Gmditt Step 2 Day 15 Ob & Peds/preventative

Front 1

What are the symptoms of a lacunar stroke?

Back 1

Pure motor hemiparesis
Pure sensory
Ataxic hemiparesis
Sensory motor
Dysarthria clumsy hand syndrome

Front 2

What medications and interventions are used in the tx of cerebral palsy to alleviate contractures and improve function?

Back 2

Dantrolene – muscle relaxer
Baclofen – muscle relaxer
Benzodiazepines
Botox

Front 3

What is the ACLS tx for ventricular fibrillation?

Back 3

CPR
Defibrillate at 360 joules,
Epinephrine or vasopressin

Front 4

Which vasopressor matches the following statement?
High doses optimize the α-1 vasoconstriction

Back 4

Epinephrine

Front 5

Which vasopressor matches the following statement?
Best choice for septic shock

Back 5

Norepinephrine

Front 6

Which vasopressor matches the following statement?
Causes vasoconstriction but with bradycardia

Back 6

Phenylephrine

Front 7

What is the next step in the evaluation of penetrating injuries to the different zones of the neck?

Back 7

Zone 1 → CT angiogram (4-vessel arteriogram)

Zone 2 → Surgical exploration

Zone 3 → CT angiogram, triple endoscopy

Front 8

What EKG finding is seen in pts with Wolff-Parkinson-White syndrome? What causes WPW?

Back 8

EKG: delta wave prior to QRS complex
Cause: reentry thru accessory conduction pathway

Front 9

What is the next step in the management of an AGUS pap smear?

Back 9

Colposcopy & Endocervical curettage

Front 10

What is the differential diagnosis for fetal tachycardia?

Back 10

Maternal fever/ infection/ dehydration
Fetal anemia
Fetal tachyarrhythmias (HR > 200)
Fetal immaturity
Chorioamnionitis
Maternal thyrotoxicosis
Drugs or medications (Terbutaline, atropine)
Fetal hypoxia

Front 11

What type of fetal surveillance strategy is typical for high-risk pregnancies?

Back 11

Biophysical profile or NST

Front 12

What are the first steps in the management of non-reassuring fetal heart tones during labor?

Back 12

Place maternal O2 + turn off Pitocin (remove cervidil) + turn mom to left side
Correct hyperstimulation if needed with terbutaline 0.25mg SubQ
Correct any maternal hypotension (often a/w epidural). IVF bolus if needed
SVE and place FSE (check for cord prolapse)
Consider need for intervention such as amnioinfusion or C-section

Front 13

One hour into the active stage of labor, a fetus’s heart tones become nonreassuring. What actions are taken immediately?

Back 13

Maternal O2
Turn off oxytocin
Turn mother in LLD position

Front 14

What would be some contraindications to fetal scalp electrode placement?

Back 14

Breech presentation
< 36wks gestation
Worry of maternal viral infection

Front 15

HYQ: What defines prolonged latent phase and prolonged active phase of labor dystocia?

Back 15

Prolonged latent phase: does not progress from latent ot active phase for >20hours in nulliparous pts or >14 hrs in multiparous pts

Prolonged active phase:
Active phase > 12 hrs or
Nulliparous < 1.2 cm/hr dilation
Multiparous < 1.5 cm/hr dilation

Front 16

What is the definition of arrest of descent? In general, how is it managed?

Back 16

Arrest of descent occurs when the cervix does not continue to dilate during the active phase of >2 hrs in multips and >3hrs in primips
Management:
Reassess the 3 Ps
Placement of IUPC to better assess “power” (>200 MVU/10min)
Augmentation with oxytocin to augment “power”
C-section if power, passenger and passage are unable to be further augmented

Front 17

What is the definition of uterine hyperstimulation? What adrenergic antagonist is particularly helpful in reversing uterine hyperstimulation?

Back 17

Uterine hyperstimulation is defined by one of the following:
>5 contractions over 10min with duration > 60secs
significant fetal heart rate decelerations
Terbutaline 0.25mg Sub-Q if often used as a tocolytic to stop uterine contractions

Front 18

What defines prolonged latent phase of labor? Prolonged active phase?

Back 18

>20 hrs nulliparous
14 hrs in multiparous
12 hrs or <1.2cm per hour nulliparous
< 1.5 cm/hr multiparous

Front 19

By how much can an epidural lengthen stage 2 of labor?

