Pediatrics

Question 1

Cyclic vomiting syndrome

Answer 1

Is an idiopathic disorder that typically presents in children 4-7 years old.
Repeated, intermittent, stereotypical bouts of severe nausea, vomiting, and lethargy, which are self-limited and have no apparent cause.
It is associated with a family (or personal) history of migraines. Supportive therapy may be required during acute episodes, and some evidence suggests the use of antimigraine medications may be beneficial as prophylaxis.

Question 1

Intestinal malrotation

Answer 1

presents in newborns with bilious emesis, an upper gastrointestinal series demonstrating a misplaced duodenum, and a “corkscrew” appearance of the distal duodenum and proximal jejunum.

Question 2

What is the best management to minimize the progression to amblyopia in the evidence of strabismus?

Answer 2

The unaffected eye should be occluded or use Cycloplegic and mydriatic eye drops to “recruit,” and encourage use of the affected eye.

Question 3

Granulomatous infantiseptica

Answer 3

Listeria monocytogenes infection
the neonatal presentation is severe and fatal in 20 to 30% of cases.
Common manifestations in the newborn include sepsis, pneumonia, meningitis, and a pathognomonic finding, widespread microabscesses, and granulomas.

Question 4

Patient presents at one minute of life with a pulse of < 100/min and an Apgar score of 5. The best next step in management is?

Answer 4

Positive-pressure ventilation and reassessment of his Apgar score at 5 minutes.

Question 5

Intussusception

Answer 5

Acute abdominal distress and jelly stools “target sign” on ultrasonography.
Pneumatic enema is very effective at diagnosing and reducing intussuscepted sections of bowel.

Question 6

Neonates with meconium ileus should undergo?

Answer 6

Sweat testing to evaluate for underlying cystic fibrosis.

Question 7

Signs of duodenal atresia occur?

Answer 7

Immediately after birth with bilious emesis and no abdominal distention.

Question 8

Neonatal malrotation with volvulus

Answer 8

Occurs due to an incomplete malrotation of the intestines during the 7-12th weeks of development. Patients will feed well until 3-7 days of life when bilious vomiting, abdominal distention, and rapid decompensation may occur.
Complications: intestinal ischemia, infection, necrosis, perforation of bowel, and ultimately shock.

A corkscrew pattern in an upper gastrointestinal series. This is a common finding of midgut volvulus.

Question 9

Pediatric patient postprandial non-bilious vomiting, persistent appetite, and “olive-like” mass is highly suggestive of?

Answer 9

Pyloric stenosis, is due to hypertrophy of the pylorus muscle.
symptoms appearing around 3-to-5 weeks of life
Nonbilious projectile vomiting immediately after feeding
Often followed by eagerness to eat again (“hungry vomiter”)
Risk factor: exposure to macrolide antibiotics

Question 10

Ebstein anomaly

Answer 10

is a congenital heart defect characterized by a malformed tricuspid valve displaced toward the apex of the right ventricle (RV), leading to an abnormally large right atrium (RA) and small RV.
Associated to mother’s lithium consumption during pregnancy.

Question 11

pharmacology treatment of Infantile capillary hemangiomas

Answer 11

If the hemangioma is ulcerated or blocking vital organs, then urgent treatment with a beta-blocker (either topical timolol or oral propranolol) is recommended.

Question 12

Meconium ileus

Answer 12

90% of cases have cystic fibrosis
Patients typically present in the first three days of life with bilious vomiting and failure to pass meconium in the first 48 hours of life, dilated proximal bowel on abdominal radiograph with visualization of a microcolon on contrast enema.

Question 13

Delayed puberty

Answer 13

Absence of breast enlargement by age 13 in girls and the lack of testicular enlargement by age 14 in boys.

Question 14

Neonatal gonococcal conjunctivitis treatment and prophylaxis?

Answer 14

Prophylaxis with erythromycin ointment
Treatment is with IM ceftriaxone

Question 15

Most common congenital heart defect in Down syndrome?

Answer 15

Complete atrioventricular septal defect (CAVSD), caused by failure of endocardial cushions to merge, leading to both ventricular septal defect (VSD) and atrial septal defect (ASD).

Question 16

Henoch-Schönlein purpura IG complications

Answer 16

It increases the risk of ileoileal intussusception due to intestinal edema and bleeding.

Question 17

Neonatal polycythemia

Answer 17

Hematocrit >65% in term infants.

