Pediatrics BMLE Course 18th May 2013

Report
BMS Study Smart Pediatric Review
Dr. Jinan Darwish
MBBCh , LRCPSI, BAO ( NUI)
CABP
18th May, 2013
Cleft lip& palate ( OSCE)
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Represents failure of the palatal
shelves to approximate or fuse.
incidence of cleft palate is ≈1/2,500
births
Possible causes include maternal
drug exposure, a syndromemalformation complex, or genetic
factors (autosomal dominant)
The timing of surgical correction
should be individualized. Usually
closure of the palate is usually done
before 1 yr of age
Recurrent otitis media and hearing
loss, malposition of the teeth,
speech defects,velopharyngeal
incompetence.
Anemia ( MCQs/ OSCE)
• A- Aplastic
Hb , Plt, neutrophils
Normal MCV
Low/absent retics
• B-Hemolytic
Hb
MCV (retics)
LDH
Unconjugated
bilirubin haptoglobin
C-Iron deficiency
Hb ferriten Iron TIBC HCT MCV
Cushing’s syndrome: Common
iatrogenic problem in paeds ex.
Steroids in Asthma
congenital hypothyroidism:
( OSCE)
Congenital Hypothyroidism
• Investigations:
Universal neonatal
screening
Blood
Wrist & hand xray
Radio-active technetium
scan
Echocardiogram
• Management:
• Thyroxine Replacement
• Regular Follow up
• Complications:
Excess thyroxine –
advanced bone age
Severe mental
neurological delay
Cystic Fibrosis (MCQs)
Autosomal recessive inheritence
Defective CFTR
Neonates 15% meconium ileus presentation
Sweat test ( gold standard)
Complications:
Resp (cor pulmonale, pneumthorax)
GI (Cirrhosis, portal HTN, DIOS)
Endocrine ( DM, infertility 99% men & subfertility
in females)
Psychological/Behavioural
sweat chloride
Chloride concentration
> 60mEq/L
Cystic Fibrosis
CF( gene CFTR mutation F508
Developmental Dysplasia of the hip
(MCQs)
• Associations: FHx ( first degree relative , 20%);
first born ( smaller uterus), oligohydramnios,
breech dlivery, LSCS
• Examination :
• OrtolAni: Abduct&Anterior ; Relocate a
dislocated hip
• Barlow : Adduct & posterior; Dislocates
unstable hip.
Developmental Dysplasia of the hip
• Diagnosis:
USS hip: High false + rate in infants <6 weeks
Xray hip: >4 months ( 2 views: adduction &
abduction)
Management:
Supportive: Pavlik harness abduction splints
until 5-6 months.USS monitoring
Surgical correction : Late diagnosis ( > 6 months)
Diabetes mellitus 1 ( MCQs)
• RBS > 11.0 mmol/L
• Fasting > 7.0 mmol/L
• HbA1c >7.5%
• Urinalysis: Ketonuria, glycosuria
( Stable product of non-enzymatic irreversible
glycosylation of β-chain of HB by plasma
glucose)
• DKA
Down Sydrome Trisomy 21 (OSCE)
Febrile Seizures
• Rule of 6 : peak 18 months
• Usually arise from infection/inflammation outside the
CNS in an otherwise neurologically normal child.
• Seizures arising from fever due to
meningitis/encephalitis are not included in the
definition.
• Simple: Isolated,brief,generalized clonic/tonic seizure.
• Complex : > 15 mins, focal features,repeat seizure
within same illness or incomplete recovery from
seizure < 1 hour.
• Febrile status epilepticus: > 30mins ( up to 5% present s
status epilepticus)
• Differential Diagnosis: CNS infection, epilepsy ( 1-2%
will develop it)
G6PD deficiency ( MCQ)
Fluids ( MCQ)
Pearl of wisdom
Henoch-Schönlein purpura
(MCQ/OSCE)
Hydrocele (OSCE)
• -Small hydroceles in infancy
are benign and spontaneously
resolve by 9-12 months of age.
-Large hydroceles rarely
resolve and may cause
vascular compromise and
testicular atrophy; these
should be resected.
• -A communicating hydrocele
(which changes in size)
indicates a completely patent
processus vaginalis and has
the potential for hernia
formation. This variety should
also be repaired
Hydrocephalus ( OSCE)
• Obstructive
• Communicating
• CSF production
• Mx: Shunt with a one-way valve from
from ventricle to peritoneum or right
atrium.
• Complications:
Shunt: obstruction,infection
(staph.epidermidis, over drainage
subdural haemorrhage.
Long-term : Global developmental delay,
impaired memory & vision, precocious
puberty.
Hypospadias ( OSCE)
• With / without
chordee
• Most are distal
• Usually isolated
• If assoc with undesc.
testis: ambiguous
genitalia workup.