Back 19

About 1 hour

Front 20

What are some of the methods that can be used for induction of labor?

Back 20

Rupture of membrane
Oxytocin
Other less common options

Front 21

What are some of the contraindications to breastfeeding?

Back 21

Front 22

What is the treatment or mastitis in a postpartum female?

Back 22

Front 23

What are the treatment options for uterine atony/ postpartum hemorrhage?

Back 23

Uterine massage
Oxytocin 10 units IM x1
Methergine (methylergonovine) 0.2 mg IM (ergot agent that is contraindicated if HTN)
Hemabate (PGF2-α) 0.25mg IM of intra-uterine (contraindicated if asthma)
Surgical options: uterine artery ligation, internal iliac artery ligation, selective arterial embolization, or hysterectomy

Front 24

What are the characteristic features of postpartum endometritis?

Back 24

Front 25

What is the treatment for postpartum endometritis?

Back 25

Front 26

What are the indications for a vertical incision vs low transverse incision for a caesarean section?

Back 26

Transverse lie
Adhesions or fibroids
Hysterectomy planned
Cervical cancer
Postmortem delivery

Front 27

What potential adverse events can occur during a VBAC?

Back 27

Uterine rupture (1/100)
Catastrophic event (1/1000)

Front 28

A woman that is postpartum day 2, s/p C-section develops a temperature of 101°F, uterine tenderness, and foul lochia. Her urine urinalysis is normal & her incision is clean, dry and intact. What does this patient likely have and what is the treatment?

Back 28

Dx: post-partum endometritis
Tx:
Clindamycin + ampicillin + gentamicin
Ceftriaxone + clindamycin
Ampicillin/sulbactam (Unasyn) + doxycycline
Cefoxitin + doxycycline

Front 29

What is the treatment for a woman that does not wish to breastfeed postpartum?

Back 29

1st line: Icepacks, tight bras, avoid stimulation, analgesia
2nd line: Oral contraceptives
3rd line: Bromocriptine

Front 30

What medications can be used to control postpartum hemorrhage?

Back 30

1st line: Uterine massage
Then: Oxytocin
Other less common options

Front 31

What is the definition of arrest of descent?

Back 31

(With epidural)
multiparous stage 2 for more than 2 hrs
nulliparous stage 2 for more than 3 hrs
if you don’t have an epidural, then subtract 1 hour

Front 32

What are the first steps in the management of uterine hyperstimulation (or non-reassuring fetal heart tones)?

Back 32

Oxygen
Remove uterine stimulant
Position in LLD
Giver terbutaline
Increase monitoring

Front 33

When is a normal child’s weight regained, doubled, tripled, and quadrupled in terms of their birth weight?

Back 33

Regain weight in 2 weeks
Double weight in 4 months
Triple weight in 12 months
Quadruple weight in 24 months

Front 34

Define failure to thrive (FTT)

Back 34

<5% on a growth chart
cross 2 or more lines in weight on the growth chart

Front 35

How do you distinguish between Type I and Type 2 diabetes in a child?

Back 35

Type 1 – skinny, anti-islet antibodies

Front 36

When does a normal child’s height increase by 50%, double, and triple?

Back 36

Height ↑ by 50% by age 1
Height doubled by age 4
Height tripled by age 13

Front 37

How many blocks can a child put in a tower at these ages: 12 months, 18months, 2 yrs, 3yrs?

Back 37

12 months → 2 blocks
18 months → 4 blocks
2 years → 6 blocks
3 years → 9 blocks

Front 38

An infant that has any remaining primitive reflexes after what age needs a work-up for CNS pathology?

Back 38

6 months of age

Front 39

What is the first solid food parents should give their child?

Back 39

Iron-fortified cereal

Front 40

Why should cow’s milk not be given before 1 year of age?

Back 40

Risk of allergy
Hemorrhaging in gut
Iron deficiency anemia

Front 41

Car Seats:

Back 41

< 1 year and <20 lbs → infant in back seat, facing backwards
1 – 4 years and > 20 lbs → in back seat but still in car seat, now have option of facing forward
Once forward-facing car seat is outgrown (4 years and 40 lbs) → booster seat in back
Keep in booster seat until the belt fits correctly (usually 4’9’’ and 8-12 years) → then belted with a lap/shoulder belt in the back seat until 13 years of age

Front 42

How many calories are present in an ounce of breast milk? How many calories are present in an ounce of formula?

