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Abstract
Portable and high yield, Pediatric Secrets is perfect for use in clinical rotations, exam prep, or as a handy clinical reference. Drs. Richard A. Polin and Mark F. Ditmar present the essential questions and answers to help you better meet the challenges you face every day, while updated chapters highlight the latest standards in pediatric care. A bestselling volume in the Secret Series®, its Q&A format, helpful lists and tables, mnemonics, and informal tone combine to make reference fast, easy, and enjoyable.
- "Key Points" boxes and a highly detailed index allow you to find information quickly and easily.
- Unique Q&A format expedites learning and retention.
- Top 100 Secrets section combines the top 100, high-yield facts into one chapter, providing a concise overview of the latest issues in pediatrics.
- High-yield content is ideal for exam preparation.
- Provides the current standards of care for pediatric students and practitioners.
- Updated chapters reflect the latest advances in pediatrics.
- Medicine eBook is accessible on a variety of devices.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | Cover | ||
Inside Front Cover | ES2 | ||
Pediatric Secrets | iii | ||
Copyright | iv | ||
Preface | v | ||
Contributors | vi | ||
Contents | x | ||
Top 100 secrets | 1 | ||
Chapter 1: Adolescent Medicine | 7 | ||
clinical issues | 7 | ||
1. What are the three leading causes of mortality in adolescents? | 7 | ||
2. How common is dating violence among adolescents? | 7 | ||
3. Which sports cause the greatest number of concussions in teenagers? | 7 | ||
4. Which diagnoses require mandatory disclosure regardless of confidentiality? | 7 | ||
5. How does the ``HEADS´´ mnemonic assist in adolescent interviewing? | 7 | ||
6. When does sexual orientation usually emerge? | 8 | ||
7. What characterizes gender identity, gender expression, and gender dysphoria? | 8 | ||
8. What health disparities are particular to LGBTQ youth? | 8 | ||
9. How may social media impact adolescent behavior? | 8 | ||
10. What is cyberbullying? | 8 | ||
11. Which teenagers <18 years can give consent for their medical care? | 8 | ||
Eating disorders | 9 | ||
12. How is the diagnosis of anorexia nervosa made? | 9 | ||
13. What are signs of anorexia nervosa on physical examination? | 9 | ||
14. What are the differential diagnoses that one must consider when evaluating a patient with anorexia nervosa? | 9 | ||
15. What are good and bad prognosticators for recovery from anorexia? | 9 | ||
16. Why are adolescent girls with anorexia nervosa at risk for low bone mineral density? | 9 | ||
17. What are the clinical differences between males and females with anorexia nervosa? | 9 | ||
18. What electrolyte disturbances occur in patients with severe anorexia nervosa and what are the potential clinical effects? | 10 | ||
19. What causes sudden death in patients with anorexia nervosa? | 10 | ||
20. What are indications for hospital admission for a patient with anorexia nervosa? | 10 | ||
21. What are the medical complications of bulimia nervosa? | 10 | ||
22. An 11-year-old with weight loss due to avoidance of food because of its sensory characteristics has what condition? | 11 | ||
23. What is the primary biochemical feature of the refeeding syndrome? | 11 | ||
24. Name the three features that constitute the ``female athlete triad.´´ | 11 | ||
Menstrual disorders | 12 | ||
25. What is the median age of menarche in the United States? | 12 | ||
26. How do you define a normal menstrual cycle? | 12 | ||
27. What is the physiology of a normal menstrual cycle? | 12 | ||
28. What is the difference between primary and secondary amenorrhea? | 12 | ||
29. What is the value of a progesterone challenge test in a patient with amenorrhea? | 12 | ||
30. What are some of the causes of amenorrhea in adolescents? | 12 | ||
31. How do you define the different types of ``rrhagias´´? | 12 | ||
32. What is the differential diagnosis of heavy menstrual bleeding? | 12 | ||
33. You see an 18-year-old female who comes to your office complaining of 10 days of heavy menstrual bleeding, including s ... | 14 | ||
34. What are the two key clinical features that determine the management of abnormal uterine bleeding? | 14 | ||
35. How would you treat a patient with heavy menstrual bleeding? | 14 | ||
36. You see a 16-year-old overweight female who reports having irregular periods, acne, and having to remove hair on her u ... | 14 | ||
37. How common is dysmenorrhea? | 14 | ||
38. Does dysmenorrhea occur more commonly in early or late adolescence? | 14 | ||
39. What is the difference between primary and secondary dysmenorrhea? | 14 | ||
40. What two classes of medications are most commonly used for dysmenorrhea? | 15 | ||
41. What is a common cause of chronic pelvic pain in adolescents without a history of pelvic inflammatory disease (PID)? | 15 | ||
42. What is the peak age for ovarian torsion? | 15 | ||
43. In what setting should ectopic pregnancy be suspected? | 15 | ||
Obesity | 16 | ||
44. What is the body mass index (BMI)? | 16 | ||
45. How predictive is early childhood obesity of later adolescent obesity? | 16 | ||
46. What are some of the health risk factors related to obesity? | 16 | ||
47. What variety of factors may contribute to obesity? | 17 | ||
48. What features on physical examination are particularly important in the evaluation of the obese patient? | 17 | ||
49. How does sleep affect weight? | 17 | ||
50. What are the diagnostic criteria for the metabolic syndrome? | 17 | ||
51. Why is a short obese 11-year-old of more clinical concern than a tall obese 11-year-old? | 17 | ||
52. What are some key points when discussing weight reduction counseling and management with a teenager? | 18 | ||
53. What are the indications for bariatric surgery in adolescents? | 18 | ||
Sexual development | 18 | ||
54. What is Tanner staging for boys? | 18 | ||
55. What is the normal progression of sexual development and growth for boys during puberty? | 19 | ||
56. What are the ranges of normal in the stages of pubertal development in girls? | 19 | ||
57. What is the normal progression of sexual development and growth for girls during puberty? | 20 | ||
58. Has the age of menarche declined in the United States during the century? | 20 | ||
59. When do boys develop the ability to reproduce? | 20 | ||
60. How is delayed puberty defined? | 20 | ||
61. Why should the sense of smell be tested in a teenager with delayed puberty? | 20 | ||
62. What is the most common cause of delayed puberty? | 20 | ||
63. What features suggest constitutional delay of puberty? | 21 | ||
64. Which laboratory tests should you consider in a boy or girl with delayed puberty? | 21 | ||
65. What is the most common cause of primary gonadal failure in boys? | 21 | ||
66. Can puberty be safely accelerated? | 21 | ||
67. How do you evaluate a breast lump noted by a teenage girl on self-examination? | 21 | ||
68. Should breast self-examination be taught and emphasized for all teenage girls? | 22 | ||
Sexually transmitted infections | 22 | ||
69. How does the prevalence of sexually transmitted infections (STIs) in adolescents compare with that of adults? | 22 | ||
70. What is the best way to screen for STIs? | 22 | ||
71. What is the most common STI in sexually active adolescent females? | 23 | ||
72. How should we screen for STIs in adolescent females? | 23 | ||
73. How should we screen for STIs in adolescent males? | 23 | ||
74. Are pelvic examinations with specula always required to obtain specimens for STI diagnosis in teenagers? | 23 | ||
75. Which STI is most closely linked to cervical cancer? | 23 | ||
76. What are the manifestations of HPV infection? | 23 | ||
77. When are Pap smears indicated in teenagers? | 24 | ||
78. Describe the appearance of condylomata acuminata | 24 | ||
79. What is the natural history of genital warts? | 24 | ||
80. What is the typical presentation of chlamydial genital infections in both female and male teenagers? | 24 | ||
81. What is the typical appearance of N. gonorrhoeae on Gram stain? | 25 | ||
82. What are the minimal criteria for the diagnosis of PID? | 25 | ||
83. What additional criteria support the diagnosis of PID? | 25 | ||
84. Which adolescents with PID should be hospitalized for intravenous antibiotics? | 25 | ||
85. What are the common causative pathogens for PID? | 26 | ||
86. A sexually active 17-year-old girl with adnexal and RUQ tenderness probably has what condition? | 26 | ||
87. What are the sequelae of PID? | 26 | ||
88. How are the genital ulcer syndromes differentiated? | 26 | ||
89. What are risk factors for the acquisition of genital ulcer disease? | 27 | ||
90. What are the main differences between HSV-1 and HSV-2? | 27 | ||
91. How do recurrent episodes of genital herpes simplex infections compare with the primary episode? | 27 | ||
92. How are the three most common causes of postpubertal vaginitis clinically distinguished? | 28 | ||
93. How does the vaginal pH help determine the cause of a vaginal discharge? | 28 | ||
94. How does evaluation of the vaginal discharge help identify the etiology? | 28 | ||
95. How is trichomoniasis diagnosed? | 28 | ||
96. If a patient is receiving a standard treatment for a trichomonal infection, why should alcohol be avoided? | 29 | ||
97. What are ``clue cells | 29 | ||
98. What is the etiology of bacterial vaginosis? | 29 | ||
99. What are the criteria for the diagnosis of bacterial vaginosis? | 29 | ||
100. What is expedited partner therapy? | 29 | ||
101. What are CDC treatment recommendations for common STIs? | 29 | ||
Substance abuse | 30 | ||
102. What are the categories of abused drugs? | 30 | ||
103. What is the CRAFFT screen? | 31 | ||
