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Pediatric Board Review Part Dos

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Pediatric Board Review Part Dos Mark Heller, MD Department of Emergency Medicine Mount Sinai School of Medicine Q 14 Answer Which of the following fracture patterns ... – PowerPoint PPT presentation

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Title: Pediatric Board Review Part Dos


1
Pediatric Board ReviewPart Dos
  • Mark Heller, MD
  • Department of Emergency Medicine
  • Mount Sinai School of Medicine

2
Question 1
Which of the following statements regarding
ingested foreign bodies is correct?
  • All children with suspected foreign body
    ingestion should undergo x-ray.
  • Ipecac can be used safely to dislodge a button
    battery in the esophagus.
  • Meat tenderizer can be used safely to dissolve an
    impacted meat bolus.
  • Most common site of esophageal foreign body
    entrapment in pediatric patients is the thoracic
    inlet.
  • Objects longer than 5cm and wider than 2cm should
    be removed before they pass through the stomach.

3
Q 1 Answer
Which of the following statements regarding
ingested foreign bodies is correct?
  • All children with suspected foreign body
    ingestion should undergo x-ray.
  • Ipecac can be used safely to dislodge a button
    battery in the esophagus.
  • Meat tenderizer can be used safely to dissolve an
    impacted meat bolus.
  • Most common site of esophageal foreign body
    entrapment in pediatric patients is the thoracic
    inlet.
  • Objects longer than 5cm and wider than 2cm should
    be removed before they pass through the stomach.

PEER VII Q20
4
Swallowed Foreign Bodies
5
Swallowed Foreign Bodies
  • Most pass spontaneously
  • Exceptions are objects longer than 5cm and wider
    than 2cm
  • Rarely pass the pylorus
  • Lodging in the esophagus
  • Children Cricopharyngeal narrowing at level C6
    (Upper Esophagus)
  • Adults Lower Esophagus

6
Swallowed Foreign Bodies (continued)
  • Need to be removed
  • Extremely pointed edges
  • Safety pins
  • Razor blades
  • Button Batteries
  • 15-35 will cause intestinal perforation
  • Need for X-ray
  • Highly debated topic
  • No difference in 5-day morbidity rates between
    x-ray and no x-ray

7
Question 2
Which of the following organisms is most likely
to cause a rash with the characteristic
slapped-cheek appearance?
a. Coxsackievirus A16 b. Group A beta-hemolytic
streptococci c. Human herpesvirus C d. Parvovirus
B19 e. Varicella-zoster virus
8
Q 2 Answer
Which of the following organisms is most likely
to cause a rash with the characteristic
slapped-cheek appearance?
a. Coxsackievirus A16 b. Group A beta-hemolytic
streptococci c. Human herpesvirus C d. Parvovirus
B19 e. Varicella-zoster virus
PEER VII Q309
9
Parvovirus B19
  • Erythema Infectiosum
  • Fifth Disease
  • Slapped Cheek
  • Viral Illness
  • Begins with Fever, Cold, HA
  • Symptoms Resolve
  • Slapped Cheek Rash Appears
  • Spreads to Trunk/Arms/Legs
  • Treatment is symptomatic

10
Coxsackievirus A16
  • Hand-Foot-and-Mouth Disease
  • Mouth Sores
  • Blisters on Hand
  • Fever
  • Sore Throat
  • Abdominal Pain

11
Varicella-Zoster Virus
  • Multiple states of rash on same body part
  • Low-grade fever, malaise, and headache
  • Treatment is symptomatic
  • Varicella-zoster immune globulin and acyclovir
    for immunocompromised children

12
Question 3
A mother brings her 14 month old son into the ED.
For the past 4 to 5 days she has seen mucus in
his diapers, and that morning she noted a red
mass protruding from his rectum. Regarding this
condition, which of the following is correct?
  • Affects girls more than boys
  • Is associated with cystic fibrosis and
    malnutrition
  • Requires excision of the lesion in the emergency
    department
  • Requires proctasigmoidoscopy
  • Requires referral for surgical correction

13
Q 3 Answer
A mother brings her 14 month old son into the ED.
For the past 4 to 5 days she has seen mucus in
his diapers, and that morning she noted a red
mass protruding from his rectum. Regarding this
condition, which of the following is correct?
  • Affects girls more than boys
  • Is associated with cystic fibrosis and
    malnutrition
  • Requires excision of the lesion in the emergency
    department
  • Requires proctasigmoidoscopy
  • Requires referral for surgical correction