• Surgical correction
between 6-12 months
Infantile Glaucoma (OSCE)
 Triad: tearing, Photophobia,
blepharospasm
 Signs: Large corneas, injection,
edema.
 Primary:
a)Congenital
b)Syndromes: Sturge Weber,
NF-1,Marfan, Stickler, HCR,
OCR(Lowe)
C)Ocular abnormalities:
 Secondary:
Infection(TORCH)/cataracts
surgery/trauma/tumor
 Treatment primarily surgical
Inflammatory Bowel Disease (MCQ)
Intussusception (MCQ)
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- The most common cause of
intestinal obstruction between 3 mo
and 6 yr of age.
-80% of the cases occur before 24 mo
- The male: female ratio is 4:1.
- if left untreated, most will lead to
intestinal infarction, perforation,
peritonitis, and death.
- Air, hydrostatic (saline), and, less
often, water-soluble contrast enemas
have replaced barium examinations
- Air reduction is associated with
fewer complications and lower
radiation exposure than traditional
contrast hydrostatic techniques.
Kawasaki Disease (MCQ/ OSCE)
•
KAWASAKI DISEASE DIAGNOSTIC CRITERIA
Kawasaki is also called Muco Cutaneous Lymph
Node Syndrome or MCLNS
Diagnostic criteria are
Fever for > 5 days
•
+ at least 4 of the following 5 criteria
MCLNS
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M = Mucous membrane changes: injected pharynx,
strwberry tongue, injected dry cracked lips
C = Conjunctivitis: non purulent and bilateral (D/D w
scarlet fever)
L = Limb changes: edema, erythema and
periungueal desquamation
N = Nodes enlargement in the Neck: usulally > 1.5
cm in diameter
S = Scarlattiniform rash
Labial adhesions (MCQ/ OSCE)
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-Common disorder in prepubertal
females. Peak incidence around the age
of 13-23 months
-The disorder is usually asymptomatic
- May be associated with postvoid
dribbling, also called vaginal voiding
and occasionally UTIs
-Treatment of labial adhesions is
typically conservative. If left untreated,
labial adhesions usually spontaneously
resolve (80% within 1 year)
- If treatment is necessary based on
symptoms or parental request, estrogen
cream is indicated twice daily for 2-4
weeks .Once the labia separate, apply
emollient 3-5 times a day for several
months to allow complete healing and
prevention of recurrence.
Measles (MCQ/ OSCE)
•
Measles: complications "MEASLES
COMP" (complications):
Myocarditis
Encephalitis
Appendicitis
Subacute sclerosing panencephalitis
Laryngitis
Early death
Sh!ts (diarrhoea)
Corneal ulcer
Otis media
Mesenteric lymphadenitis
Pneumonia and related (bronchiolitisbronchitis-croup)
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7 Cs of Measles?
Cough
Coryza
Conjunctivitis
Concurrent fever and rash
Coplik (koplik spot
Cephalocaudal spreading rash
Cervical lymphadenopathy
Measles
•
Measles is caused by the paramyxovirus, and
is highly contagious.
•
The incubation period is on average 10 days
(7-18 days), and patients are usually
considered infectious for several days before
and after the onset of the rash when the viral
load is highest.
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There is a prodromal illness which consists of
the 3 C's (cough, coryza and conjunctivitis).
Koplik spots (seen in the buccal mucosa) are
pathognomonic for measles and are usually
seen several days after onset of the ilness.
Described as being like "grains of sand"
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•
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Rash starts 3-4 days after onset of symptoms.
Starts behind the ears and forehead,
spreading over the whole body from head to
foot. The rash is dark red macules and
papules which become confluent and
blotchy.
Rash usually lasts for 5-10 days and
classically desquamates as it resolves.
Patients should be isolated for at least 5 days
after appearance of rash. Any contacts if not
immune should be vaccinated within 72
hours.
Anti-measles IgM is generally detectable 3
days after onset of rash.
Anti-measles IgG has a delayed onset before
becoming positive - usually peaks at 14 days
after onset of rash.
Other diagnostic tests include NPA for
measles IF and first pass urine for measles
PCR.
Meningitis (OSCE)
Neonatal Jaundice (MCQ)
Pneumonia (OSCE/ MCQ)
Pneumothorax (OSCE)
• What is this five week old baby’s
chest xray showing?
• Answer: spontaneous rightsided tension pneumothorax
• Name objects labeled by arrows?
• Answer: Blue- ECG lead
•
Red – Endotracheal tube
(ETT)
•
Green- Nasogastric tube
(NGT)
• How would you treat?
• Answer: Insert right intercostral
drain (ICD)
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Pyloric Stenosis (MCQ)
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Multifactorial inheritence
30% first-born males
M:F 4:1
7% FHx (parental)
12% Associated Nephrotic Syndrome
Progressive non-bilous vomiting within
30 mins of feed; may become
projectile.
