pediatrics

Question 1

Kawasaki disease diagnostic criteria

Answer 1

fever > or = 5 days AND 4 of 5 findings

1) bilateral conjunctival injection, non-purulent
2) oral change : cracked erythematous lips and strawberry tongue
3) cervical lymphadenopathy (most likely > 1.5 cm in diameter, general unilateral)
4) extremity change : erythema or palm and sole desquamation
5) polymorphous rash: maculopapular, erythema multiforme–like or scarlatiniform rash, involving extremities, trunk, and perineal regions

Question 2

diagnostic criteria of atypical (incomplete) Kawasaki disease

Answer 2

fever > or = 5 days AND 2-3 of 5 findings

1) bilateral conjunctival injection
2) oral change : cracked erythematous lips and strawberry tongue
3) cervical lymphadenopathy
4) extremity change : erythema or palm and sole desquamation
5) polymorphous rash

Question 3

the diagnostic imaging modality of choice of Kawasaki disease

Answer 3

Transthoracic echocardiography to rule out coronary artery aneurysm

Question 4

ER management of child poisoning - initial info from the mother on the phone (old SAMP question)

Answer 4

• child weight
• child past medical history/ allergy/ current medications
• time of ingestion
• type of exposure/ name of the product ingested
• amount of ingestion

Question 5

method to reduce poison absorption

Answer 5

administration of active charcoal

Question 6

methods to enhance poison excretion

Answer 6

• forced diuresis
• hemodialysis
• hemoperfusion (over activated charcoal or resin)
• acidification/ alkalization of the urine

Question 7

How long after the ingestion will you be able to assess the severity of acetaminophen poisoning adequately?

Answer 7

4 - 24 hours after ingestion

Question 8

Antidote of acetaminophen poisoning

Answer 8

N-acetylcysteine (NAC)

Question 9

What laboratory tests are important for determining whether N-acetylcystine treatment is effective for acetaminophen poisoning?

Answer 9

• Aspartate tramsaminase testing (AST)
• Alanine transaminase testing (ALT)
• Bilirubin testing
• measurement of prothrombin time (PT) / measurement of International Normalized Ra`tio (INR)

Question 10

management of croup

Answer 10

• Dexamethasone 0.6mg/kg po x1 max 10mg
• consider blow-by O2
• benulized epinephrine

Question 11

Rourke milestone - 2 months old

Answer 11

•  Follows movement with eyes
  - Coos – throaty, gurgling sounds
•  Lifts head up while lying on tummy
  - Can be comforted & calmed by touching/rocking

Question 12

Rourke milestone - 4 months old

Answer 12

• holds head steady when supported at the chest or waist in a sitting position
• Laughs/smiles responsively

Question 13

Rourke milestone - 6 months old

Answer 13

• Sits with support (e.g. pillows) *** No head lag
• Reaches/grasps objects with both hands equally, no persistent closed/fisted hands
• Rolls from back to side
• Turns head toward sounds
• ** introduction of solids
• ** teeth/Caries risk assessment

Question 14

Rourke milestone - 9 months old

Answer 14

• Plays social games (pee-a-boo)
• babbles
• Cries or shouts for attention
  - Sits without support
• Stands with support when helped into standing position

Question 15

Rourke milestone - 12 mo

Answer 15

• Responds to own name
  - Understands simple requests
• Says 3 or more words
• Crawls or ‘bum’ shuffles
• Pulls to stand/walks holding on
• Has pincer grasp to pick up and eat finger foods (8 mo)
• Shows distress when separated from parent/caregiver (separation anxiety)
• Follows your gaze to jointly reference an object

Question 16

Rourke milestone - 15 mo

Answer 16

• cruise (Walks sideways holding onto furniture)
• stranger anxiety (Shows fear of strange people/places)
• crawls up a few stairs/steps
• tries to squat to pick up toys from the floor
• says 5 or more words

Question 17

Rourke milestone - 18 mo

Answer 17

Social/Emotional
Interested in other children
Comes for comfort when distressed

Points to several different body parts
Turns/responds when name is called
Points to what he/she wants

Feeds self with spoon with little spilling
Walks alone
Removes hat/socks without help

Question 18

Rourke milestone - 2 y/o

Answer 18

• Tries to run