104. What are characteristic physical signs of illicit drug use? | 31 | ||
105. Should an adolescent be screened for drug abuse without his or her consent? | 32 | ||
106. How long do illicit drugs remain detectable in urine specimens? | 32 | ||
107. What is the genetic predisposition for alcoholism? | 33 | ||
108. What are other individual risk factors for alcohol abuse? | 33 | ||
109. Which type of substance abuse is more common in younger adolescents than older adolescents? | 33 | ||
110. What is the leading cause of fatality related to inhalant abuse? | 33 | ||
111. What are the toxicities of chronic marijuana use? | 33 | ||
112. Is marijuana a ``gateway´´ drug? | 33 | ||
113. What performance-enhancing drugs are used by teenagers? | 33 | ||
114. What are the potential side effects of anabolic steroids? | 34 | ||
115. When does cigarette smoking begin? | 34 | ||
116. What are the main reasons that cigarette smoking begins? | 34 | ||
117. What are the risks of chewing tobacco? | 34 | ||
118. What are the risks of E-cigarette use among adolescents? | 34 | ||
119. What are the 5 ``As´´ of smoking cessation counseling? | 35 | ||
120. Are tattoos a tip-off to high-risk behaviors? | 35 | ||
Teenage male disorders | 35 | ||
121. How common is gynecomastia in teenage boys? | 35 | ||
122. Why does gynecomastia occur so commonly in young teenage boys? | 35 | ||
123. Which boys with gynecomastia warrant further evaluation? | 35 | ||
124. What are the clinical manifestations of testicular torsion? | 36 | ||
125. When is testicular torsion likely to occur? | 36 | ||
126. How is testicular torsion diagnosed? | 36 | ||
127. How is testicular torsion treated? | 36 | ||
128. If complete testicular torsion has occurred, how long is it before irreversible changes develop? | 36 | ||
129. How is testicular torsion clinically differentiated from other causes of the acute painful scrotum? | 36 | ||
130. How does the Prehn sign help distinguish between epididymitis and testicular torsion? | 37 | ||
131. What is the most frequent solid cancer in older adolescent males? | 37 | ||
132. What is the significance of a varicocele in a teenager? | 37 | ||
133. Which varicoceles warrant surgical intervention? | 37 | ||
134. On which side do varicoceles more commonly occur? | 37 | ||
135. What is the difference between phimosis and paraphimosis? | 37 | ||
136. What are pearly penile papules and should a teen worry about them? | 37 | ||
Teenage pregnancy and contraception | 38 | ||
137. What are trends in teenage pregnancy in the United States? | 38 | ||
138. What factors make it more likely that a teenager will become pregnant? | 38 | ||
139. If a teenager has been pregnant once, how likely is she to become pregnant again during her teenage years? | 38 | ||
140. What are the risks for infants of teenage mothers? | 38 | ||
141. How soon after conception will a urine pregnancy test become positive? | 38 | ||
142. Which contraceptive methods are appropriate for adolescents? | 39 | ||
143. What are contraindications to the use of estrogen-containing contraceptive methods? | 39 | ||
144. How likely are teenagers to use contraception? | 39 | ||
145. Is a pelvic examination mandatory before starting a patient on contraception? | 40 | ||
146. What oral treatment is most commonly used for emergency postcoital contraception? | 40 | ||
Teenage suicide | 40 | ||
147. What is the main predictor of suicidal ideation in teenagers? | 40 | ||
148. How often do adolescents attempt suicide in the United States? | 40 | ||
149. Who are more likely to attempt suicide, males or females? | 40 | ||
150. Which adolescents are at increased risk for suicide? | 41 | ||
151. Is a 16-year-old female able to give consent for treatment of a sexually transmitted infection (STI) in most states? | 41.e1 | ||
152. What drugs are associated with gynecomastia? | 41.e1 | ||
153. What is the Maudsley Method for treating anorexia nervosa? | 41.e1 | ||
154. If a teenager has infectious mononucleosis (IM), how likely is she to develop chronic fatigue syndrome (CFS)? | 41.e1 | ||
155. What is binge eating disorder? | 41.e1 | ||
156. A teenage girl develops migratory polyarthritis, fever, and scattered petechial lesions several days before menses. ... | 41.e1 | ||
157. How is the diagnosis of PID definitively made? | 41.e1 | ||
158. What are the two subtypes of anorexia nervosa? | 41.e2 | ||
159. What hormonal abnormalities may be seen in anorexia nervosa? | 41.e2 | ||
160. How is the diagnosis of bulimia nervosa made? | 41.e2 | ||
161. What modalities are used to treat eating disorders? | 41.e2 | ||
162. How should a very anemic teenager with abnormal uterine bleeding and orthostatic signs be managed? | 41.e2 | ||
163. How effective is treatment for bacterial vaginosis? | 41.e3 | ||
164. Why do more ovarian torsions occur on the right than the left? | 41.e3 | ||
165. Is ultrasonography typically diagnostic in the setting of ovarian torsion? | 41.e3 | ||
Chapter 2: Behavior and Development | 42 | ||
Attention-deficit/hyperactivity disorder | 42 | ||
1. What are the characteristics of attention-deficit/hyperactivity disorder (ADHD)? | 42 | ||
2. How common is ADHD? | 42 | ||
3. Are boys or girls more likely to be diagnosed with ADHD? | 42 | ||
4. Is there a genetic predisposition to ADHD? | 42 | ||
5. What conditions can mimic ADHD? | 42 | ||
6. Is there a definitive diagnostic test for ADHD? | 43 | ||
7. How should ADHD be treated? | 43 | ||
8. What are the best medications for treating ADHD? | 43 | ||
9. Is a positive response to stimulant medication diagnostic of ADHD? | 43 | ||
10. Is an electrocardiogram (ECG) required before beginning patients on stimulant medication for ADHD? | 43 | ||
11. How young is ``too young´´ to diagnose ADHD and prescribe stimulant medications? | 43 | ||
12. What are the risks for adolescents with ADHD? | 44 | ||
13. Does sugar or food additives make children hyperactive? | 44 | ||
14. Are complementary or alternative medicine (CAM) therapies beneficial for ADHD? | 44 | ||
15. Do children with ADHD become teenagers and adults with ADHD? | 44 | ||
Autism | 45 | ||
16. What is the DSM-5? | 45 | ||
17. How did classifications change for disorders of autism in the DSM-5? | 45 | ||
18. What are the two essential features of autism? | 45 | ||
19. Which behaviors of children should arouse suspicion of possible autism? | 45 | ||
20. When should screening be done for autism? | 45 | ||
21. What studies should be considered in the evaluation of a child with suspected autism? | 46 | ||
22. What accounts for the apparent increase in autism in the United States? | 46 | ||
23. Do vaccines cause autism? | 46 | ||
24. Does early intervention and/or therapy improve the outcome in children with autism? | 46 | ||
Behavior problems | 47 | ||
25. What are the most common types of behavior problems in children? | 47 | ||
26. How much do babies normally cry each day? | 47 | ||
27. What is infantile colic? | 47 | ||
28. What causes colic? | 47 | ||
29. Are there any treatments that are useful for colic? | 47 | ||
30. What evaluations should be done for the excessively crying infant? | 47 | ||
31. How should children be punished? | 48 | ||
32. How valid is the proverb ``spare the rod and spoil the child´´ as a defense for corporal punishment? | 48 | ||
33. Is physical injury a concern in children with head banging? | 48 | ||
34. What is the difference between a ``blue´´ breath-holding spell and a ``white´´ breath-holding spell? | 48 | ||
35. When should a diagnosis of seizure disorder be considered rather than a breath-holding spell? | 48 | ||
36. Does treatment with iron decrease the frequency of breath-holding spells? | 49 | ||
37. When does prolonged thumb-sucking warrant intervention? | 49 | ||
38. What treatments are used for thumb-sucking? | 49 | ||
39. When should ``toilet training´´ be started? | 49 | ||
40. Are girls or boys toilet trained earlier? | 49 | ||
Cranial disorders | 49 | ||
41. How many fontanels are present at birth? | 49 | ||
42. When does the anterior fontanel close? | 49 | ||
43. Which conditions are most commonly associated with premature or delayed closure of the fontanel? | 50 | ||
44. When is an anterior fontanel too big? | 50 | ||
45. What are the types of primary craniosynostosis? | 50 | ||
46. What is the most common type of primary craniosynostosis? | 50 | ||
47. What causes craniosynostosis? | 51 | ||
48. What is positional or deformational plagiocephaly? | 51 | ||
49. How is positional plagiocephaly differentiated from plagiocephaly caused by craniosynostosis? | 51 | ||
50. What conditions are associated with skull softening? | 51 | ||
51. What is the significance of craniotabes? | 52 | ||
52. What evaluations should be done in a child with microcephaly? | 52 | ||
53. What are the three main general causes of macrocephaly? | 52 | ||
Dental development and disorders | 53 | ||
54. When do primary and permanent teeth erupt? | 53 | ||
55. What is the significance of natal teeth? | 53 | ||
56. How common is the congenital absence of teeth? | 53 | ||
57. What are mesiodentes? | 53 | ||
58. What is the significance of an infant presenting with a single central upper tooth? | 53 | ||
59. What is a ranula? | 54 | ||
60. Where are Epstein pearls located? | 54 | ||
61. What is the most common chronic disease of childhood? | 54 | ||
62. What are milk-bottle caries? | 54 | ||
63. How does fluoride minimize the development of dental caries? | 54 | ||
64. What is fluorosis? | 55 | ||
65. How long should fluoride supplementation be continued? | 55 | ||
66. How effective are dental sealants for preventing cavities? | 55 | ||
67. How common is gingivitis in children? | 55 | ||
68. What is the largest health-related expense before adulthood for normally developing children? | 55 | ||