• Hypochloraemic Hypokalemic Alkalosis
• USS abdomen: Pyloric muscle diameter
> 3-4 mm & pyloric channel > 18mm in
length.
• Rx: Ramstedt pyloromyotomy
Rickets ( MCQ/ OSCE)
Retinoblastoma (OSCE)
Leukocoria
• Absent red reflex
• Should not be
missed
•
Scabies (OSCE)
• Sarcoptes scabei
• Mechanism of spread:
prolonged direct human contact(
>20mins)- holding hands/playing
contact games.Fomite
(towels,underclothing,toilet
seats)
• Rx: Permethrin 5% dermal cream
applied to all areas below the
neck overnight.
• Malathion 0.5% (Allergic to
Permethrin)
• Mittens < 2 years prevents
excoriation & secondary
infection.
SCD
mode of inheritence; premarital & new born screening, how to read HPLC
Talipes Equinovarus (Club foot)
 Features: CAVE (cavus, adductus,
varus, equinus).
1) Plantar flexion of foot at
ankle
2) Inversion of heel
3) Medial Deviation of
forefoot.
• Categories: 1) Idiopathic
2) Neurogenic
3) Syndromic(Larsen sn,
Arthrog)
• Always check for assoc. anomalies,
specially spine.
• Early treatment(first day): Casting ,
rapid correction
• Late treatment: Surgical
Tetralogy of Fallot (MCQ)
PROVe
Pulmonary Hypertension
Right Ventricular Hypertrophy
Overriding Aorta
VSD
• Most common cyanotic
disease.
• components
Thalassemia( OSCE)
Transposition of Great Arteries
• Most common cyanotic
disease in first 24 hours
Turner Syndrome (MCQ/ OSCE)
•
Turner Syndrome Patients look like CLOWNS (only
to remember its features):
C - Cardiac anomalies (most common - coarctation
of aorta)
L - Lymphoedema, low thyroid
O - Ovaries under developed (streak ovaries),
primary Amenorrhea
W - Webbed neck
N - Nipples widely placed
S - Short stature, Sensoneural hearing loss, Short
4th metacarpal
Undescended Testis (MCQ/ OSCE)
• 4.5% of boys have undesc.
Testis at birth
• 0.8% by age 6 months
• Will not descend after 4
months of age
• Histopathologic changes
demonstratable by 6-12
months of age.
• Surgical correction at
6months of age(no later
than 9-15months)- success
rate of 98%
• LHRH, HCG: Not effective
Varicella ( chicken pox) ( MCQ/ OSCE)
MCQs
1. A patient with acute asthma is most likely to
have decreased
A.
B.
C.
D.
E.
Forced expiratory volume in 1 second
Residual volume
Functional residual capacity
Total lung capacity
Tidal volume
2. A 14-month old infant has had a clear nasal discharge and a
mild cough for about two weeks. Despite therapy with
Amoxicillin, his condition has not improved. The cough has
worsened and the infant has been vomiting at each feeding.
The leukocyte count is 20,000/mm3 with 80% lymphocytes,
15% neutrophils and 5% band forms. X-ray study of the
chest shows bilateral perihilar infiltrates with shaggy heart
border.
The most likely diagnosis is
A.
B.
C.
D.
E.
Acute bronchial asthma
Acute lympocytic leukemia with pulmonary infiltration
Influenza virus infection
Pertusis
Hemophilus influenzae pneumonia
3.Regarding steroid inhaler therapy for a 4-year
old child with asthma, you should tell the
mother
A. It is most effective with acute exacerbation
B. It should be administered every two hours when the child
is having an acute episode of asthma
C. The primary value is in the prevention of episodes of
asthma
D. It will not be of value in the management of the child’s
exercise-induced episodes of asthma
E. The most common side effect is the development of oral
candidiasis.
4. A 2-1/2 year old child has had cough for two weeks after
having been hospitalized one month ago for pneumonia in
the right lower lobe. X-ray study of the chest reveals
persistence of pneumonia in the right lower lobe.
Of the following , the most likely diagnosis is
A. Staphylococcal pneumonia
B. Foreign body aspiration
C. Cystic Fibrosis
D. Pneumonia due to Mycoplasma pneumoniae
E.
Pneumonia due to respiratory synctial virus
5. School phobias (school refusals) in gradeschool children most commonly result from
A.
B.
C.
D.
Fear of a strict teacher
Concern about failing school
Fear of separation from parent
Desire to avoid unfriendly classmates
E. Inability to do school work
6. You are discussing with a resident who has just evaluated a 4-yearold who has classic varicella lesions and a history that is
consistent with this diagnosis. He put small pox as D/D.