Back 42

20 kilocalories/ounce in both breast milk and formula

Front 43

What are the caloric needs for an infant younger than 6 mos?

Back 43

100-120 calories/kg/day

Front 44

What work-up should be performed on a newborn with a single umbilical artery?

Back 44

Occurs in ~0.5% of births and 20-30% of these infants have major structural anomalies
Obtain renal sonagram as 7% will have clinically significant renal symptomatic anomalies

Front 45

What are the most common problems that arise in premature infants?

Back 45

Respiratory distress syndrome, hypoglycemia, persistent PDA, infection/sepsis, retinopathy of prematurity, intraventricular hemorrhage, necrotizing enterocolitis

Front 46

What is the difference between caput succedaneum and cephalohematoma?

Back 46

Caput → diffuse swelling or edema of the scalp, edema crosses suture lines, resolves within a few days
Cephalohematoma → subperiosteal hemorrhage, does NOT cross suture lines, resolves in weeks to months

Front 47

What is the next step in the management of a newborn female with bloody vaginal discharge in the first week of life?

Back 47

Nothing (withdrawal from hormones)

Front 48

is this benign?

Back 48

Yes - Cutis marmorata: spider webbing/ marbling of the skin. Non-concerning

a normal reticulated mottling of the skin caused by vascular response to cold.

Front 49

Is this benign?

Back 49

Erythema toxicum neonatorum: 2-3 mm, yellow pustule with red base (similar appearance to white-head) arising in the first 24-72 hours, microscopic examination of the pustular contents (not necessary for diagnosis) reveals numerous eosinophils, usually gone by 3 weeks, tell parents to leave alone

Erythema toxicum neonatorum can result in a “flea-bitten” appearance.

Front 50

what is this?

Back 50

Transient neonatal pustular melanosis: superficial pustules overlying hyperpigmented macules. Tell parents to leave alone

Transient neonatal pustular melanosis is a vesiculopustular rash that occurs in 5 percent of black newborns, but in less than 1 percent of white newborns.6,9 In contrast with erythema toxicum neonatorum, the lesions of transient neonatal pustular melanosis lack surrounding erythema. In addition, these lesions rupture easily, leaving a collarette of scale and a pigmented macule that fades over three to four weeks. All areas of the body may be affected, including palms and soles.

Front 51

what is this?

Back 51

Neonatal acne (acne neonatorum): seen in 20% of infants, due to maternal hormone stimulation of sebaceous glands, usual age of onset is 3 weeks old. There is no increased risk of acne in adolescence. Mild lesions should be left alone and will resolve in 4 months. Severe inflammation can be managed with benzoyl peroxide or topical retinoids

It typically consists of closed comedones on the forehead, nose, and cheeks, although other locations are possible. Open comedones, inflammatory papules, and pustules can also develop.

Front 52

What is this?

Back 52

Milia (Miliaria): due to accumulation of sweat beneath eccrine sweat ducts that are obstructed by keratin at the stratum corneum usually develops in 1st week after birth, a/w excess warmth (incubator, excess clothes, fever). No treatment is needed except possibly to reduce sweating with loose clothing and cool baths

Miliaria crystallina is caused by superficial eccrine duct closure. It consists of 1- to 2-mm vesicles without surrounding erythema, most commonly on the head, neck, and trunk (Figure 5). Each vesicle evolves, with rupture followed by desquamation, and may persist for hours to days.

Front 53

What is this?

Back 53

Harlequin color change: intense reddening of gravity dependent side and blanching of the nondependent side with a line of demarcation between the two, lasts a few sec-min, affects 10% of newborns (more common in newborns), most common in the first few days of life, may be due to immaturity of autonomic innervation to skin vessels. Completely benign and will resolve in days- 3 weeks.

Front 54

What is this?

Back 54

Macular stains (Stork bites): permanent vascular malformations most commonly occurring on the nape of the neck, but also upper eyelids and middle of forehead. Benign but persist throughout life

Front 55

What is this?

Back 55

Mongolian spot: bluish discoloration over buttocks and base of spine, probably present on at least one of the parents. Benign and will usually fade in 1-2 years. Document to avoid later confusion with bruises

Front 56

What is this?