69. What causes halitosis is children? | 55 | ||
70. Pacifiers: friend or foe? | 56 | ||
Developmental assessment | 56 | ||
71. What aspects of development are typically monitored? | 56 | ||
72. What are primitive reflexes? | 56 | ||
73. What three primitive reflexes, if persistent beyond 4 to 6 months, can interfere with the development of the ability ... | 56 | ||
74. At what age do children develop handedness? | 56 | ||
75. What percentage of children are left-handed? | 56 | ||
76. Are there ethnic differences in development in the first year of life? | 57 | ||
77. What are the major developmental landmarks for motor skills during the first 2 years of life? | 57 | ||
78. How valuable is the timing of crawling as a marker of development? | 57 | ||
79. What are the most common causes of gross motor delay? | 57 | ||
80. What are major red flags that a childs development is abnormal? | 57 | ||
81. What features suggest a possible metabolic cause for disordered development? | 58 | ||
82. Do infant walkers promote physical strength or development of the lower extremities? | 58 | ||
83. Do twins develop at a rate that is comparable to infants of single birth? | 58 | ||
84. Do premature infants develop at the same rate as term infants? | 58 | ||
85. When can an infant smell? | 59 | ||
86. What are the best measures of cognitive development? | 59 | ||
87. What do the stages of play tell us about a child's development? | 59 | ||
88. What can one learn about a child's developmental level with regard to the use of a crayon? | 59 | ||
89. What is the value of the Goodenough-Harris drawing test? | 60 | ||
90. What are key physical exam features in the evaluation of a child with possible developmental delay? | 60 | ||
91. In infants with global developmental delay, what are the likely causes? | 60 | ||
92. What factors increase the likelihood of finding a potentially progressive disease in patients with global delay? | 60 | ||
Language development and disorders | 60 | ||
93. What are average times for the development of expressive, receptive, and visual language milestones? | 60 | ||
94. What are signs of significantly delayed receptive and expressive speech warranting evaluation? | 61 | ||
95. Do deaf infants babble? | 61 | ||
96. At what age does a child's speech become intelligible? | 61 | ||
97. What are the most common causes of so-called delayed speech? | 61 | ||
98. What risk factors make hearing loss more likely in a newborn or young infant? | 61 | ||
99. What causes flat tympanograms? | 62 | ||
100. A toddler with a bifid uvula and hypernasal speech most likely has what condition? | 62 | ||
101. When is stuttering abnormal? | 63 | ||
102. What advice should be given to parents of a child who stutters? | 63 | ||
103. Which infants with ``tongue tie´´ should have surgical correction? | 63 | ||
Mental retardation/intellectual disability | 64 | ||
104. Why is the term mental retardation being changed? | 64 | ||
105. How is intellectual disability defined? | 64 | ||
106. How is intelligence classified with IQ scores? | 64 | ||
107. What features can indicate cognitive problems in infants and young children? | 64 | ||
108. Worldwide, what is the most common preventable cause of intellectual disability? | 65 | ||
Psychiatric disorders | 65 | ||
109. What is the prevalence of childhood psychiatric disorders? | 65 | ||
110. What items constitute the ``11 Action Signs´´? | 65 | ||
111. If a parent has an affective disorder, what is the likelihood that an offspring will have similar problems? | 66 | ||
112. How does mania differ in children and adolescents? | 66 | ||
113. What ritualistic behaviors are common in children with obsessive-compulsive disorder? | 66 | ||
114. What are the differences between child-onset OCD and adult-onset OCD? | 66 | ||
115. What distinguishes a conduct disorder from an oppositional defiant disorder? | 67 | ||
116. What are common symptoms of depression in children and adolescents? | 67 | ||
117. How is major depressive disorder in children diagnosed? | 67 | ||
118. What are treatments for major depressive disorder in children and adolescents? | 67 | ||
119. How likely is it that a depressed teenager will be a depressed adult? | 67 | ||
120. What are types of anxiety disorders in children? | 67 | ||
121. Which is preferable for children with anxiety disorders, cognitive behavioral therapy (CBT) or medication? | 68 | ||
122. What characterizes bipolar disorder? | 68 | ||
Psychosocial family issues | 68 | ||
123. How likely is it that children in the United States will experience the separation or divorce of their parents? | 68 | ||
124. How do children of different ages vary in their response to parental divorce? | 68 | ||
125. What factors are central to a good outcome after a divorce? | 68 | ||
126. What is the ``vulnerable child syndrome´´? | 69 | ||
127. How does the cognitive understanding of death evolve? | 69 | ||
128. Should adopted children be informed of their adoption? | 69 | ||
129. How common is domestic violence? | 69 | ||
130. Who are ``latchkey´´ children? | 69 | ||
131. What are the effects of heavy television watching in young children? | 70 | ||
School problems | 70 | ||
132. How is ``learning disability´´ defined? | 70 | ||
133. What distinguishes dyslexia, dyscalculia, and dysgraphia? | 70 | ||
134. What are clues that a school-age child may have dyslexia? | 70 | ||
135. How are the two types of school avoidance behaviors distinguished? | 71 | ||
136. How much of a problem are bullies? | 71 | ||
Sleep problems | 71 | ||
137. What is the average daily sleep requirement by age? | 71 | ||
138. Why is the supine sleeping position recommended for infants? | 71 | ||
139. When do infants begin to sleep through the night? | 71 | ||
140. What advice to parents may minimize the problem of night waking? | 71 | ||
141. How common are sleep problems in elementary school-age children? | 72 | ||
142. What are parasomnias? | 72 | ||
143. At what age do sleepwalking and sleeptalking occur? | 72 | ||
144. What is the difference between nightmares and night terrors? | 72 | ||
145. What recommendation should be given to a parent whose child is having night terrors? | 72 | ||
Visual development and disorders | 72 | ||
146. How well does a newborn see? | 72 | ||
147. Do babies make tears? | 72 | ||
148. At what age does an infant's eye color assume its permanent color? | 73 | ||
149. A 2-week-old infant with intermittent eye discharge and clear conjunctiva has what likely diagnosis? | 73 | ||
150. What are the valves of Rosenmüller and Hasner? | 73 | ||
151. What is normal visual acuity for children? | 73 | ||
152. When do binocular fixation and depth perception develop in children? | 73 | ||
153. How does refractive capacity vary with age? | 74 | ||
154. How are the degrees of blindness classified? | 74 | ||
155. What is strabismus? | 74 | ||
156. A 2-month-old baby is noted to have eyes that appear to turn outward rather than looking forward. Is this strabismus? | 74 | ||
157. Name the types of childhood strabismus | 75 | ||
158. What separates pseudostrabismus from true strabismus? | 75 | ||
159. What is amblyopia? | 76 | ||
160. What are the causes of amblyopia? | 76 | ||
161. Which treatments are effective for amblyopia? | 76 | ||
162. What is the red reflex test? | 76 | ||
163. Why are early diagnosis and treatment critical for patients with congenital cataracts? | 76 | ||
164. What is ectopia lentis? | 76 | ||
165. What diseases may present with a white pupil? | 76 | ||
166. How common are unequally sized pupils? | 77 | ||
167. Is heterochromia normal? | 77 | ||
168. When are children aware of color differences? | 77 | ||
169. How is color blindness inherited? | 77 | ||
170. What are the comorbid disorders commonly seen with ADHD? | 77.e1 | ||
171. When is masturbation in a child considered pathologic? | 77.e1 | ||
172. Does participation in day care during infancy and the toddler years have negative effects on cognitive development? | 77.e1 | ||
173. In addition to learning disabilities, what factors may contribute to academic underachievement? | 77.e1 | ||
Chapter 3: Cardiology | 78 | ||
Clinical issues | 78 | ||
1. Is cardiac pathology the most common cause of chest pain in children? | 78 | ||
2. What is the clinical distinction between costochondritis and Tietze syndrome? | 78 | ||
3. What are potential red flags that increase the likelihood of a cardiac cause for chest pain? | 78 | ||
4. A child with sharp, stabbing, very localized chest pain that occurs at rest and resolves completely without associated... | 78 | ||
5. What is the significance of mitral valve prolapse (MVP)? | 79 | ||
6. What connective tissue diseases may be associated with MVP? | 79 | ||
7. What are the common types of vascular rings and slings? | 79 | ||
8. What evaluations are commonly done if a vascular ring is suspected? | 80 | ||
9. Describe four categories of cardiomyopathy in children | 80 | ||
10. What mineral is added to hyperalimentation fluids to prevent a potential cardiomyopathy? | 81 | ||
11. What are the cardiac causes of sudden cardiac death in children and adolescents? | 81 | ||
12. What historical features may identify the patient who is at risk for sudden death? | 81 | ||
13. What features in the preparticipation sports physical examination identify patients at risk for sudden death? | 81 | ||
14. Should an electrocardiogram (ECG) be included in the preparticipation screening of young athletes? | 81 | ||
15. Name five disorders in which a screening ECG might identify a subject at risk for sudden death | 82 | ||
16. What is the likely diagnosis in a 10-year-old little leaguer who develops sudden cardiac arrest after being struck in... | 82 | ||