PEER VII Q334
14
Rectal Prolapse
  • Affects very young and very old
  • Loose connection of mucosa to submucosa
  • Laxity of anal sphincter
  • Mucus or Blood-stained mucus in diaper
  • Protruding mass after bowel movement
  • Associated with cystic fibrosis
  • Reducible in ED with sedation as needed

15
Question 4
For previously healthy children with
community-acquired pneumonia, which of the
following statement is correct?
a. Age is the most important factor in selecting
empiric antibiotic therapy b. Concurrent presence
of watery diarrhea reliably identifies a viral
etiology c. Localized chest pain is the most
commonly associated with viral pneumonia d. Viral
and bacterial pneumonias can reliably be
differentiated in infants e. Wheezing in
preschool-aged children is pathognomonic for
viral pneumonia
16
Q 4 Answer
For previously healthy children with
community-acquired pneumonia, which of the
following statement is correct?
a. Age is the most important factor in selecting
empiric antibiotic therapy b. Concurrent presence
of watery diarrhea reliably identifies a viral
etiology c. Localized chest pain is the most
commonly associated with viral pneumonia d. Viral
and bacterial pneumonias can reliably be
differentiated in infants e. Wheezing in
preschool-aged children is pathognomonic for
viral pneumonia
PEER VII Q343
17
Pneumonia in Children
  • Etiologic agents have seasonal variations
  • Parainfluenze Virus Fall
  • RSV Bacteria Winter
  • Influenza Spring
  • Clinical Features
  • Variable and Dependent on Age
  • Neonates and Young Infants
  • Can present w/ Sepsis Syndrome
  • Fever, apnea, tachypnea, poor feeding, V/D,
    lethargy, shock
  • Older Children
  • Fever, abnormal lung exam, cough, pleuritic chest
    pain

18
Pneumonia in Children
  • Abbreviated Reference
  • Neonates (lt28 days)
  • Group B Strep, E.Coli, Klebsiella
  • Ampicillin and Cefotaxime
  • 1-24 months
  • RSV, Parainfluenza, Strep
  • Erythromycin, Cefuroxime, Ampicillin
  • 2-5 years
  • Influenza A and B, Strep
  • Amoxicillin
  • 6-18 years
  • Mycoplasma pneumoniae, S. Pneumoniae
  • Azithromycin

19
Name That Saturday Morning Cartoon Character
20
Name That Saturday Morning Cartoon Character
Astro
21
Name That Saturday Morning Cartoon Character
22
Name That Saturday Morning Cartoon Character
Betty
23
Name That Saturday Morning Cartoon Character
24
Name That Saturday Morning Cartoon Character
Brainy Smurf
25
Question 5
For a previously healthy toddler with mild croup,
the administration of oral dexamethasone
  • Is indicated only for moderate-to-sever croup,
    because mild croup is self-limited.
  • Is indicated only if the parents are unable to
    provide cool mist at home
  • Is precluded by an unacceptably high rate of
    uncontrollable vomiting after administration
  • Leads to mild hyperactivity that interferes with
    normal sleep patterns
  • Leads to quicker resolution of symptoms when
    compared with observation

26
Q 5 Answer
For a previously healthy toddler with mild croup,
the administration of oral dexamethasone
  • Is indicated only for moderate-to-sever croup,
    because mild croup is self-limited.
  • Is indicated only if the parents are unable to
    provide cool mist at home
  • Is precluded by an unacceptably high rate of
    uncontrollable vomiting after administration
  • Leads to mild hyperactivity that interferes with
    normal sleep patterns
  • Leads to quicker resolution of symptoms when
    compared with observation

PEER VII Q347
27
Croup
  • Inflammation of the Upper Airway
  • Epidemiology
  • Parainfluenza, RSV, Influenza
  • Clinical Features
  • 6 months to 3 years old
  • Late Fall to Early Winter
  • Bark-Like Cough
  • Biphasic Stridor
  • Treatment
  • Humidified Air
  • Dexamethasone in Mild to Moderate Croup
  • Nebulized Epinephrine (racemic epi) for moderate
    to severe
  • Intubate if necessary