Back 56

Infantile Acne: different than neonatal acne, onset usually at 3-4 months of age, yellow papules around nose & cheeks, usually clears by age one but may persist until age 3. Severe inflammation can be managed with benzoyl peroxide or topical retinoids

Front 57

Who under the age of 11-12 should receive an MCV4 meningococcal vaccine?

Back 57

Moving to endemic area
Children > age 2 with functional true asplenia

Front 58

When can a child switch to a front-facing car seat? A booster seat in the back seat?

Back 58

Forward facing → > 2 years
Booster seat → until 4 ft 9 in & btw 8-12 years

Front 59

How many kilocalories are in an ounce of breast milk? Formula?

Back 59

20 kcal/ounce

Front 60

Cephalohematoma increases the likelihood of what?

Back 60

Jaundice
Note: more common with vacuum-assisted deliveries

Front 61

A 2-day old baby boy presents with 2-3mm yellow pustules with red bases. What are these likely to be and what is the prognosis?

Back 61

Erythema toxicum neonatorum

Front 62

Why is it important to document Mongolian spots?

Back 62

Prevent false accusations of abuse

Front 63

What are some risk factors for SIDS?

Back 63

2-3 months old
While infant is sleeping
Low SES
Maternal age < 20
Drugs/ cigarettes in pregnancy
Prior sibling with SIDS
Prone sleeping position
Sleeping on soft surface
Overheating

Front 64

What medications can be used to treat thrush in an infant?

Back 64

Nystatin oral suspension

Front 65

What are the risk factors for Sudden Infant Death Syndrome (SIDS)?

Back 65

Front 66

When would you expect the anterior fontanelle to close in a child? What would you suspect if it did not close in the expected time frame?

Back 66

- Closed in 1% by age 3 months, 38% by 12 months, and 96% by 24 months
- If delayed consider: Down syndrome, achondroplasia, Rickets, congenital hypothyroidism, ↑ intracranial pressure
- If closure < 3 months, carefully monitor head circumference for craniosynostosis (premature closure of cranial sutures)
- Craniotabes (soft occipital bone, like ping-pong ball) from 3 – 12 months is highly suspicious for Rickets

Front 67

What are the signs of severe dehydration in a child?

Back 67

Front 68

What mnemonic can you use for the questions you should ask during an annual adolescent exam?

Back 68

“HEADSSS”
Home environment
Employment/ Education
Activities
Drugs
Sex. Suicide, Safety

Front 69

What are the clinical features of measles infection (rubeola)?

Back 69

Prodrome for 2-3 days: fever, malaise, anorexia, and 3 “Cs” (Cough, Coryza, Conjunctivitis)

Koplik spots on buccal mucosa after 1-2 days (white-gray spots with a red base) → occur 48hrs prior to rash. Pathognomonic for measles

Rash 5 days after prodrome onset: erythematous, maculopapular starting at the head then spreading to the feet → lasts 4 -5 days → resolves from head down

Front 70

What is the treatment for measles?

Back 70

Supportive therapy (antipyretics, fluids)
Monitoring & treating bacterial superinfections such as pneumonia or otitis media
Vit A
100,000 IU PO x1 in 6 – 12 mo olds, 200,000 IU PO x1 if older than 12 months
WHO recommends vit A to all children with measles in areas where vitamin A def is prevalent and measles mortality exceeds 1%
AAP recommends vit A given as above to children 6mos—12 years hospitalized for measles or its complications or if immunodeficient or high likelihood of vitamin A deficiency (ophthalmologic evidence, intestinal malabsorption, malnutrition, or recent immigration from an area with high measles mortality)
Ribavirin is not yet well studied and not currently standard of care for measles despite that it harms measles virus in vitro

Front 71

What are the classic features of rubella virus (German measles)?

Back 71

Low grade fever, lymphadenopathy, and rash
Prodromal malaise, fever, anorexia for 1-5 days prior to rash
Lymphadenopathy – suboccipital & posterior cervical
Erythematous, tender maculopapular rash that starts at the face then generalizes
Rash persists 5 days and does not darken as does the rash of measles
Polyarthritis may be seen up to a month in women and adolescents

Front 72

What are the characteristic features of Coxsackie hand, foot, and mouth disease?