Of the following, the MOST accurate statement about the tow
pathologies is that
A. lesions of both varicella and smallpox follow a 7- to 10-day course
from eruption to resolution
B. lesions of both varicella and smallpox frequently produce deep,
pitted scars
C. varicella lesions are transient vesicles; smallpox lesions are
persistent pustules until resolution of the illness
D. varicella lesions are concentrated on the face; smallpox lesions
are concentrated over bony Prominences
E. varicella lesions appear in stages or crops; smallpox lesions are
uniformly in the same stage of development
7. A 13 year old female presents with hypertension
and increasing weight. Which of the following
features would be most suggestive of Cushing’s
syndrome rather than simple obesity?
A. Moon face.
B. Acanthosis Nigricans
C. Abdominal striae.
D. Proximal myopathy
E. Buffalo Hump
8. A 24 month old boy presents with high fever of 6
days duration, tender neck, red eyes and cracked
lips. In the second week he developed maculopapular erythematous rash and blanching.
What is the most likely diagnosis
A. Kawasaki disease
B. Stevens-Johnson syndrome
C. Acute toxoplasmosis
D. Meningococcal sepsis
E. Measles.
9. A 12 year old female underwent a renal
transplant. She was concerned about
the effects of long-term Cyclosporin
treatment.
Which on of the following is a common
adverse effect of this
A.
B.
C.
D.
E.
Alopecia.
Paraesthesiae.
Hepatotoxicity
Nephrotoxicity.
Bone marrow depression
10. A 7 years old male presented with a strongly
positive Mantoux test. Which one of the following
statements regarding his immune reaction is
correct?
A. The reaction typically develops within 24 hours
B. It is a cell mediated immune response
C. The area of induration will be less than 10 mm in
diameter
D. The response is mediated by B lymphocytes
E. If a skin biopsy were taken, immunohistochemistry
would show immune complex deposition.
11. A 5-year old girl is brought to your office by her mother
who reports that the child is one of four children in her
nursery school class who have similar rashes. Two days
ago the patient had a low grade fever with the
temperature reaching 38 C . The cheeks became red. She
denied having sore throat. Today she has a generalized,
discrete maculopapular rash. The most likely diagnosis is
A.
B.
C.
D.
E.
Rubella
Measles
Scarlet fever
Erythema infectiosum
Pityriasis rosea
12. Stridor, tachypnea and wheezing develop
suddenly in a 10-year old girl who has received an
injection of contrast medium for intravenous
pyelography. Large urticarial lesions appear over
the face , chest and extremities.
Of the following agents, you should first administer
A.
B.
C.
D.
E.
Diphenhydramine
Epinephrine
Theophylline
Corticosteroids
Antibiotics
13. A 4-week old girl was found shortly after birth to
have a cardiac murmur. Her color is now good and
weight gain has been satisfactory. Pulse rate is
160/min and respiratory rate is 70/min. Her
mother has noted that the infant sweats despite
normal ambient temperature and that she sleeps
poorly.
The infant most likely has
A.
B.
C.
D.
E.
Pneumonia
Sepsis
Paroxysmal Atrial tachycardia
A left to right shunt circulation
A Septal defect that has begun to close
14. A woman who is positive for hepatitis B surface antigen (HbsAg)
but negative for hepatitis Be antigen (HbeAg), delivers at term. After
careful bathing, the BEST management for this woman’s infant would
be to:
A.
B.
C.
D.
E.
Administer gamma globulin intramuscularly immediately
and at 1 month of age.
Administer HBIG and HB vaccine immediately and HB
vaccine again at 1 month and 6 months of age.
Administer hepatitis B immunoglobulin (HBIG) if cord blood
is positive for HBSAg.
Administer hepatitis B (HB) vaccine immediately and at 1
month and 6 months of age
Advise mother that breast feeding is contraindicated.
15. The parents of an 18-month old boy bring the infant to you as
a new patient. They state that he has been constipated since
early infancy. He has been managed with fair success with
glycerin suppositories and laxatives. Physical examination
discloses no distention of the abdomen. A copious amount of
fecal material is palpated in the large bowel. The rectal
ampulla is empty.
The management of choice would be to
A. Continue the present treatment regimen
B. Continue the present treatment regimen but add more bulk
to the diet
C. Prescribe mineral oil
D. Order a barium enema examination
E. Discontinue all medications and observe the patient
16. A 2-month old boy is hospitalized because of cough and rapid
respirations. The infant has been well since birth except for a
mild mucoid conjunctivitis. Length and weigh are at the 15th
percentile. An x-ray study of the chest reveals hyperinflation
and bilateral interstitial pneumonia. His temperature is 38.0C
and his respiratory rate is 56/min. Leukocyte count is
10,000/mm3 with 60% Neutrophil, 5% band forms, 35%
lymphocytes, and 10% eosinophils. The serum IgM
concentration is markedly increased.