28
Question 6
For a child with stridor, which of the following
best differentiates croup from bacterial
tracheitis?
a. Drooling and fever b. Normal chest x-ray c.
Productive cough d. Rhinorrhea prodrome e.
Stridor at rest
29
Q 6 Answer
For a child with stridor, which of the following
best differentiates croup from bacterial
tracheitis?
a. Drooling and fever b. Normal chest x-ray c.
Productive cough d. Rhinorrhea prodrome e.
Stridor at rest
PEER VII Q368
30
Bacterial Tracheitis
  • Clinical Features
  • More severe form of croup
  • Bacterial superinfection
  • 3 months to 13 years old
  • S. aureus, S. pneumoniae
  • More respiratory distress than croup
  • Appear septic
  • Inspiratory and expiratory stridor
  • Thick sputum production
  • Raspy hoarse voice
  • Diagnosis
  • Radiograph of lateral neck and chest
  • Subglottic narrowing of the trachea
  • Treatment
  • Similar to epiglottitis
  • 85 require intubation
  • Vanc and Ceftriaxone

31
Question 7
A 9 month old boy presents with hypotonia and
constipation. His mother says he has recently
started eating table food. Which of the
following is the most likely diagnosis?
a. Botulism b. Ciguatera c. Listeriosis d.
Scombroid poisoning e. Typhoid
32
Q 7 Answer
A 9 month old boy presents with hypotonia and
constipation. His mother says he has recently
started eating table food. Which of the
following is the most likely diagnosis?
  • Botulism
  • Ciguatera
  • Listeriosis
  • Scombroid poisoning
  • Typhoid

PEER VII Q349
33
Botulism
  • Toxin Produced by Clostridium botulinum
  • Blocks acetylcholine release at synapse causing
    flaccid paralysis
  • Onset 1 to 4 days post intake
  • Symptoms
  • Constipation
  • Difficulty sucking
  • Difficulty swallowing
  • Hypotonia
  • Care is symptomatic
  • Antitoxin should be given

34
Question 8
Which of the following statements regarding
intussusception is correct?
  • If the stool is negative for occult blood, the
    diagnosis is excluded.
  • Most patients show profound dehydration at the
    time of diagnosis
  • Mucus-laden, bloody, currant jelly stools are
    seen in most cases
  • Postreduction recurrence is best predicted by
    patient age and sex
  • Ultrasonography is an accepted diagnostic test

35
Q 8 Answer
Which of the following statements regarding
intussusception is correct?
  • If the stool is negative for occult blood, the
    diagnosis is excluded.
  • Most patients show profound dehydration at the
    time of diagnosis
  • Mucus-laden, bloody, currant jelly stools are
    seen in most cases
  • Postreduction recurrence is best predicted by
    patient age and sex
  • Ultrasonography is an accepted diagnostic test

PEER VII Q354
36
Intussusception
  • Telescoping of one portion of the intestine into
    another
  • Most commonly occurs between the ileum and colon
  • Most prevalent 3 months to 6 years old
  • Presentation
  • Sudden abdominal pain
  • Pain-free intervals
  • Sausage-shaped mass on R
  • Diagnosis
  • US used for diagnosis
  • Treatment
  • Barium or Air enema diagnostic
  • and therapeutic
  • Possible Surgical Correction

37
Question 9
For young infants who are vomiting, which of the
following is most likely to differentiate acute
malrotation with midgut volvulus from pyloric
stenosis?
  • Abdominal examination
  • Color of the vomitus
  • History of constipation
  • Presence of high fever
  • Resting tachycardia

38
Q 9 Answer
For young infants who are vomiting, which of the
following is most likely to differentiate acute
malrotation with midgut volvulus from pyloric
stenosis?
a. Abdominal examination b. Color of the
vomitus c. History of constipation d. Presence of
high fever e. Resting tachycardia
PEER VII Q357
39
Pyloric Stenosis
  • Clinical Presentation
  • Nonbilious Projectile Vomiting
  • Just after feeding
  • Seen in 2nd or 3rd week
  • Diagnosis
  • Palpation of pyloric
  • mass in LUQ
  • US