Back 72

Constitutional fever & anorexia
Oral vesicle on the buccal mucosa and tongue
Small, tender, maculopapular/vesicular rash on the hands, feet and sometimes buttocks
Duration is typically 3-5 days without complications

Front 73

What are the signs and symptoms or scarlet fever caused by Streptococcus pyogenes?

Back 73

Rash that is coarse (“sandpaper-like”), erythematous and blanching (“sunburn-like”)
Rash starts on the trunk that generalizes, but spares palms & soles
Rash is most prominent in skin creases of axilla and groin (Pastia’s lines/sign)
Strawberry tongue, beefy-red pharynx, cervical LAD
Fever/chills
Later desquamation of hands & feet (addn ddx Kawasaki disease, Toxic Shock Sydrome, acrodynia or mercury poisoning)
(+) throat culture or rapid strep test

Front 74

What are the characteristic symptoms of roseola infantum (HHV-6)?

Back 74

Sudden, high fever (exceeding 102°F) for 3-4 days
Child has no other signs of infection and often acts/plays normally
Rash that appears when fever dissipates and starts on the trunk then spreads over entire body & lasts 24 hours
Other common findings: erythematous papules on soft palate & uvula, mild cervical LAD, edematous eyelids, bulging anterior fontanel in infants
Commonly misdiagnosed as acute otitis media and subsequent antibiotic allergy!

Front 75

What is the treatment for roseola infantum?

Back 75

Antipyretics as needed

Front 76

What is the differential diagnosis for cervical lymphadenopathy in a child?

Back 76

Front 77

What is PFAPA syndrome?

Back 77

Benign 4-5 day syndrome consisting of Periodic Fever, Aphthous ulcers, Pharyngitits, and Adenitis
Occurs monthly (q 28 days)
Exclusion criteria include neutropenia, cough, coryza, diarrhea, severe abdominal pain, rash, arthritis, and neuro defects
Usually affects preschool-aged children (2-5 yr olds)
Benign, self-limiting disease
Treatments
Glucocorticoids relieve symptoms in a matter of hours
Cimetidine may be used for prevention of episodes but is of questionable efficacy
Average duration of recurring symptoms is 4.5 years

Front 78

What are the classic symptoms of pertussis?

Back 78

Incubation 7 – 10 days
Catarrhal stage (1 – 6 weeks): paroxysms of cough with inspiratory whoop that is worse at night & often with post-tussive emesis and exhaustion
Often confused with acute bronchitis
Convalescent stage (2 – 3 weeks): waning of symptoms

Front 79

What is the treatment for pertussis?

Back 79

Front 80

What additional workup, if any, is needed in a child diagnosed with a UTI?

Back 80

Voiding cystourethrogram (VCUG) and Renal U/S if:
Child 2 months – 2 years of age (AAP)
Male of any age
Girl < 3 years (or unable to verbalize urinary symptoms
Febrile UTI or recurrent UTI
Other red flags: abnormal voiding pattern, poor growth, FHx of renal disease, hypertension, abnormalities of the urinary tract

Front 81

What is the mnemonic for questions you should ask while examining adolescents?

Back 81

“HEADSSS”
Home environment
Employment/ Education
Activities
Drugs
Sex. Suicide, Safety

Front 82

In addition to MCV4, what other vaccines should asplenic pediatric patients >2 years receive?

Back 82

HIB & pneumococcal

Front 83

What are the 3 C’s of the prodrome of rubeola?

Back 83

Coryza, Cough, Conjunctivitis

Front 84

What are some causes of desquamation of the hands & feet?

Back 84

Scarlet fever
Kawasaki Disease
Toxic Shock Syndrome
Acrodynia
Steven-Johnson Syndrome

Front 85

How long is the incubation period for pertussis? What is the treatment?

Back 85

Incubation: 7-10 days
Treatment: macrolide

Front 86

Which viral infection is characterized by sudden high fevers for 3-4 days but is otherwise asymptomatic? A rash will often appear when the fever dissipates

Back 86

Roseola Infection (HHV 6)

Front 87

Intense reddening of gravity dependent side and blanching of the non-dependent side with a line of demarcation between the two, lasts a few sec-min

Back 87

Harlequin Color Change

Front 88

Due to accumulation of sweat beneath eccrine sweat ducts that are obstructed by keratin at the stratum corneum

Back 88

Milia

Front 89

HYQ: If a patient with measles required treatment with medication, what medication would you use?