17. In which patients is syncope more likely to be of a cardiac nature? | 82 | ||
18. What arrhythmias may be associated with syncope? | 82 | ||
19. What are the most common clinical signs of coarctation of the aorta (Fig.3-2) in older children? | 83 | ||
20. How much does peak exercise affect cardiac output? | 83 | ||
21. What cardiac lesions can lead to thrombosis and stroke? | 83 | ||
22. What are two of the more common neuromuscular diseases in which a cardiac consultation is routinely recommended? | 84 | ||
23. Why are chemotherapeutic agents that use arsenic of cardiac concern? | 84 | ||
Congenital heart disease | 84 | ||
24. What prenatal maternal factors may be associated with cardiac disease in the neonate? | 84 | ||
25. In a cyanotic newborn, what test can help distinguish pulmonary disease from cyanotic congenital heart disease (CHD)? | 84 | ||
26. Which congenital heart lesions commonly appear with cyanosis during the newborn period? | 85 | ||
27. In the patient with suspected heart disease, what bony abnormalities seen on a chest radiograph increase the likelihoo ... | 85 | ||
28. How do pulmonary vascular markings on a chest radiograph help in the differential diagnosis of a cyanotic newborn with ... | 85 | ||
29. What ECG findings suggest specific congenital heart conditions? | 85 | ||
30. What chest radiograph findings (Fig.3-3) are considered characteristic for various CHDs? | 86 | ||
31. What are the common ductal-dependent cardiac lesions? | 86 | ||
32. What types of CHDs are associated with the right aortic arch? | 86 | ||
33. Name 5 different types of left ventricular outflow tract stenosis | 86 | ||
34. Which genetic syndromes are most commonly associated with CHD? | 86 | ||
35. Which infants with CHD should be evaluated for other anomalies? | 87 | ||
36. Describe the clinical manifestations of a large patent ductus arteriosus (PDA) | 87 | ||
37. How commonly do PDAs occur in premature infants? | 87 | ||
38. Is a ``to-and-fro´´ murmur a good description for the heart murmur of a PDA? | 87 | ||
39. How can you explain a PaO2 of more than 400mm Hg in a blood sample from an umbilical catheter in a newborn with transp ... | 88 | ||
40. How do the presenting symptoms of ventricular septal defect (VSD) and atrial septal defect (ASD) differ? | 88 | ||
41. What is the primary concern of the pediatric cardiologist if a child with a large VSD is lost to follow-up and comes ... | 88 | ||
42. What are some of the common presenting symptoms in older children with primary pulmonary hypertension? | 88 | ||
43. What examination features are suggestive of pulmonary hypertension? | 88 | ||
44. What is the anomaly in Ebstein anomaly? | 88 | ||
45. What are the four structural abnormalities of tetralogy of Fallot? | 88 | ||
46. What occurs during a ``Tet spell´´? | 88 | ||
47. Name two conditions in which the murmur has disappeared or diminished in intensity and yet the patient is actually worse | 89 | ||
48. After what age does a presumed peripheral pulmonic branch stenosis murmur deserve more detailed study? | 89 | ||
49. What is the role of pulse oximetry in screening for complex congenital heart disease (CCHD) in asymptomatic infants i... | 89 | ||
50. What is the AAP screening protocol for CCHD using pulse oximetry? | 89 | ||
51. Which ductal-dependent lesions are the AAPs primary targets for screening with the use of pulse oximetry? | 90 | ||
52. What should parents be told about the risk for recurrence of common heart defects? | 90 | ||
53. Can you think of a ``handy´´ way to remember the congenital cyanotic heart diseases? | 90 | ||
Congestive heart failure | 90 | ||
54. Identify the clinical signs and symptoms associated with CHF in children. | 90 | ||
55. How is heart size assessed in older children? | 90 | ||
56. In infancy, how does the likely cause of CHF vary by age? | 90 | ||
57. What are the typical ages for the presentation of CHF with CHD? | 92 | ||
58. If a patient develops CHF and cardiomegaly during the newborn period, but no heart murmur is heard, what is the diffe... | 92 | ||
59. If a patient develops CHF and cardiomegaly after the newborn period, but no murmur is heard, what is the differential... | 92 | ||
Electrocardiograms and arrhythmias | 92 | ||
60. How does the ECG of a term infant differ from that of the older child? | 92 | ||
61. What are the characteristic features of the ECG of a premature infant? | 92 | ||
62. Describe the ECG abnormalities associated with potassium and calcium imbalances | 92 | ||
63. What is the difference between a QT interval and a corrected QT interval (QTc)? | 93 | ||
64. What causes a prolonged QT interval? | 93 | ||
65. What ECG features are found in the long QT syndromes? | 94 | ||
66. What characterizes torsades de pointes? | 94 | ||
67. When should amiodarone not be used as the first-line therapy in patients with ventricular tachycardia? | 94 | ||
68. What are the ECG findings in patients with complete heart block? | 95 | ||
69. How abnormal are premature atrial contractions? | 95 | ||
70. How does SVT in children differ from physiologic sinus tachycardia? | 95 | ||
71. When are isolated premature ventricular contractions (PVCs) usually benign in the otherwise healthy school-aged child? | 95 | ||
72. Name the two most common mechanisms of SVT | 95 | ||
73. What are the clinical settings in which SVT may occur? | 95 | ||
74. What are some of the causes of a wide QRS complex? | 95 | ||
75. What vagal maneuvers are used to treat paroxysmal SVT in children? | 96 | ||
76. In addition to vagal maneuvers, what treatments are used acutely for managing SVT? | 96 | ||
77. Why should an electrographic tracing (preferably with multiple leads) be carried out while administering intravenous ... | 96 | ||
78. In what settings should the dose of adenosine be modified for a suspected cardiac arrhythmia? | 96 | ||
79. Which children are candidates for transcatheter ablation techniques for SVT? | 96 | ||
80. What is the lethal arrhythmia of WPW syndrome? | 97 | ||
81. How is WPW syndrome diagnosed on the baseline ECG? | 97 | ||
Infectious and inflammatory disorders | 97 | ||
82. How many blood cultures should be obtained in patients suspected of bacterial endocarditis? | 97 | ||
83. Why might properly collected blood cultures be negative in the setting of clinically suspected bacterial endocarditis? | 97 | ||
84. When is antibiotic prophylaxis for a dental procedure recommended? | 98 | ||
85. How reliable is the echocardiogram for diagnosing bacterial endocarditis (BE)? | 98 | ||
86. When should myocarditis be suspected? | 98 | ||
87. What conditions are associated with the development of myocarditis? | 98 | ||
88. A child visiting from South America presents with symptoms including unilateral eye swelling and new-onset acute CHF.... | 99 | ||
89. What are the common clinical signs and symptoms of pericarditis? | 99 | ||
90. What is the position of comfort in the patient with pericarditis? | 99 | ||
91. What is Kawasaki disease? | 99 | ||
92. What are the principal diagnostic criteria for Kawasaki disease? | 99 | ||
93. What makes incomplete (or atypical) Kawasaki disease incomplete (or atypical)? | 99 | ||
94. Which diagnostic manifestation of Kawasaki disease is most commonly absent? | 99 | ||
95. What laboratory tests are often abnormal in the first 7 to 10 days of the Kawasaki disease? | 100 | ||
96. What is the typical age of children with Kawasaki disease? | 100 | ||
97. Why should all children with Kawasaki disease receive intravenous immunoglobulin (IVIG) therapy? | 100 | ||
98. Is aspirin therapy of benefit for children with Kawasaki disease? | 100 | ||
99. What is the likelihood of a patient developing coronary artery pathology with and without treatment for Kawasaki disease? | 101 | ||
Pharmacology | 101 | ||
100. How long before oral digoxin begins to work? | 101 | ||
101. A child with WPW syndrome is given digoxin to prevent SVT. Why is the pediatric cardiologist concerned? | 101 | ||
102. When should indomethacin be administered to newborns with a PDA? | 101 | ||
103. What are the side effects of indomethacin in the neonate? | 101 | ||
104. What are the contraindications for indomethacin therapy? | 102 | ||
105. What are the indications for prostaglandin E1 (PGE1) in the neonate? | 102 | ||
106. What are the major side effects of PGE1? | 102 | ||
107. How do α, β, and dopaminergic receptors differ? | 102 | ||
108. How do relative receptor effects differ by drug type? | 102 | ||
109. How are emergency infusions for cardiovascular support prepared? | 102 | ||
Physical examination | 103 | ||
110. What causes the first heart sound? | 103 | ||
111. What causes the second heart sound? | 103 | ||
112. In what settings can an abnormal second heart sound be auscultated? | 103 | ||
113. What is the difference between pulsus alternans and pulsus paradoxus? | 103 | ||
114. How is pulsus paradoxus measured? | 103 | ||
115. What is the differential diagnosis for a systolic murmur in each auscultatory area? | 103 | ||
116. What are the most common innocent murmurs? | 103 | ||
117. What is the effect of sitting up on the typical innocent murmur? | 103 | ||
118. What features are suggestive of a pathologic murmur? | 105 | ||
119. If a murmur is detected, what other factors suggest that the murmur is pathologic? | 105 | ||
Surgery | 105 | ||
120. What are shunt operations? | 105 | ||
121. Name the major shunt operations (Fig.3-13) for CHD. | 105 | ||
122. What is the purpose of the Fontan procedure? | 106 | ||
123. What are the most common rhythm disturbances after the Fontan procedure? | 106 | ||
124. In what type of cardiac surgery is the complication of protein-losing enteropathy more common? | 106 | ||