Causes:
Increased erythropoiesis due to intrauterine hypoxia (maternal diabetes, hypertension, smoking, intrauterine growth restriction)
Erythrocyte transfusion (delayed cord clamping, twin-twin transfusion)
Genetic/metabolic diseases (hypothyroidism/hyperthyroidism, genetic trisomy)

Asymptomatic (most common)
Ruddy skin
Hypoglycemia, hyperbilirubinemia
Respiratory distress, cyanosis, apnea
Irritability, jitteriness
Abdominal distension

Treat: Intravenous fluids, glucose and partial exchange transfusion

Question 18

Galactosemia

Answer 18

AR due to galactose-1-P uridylyltransferase (GALT) deficiency.
Symptoms: poor feeding and vomiting, typically arise within days of life after galactose introduction via breast milk or formula, jaundice, hepatomegaly, and potential cataract formation.
Increased risk of Escherichia coli sepsis.
Hypoglycemia, metabolic acidosis, elevated transaminases, and conjugated hyperbilirubinemia, with unconjugated hyperbilirubinemia likely caused by galactose 1-phosphate accumulation in RBCs, leading to hemolytic anemia.

Question 19

Congenital cytomegalovirus infection

Answer 19

The most common congenital infection
Hepatosplenomegaly, jaundice, periventricular calcifications, microcephaly, and thrombocytopenia.
About 10% of affected infants are symptomatic. The primary long-term effect is sensorineural hearing loss.

Question 20

Breastfeeding contraindications

Answer 20

Maternal: active untreated tuberculosis, HIV infection, herpetic breast lesions, active varicella infection, chemotherapy or radiation therapy, active substance use disorder.

Infant: galactosemia

Question 21

Neonatal conjunctivitis

Answer 21

Gonococcal: 2-5 days, profuse purulent discharge, marked conjunctival injection & eyelid edema, treated with IM/IV cefotaxime (single dose).

Chlamydial: 5-14 days, watery, serosanguineous, or mucopurulent eye discharge, mild eyelid swelling, treated with oral erythromycin.

Question 22

A new born with a lower postductal oxygen saturation than preductal saturation suggests?

Answer 22

A lower postductal (PDA) oxygen saturation (right foot) than preductal saturation (right hand) suggests persistent pulmonary hypertension, for example in meconium aspiration syndrome.

Question 23

Klumpke palsy

Answer 23

A complication of shoulder dystocia resulting from injury to the eighth cervical and first thoracic nerves, leading to hand paralysis (clawhand) and ipsilateral Horner syndrome.

Question 24

CHARGE syndrome

Answer 24

Coloboma heart defects choanal atresia growth retardation genitourinary and ear abnormalities. Other features are hypotonia and cleft lip or palate. Mutations in CHD7, which is important for fetal gene expression, and genetic testing confirm the diagnosis.

Question 25

Kawasaki disease treatment

Answer 25

KD symptoms usually resolve in 2 weeks, but coronary artery aneurysms can be life-threatening. A single dose of intravenous immunoglobulin within 10 days of fever onset reduces the risk of these aneurysms and should be given to all KD patients. Aspirin is also used for its anti-inflammatory and antiplatelet effects.

Question 26

Lactation failure jaundice vs breast milk jaundice

Answer 26

*Diagnosis Timing: LFJ: age <1 week BMJ: >1 week (peaks at 2 weeks) *Pathophysiology: LFJ: Insufficient breast milk leads to decreased bilirubin elimination and increased enterohepatic circulation. BMJ: Increased β-glucuronidase in breast milk causes increased deconjugation of intestinal bilirubin and enhanced enterohepatic circulation. *Clinical features: LFJ: Suboptimal breastfeeding and signs of dehydration. BMJ: Adequate breastfeeding and well-hydrated.

Question 27

Apnea of prematurity treatment

Answer 27

Caffeine therapy and/or noninvasive respiratory support (eg, high-flow nasal cannula, continuous positive airway pressure) is warranted. Caffeine is a methylxanthine that chemically stimulates the respiratory drive and is given until the respiratory centers mature, which typically occurs by the expected due date.

Question 28

Speech should be intelligible by?

Answer 28

Age 4.

Question 29

Cephalohematomas

Answer 29

Common birth injuries with assisted vaginal deliveries. Traumatic rupture of blood vessels that supply the periosteum of skull breakdown products of the hematoma can overwhelm the neonatal liver's ability for conjugation, and should be screened with measurements of serum bilirubin concentration and observed for jaundice.

Question 30

Vitamin D deficiency symptoms in infants

Answer 30

Results in poor bone mineralization and growth plate cartilage accumulation. Infants may exhibit craniotabes (skull bones that depress with pressure), widened wrists, radial/ulnar bowing, delayed fontanel closure, costochondral joint widening and lower extremity bowing (genu varum) as they start weight-bearing. X-rays of rapidly growing areas show metaphyseal widening with cupping and fraying.