The most likely diagnosis is
A.
B.
C.
D.
E.
Pertussis
Pneumonia due to Chlamydia Trachomatis
Pneumonia due to Myoplasma pneumoniae
Pneumonia due to Hemophillus Influenzae
Pneumonia due to Staphylococcus Aureus
17. An infant who has not yet passed meconium begins
vomiting when he is 36 hours old. His abdomen has doughy
distension. The rectum is empty on examination, no
meconium was seen on the examiner’s finger. An x-ray
study of the abdomen shows distended intestinal loops, but
fluid levels are not present. The abdomen has a granular,
ground glass appearance with flecks of calcium scattered
throughout.
The most likely diagnosis is
A.
B.
C.
D.
E.
Aganglionic megacolon (Hirschsprung’s disease)
Intestinal Atresia
Meconium plug syndrome
Ruptured appendix
Cystic fibrosis, Meconium ileus and peritonitis
18. In infants with serious dehydration, the
clinical signs of tachycardia , poor turgor
and cool distal extremities result primarily
from
A.
B.
C.
D.
E.
metabolic acidosis
Starvation
Hypovolemia
Cortisol deficit
Oliguria
19. A 12 years old girl presented with acute GuillainBarre syndrome and has developed worsening
proximal muscle weakness. Which one of the
following tests should be used to monitor her
respiratory function?
A.
B.
C.
D.
E.
Arterial blood gas.
Vital capacity.
FEV1/FVC ratio.
Peak expiratory flow rate.
Chest expansion
20. A child with chronic renal failure has persistent acidosis
with an increased anion gap. Increased serum
concentration of which of the following substances would
likely contribute most to this finding?
A.
B.
C.
D.
E.
Lactic acid
Protein
Urea
Inorganic acids
Keto acids
21. Hyperpnea, lethargy and fever have developed in a 2 year
old girl with rheumatoid arthritis. She is not dehydrated or
disoriented. There is no nuchal rigidity on physical
examination. The lungs are clear. Findings on x-ray study of
the chest are normal. Blood oozes from a venipuncture
site. Urinalysis reveals reducing substance but no ketones.
An aunt has diabetes mellitus.
The most likely diagnosis is
A.
B.
C.
D.
E.
Diabetic Ketoacidosis
Reactive airways disease
Gastroenteritis with acidosis
Salicylate intoxication
Oranophosphate ingestion
22- A 2-year-old boy presents with a 3-day history of diarrhea and vomiting.
He has been able to tolerate small amounts of fluids. He is moderately
dehydrated, with dry mucous membranes and a heart rate of 145
beats/min.
Of the following, the BEST management for this patient's fluid status is
A. hospitalization with intravenous fluids and a restrictive bland
diet
B. hospitalization with intravenous fluids and gut rest for 24 hours
C. oral rehydration therapy at home followed by a diet of fruits,
vegetables, and meats
D. oral rehydration therapy at home followed by a clear liquid diet
for 24 hours
E. oral rehydration therapy at home followed by a restrictive bland
diet
23. The parents of a child who has Down syndrome
and a 47,XX+21 karyotype come to you for
counseling about future pregnancies. Of the
following, their risk for giving birth to another
child who has trisomy is CLOSEST to
A. no greater than the general population at risk
B. 1% added to the mother's age-related risk
C. 5% added to the mother's age-related risk
D. 10% added to the mother's age-related risk
E. 25% added to the mother's age-related risk
24. An 8-year old boy is brought to your office because he has
fever, bilateral knee pain, and a limp. The patient is a
black child with generalized lymphadenopathy, an enlarge
spleen and a swollen, tender knee. Laboratory studies
reveal a hemoglobin concentration of 5 g/dL and a
leukocyte count of 2500 mm3 with 80% lymphocytes.
Which of the following studies would be most helpful in
confirming the diagnosis?
A.
B.
C.
D.
E.
Erythrocyte sedimentation rate
Heterophil titer
Coagulation profile
Examination of a bone marrow aspirate
X-ray study of the knee
25. A diagnosis of Kawasaki Syndrome has been made
in a 6-year old girl. Four days after hospitalization,
abdominal pain and distention develop. These
developments are most likely due to:
A. Hydrops of the gallbladder
B. Enterocolitis
C. Intussusception
D. Volvulus
E. Hepatic Haematoma
1. A patient with acute asthma is most likely to
have decreased
A.
B.
C.
D.
E.