125. What are some of the reasons to surgically close a VSD? | 106 | ||
126. What are the indications for closure of an atrial septal defect? | 107 | ||
127. What is the typical timing for the three operations for children with HLHS? | 107 | ||
128. What are long-term survival rates for children who undergo surgery for HLHS? | 107 | ||
129. What is the long-term prognosis for heart transplantation during infancy and childhood? | 107 | ||
130. A 5-year-old girl, 2 weeks after an uncomplicated repair of a secundum atrial septal defect, presents with fever, re... | 107 | ||
131. What is the etiology of postoperative hypertension following repair of coarctation of the aorta? | 107 | ||
132. A 5-year-old boy, 6 days after an uncomplicated surgical repair of a coarctation of the aorta, presents with respira... | 107 | ||
133. Can a patient with heart disease simultaneously be polycythemic and iron deficient? | 108.e1 | ||
134. What syndrome should come to mind for the patient with pulmonary stenosis, liver disease, and hypercholesterolemia? | 108.e1 | ||
135. What is the difference between isotonic and isometric exercise? | 108.e1 | ||
136. What are some of the genetic diseases associated with pulmonary valve stenosis and/or pulmonary artery branch stenosis? | 108.e1 | ||
137. You are seeing a newborn with a heart murmur and the parents tell you that their obstetrician had obtained a fetal c... | 108.e1 | ||
138. What is the typical ventricular heart rate in newborns with atrial flutter? | 108.e1 | ||
139. What are the chances of an infant having complete heart block if the infants mother has systemic lupus erythematosus... | 108.e1 | ||
140. What conditions should be considered in the differential diagnosis of Kawasaki disease? | 108.e1 | ||
141. Is palpation for femoral pulses a reliable screening tool for coarctation of the aorta in infants and older children? | 108.e2 | ||
142. Where is the best place to position your stethoscope to hear an aortic ejection click? | 108.e2 | ||
143. What is postcoarctectomy syndrome? | 108.e2 | ||
Chapter 4: Dermatology | 109 | ||
Acne | 109 | ||
1. When is acne most likely to develop? | 109 | ||
2. When are pimples precocious? | 109 | ||
3. Which skin structure is involved in acne pathogenesis? | 109 | ||
4. What are the four key factors in acne pathogenesis? | 109 | ||
5. Are blackheads caused by dirty skin? | 109 | ||
6. What is the difference between neonatal acne and infantile acne? | 109 | ||
7. Which disorders resemble neonatal and infantile acne? | 110 | ||
8. Is an infant with acne more likely to be a teenager with acne? | 110 | ||
9. Which factors exacerbate acne? | 110 | ||
10. What are the most severe forms of acne? | 110 | ||
11. What is the therapeutic approach to acne? | 111 | ||
12. When is the use of oral isotretinoin indicated in teenagers with acne? | 111 | ||
13. What serious side effects may be associated with systemic minocycline therapy for acne? | 111 | ||
14. Which combination of acne products will cause a yellow-orange skin and hair discoloration? | 111 | ||
15. What other topical acne products should not be used in combination? | 112 | ||
16. What color will your red towel become after you wipe your BPO-covered face with it? | 112 | ||
Clinical issues | 112 | ||
17. What skin findings in the midline lumbosacral region are suggestive of occult spinal dysraphism? | 112 | ||
18. What is the significance of accessory tragi? | 113 | ||
19. What conditions cause ringlike rashes on the skin? | 113 | ||
20. What is the appearance and natural history of molluscum contagiosum? | 113 | ||
21. What is the best way to eradicate molluscum contagiosum? | 113 | ||
22. What are the common causes of acute urticaria in children? | 113 | ||
23. What is the characteristic clinical picture of erythema nodosum? | 114 | ||
24. What, technically, are warts? | 114 | ||
25. How are plantar warts distinguished clinically from calluses? | 114 | ||
26. How can common warts be treated? | 114 | ||
27. An 8-year-old has a hard, nontender, freely mobile nodule of the neck with a slightly bluish hue of the skin. What is... | 115 | ||
28. What is the ``teeter-totter sign´´? | 115 | ||
29. What are the most common causes of lumps and bumps in the skin of children? | 115 | ||
30. Why is a pyogenic granuloma neither pyogenic nor a granuloma? | 115 | ||
31. What condition is classically diagnosed by the Darier sign? | 115 | ||
32. What disorder can present as ``freckles´´ associated with hives? | 116 | ||
33. What is impetigo? | 116 | ||
34. Is topical or systemic therapy better for impetigo? | 116 | ||
35. What dermatologic sign starts from a scratch? | 116 | ||
36. Does a geographic tongue occur as a result of global travel? | 117 | ||
37. What diseases are associated with a strawberry tongue? | 117 | ||
38. What should parents look for in a sunscreen label? | 117 | ||
Eczematous disorders | 117 | ||
39. What is the difference between eczema and atopic dermatitis? | 117 | ||
40. What is the usual distribution of rash in atopic dermatitis? | 118 | ||
41. Describe the five key battle plans to treat atopic dermatitis | 118 | ||
42. Why is there a black box warning on topical calcineurin inhibitors? | 118 | ||
43. Why shouldnt fluorinated (halogenated) and other potent topical steroids be used on the face? | 119 | ||
44. Is there a genetic basis for atopic dermatitis? | 119 | ||
45. Are there consistent immunologic alterations in children with atopic dermatitis? | 119 | ||
46. What is the role of filaggrin mutations in the development of atopic dermatitis? | 119 | ||
47. What other skin conditions mimic atopic dermatitis? | 119 | ||
48. What is the ``atopic march´´? | 120 | ||
49. What features help differentiate seborrheic from atopic dermatitis during infancy? | 120 | ||
50. How should parents cope with cradle cap? | 120 | ||
51. What condition causes bumps on the cheeks, upper arms, and thighs? | 120 | ||
52. What are the causes of irritant contact diaper rash? | 120 | ||
53. What features of diaper rash suggest more sinister diseases? | 120 | ||
54. Are topical steroid/antifungal preparations useful for treating children with diaper dermatitis? | 121 | ||
55. Which dietary deficiencies may be associated with an eczematous dermatitis? | 121 | ||
56. What are the two main types of contact dermatitis? | 121 | ||
57. What type of agents can cause allergic contact dermatitis in children? | 121 | ||
58. When does the rash in poison ivy appear relative to exposure? | 121 | ||
59. Are the vesicles in poison ivy contagious? | 121 | ||
60. What is the ``id´´ reaction? | 121 | ||
61. How does the vehicle used in a dermatologic preparation affect therapy? | 122 | ||
Fungal infections | 122 | ||
62. What are useful methods for diagnosing tinea infections? | 122 | ||
63. How does one differentiate between irritant diaper dermatitis and candidal diaper dermatitis? | 122 | ||
64. Does a scaly scalp and swollen glands qualify a patient to initiate griseofulvin? | 123 | ||
65. Why is it necessary to culture for tinea capitis? | 123 | ||
66. How can a culture be obtained if fungal culture medium is not available in the office? | 123 | ||
67. What are the clinical presentations of tinea capitis? | 123 | ||
68. How should children with tinea capitis be treated? | 123 | ||
69. How should children who are receiving systemic medication for tinea capitis be monitored? | 124 | ||
70. What is a kerion? | 124 | ||
71. What puts the ``versicolor´´ in tinea versicolor? | 124 | ||
72. How is tinea versicolor treated? | 124 | ||
73. Which rashes resemble tinea pedis (athletes foot) in children? | 125 | ||
Hair and nail abnormalities | 125 | ||
74. How fast does hair grow? | 125 | ||
75. On what parts of the skin is hair not normally found? | 125 | ||
76. What causes sparse or absent hair in children? | 125 | ||
77. Which kind of alopecia simply requires a change in hairstyle as the treatment? | 125 | ||
78. How can alopecia areata be differentiated clinically from tinea capitis? | 125 | ||
79. What are reported as poor prognostic indicators for recovery of hair in patients with alopecia areata? | 126 | ||
80. What are treatments for alopecia areata? | 126 | ||
81. Are most hairs growing or resting? | 126 | ||
82. You are evaluating a healthy 4-year-old with fine, sparse hair who has never had a haircut. What condition do you sus... | 126 | ||
83. What is the likely diagnosis in a child who develops diffuse hair loss 3 months after major surgery? | 126 | ||
84. What puzzling cause of asymmetric hair loss in a child will sometimes cause an intern to pull his or her hair out? | 127 | ||
85. What causes green hair? | 127 | ||
86. How should ingrown toenails be managed? | 127 | ||
87. Which pathogens are responsible for paronychia? | 127 | ||
88. A healthy 7-year-old child who develops progressive yellowing and increasing friability of all nails over a period of... | 127 | ||
89. What nail change may follow hand, foot, and mouth disease (HFMD) several weeks after the other hand and foot changes ... | 127 | ||
Infestations | 127 | ||
90. How do lice differ? | 127 | ||
91. What are the clinical findings of head lice infestation? | 128 | ||
92. How is the diagnosis of head lice made? | 128 | ||
93. What types of treatment are available for head lice? | 128 | ||
94. What precautions should be taken before prescribing malathion 0.5% lotion (Ovide) for head lice? | 129 | ||
95. Should parents nit pick? | 129 | ||
96. How is a skin scraping for scabies or ``scabies prep´´ done? | 129 | ||
97. What treatment eliminates the scabies babies? | 129 | ||
98. Which areas of the body are more commonly involved in scabies in younger children compared with adults? | 130 | ||
99. In what conditions is the ``breakfast, lunch, and dinner´´ sign noted? | 130 | ||