40
Malrotation
  • Clinical Presentation
  • Bilious Vomiting
  • Abdominal Distention
  • Streaks of Blood in Stool
  • Most present within
  • first month of life
  • Diagnose
  • Abdominal Radiograph

41
Name That Saturday Morning Cartoon Character
42
Name That Saturday Morning Cartoon Character
Skeletor
43
Name That Saturday Morning Cartoon Character
44
Name That Saturday Morning Cartoon Character
Patrick Star (SpongeBobs Friend)
45
Name That Saturday Morning Cartoon Character
46
Name That Saturday Morning Cartoon Character
Snorks
47
Question 10
Which of the following is the most common cause
of lower gastrointestinal bleeding in school-aged
children?
  • Anal fissures
  • Infectious diarrhea
  • Juvenile polyps
  • Milk-protein allergy
  • Vitamin K deficiency

48
Q 10 Answer
Which of the following is the most common cause
of lower gastrointestinal bleeding in school-aged
children?
  • Anal fissures
  • Infectious diarrhea
  • Juvenile polyps
  • Milk-protein allergy
  • Vitamin K deficiency

PEER VII Q358
49
Infectious Diarrhea
  • Etiology
  • Campylobacter
  • E. coli
  • Salmonella
  • Shigella
  • Most common cause of bloody diarrhea in
    school-aged children
  • Treatment
  • Treat for Dehydration
  • No role for antiemetics / antidiarrhea
    medications
  • No antibiotics

50
Question 11
A 14 year old girl is brought to the emergency
department because she has difficulty walking.
She has been noted to have some weakness in her
legs over the past 36 hours. There is no history
of trauma, and she is afebrile. On examination
she has normal mental status and normal strength
and sensation in her arms. In her lower
extremities, she ahs flaccid paralysis, absent
reflexes, and no sensation. Which of the
following should be done next in the ED?
a. Administer an intravenous cephalosporin b.
Immediately strap her down to long board c.
Initiate fluid resuscitation with 2 L normal
saline d. Order MRI of the spine e. Perform
lumbar puncture and administer intravenous
acyclovir
51
Q 11 Answer
A 14 year old girl is brought to the emergency
department because she has difficulty walking.
She has been noted to have some weakness in her
legs over the past 36 hours. There is no history
of trauma, and she is afebrile. On examination
she has normal mental status and normal strength
and sensation in her arms. In her lower
extremities, she ahs flaccid paralysis, absent
reflexes, and no sensation. Which of the
following should be done next in the ED?
a. Administer an intravenous cephalosporin b.
Immediately strap her down to long board c.
Initiate fluid resuscitation with 2 L normal
saline d. Order MRI of the spine e. Perform
lumbar puncture and administer intravenous
acyclovir
PEER VII Q373
52
Acute Spinal Cord Dysfunction
  • Etiology
  • Transverse Myelitis
  • Guillain-Barre
  • Spinal Cord Tumors
  • Diagnosing
  • MRI Spine
  • Treatment
  • Supportive
  • Respiratory Support
  • Admission to Neurology

53
Question 12
Which of the following is most commonly seen in
infants with congestive heart failure?
a. Bilateral pedal edema b. Bounding femoral
pulses c. Excessive weight gain d. Jugular venous
distention e. Sweating with eating
54
Q 12 Answer
Which of the following is most commonly seen in
infants with congestive heart failure?
a. Bilateral pedal edema b. Bounding femoral
pulses c. Excessive weight gain d. Jugular venous
distention e. Sweating with eating
PEER VII Q376
55
Congestive Heart Failure
  • Clinical Features
  • Poor feeding
  • Diaphoresis
  • Irritability or Lethargy with Feeding
  • Diagnosis
  • Cardiomegaly on CXR
  • EKG w/ ST changes, dysrhythmias or ectopy
  • Treatment
  • Oxygen
  • Lasix
  • Inotropic Agents (Dopamine or Dobutamine)
  • Admission