Forced expiratory volume in 1 second
Residual volume
Functional residual capacity
Total lung capacity
Tidal volume
2. A 6-year old boy suffers major abdominal trauma in a motor
vehicle accident. One hour later in the emergency
department, blood pressure is 65/40 mmHg. Hemoglobin
concentration is 6.0 g/dL. Arterial blood gas and pH
analysis while the patient is breathing room air shows pH
7.47, PO2 45 mmHg and PCO2 30 mmHg, FiO2 is 0.21. An xray study of the chest reveals diffuse bilateral pulmonary
infiltrates.
Which of the following will provide the greatest improvement in
oxygen transport?
A. Vasopressors
B. Intubation and ventilation with positive end-expiratory
pressure (PEEP)
C. Administration of 100% oxygen
D. Blood transfusion
E. Diuretics
3. A 14-month old infant has had a clear nasal discharge and a
mild cough for about two weeks. Despite therapy with
Amoxicillin, his condition has not improved. The cough has
worsened and the infant has been vomiting at each feeding.
The leukocyte count is 20,000/mm3 with 80% lymphocytes,
15% neutrophils and 5% band forms. X-ray study of the
chest shows bilateral perihilar infiltrates with shaggy heart
border.
The most likely diagnosis is
A.
B.
C.
D.
E.
Acute bronchial asthma
Acute lympocytic leukemia with pulmonary infiltration
Influenza virus infection
Pertusis
Hemophilus influenzae pneumonia
4.Regarding steroid inhaler therapy for a 4-year
old child with asthma, you should tell the
mother
A. It is most effective with acute exacerbation
B. It should be administered every two hours when the child
is having an acute episode of asthma
C. The primary value is in the prevention of episodes of
asthma
D. It will not be of value in the management of the child’s
exercise-induced episodes of asthma
E. The most common side effect is the development of oral
candidiasis.
5. A 2-1/2 year old child has had cough for two weeks after
having been hospitalized one month ago for pneumonia in
the right lower lobe. X-ray study of the chest reveals
persistence of pneumonia in the right lower lobe. Of the
following , the most likely diagnosis is
A. Staphylococcal pneumonia
B. Foreign body aspiration
C. Cystic Fibrosis
D. Pneumonia due to Mycoplasma pneumoniae
E. Pneumonia due to respiratory synctial virus
6. School phobias (school refusals) in gradeschool children most commonly result from
A.
B.
C.
D.
Fear of a strict teacher
Concern about failing school
Fear of separation from parent
Desire to avoid unfriendly classmates
E. Inability to do school work
7. A 6-year old boy suffers major abdominal trauma in a motor
vehicle accident. One hour later in the emergency
department, blood pressure is 65/40 mmHg. Hemoglobin
concentration is 6.0 g/dL. Arterial blood gas and pH
analysis while the patient is breathing room air shows pH
7.47, PO2 45 mmHg and PCO2 30 mmHg, FiO2 is 0.21. An xray study of the chest reveals diffuse bilateral pulmonary
infiltrates.
Which of the following will provide the greatest improvement in
oxygen transport?
A. Vasopressors
B. Intubation and ventilation with positive end-expiratory
pressure (PEEP)
C. Administration of 100% oxygen
D. Blood transfusion
E. Diuretics
8. You are discussing with a resident who has just evaluated a 4-yearold who has classic varicella lesions and a history that is
consistent with this diagnosis. He put small pox as D/D. Of the
following, the MOST accurate statement about the tow
pathologies is that
A. lesions of both varicella and smallpox follow a 7- to 10-day course
from eruption to resolution
B. lesions of both varicella and smallpox frequently produce deep,
pitted scars
C. varicella lesions are transient vesicles; smallpox lesions are
persistent pustules until resolution of the illness
D. varicella lesions are concentrated on the face; smallpox lesions
are concentrated over bony Prominences
E. varicella lesions appear in stages or crops; smallpox lesions are
uniformly in the same stage of development
9. A 16 years old female presents with
hypertension and increasing weight. Which
of the following features would be most
suggestive of cushing’s syndrome rather
than simple obesity?
A. Moon face.
B. Acanthosis Nigricans
C. Abdominal striae.
D. Proximal myopathy
E. Buffalo Hump
10. A 24 month old boy presents with high fever
of 6 days duration, tender neck, red eyes and
cracked lips. In the second week he
developed maculopapular erythematous
rash and blanching.
What is the most likely diagnosis
A. Kawasaki disease
B. Stevens-Johnson syndrome
C. Acute toxoplasmosis
D. Meningococcal sepsis
E. Measles.
11. A 15 years old female underwent a
renal transplant. She was concerned
about the effects of long-term
Cyclosporin treatment.
Which on of the following is a common
adverse effect of this
A.
B.
C.
D.
E.
Alopecia.
Paraesthesiae.
Hepatotoxicity
Nephrotoxicity.
Bone marrow depression
12. A 7 years old male presented with a
strongly positive Mantoux test. Which one
of the following statements regarding his
immune reaction is correct?