100. Will getting a new mattress ensure that the bed bugs wont bite? | 130 | ||
Neonatal conditions | 130 | ||
101. What are the most common birthmarks? | 130 | ||
102. How should pustular lesions be evaluated in the newborn period? | 131 | ||
103. What is the differential diagnosis of vesicles or pustules in the newborn? | 131 | ||
104. What is the medical significance of cutis marmorata? | 131 | ||
105. A healthy infant with scattered reddish nodules on the back skin most likely has what condition? | 132 | ||
106. What should the family of a newborn with a yellow, hairless patch with a cobblestone texture be advised to do? | 132 | ||
107. What syndromes are associated with aplasia cutis congenita? | 132 | ||
108. Describe the appearance and distribution of transient neonatal pustular melanosis. | 133 | ||
109. Is erythema toxicum neonatorum really toxic? | 134 | ||
110. For academic (and billing) purposes, is it possible to be more scientific about the diagnosis of ``prickly heat´´? | 134 | ||
Papulosquamous disorders | 134 | ||
111. What diseases are associated with the Koebner reaction? | 134 | ||
112. What is the typical pattern of lesions in childhood psoriasis? | 135 | ||
113. What percentage of children with psoriasis have nail involvement? | 135 | ||
114. A skin scale that easily bleeds on removal is characteristic of what condition? | 136 | ||
115. How is the increased prevalence of childhood obesity associated with psoriasis? | 136 | ||
116. What are treatment modalities for psoriasis? | 136 | ||
117. What are the eight Ps of lichen planus? | 136 | ||
118. How is pityriasis rosea distinguished from secondary syphilis? | 136 | ||
119. What is the treatment for pityriasis rosea? | 136 | ||
120. What is the likely diagnosis for a 5-year-old who presents with a linear array of recently acquired pink to hypopigm... | 137 | ||
Photodermatology | 137 | ||
121. Why is limiting excessive sun exposure in children important? | 137 | ||
122. Why should indoor tanning be addressed and discouraged in children? | 137 | ||
123. What are good strategies for protection against sun exposure? | 137 | ||
124. How is the SPF of a sunscreen determined? | 137 | ||
125. Should sunscreens be avoided in infants? | 137 | ||
126. Do we risk developing vitamin D deficiency by using sun protection? | 138 | ||
127. Which ``lime´´ disease is not transmitted by ticks? | 138 | ||
128. Which conditions are associated with marked sun sensitivity? | 138 | ||
129. What is the appearance of polymorphous light eruption? | 138 | ||
130. Is a child with sun sensitivity protected by sitting behind a window? | 138 | ||
Pigmentation disorders | 139 | ||
131. What disorders of childhood are associated with areas of hypopigmentation? | 139 | ||
132. Is treatment helpful for children with postinflammatory hypopigmentation? | 139 | ||
133. What treatments are available for vitiligo? | 139 | ||
134. What conditions are associated with congenital depigmentation of the skin? | 139 | ||
135. What is the likely diagnosis if a patient taking trimethoprim-sulfamethoxazole develops a single erythematous, sharp... | 140 | ||
136. Why are Spitz nevi and malignant melanoma often confused? | 140 | ||
137. In children with pigmented nevi, what factors increase the risk of melanoma? | 140 | ||
138. How do the ABCs of pediatric melanoma differ from adult melanoma? | 140 | ||
Vascular birthmarks | 140 | ||
139. How are vascular birthmarks classified? | 140 | ||
140. What is the natural history of untreated infantile hemangiomas? | 141 | ||
141. What are the major goals of the management of infantile hemangiomas? | 141 | ||
142. What can patterns of hemangiomas on the skin surface tell us? | 141 | ||
143. Which hemangiomas are especially worrisome? | 142 | ||
144. When is treatment indicated for infantile hemangiomas? | 142 | ||
145. What are the most commonly used treatments for problematic infantile hemangiomas? | 142 | ||
146. Why is an infant with a vascular tumor and new-onset thrombocytopenia so worrisome? | 143 | ||
147. How do superficial hemangiomas differ from port wine stains? | 143 | ||
148. What is ``simple´´ about a nevus simplex? | 144 | ||
149. When are port wine stains associated with other anomalies? | 144 | ||
150. How are port wine stain-type capillary malformations treated? | 144 | ||
Vesicobullous disorders | 144 | ||
151. What is the Nikolsky sign? | 144 | ||
152. What are causes of skin blistering in childhood? | 145 | ||
153. How is SSSS differentiated from toxic epidermal necrolysis (TEN)? | 145 | ||
154. Why are neonates susceptible to SSSS? | 145 | ||
155. Where can the S. aureus be found in patients with SSSS? | 145 | ||
156. What is the likely diagnosis for a 4-year-old child who develops a 1-week history of widespread painful and pruritic... | 145 | ||
157. What are the subtypes of epidermolysis bullosa (EB)? | 146 | ||
158. Should epidermolysis bullosa blisters be ``popped´´? | 146 | ||
159. Which disorder is associated with ``target lesions´´? | 146 | ||
160. Is EM part of a continuum with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)? | 146 | ||
161. What distinguishes SJS from TEN? | 147 | ||
162. What medications are most commonly associated with SJS and TEN in children? | 147 | ||
163. Is steroid therapya beneficial for the treatment of SJS or TEN? | 147 | ||
164. What therapy should be considered for patients with rapidly progressive SJS or TEN? | 147 | ||
165. What infection should be considered in a child with SJS and a cough? | 147 | ||
166. In addition to hand-foot-mouth, which other body site is often affected in children with coxsackie virus infections? | 147 | ||
167. Can acne be scrubbed away? | 147.e1 | ||
168. Can lasers be used to treat acne? | 147.e1 | ||
169. Are there any ``quick fixes´´ for acne? | 147.e1 | ||
170. Can dilute bleach be used for purposes other than cleaning your clothes? | 147.e1 | ||
171. Do soaps or clothes make any difference in atopic dermatitis? | 147.e1 | ||
172. Frequency of bathing for children with atopic dermatitis: more or less? | 147.e1 | ||
173. What is the most common side effect of topical pimecrolimus and tacrolimus? | 147.e1 | ||
174. What is a cause of a localized triangular area of alopecia on the scalp of children? | 147.e1 | ||
175. What is the ``flag sign´´? | 147.e2 | ||
176. Is there an oral treatment available to treat scabies? | 147.e2 | ||
177. What types of sunscreens are available? | 147.e2 | ||
178. Describe causes of pseudoporphyria in children | 147.e2 | ||
179. What are the clinical features of familial dysplastic nevus syndrome? | 147.e2 | ||
180. Which hemangioma is an exception to the rule of gradual resolution? | 147.e2 | ||
181. What is ``eczema coxsackium´´? | 147.e2 | ||
Chapter 5: Emergency Medicine | 148 | ||
Bioterrorism | 148 | ||
1. Why are children more vulnerable to biologic agents than adults? | 148 | ||
2. What are the three routes of transmission of anthrax? | 148 | ||
3. How are the lesions of smallpox distinguished from varicella (chickenpox)? | 148 | ||
4. How can the presenting symptoms of bubonic plague be differentiated from those of plague resulting from bioterrorism? | 148 | ||
5. Why should families living near nuclear power plants keep potassium iodide (KI) in their medicine cabinets? | 149 | ||
6. Why are children particularly vulnerable to terrorism in the form of explosive and blast attacks? | 149 | ||
7. What categories of agents should be considered in the event of a chemical weapons attack? | 149 | ||
8. What should be the practitioner's initial management when a chemical weapons event occurs? | 149 | ||
Child abuse: physical and sexual | 149 | ||
9. What are important historical indicators of possible child abuse? | 149 | ||
10. What is the most common cause of severe closed head trauma in infants younger than 1 year? | 150 | ||
11. Why is the diagnosis of abusive head trauma often overlooked? | 150 | ||
12. What diagnostic tests may be contributory if abusive head trauma is suspected? | 151 | ||
13. What physical examination findings are indicators of possible child abuse? | 151 | ||
14. If retinal hemorrhages are noted in a child with seizures, how likely are the seizures to have caused the hemorrhages? | 151 | ||
15. In a suspected victim of child abuse, is an ophthalmology exam looking for retinal hemorrhages routinely indicated as... | 151 | ||
16. When should child abuse be considered in the event of an unexplained death of a child? | 152 | ||
17. Which conditions with ecchymoses (bruising) can be mistaken for child abuse? | 152 | ||
18. How are fractures dated radiographically in children? | 153 | ||
19. What fractures are suggestive of child abuse? | 153 | ||
20. How certain can a clinician be in attributing a femur fracture in a nonambulatory child to nonaccidental trauma? | 154 | ||
21. What is the purpose of the skeletal survey? | 154 | ||
22. What constitutes the skeletal survey? | 154 | ||
23. Up to what age should a skeletal survey be ordered? | 154 | ||
24. What is the value of a follow-up skeletal survey? | 154 | ||
25. In addition to child abuse, what conditions must you consider as a cause of multiple unexplained long bone fractures ... | 155 | ||
26. When are burn injuries suspicious for child abuse? | 155 | ||
27. How do you recognize child abuse in a medical setting? | 155 | ||
28. How often is sexual abuse committed by an individual known previously by the child or adolescent? | 155 | ||
29. In the case of suspected prepubertal sexual abuse, how critical is it to perform the physical exam immediately on pre... | 155 | ||
30. After the documentation of history and a careful physical examination, what evidence should be collected in cases of ... | 156 | ||