Back 89

Vitamin A

Front 90

What is the treatment for roseola infantum?

Back 90

Generally no treatment except antipyretics

Front 91

What are some common causes of delayed closure of the anterior fontanelle?

Back 91

Rickets
Down syndrome
Achondroplasia
Congenital hypothyroidism
Elevated Intracranial pressure

Front 92

When do children first exhibit stranger anxiety?

Back 92

6 – 9 months

Front 93

When is gender identity typically formed?

Back 93

2 – 3 years

Front 94

When can children begin to eat solid foods?

Back 94

4 – 6 months

Front 95

When can children drink cow’s milk?

Back 95

1 year

Front 96

What interventions have been shown to ↓ incidence of SIDS?

Back 96

Back to bed
Pacifier
Fan on in room
No smoking in house
No pillows/ toys in bed

Front 97

How many total doses of the DTaP vaccine should a 6yo have received?

Back 97

5 doses

Front 98

At what age is the meningococcal vaccine indicated?

Back 98

11 years

Front 99

How would you expect weight to increase in the first 2yrs?

Back 99

Double newborn weight – 4 mos
Triple newborn weight – 12 mos
Quadruple newborn weight – 24 mos

Front 100

Bruton’s Agammaglobulinemia

Back 100

X-linked (Boys)
B-cell deficiency → defective tyrosine kinase gene → low levels of ALL immunoglobulins
Recurrent Bacterial infections after 6 months
No B-cells on peripheral smear

Front 101

Thymic aplasia (DiGeorge Syndrome)

Back 101

3rd & 4th brachial pouches fail to develop
↓
no thymus → no T cells
no PTHs → low Ca2+ → tetany
congenital defects in heart/ great vessels
recurrent viral, fungal, protozoal infections
90% have a chr 22q11 deletion

Front 102

Severe Combined ImmunoDeficiency (SCID)

Back 102

Defect in early stem cell differentiation
Can be caused by at least 7 different gene defects (ie adenosine deaminase deficiency)
Presentation triad:
Severe recurrent infections
Chronic mucocutaneous candidiasis
Fatal or recurrent RSV, VZV< HSV, Measles, Influenza, Parainfluenza
PCP pneumonia
Chronic Diarrhea
Failure to Thrive (FTT)
no thymic shadow on newborn CXR
DO NOT GIVE LIVE VACCINES!!

Front 103

Chronic mucocutaneous candidiasis

Back 103

T-cell dysfunction vs C. albicans
Tx: antifungals (ketoconazole, fluconazole)

Front 104

Wiskott-Aldrich syndrome: “WAITER”

Back 104

Wiskott-Aldrich
Immunodeficiency
Thrombocytopenia
Eczema (of the trunk)
Recurrent pyogenic infections

Front 105

(A)taxia-Telangiectasia

Back 105

Ig(A) deficiency
Cerebellar (A)taxia, and poor smooth pursuit of moving target with eyes
Telangiectasias of face > 5 yo
↑ cancer risk: lymphoma & acute leukemias
Radiation sensitivity (try to avoid x-rays)
+/- ↑ AFP in children > 8 months
average age of death ~ 25 years

Front 106

Selective Immunoglobulin Deficiencies

Back 106

IgA deficiency is most common
Most appear healthy
Sinus & lung infections
1/600 European descent
a/w atopy, asthma
possible anaphylaxis to blood transfusions and blood products

Front 107

What is the half-life of the IgG antibodies transferred from mother to infant?

Back 107

28 days

Front 108

What is the presentation triad for SCID?

Back 108

Severe recurrent infections
Chronic diarrhea
Failure to thrive (FTT)

Front 109

What are the clinical features of Wiskott-Aldrich syndrome?

Back 109

“WAITER”
Wiskott-Aldrich
Immunodeficiency
Thrombocytopenia
Eczema
Recurrent pyogenic infections

Front 110

What is the management of chronic granulomatous disease?

Back 110

Prophylactic TMP-SMX (Bactrim), Interferon-γ

Front 111

If a female child is in the 80th percentile for height & the 25th percentile for head circumference, what chromosomal abnormality should you suspect?

Back 111

Turner Syndrome (XO)

Front 112

What is the most common malformation of the head & neck?

Back 112

Unilateral cleft lip (multifactorial causes)

Front 113

What features are characteristic of fetal alcohol syndrome?