A. The reaction typically develops within 24 hours
B. It is a cell mediated immune response
C. The area of induration will be less than 10 mm in
diameter
D. The response is mediated by B lymphocytes
E. If a skin biopsy were taken, immunohistochemistry
would show immune complex deposition.
13. A 5-year old girl is brought to your office by her mother
who reports that the child is one of four children in her
nursery school class who have similar rashes. Two days
ago the patient had a low grade fever with the
temperature reaching 38 C . The cheeks became red. She
denied having sore throat. Today she has a generalized,
discrete maculopapular rash.The most likely diagnosis is
A.
B.
C.
D.
E.
Rubella
Measles
Scarlet fever
Erythema infectiosum
Pityriasis rosea
14. Stridor, tachypnea and wheezing develop
suddenly in a 10-year old girl who has received an
injection of contrast medium for intravenous
pyelography. Large urticarial lesions appear over
the face , chest and extremities.
Of the following agents, you should first administer
A.
B.
C.
D.
E.
Diphenhydramine
Epinephrine
Theophylline
Corticosteroids
Antibiotics
15. A 4-week old girl was found shortly after birth to
have a cardiac murmur. Her color is now good and
weight gain has been satisfactory. Pulse rate is
160/min and respiratory rate is 70/min. Her
mother has noted that the infant sweats despite
normal ambient temperature and that she sleeps
poorly.
The infant most likely has
A.
B.
C.
D.
E.
Pneumonia
Sepsis
Paroxysmal Atrial tachycardia
A left to right shunt circulation
A Septal defect that has begun to close
16. A woman who is positive for hepatitis B surface antigen (HbsAg)
but negative for hepatitis Be antigen (HbeAg), delivers at term. After
careful bathing, the BEST management for this woman’s infant would
be to:
A.
B.
C.
D.
E.
Administer gamma globulin intramuscularly immediately
and at 1 month of age.
Administer HBIG and HB vaccine immediately and HB
vaccine again at 1 month and 6 months of age.
Administer hepatitis B immunoglobulin (HBIG) if cord blood
is positive for HBSAg.
Administer hepatitis B (HB) vaccine immediately and at 1
month and 6 months of age
Advise mother that breast feeding is contraindicated.
17. The parents of an 18-month old boy bring the infant to you
as a new patient. They state that he has been constipated
since early infancy. He has been managed with fair success
with glycerin suppositories and laxatives. Physical
examination discloses no distention of the abdomen. A
copious amount of fecal material is palpated in the large
bowel. The rectal ampulla is empty.
The management of choice would be to
A. Continue the present treatment regimen
B. Continue the present treatment regimen but add more bulk
to the diet
C. Prescribe mineral oil
D. Order a barium enema examination
E. Discontinue all medications and observe the patient
18. A 2-month old boy is hospitalized because of cough and rapid
respirations. The infant has been well since birth except for a
mild mucoid conjunctivitis. Length and weigh are at the 15th
percentile. An x-ray study of the chest reveals hyperinflation
and bilateral interstitial pneumonia. His temperature is 38.0C
and his respiratory rate is 56/min. Leukocyte count is
10,000/mm3 with 60% Neutrophil, 5% band forms, 35%
lymphocytes, and 10% eosinophils. The serum IgM
concentration is markedly increased.
The most likely diagnosis is
A.
B.
C.
D.
E.
Pertussis
Pneumonia due to Chlamydia Trachomatis
Pneumonia due to Myoplasma pneumoniae
Pneumonia due to Hemophillus Influenzae
Pneumonia due to Staphylococcus Aureus
19. In infants with serious dehydration, the
clinical signs of tachycardia , poor turgor
and cool distal extremities result primarily
from
A.
B.
C.
D.
E.
metabolic acidosis
Starvation
Hypovolemia
Cortisol deficit
Oliguria
20. An infant who has not yet passed meconium begins
vomiting when he is 36 hours old. His abdomen has doughy
distension. The rectum is empty on examination, no
meconium was seen on the examiner’s finger. An x-ray
study of the abdomen shows distended intestinal loops, but
fluid levels are not present. The abdomen has a granular,
ground glass appearance with flecks of calcium scattered
throughout.
The most likely diagnosis is
A.
B.
C.
D.
E.
Aganglionic megacolon (Hirschsprung’s disease)
Intestinal Atresia
Meconium plug syndrome
Ruptured appendix
Cystic fibrosis, Meconium ileus and peritonitis
21. A 12 years old girl presented with acute GuillainBarre syndrome and has developed worsening
proximal muscle weakness. Which one of the
following tests should be used to monitor her
respiratory function?
A.
B.
C.
D.
E.
Arterial blood gas.
Vital capacity.
FEV1/FVC ratio.
Peak expiratory flow rate.