56
Name That Saturday Morning Cartoon Character

57
Name That Saturday Morning Cartoon Character

Mr. Owl
58
Name That Saturday Morning Cartoon Character

59
Name That Saturday Morning Cartoon Character

Dora
60
Name That Saturday Morning Cartoon Character

61
Name That Saturday Morning Cartoon Character

Bill
62
Question 13
A 4 day old boy presents in shock. According to
the mother, he seemed to be doing well until 2
hours prior to presentation. He is cyanotic with
mottled skin, has poor tone, and cries weakly.
Initial pulse oximetry reading is 78. After
successful intubation and the administration of
high-flow oxygen, the pulse oximetry reading
remains between 78-82. Of the following, what
is the most appropriate next step?
a. Administer intravenous antibiotics and
acyclovir b. Call child protective services, and
order xrays c. Extubate, suction the airway, and
intubate again d. Insert a nasogastric tube to
decompress the stomach e. Promptly administer
intravenous prostaglandin E1
63
Q 13 Answer
A 4 day old boy presents in shock. According to
the mother, he seemed to be doing well until 2
hours prior to presentation. He is cyanotic with
mottled skin, has poor tone, and cries weakly.
Initial pulse oximetry reading is 78. After
successful intubation and the administration of
high-flow oxygen, the pulse oximetry reading
remains between 78-82. Of the following, what
is the most appropriate next step?
a. Administer intravenous antibiotics and
acyclovir b. Call child protective services, and
order xrays c. Extubate, suction the airway, and
intubate again d. Insert a nasogastric tube to
decompress the stomach e. Promptly administer
intravenous prostaglandin E1
PEER VII Q382
64
Ductal-Dependent Lesions
  • Ductus arteriosus closes in first 2 weeks of life
  • Babies with congenital heart conditions can
    depend on a patent ductus arteriosus to perfuse
    the body will rapidly deteriorate.
  • Babies remain hypoxic
  • despite high flow oxygen
  • Treatment
  • Prostaglandin E1
  • Sepsis workup as well

65
Question 14
Which of the following fracture patterns is most
likely to be caused by nonaccidental trauma
(child abuse) in a 2 year old boy?
a. Linear nondepressed parietal skull fracture
after falling out of a shopping cart b.
Metaphysial corner fracture of the distal tibia
after falling out of bed c. minimally displaced
supracondylar humerus fracture after falling
backwards off a piece of playground equipment d.
Torus fracture of the distal radius after falling
down three stairs e. Transverse fracture of the
middle phalanx of the index finger after the
finger was closed in a door by an older sibling
66
Q 14 Answer
Which of the following fracture patterns is most
likely to be caused by nonaccidental trauma
(child abuse) in a 2 year old boy?
a. Linear nondepressed parietal skull fracture
after falling out of a shopping cart b.
Metaphysial corner fracture of the distal tibia
after falling out of bed c. minimally displaced
supracondylar humerus fracture after falling
backwards off a piece of playground equipment d.
Torus fracture of the distal radius after falling
down three stairs e. Transverse fracture of the
middle phalanx of the index finger after the
finger was closed in a door by an older sibling
PEER VI Q59
67
Child Abuse - Fractures
  • Metaphyseal corner and Triangular
    bucket-handle
  • Caused by joints being pulled apart forcefully
    and joint surfaces crushed together and moved
    back and forth
  • Any fracture can be a sign of child abuse

68
Question 15
A 7 year old boy is brought in for evaluation of
fever and headache. Examination reveals an
acutely ill child with a temperature of 39C
(102.2F). A maculopapular rash is present on the
wrists, palms, and lower legs. The patient has
complained of myalgias, particularly in the lower
extremities. Which of the following intravenous
agents is most appropriate?
a. Acyclovir b. Ampicillin/Sulbactam c.
Azithromycin d. Chloramphenicol e. Levofloxacin
69
Q 15 Answer
A 7 year old boy is brought in for evaluation of
fever and headache. Examination reveals an
acutely ill child with a temperature of 39C
(102.2F). A maculopapular rash is present on the
wrists, palms, and lower legs. The patient has
complained of myalgias, particularly in the lower
extremities. Which of the following intravenous
agents is most appropriate?
a. Acyclovir b. Ampicillin/Sulbactam c.
Azithromycin d. Chloramphenicol e. Levofloxacin
PEER VI Q134
70
Rocky Mountain Spotted Fever
  • Etiology
  • Rickettsia rickettsii
  • Transmitted by ticks
  • Clinical Features
  • Rash
  • Headache
  • Myalgias
  • Fever
  • Treatment
  • Tetracycline
  • Doxycycline
  • Chloramphenicol

71
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