Question 31

Neonatal respiratory distress syndrome Xray

Answer 31

The lungs exhibit a diffuse reticulogranular (ground-glass) pattern from widespread atelectasis and low lung volumes. Diffuse alveolar collapse leads to air bronchograms.

Question 32

Juvenile idiopathic arthritis

Answer 32

Chronic autoinflammatory disorder of childhood subdivided into systemic, polyarticular, and oligoarticular. Systemic JIA: present any time during childhood, arthritis in ≥1 joint for ≥6 weeks, commonly affected the hips, knees, and hands, arthralgias prior to the onset of arthritis. Fever for ≥2 weeks, occurs in a quotidian pattern (high temperatures spike once daily, often in the evening followed by spontaneous return to normothermia), an evanescent pink rash accompanies the fever, hepatosplenomegaly and lymphadenopathy are also common.

Question 33

Fetal hydantoin syndrome

Answer 33

In utero exposure to an antiepileptic (eg, phenytoin , carbamazepine, valproate), are teratogenic due to low folate levels and high oxidative metabolites levels in the fetus. Cleft lip and palate , wide anterior fontanelle, distal phalange hypoplasia , and cardiac anomalies (eg, pulmonary stenosis, aortic stenosis). The associated neural tube defects and microcephaly can also result in developmental delay and poor cognitive outcomes.

Question 34

Tracheo-esophageal fistula and esophageal atresia should undergo screening with?

Answer 34

Up to 50% of patients with TEF and EA have congenital abnormalities, often from the VACTERL association (Vertebral, Anal, Cardiac, Tracheo-esophageal fistula, Renal, Limb). All TEF with EA patients should undergo screening echocardiography and renal ultrasonography.

Question 35

most common cause of anemia in preterm infants?

Answer 35

Anemia of prematurity is caused by impaired erythropoietin production, leading to normocytic, normochromic anemia and minimal reticulocyte response.

Question 36

Congenital toxoplasmosis triad

Answer 36

Chorioretinitis, diffuse intracranial calcifications, hydrocephalus.

Question 37

Transitional tachypnea of the newborn

Answer 37

Occurs due to delayed pulmonary fluid clearance, often seen in premature or cesarean-delivered infants. Chest x-ray: Hyperinflation, interlobar fissures fluid.

Question 38

Persistent pulmonary hypertension of the newborn

Answer 38

Abnormal persistence of elevated pulmonary vascular resistance, causing right-to-left shunting across a patent ductus arteriosus. Patients have a low postductal saturation compared to the preductal saturation and normal distal pulses. Risk factors: lung hypoplasia, infection, or meconium aspiration, some cases have no clear cause. Symptoms: respiratory distress and cyanosis, or asymptomatic.

Question 39

The most common cause of nonhereditary SNHL in children is?

Answer 39

Congenital cytomegalovirus infection .

Question 40

First-line management for pediatric Obstructive Sleep Apnea

Answer 40

Tonsillectomy and adenoidectomy

Question 41

Hypoxia in neonatal respiratory distress syndrome

Answer 41

Surfactant deficiency = increased alveolar surface tension and atelectasis. Areas of the lung that are perfused but not ventilated (ie, ventilation/perfusion mismatch) lead to intrapulmonary right-to-left shunting and hypoxia.

Question 42

Congenital syphilis

Answer 42

Clinical features: Early: Snuffles: clear or purulent rhinorrhea Maculopapular rash: palms, soles, buttocks, legs Desquamation & hyperpigmentation Long bone abnormalities. jaundice, hepatosplenomegaly, growth restriction, "blueberry muffin" spots. Late: Saddle nose, notched teeth, saber shins, hearing loss

Question 43

The likely cause of jitteriness in infants of diabetic mothers?

Answer 43

Hypoglycemia, but it is normal, hypocalcemia is another cause linked to maternal hypomagnesemia from osmotic diuresis due to poorly controlled gestational diabetes, resulting in low fetal magnesium and subsequent suppression of PTH, leading to low neonatal calcium levels.

Question 44

Acute postinfectious cerebellar ataxia

Answer 44

acute cerebellar ataxia, which often follows viral illness (eg, coxsackievirus, some human herpesvirus infections). Symptoms occur approximately 1-3 weeks after infection and generally resolve spontaneously within 2 weeks. No specific diagnostic test exists. It is a clinical diagnosis of exclusion after other sources of cerebellar dysfunction (eg, toxins, metabolic disease) are ruled out.