Chest expansion
22. A child with chronic renal failure has persistent acidosis
with an increased anion gap. Increased serum
concentration of which of the following substances would
likely contribute most to this finding?
A.
B.
C.
D.
E.
Lactic acid
Protein
Urea
Inorganic acids
Keto acids
23. Hyperpnea, lethargy and fever have developed in a 2 year
old girl with rheumatoid arthritis. She is not dehydrated or
disoriented. There is no nuchal rigidity on physical
examination. The lungs are clear. Findings on x-ray study of
the chest are normal. Blood oozes from a venipuncture
site. Urinalysis reveals reducing substance but no ketones.
An aunt has diabetes mellitus.
The most likely diagnosis is
A.
B.
C.
D.
E.
Diabetic Ketoacidosis
Reactive airways disease
Gastroenteritis with acidosis
Salicylate intoxication
Oranophosphate ingestion
24- A 2-year-old boy presents with a 3-day history of diarrhea and vomiting.
He has been able to tolerate small amounts of fluids. He is moderately
dehydrated, with dry mucous membranes and a heart rate of 145
beats/min.
Of the following, the BEST management for this patient's fluid status is
A. hospitalization with intravenous fluids and a restrictive bland
diet
B. hospitalization with intravenous fluids and gut rest for 24 hours
C. oral rehydration therapy at home followed by a diet of fruits,
vegetables, and meats
D. oral rehydration therapy at home followed by a clear liquid diet
for 24 hours
E. oral rehydration therapy at home followed by a restrictive bland
diet
25. The parents of a child who has Down syndrome
and a 47,XX+21 karyotype come to you for
counseling about future pregnancies. Of the
following, their risk for giving birth to another
child who has trisomy is CLOSEST to
A. no greater than the general population at risk
B. 1% added to the mother's age-related risk
C. 5% added to the mother's age-related risk
D. 10% added to the mother's age-related risk
E. 25% added to the mother's age-related risk
26. An 8-year old boy is brought to your office because he has
fever, bilateral knee pain, and a limp. The patient is a
black child with generalized lymphadenopathy, an enlarge
spleen and a swollen, tender knee. Laboratory studies
reveal a hemoglobin concentration of 5 g/dL and a
leukocyte count of 2500 mm3 with 80% lymphocytes.
Which of the following studies would be most helpful in
confirming the diagnosis?
A.
B.
C.
D.
E.
Erythrocyte sedimentation rate
Heterophil titer
Coagulation profile
Examination of a bone marrow aspirate
X-ray study of the knee
27. A diagnosis of Kawasaki Syndrome has been made
in a 6-year old girl. Four days after hospitalization,
abdominal pain and distention develop. These
developments are most likely due to;
A. Hydrops of the gallbladder
B. Enterocolitis
C. Intussusception
D. Volvulus
E. Hepatic Haematoma
OSCE
• Blood: CBC, LFT,
TORCH,HPLC,
• Radiology: CXR, KUB
• ECG: Hyperkalemia, VT,
SVT,WPW,VF
• Pictures: Syndromes
• Growth charts: short
stature, FTT, obesity
• Equipment
Station 1
• 1- Name this condition
• 2-Who does it affect
more males or females?
• 3-List the components
of the triad
• 4-Which cardiac
anomalies are
associated with it?
Station 2
• 1- What is the
diagnosis?
• 2-What are the
causes?
• 3-How would you
proceed in
investigating it?
Prune Belly Syndrome:
-AKA Eagle-Barrett Syndrome
-Three main problems: Poor development of the
abdominal muscles,(cryptorchidism) and urinary tract
problems
-The causes of prune belly syndrome are unknown
-The condition affects mostly boys (95%).
-The amniotic fluid volume may be normal or decreased
in neonates with prune belly syndrome.
-The presence of oligohydramnios may account for some
of the accompanying findings of the extremities
-Poor abdominal wall muscles : poor coughing and
constipation
-Mortality rate 20%
-Patients with prune belly syndrome also have an
increased incidence of TOF and ventriculoseptal defects.
Congenital Cataracts:
-Definition: Opacification of the lens. Congenital cataracts
usually are diagnosed at birth.
-Patients require a full metabolic, infectious, systemic, and
genetic workup.
-Common causes are hypoglycemia, trisomy (eg, Down,
Edward, and Patau syndromes), myotonic dystrophy, TORCH,
and prematurity.
-Workup: For unilateral cataracts: TORCH titers and Venereal
Disease Research Laboratory (VDRL) test.
-For bilateral cataracts: CBC, BUN, TORCH titers, VDRL,
urine for reducing substances, red cell galactokinase, urine for
amino acids, calcium, and phosphorus.
-Additional Tests: CT scan of brain. Hearing test
Thank you for actively listening

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