31. After the documentation of history and a careful physical examination, what evidence should be collected in cases of ... | 156 | ||
32. After the initial ED evaluation for sexual assault, what kind of follow-up care should the ED physician offer? | 156 | ||
33. If a child who is not sexually active is diagnosed with an infection caused by an STI-associated organism, how likely... | 156 | ||
34. Is the size of the hymenal opening an important finding in the diagnosis of sexual abuse? | 157 | ||
35. What is the most common finding of the physical examination of a child who has been sexually abused? | 157 | ||
36. What are the date-rape drugs? | 157 | ||
37. How can you tell whether a patient has been given a date-rape drug? | 157 | ||
Environmental injury | 158 | ||
38. How do fresh- and salt-water drownings differ? | 158 | ||
39. How is the duration of submersion predictive of outcomes in drownings? | 158 | ||
40. What cardiovascular changes occur as body temperature falls? | 159 | ||
41. What are the physiologic consequences of externally warming a severely hypothermic patient too rapidly? | 159 | ||
42. What are acceptable rewarming methods for the hypothermic child? | 159 | ||
43. What organ systems are affected in patients suffering from heat stroke? | 159 | ||
44. How quickly can temperature rise inside an enclosed automobile? | 159 | ||
45. What are characteristics of heat stroke? | 160 | ||
46. Why are children more vulnerable to effects of external temperature changes? | 160 | ||
47. What are the signs and symptoms of significant upper airway heat exposure in a patient who has been in a house fire? | 160 | ||
48. What are the signs and symptoms of impending respiratory failure as a result of mucosal injury and edema from heat ex... | 160 | ||
49. Which laboratory studies are needed for patients with suspected carbon monoxide (CO) poisoning? | 160 | ||
50. What are the key aspects of treatment for carbon monoxide poisoning in children? | 160 | ||
51. Why is carbon monoxide such a deadly toxin? | 161 | ||
52. What is the pathophysiology of carbon monoxide poisoning? | 161 | ||
53. What other serious exposure risk should one consider when managing a patient suffering from carbon monoxide poisoning? | 161 | ||
54. What are the different degrees of burn injuries? | 161 | ||
55. How does the ``rule of nines´´ apply in children? | 161 | ||
56. Which burn injuries are indications for hospitalization? | 162 | ||
57. Why are alkali burns worse than acid burns in the eye? | 162 | ||
58. How do the injuries produced by lightning and high-voltage wires differ? | 162 | ||
59. In electrical injury, is alternating or direct current more hazardous? | 162 | ||
60. What agents are the most common causes of anaphylaxis seen in U.S. emergency rooms? | 163 | ||
61. What are important considerations when treating frostbite in children? | 163 | ||
Resuscitation | 163 | ||
62. What are common problems identified in cardiopulmonary resuscitation (CPR) done by professionals? | 163 | ||
63. What is the role for capnography during resuscitation? | 163 | ||
64. Why is the airway of an infant or child more prone to obstruction than that of an adult? | 164 | ||
65. How can the correct size of endotracheal tubes (ETTs) be estimated for a given patient? | 164 | ||
66. When should cuffed versus uncuffed ETTs be used? | 164 | ||
67. How should the appropriate depth of an ETT be calculated? | 164 | ||
68. How should correct placement of an ETT be confirmed? | 164 | ||
69. What emergency drugs can be given through an ETT? | 164 | ||
70. What are the potential reasons for acute deterioration in an intubated patient? | 165 | ||
71. When is atropine indicated during cardiopulmonary resuscitation? | 165 | ||
72. When is the use of calcium indicated during cardiopulmonary resuscitation? | 165 | ||
73. What are contraindications to the use of an intraosseous line? | 165 | ||
74. Can laboratory tests be obtained from intraosseous lines? | 165 | ||
75. What are the complications of intraosseous lines? | 166 | ||
76. What features indicate that an intraosseous needle has been correctly placed? | 166 | ||
77. How can a child's weight be estimated? | 166 | ||
78. Name the potentially reversible causes of cardiac arrest. | 166 | ||
79. What are the typical clinical findings associated with supraventricular tachycardia (SVT)? | 166 | ||
80. If an infant develops SVT, how long before congestive heart failure (CHF) develops? | 167 | ||
81. What factors may be predictive of outcomes after pediatric cardiac arrest? | 167 | ||
82. Are fixed and dilated pupils a contraindication to resuscitation for a pediatric patient in cardiac arrest? | 167 | ||
83. When should a failing resuscitation be stopped? | 167 | ||
84. Why is resuscitation less successful in children than in adults? | 167 | ||
85. Should family members be allowed to observe a resuscitation? | 168 | ||
Shock | 168 | ||
86. Are all children in shock hypotensive? | 168 | ||
87. What are the signs and symptoms of early or compensated shock? | 168 | ||
88. What are the signs and symptoms of late or uncompensated shock? | 168 | ||
89. What external factors can affect the accuracy of measurement of capillary refill time in children and neonates? | 168 | ||
90. How much blood volume can be lost before hypotension may be seen in children? | 168 | ||
91. What defines hypotension in children (i.e., systolic blood pressure <5th percentile for age)? | 169 | ||
92. What types of shock can occur in children? | 169 | ||
93. What are the hallmarks of septic shock? | 169 | ||
94. What are the key initial management items for septic shock? | 169 | ||
95. Are corticosteroids recommended for the treatment of septic shock? | 169 | ||
96. What is the most important pharmacologic therapy for anaphylactic shock? | 170 | ||
97. What are the possible causes of shock in the newborn period? | 170 | ||
98. A 4-day-old infant presents to the ED in shock with evidence of CHF and cyanosis. In addition to managing the airway ... | 170 | ||
99. What are the four classes of medications that can be used to support cardiac output? | 170 | ||
100. An 8-year-old presents to the ED after falling headfirst into an empty swimming pool. His heart rate is normal, yet ... | 170 | ||
Toxicology | 171 | ||
101. What are the most common poisonings in children younger than 6 years? | 171 | ||
102. Which medications can kill a 10-kg toddler with 1 or 2 tablets, capsules, or teaspoonfuls? | 171 | ||
103. What medication causes the most overdose deaths in children each year in the United States? | 171 | ||
104. Name the toxicology ``time bombs.´´ | 172 | ||
105. What empirical drug therapies are indicated for the poisoned child who presents with altered mental status? | 172 | ||
106. What is gastrointestinal decontamination? | 172 | ||
107. How does single-dose activated charcoal work and when should it be considered? | 172 | ||
108. For what substances is charcoal not recommended? | 172 | ||
109. When is gastric lavage indicated? | 172 | ||
110. What are the indications for whole bowel irrigation (WBI) in acute ingestions? | 173 | ||
111. How is the manipulation of urinary pH used in treating poisonings? | 173 | ||
112. What ingestions and exposures have available antidotes? | 173 | ||
113. For which kinds of ingestions is naloxone considered an antidote? | 174 | ||
114. Which ingestions are radiopaque on abdominal radiograph? | 174 | ||
115. What causes the radiographic ``lead lines´´ of chronic lead poisoning? | 174 | ||
116. What is a toxidrome? | 174 | ||
117. What is the toxidrome for anticholinergics? | 175 | ||
118. What breath odors may be associated with specific ingestions? | 175 | ||
119. What are the limitations of the routine toxicology screen? | 175 | ||
120. After use of marijuana, how long does a urine screen remain positive? | 176 | ||
121. How do the types of alcohol ingestions vary? | 176 | ||
122. Which alcohol is considered the most lethal? | 176 | ||
123. What is the treatment for methanol and ethylene glycol ingestions? | 176 | ||
124. What is ``MUDPILES´´? | 176 | ||
125. How can pupillary findings assist in the diagnosis of toxic ingestions? | 177 | ||
126. If a child has ingested an acetaminophen-containing product, when should the first acetaminophen level be obtained? | 177 | ||
127. When should a ``NAC attack´´ begin? | 177 | ||
128. How does NAC prevent hepatotoxicity in acetaminophen overdose? | 177 | ||
129. What arterial blood gas pattern is classic for salicylate poisoning? | 177 | ||
130. What are hidden salicylates? | 177 | ||
131. What are the classic ECG findings associated with tricyclic antidepressants? | 177 | ||
132. Which clinical and laboratory features correlate with an acutely elevated serum iron? | 178 | ||
133. What are the four clinical stages of iron toxicity and the correlating pathophysiology? | 178 | ||
134. Which is more toxic, drinking dishwashing detergent or toilet bowl cleaner? | 178 | ||
135. Which hydrocarbons pose the greatest risk for chemical pneumonitis? | 178 | ||
136. What is the differential diagnosis in a child who presents with confusion and lethargy? | 178 | ||
137. A patient receiving an antiemetic drug (e.g., promethazine) who develops involuntary, prolonged, twisting, writhing ... | 178 | ||
138. What do ``SLUDGE´´ and ``DUMBELS´´ have in common? | 179 | ||
139. What metal intoxication can mimic Kawasaki disease? | 179 | ||
140. Why is cyanide so toxic? | 179 | ||
141. In what settings should cyanide poisoning be suspected? | 179 | ||
142. What kinds of plants account for the greatest percentage of deaths due to plant poisonings? | 179 | ||
143. Is mistletoe toxic? | 179 | ||
144. Should swallowed disc batteries be removed? | 180 | ||
