

Bowel obstruction or perforation in an infant

Answer 17

-emesis, poor feeding, distended abdomen, metabolic acidosis

Question 18

Use of magnesium citrate as a laxative results in

Answer 18

-hypokalemia, hyponatremia, hypomagnesia

Question 19

Pulmonary hypertension

Answer 19

• presents with hypotension, tachycardia, and then bradycardia, irritability, hypoxia, chest pain, seizures, decreased exercise tolerance
• treatment focused on managing the acute events by providing a stable environment and lowering pulmonary vascular resistance through stabilizing hemodynamics and treating acidosis and hypercarbia
• use of vasodilating agents is appropriate in both acute and chronic settings of pulmonary hypertension. Milrinone is a nonspecific vasodilating agent like sildenafil and prostaglandin which would be used first line in the treatment of pulmonary hypertension.

Question 20

AGVHD (acute graft versus host disease)

Answer 20

• a serious complication of allogeneic hematopoietic stem cell transplant which typically occurs in the first 100 days after transplant
• characterized by inflammation of the skin, liver, and gastrointestinal systems as a result of the donor cell’s immune response recognizing the recipient tissue as foreign.
• manifestations of AGVHD include generalized erythematous maculopapular rash which can progress to bullae formation and desquamation, hyperbilirubinemia, transaminitis, vomiting, diarrhea, abdominal pain, anorexia, mucosal sloughing, bloody stools, and ileus.

Question 21

Cryoprecipitate

Answer 21

-obtained by centrifuging plasma and removing the precipitate. -blood product used to replace low fibrinogen levels and assist in stabilizing coagulation disorders

Question 22

basilar skull fracture

Answer 22

• linear fracture at the base of the skull, typically occurs as a result of blunt trauma or crush forces to the head, presents with battle sign and raccoon eyes
• Battle sign is bruising noted behind the ears which can show up even a few days after the accident.
• Raccoon eyes include bruising and potential swelling around the eyes, indicative of a frontal basilar skull fracture.

Question 23

Infants with liver failure

Answer 23

-present with poor feeding, lethargy, hepatomegaly and failure to thrive

Question 24

VACTERL

Answer 24

• vertebral defects, anal atresia, cardiac defects, TEF, renal anomalies, and limb abnormalities
• 50% to 80% of infants with VACTERL syndrome have a TEF

Question 25

Switching from a second- to a third-generation cephalosporin

Answer 25

-adds pseudomonal coverage

Question 26

Septic shock

Answer 26

- state of acute circulatory failure characterized by persistent hypoperfusion despite adequate fluid resuscitation or by tissue hypoperfusion (manifested by a lactate concentration >4 mg/dL) unexplained by other causes. - Clinical findings include prolonged capillary refill, decreased or absent urine output and potential renal failure, fever, and hypotension along with respiratory compromise

Question 27

Drug-resistant streptococcal infection

Answer 27

- pneumococcal infection resistant to β-lactams | - primarily involves the respiratory system and includes otitis media, sinusitis, and pneumonia

Question 28

Meckel diverticulum

Answer 28

- congenital abnormality of the small intestine, caused by an incomplete obliteration of the vitelline duct - majority present with painless rectal bleeding prior to their second birthday. - Meckel scan completed in nuclear medicine is the study of choice to best diagnose this problem. - a complete blood count with differential and metabolic studies should be completed.

Question 29

Hirschsprung disease

Answer 29

- absence of enteric neurons within the myenteric and submucosal plexus of the rectum and/or colon - aganglionic segment results in constipation, abdominal distention, and discomfort

Question 30

Side effects of abuterol

Answer 30

- β2-adrenergic agent | - side effects of inhaled albuterol include tachycardia, hypertension, nausea and vomiting, and hypokalemia

Question 31

Guillain–Barré syndrome (GBS)

Answer 31

- presents with ascending, symmetric weakness, paralysis with areflexia, meningismus, vomiting, headache, ataxia, and ophthalmoplegia - symptoms of GBS are typically preceded by an infection or immunization

Question 32

Pulmonary contusion

Answer 32

- result of chest trauma with damage to the capillaries and resulting fluid and blood collection in the lung tissues - symptoms include pain and hypoxia - symptoms peak at 24 to 48 hours and typically resolve within 1 week of injury

Question 33

botulism

Answer 33

- constipation, poor feeding, and increasing weakness | - weak cry, expressionless face, ptosis, hypotonia, and symmetrical cranial nerve palsies

Question 34

Cushing triad

Answer 34

- occurs with increased intracranial pressure (ICP) | - bradycardia with hypertension and an abnormal respiratory pattern

Question 35

Encephalitis

Answer 35

- inflammatory process of the brain parenchyma - presents very similarly to meningitis and can involve a viral or bacterial process - Elevated protein, normal glucose and pleocytosis - elevated opening pressure

Question 36

cerebral perfusion pressure

Answer 36

- CCP = MAP – ICP | - goal is >50

Question 37

Myasthenia gravis

Answer 37

- neuromuscular disorder that is characterized by varying degrees of weakness of the voluntary skeletal muscles. - symptoms include weakness that increases during periods of activity and improves after periods of rest - therapy for myasthenia gravis includes an anticholinesterase medication (e.g. neostigmine), immunosuppressants (e.g systemic steroids, azothiaprine, cyclophosphamide), intravenous immune globulin, plasmapheresis, and thymectomy

Question 38

Measles

Answer 38

-high, persistent fever over several days, diffuse red confluent rash, Koplik spots inside the mouth, cough, and coryza

Question 39

necrotizing enterocolitis

Answer 39

- abdominal radiograph shows pneumatosis-intestinalis, dilated loops of bowel that do not change on repeated abdominal radiographs (fixed loops), intrahepatic portal venous air, and ascites. - treatment with bowel rest, gastric decompression, and broad spectrum antibiotics

Question 40

Epidural hematoma

Answer 40

- hemorrhage located between the dura mater and overlying skull often caused by trauma. - symptoms include headache, vomiting, or irritability and often presents with a lucid interval. - classic appearance is a biconvex or lentiform mass that pushes the brain away from the skull bone, does NOT cross suture lines.