Back 113

Facial features:
Short palpebral fissures
Thin upper lip
Smooth philtrum
Flattened midface
Deficient brain growth:
Structural brian abnormalities
< 10th percentile for head circumference
Abnormal neuro exam
Variable mental retardation
Growth retardation:
< 10th percentile for height and weight
Failure to thrive (FTT) despite adequate intake
Disproportional low weight to height

Front 114

What are the differences in presentation btw branchial cleft cyst and thyroglossal duct cyst?

Back 114

Brachial cleft: lateral neck
Thyroglossal: (most common = tongue) midline neck, moves with swallowing, most common congenital neck cyst, commonly assoc with ectopic thyroid tissue

Front 115

What are the common possible presenting features of tuberous sclerosis?

Back 115

Distinctive brown, fibrous plaque on the forehead seen in infancy
Ash leaf spots (hypopigmented macules) → most easily seen with Wood’s lamp
Shagreen patch (leathery cutaneous thickening usually on the lower trunk)
Facial angiofibromas (AKA adenoma sebaceum)
Seizures
Mental Retardation



My notes:
Seizures, shagreen path, sebaceous adenoma, “ash leaf” spots, mental retardation
Hamartomas (mass of tissue in endogenous location) - in CNS, skin, organs
Assoc cancers: “Angie, the astronaut, made a rap (rhabdo) about her heart and kidney” also think – when in space as an astronaut, your heart hurts b/c you miss your family & your kidney hurts cuz its hard to pee”
Cardiac rhabdomyoma
Renal angiomyolipoma
Astrocytoma

Front 116

Lactic acidosis, hyperlipidemia, hyperuricemia (gout)

Back 116

Type I
(Von Gierkes Disease)

Front 117

Diaphragm weakness → respiratory failure

Back 117

Type II
(Pompe’s Disease)

Front 118

↑ glycogen in liver, severe fasting hypOglycemia

Back 118

Type I
(Von Gierkes Disease)

Front 119

Hepatomegaly, hypOglycemia, hyperlipidemia (normal kidneys, lactate, uric acid)

Back 119

Type III
Cori Disease

Front 120

Painful muscle cramps, myoglobinuria with strenuous exercise

Back 120

Type V
(McArdle’s)

Front 121

Severe hepatosplenomegaly, enlarged kidneys

Back 121

Type I
(Von Gierkes Disease)

Front 122

What malignancy is a/w Down syndome?

Back 122

Acute lymphocytic leukemia (ALL) – “we ALL fall DOWN”

Front 123

What GI complications are a/w Down syndrome?

Back 123

Duodenal atresia
Hirschsprung’s disease
Annular pancreas
Celiac Disease

Front 124

What is WAGR syndrome?

Back 124

Wilm’s tumor
Aniridia
Genital abnormalities
Retardation

Front 125

What is the most common cause of congenital mental retardation in men?

Back 125

Fragile X Syndrome

Front 126

A child presents with short palpebral fissures, a thin upper lip, smooth filtrum, and a flattened midface. He is below the 10th percentile for height & weight and his IQ is 65. What is the cause of his abnormalities? What could have been done to prevent them?

Back 126

Dx: Fetal alcohol syndrome
Prevent – Don’t drink!

Front 127

Congenital heart defect + low calcium + recurrent infections

Back 127

DiGeorge Syndrome

Front 128

Chronic mucocutaneous candidiasis + chronic diarrhea + FTT

Back 128

SCID

Front 129

Thrombocytopenia + eczema + recurrent infections

Back 129

Wiskott-Aldrich

Front 130

Poor smooth pursuit of eyes + elevated AFP after 8 months

Back 130

Ataxia Telangiectasia

Front 131

Partial albinism + recurrent URIs + neurologic disorders

Back 131

Chédiak- Higashi Disease

Front 132

Cleft lip/palate, life expectancy < 1 yr, polydactyly

Back 132

Trisomy 13

Front 133

High-pitched cat-like cry

Back 133

Cri du chat

Front 134

Elfin facial features, cardiac defects

Back 134

William Syndrome

Front 135

Tall, thin male with gynecomastia and testicular atrophy

Back 135

Klinefelter Syndrome

Front 136

Obesity & overeating

Back 136

Prader Willi

Front 137

Micrognathia, life expectancy < 1 yr, rocker-bottom feet

Back 137

Trisomy 18

Front 138

Happy mood, inappropriate laughter, ataxic gait

Back 138

Angelman syndrome

Front 139

Large ears, MR, macroorchidism

Back 139

Fragile X

Front 140

MR, Simian crease, GI & Cardiac defects

Back 140

Trisomy 21

Front 141

Short stature, infertility, coarctation of aorta

Back 141

Turner Syndrome (XO)

Front 142

When do infections typically begin in children with immune disorders?

Back 142

After first 3 months of life

Front 143

What are the current screening recommendations for breast cancer in average risk women?

Back 143

- Ages 40-49: Screening mammogram q 1-2 yrs +/- clinical breast exam
- Benefits of screening in this age group are uncertain, but most all expert groups recommend screening of this age group (ACS, AMA, ACOG, AAFP…)
- Every group agrees that at least offering a mammogram and shared decision making for this age range is appropriate
- Ages 50-69: Screening mammogram q1-2 years +/- clinical breast exam
- Proven benefits and all expert groups agree here
- Ages 70+ and life expectancy > 10 years → screening mammogram q 1-2 years +/- clinical breast exam

Front 144

What is the USPSTF recommendation for hypertension screening?

Back 144

Every 2 years in normotensive pts, starting at age 18

Front 145

What is the USPSTF recommendation for cholesterol screening in pts without CAD risk factors?

Back 145

Start at age 35 in men
Start at age 45 in women

Front 146

What specific interventions are helpful in smoking cessation?

Back 146

Front 147

How often should a normotensive pt get their BP checked?

Back 147

Every 2 years starting at age 18 years

Front 148

When should you start screening for high cholesterol in otherwise healthy patients?

Back 148

Men: after age 35
Women: after age 45

Front 149

Which medication for smoking cessation carries a black box warning about its side effect of suicidality?

Back 149

Varencicline (Chantix)

Front 150

What smoking cessation method doubles the quit rate?

Back 150

Nicotine replacement therapy

Front 151

What symptoms of vitamin deficiency do you get if you haven’t have enough folate? Vit A? VIt D? E? B3?

Back 151

Folate:
Neural tube defects
Megaloblastic anemia
Vit A:
Bitot’s spots
Keratomalacia
Xerothalmia
Vit D: osteomalacia, Rickets
Vit E: ↑ RBC fragility
Vit B3: Dermatitis, Diarrhea, Dementia

Front 152

What vitamin can be used to treat psoriasis?

Back 152

Vit D analogs

Front 153

Which vitamin deficiency:

↑ RBC fragility

Back 153

Vit E

Front 154

Which vitamin deficiency:
Dermatitis, cheilosis, glossitis

Back 154

Iron Def & B2, B3

Front 155

Which vitamin deficiency:
Peripheral neuropathy, angular cheilosis, glossitis

Back 155

B12

Front 156

Which vitamin deficiency:
Hemorrhagic disease

Back 156

Vit K

Front 157

Which vitamin deficiency:
Dermatitis, Diarrhea, Dementia

Back 157

B3 (niacin)

Front 158

Which vitamin deficiency:
Megaloblastic anemia

Back 158

Folate/ B12

Front 159

Which vitamin deficiency:
Pernicious anemia

Back 159

B12

Front 160

Which vitamin deficiency:
Bitot’s spots, keratomalacia, xerophthalmia

Back 160

Vit A

Front 161

Which vitamin deficiency:
Osteomalacia, Rickets

Back 161

Vit D

Front 162

Which vitamin:

Can be used to treat acne & psoriasis

Back 162

Vit A

Front 163

Which vitamin:
Involved in the hydroxylation of prolyl residues

Back 163

Vit C

Front 164

Which vitamin:
Requires intrinsic factor for absorption

Back 164

B12 (Cobalamine)

Front 165

Which vitamin:
Deficiency may result from kidney disease

Back 165

Vit D

Front 166

Which vitamin:
Given prophylactically to newborns

Back 166

Vit K

Front 167

Which vitamin:
Can be used to elevate HDL and lower LDL

Back 167

B3 (niacin)

Front 168

Which vitamin:
Deficiency can be caused by isoniazid use

Back 168

B6 (pyridoxine)

Front 169

Which vitamin:
Cobalt is found within this vitamin

Back 169

B12