145. What are the available methods used to remove a foreign body from the esophagus? | 180 | ||
146. What recreational drug is most frequently associated with rave parties? | 180 | ||
147. Why is ecstasy considered so dangerous? | 180 | ||
Trauma | 180 | ||
148. What are the major signs of a blowout fracture? | 180 | ||
149. When evaluating a patient with an eye injury, when should you suspect a ruptured globe and how should you handle it? | 181 | ||
150. When should an avulsed tooth be reimplanted? | 181 | ||
151. What are the three most important considerations when evaluating nasal trauma? | 181 | ||
152. How long can you wait before a broken nose in a child must be reduced? | 182 | ||
153. After a motor vehicle collision, an 8-year-old presents with right-sided pain, a heart rate of 150 beats per minute,... | 182 | ||
154. What are the signs and symptoms of a tension pneumothorax? | 182 | ||
155. Which children with acute minor blunt head trauma require emergency CT scans? | 182 | ||
156. What is the risk associated with CT scans in children? | 182 | ||
157. When intracranial pressure is acutely elevated, how long is it before papilledema develops? | 182 | ||
158. What are the components of the Glasgow Coma Scale (GCS)? | 182 | ||
159. How does the location of cervical spine fractures vary between younger children and older children and adults? | 183 | ||
160. What is SCIWORA? | 183 | ||
161. Are single lateral cervical spine radiographs sufficient to ``clear´´ a patient after neck injury? | 184 | ||
162. Why is left shoulder pain after abdominal trauma a worrisome sign? | 184 | ||
163. A 5-year-old child has ecchymosis of the lower abdomen after a motor vehicle collision. What should you immediately ... | 184 | ||
164. In a 7-year-old boy with a radiographically proven pelvic fracture, what diagnostic procedure should be done? | 184 | ||
165. In this same patient as in question 164, blood at the tip of the penis is noted. Why is catheterization contraindicated? | 184 | ||
166. What is the focus of the FAST examination? | 184 | ||
167. In children with blunt abdominal trauma, are there clinical findings that predict low risk of clinically important i... | 185 | ||
Wound repair | 185 | ||
168. What advice should be given over the telephone regarding the transportation of an avulsed digit? | 185 | ||
169. Which lacerations should be referred to a surgeon or an ED physician who is familiar with wound repair? | 185 | ||
170. How many days should sutures remain in place? | 185 | ||
171. When should a nerve injury be suspected in a finger laceration? | 185 | ||
172. What should be done if nerve damage is suspected? | 185 | ||
173. Which lacerations should not be sutured? | 186 | ||
174. Which are at greater risk for infection, dog bites or cat bites? | 186 | ||
175. Should antibiotic prophylaxis be given for dog, cat, and human bites? | 186 | ||
176. Which animals most often carry the rabies virus? | 186 | ||
177. Which are more likely to be rabid: cats or dogs? | 187 | ||
178. If at a local petting zoo a playful 20-month-old child is bitten by a duck, scratched by a rabbit (breaking skin), s... | 187 | ||
179. When is the use of lidocaine with epinephrine contraindicated as a local anesthetic? | 187 | ||
180. What are methods for decreasing the pain of local lidocaine infiltration? | 187 | ||
181. What are some of the ingredients in the alphabet soup of topical anesthetics? | 187 | ||
182. When should tissue adhesives be considered or avoided? | 187 | ||
183. In which situations might you choose absorbable over nonabsorbable sutures when repairing a pediatric laceration? | 188 | ||
184. What is the proper fluid to use for wound irrigation? | 188 | ||
185. How is conscious sedation best managed in children? | 188 | ||
186. To reduce the exposure to radiation from a complete skeletal survey, can the survey be modified to include fewer x-r... | 188.e1 | ||
187. If physical abuse is suspected, are physicians mandated to photograph physical findings? | 188.e1 | ||
188. If a toddler suffers a full-thickness burn to the corner of the mouth after biting an electrical cord, what complica... | 188.e1 | ||
189. What is a laryngeal mask airway (LMA)? | 188.e1 | ||
190. What is the Sellick maneuver? | 188.e1 | ||
191. Should activated charcoal be given to a sleepy 2-year-old girl who consumed half a bottle of a liquid antihistamine ... | 188.e2 | ||
192. When can a toddler who may have swallowed some multivitamins be discharged home? | 188.e2 | ||
193. If the abdominal CT scan is negative in a patient with blunt abdominal trauma, can you be certain that there is no i... | 188.e2 | ||
194. In children with blunt thoracic trauma, are there clinical exam findings that predict low risk of significant injury? | 188.e2 | ||
Chapter 6: Endocrinology | 189 | ||
Adrenal disorders | 189 | ||
1. What are the symptoms of adrenal insufficiency? | 189 | ||
2. What distinguishes primary and secondary adrenal insufficiency? | 189 | ||
3. What is the differential diagnosis of primary adrenal insufficiency? | 189 | ||
4. What are the most common causes of secondary adrenal insufficiency? | 189 | ||
5. What clinical clues suggest that adrenal insufficiency is a primary rather than a secondary problem? | 189 | ||
6. What is the most common form of congenital adrenal hyperplasia (CAH)? | 189 | ||
7. In newborns with CAH, why are girls likely to be diagnosed earlier than boys? | 190 | ||
8. How do the major steroid preparations vary in potency? | 190 | ||
9. How do physiologic, stress, and pharmacologic doses of hydrocortisone differ? | 190 | ||
10. When does adrenal-pituitary axis suppression occur in prolonged glucocorticoid treatment? | 190 | ||
Calcium metabolism and disorders | 191 | ||
11. What are the causes of hypercalcemia? | 191 | ||
12. An 8-year-old in a spica cast after hip surgery develops vomiting and a serum calcium concentration of 15.3 mg/dL. H ... | 191 | ||
13. Is it the Chvostek or Trousseau sign that gets the tap? | 192 | ||
14. What is hypoparathyroidism? | 192 | ||
15. In what clinical circumstances should hypoparathyroidism be suspected? | 192 | ||
16. What are the main causes of hypocalcemia in children? | 192 | ||
17. What is the most likely diagnosis in a child with hypocalcemia who has abnormally shaped fingers? | 193 | ||
Clinical syndromes | 194 | ||
18. How does the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) develop? | 194 | ||
19. What is cerebral salt wasting and how is it separated from SIADH? | 194 | ||
20. What are the five criteria for the diagnosis of SIADH? | 194 | ||
21. What clinical features suggest diabetes insipidus (DI)? | 194 | ||
22. How is the diagnosis of DI made? | 194 | ||
Diabetic ketoacidosis | 195 | ||
23. What is diabetic ketoacidosis (DKA)? | 195 | ||
24. What percentage of newly diagnosed diabetic patients present with symptoms of DKA? | 195 | ||
25. What are the mainstays of therapy for DKA? | 195 | ||
26. What should be the initial fluid management in DKA? | 195 | ||
27. Why is a falling serum sodium concentration during the treatment of DKA of concern? | 196 | ||
28. What is the typical potassium status in children with DKA? | 196 | ||
29. Why do potassium levels fall during the management of DKA? | 196 | ||
30. Should bicarbonate be used for the treatment of children with DKA? | 196 | ||
31. Are there any indications for the use of bicarbonate? | 197 | ||
32. When should glucose be added to the intravenous fluids in patients with DKA? | 197 | ||
33. In the past, a bolus of insulin was given at the start of therapy for DKA. Is that still recommended? | 198 | ||
34. Is continuous or bolus insulin better for the initial treatment of DKA? | 198 | ||
35. Which corrects sooner during continuous insulin administration: hyperglycemia or acidosis? | 198 | ||
36. What is the main cause of mortality in DKA? | 198 | ||
37. What risk factors are associated with the development of cerebral edema? | 198 | ||
38. What signs and symptoms suggest worsening cerebral edema during the treatment of DKA? | 199 | ||
Diabetes mellitus | 199 | ||
39. What are the risks of a child developing type 1 diabetes (T1D) if one sibling or parent is affected? | 199 | ||
40. How long does the ``honeymoon´´ period last in patients with newly diagnosed T1D? | 199 | ||
41. How do the types of insulin vary in their onset and duration of action? | 199 | ||
42. When should the Somogyi phenomenon be suspected? | 200 | ||
43. What causes the ``dawn phenomenon´´? | 200 | ||
44. How rapidly can renal disease develop after the onset of diabetes mellitus? | 200 | ||
45. How is hemoglobin A1C (HbA1C) helpful for monitoring glycemic control? | 201 | ||
46. What are the goals for hemoglobin A1C? | 201 | ||
47. What pathophysiologic process characterizes type 2 diabetes (T2D)? | 201 | ||
48. Is the prevalence of T2D in children increasing? | 201 | ||
49. What historical and clinical features suggest type 2 rather than type 1 diabetes? | 201 | ||
50. What laboratory features are helpful to distinguish T1D from T2D? | 202 | ||
51. What is acanthosis nigricans? | 202 | ||
52. How is T2D diagnosed? | 202 | ||
53. Which pediatric patients should be screened for T2D? | 203 | ||
54. What hemoglobin A1C level is sufficient to diagnose diabetes? | 203 | ||
55. When should oral hypoglycemic agents be considered as part of therapy? | 203 | ||
Growth disturbances | 203 | ||
56. How do the growth rates of boys and girls differ? | 203 | ||
57. What is the best predictor of a child´s eventual adult height? | 203 | ||
58. When have most children achieved the height percentile that is consistent with parental height? | 204 | ||
59. When is a detailed evaluation for short stature warranted? | 204 | ||
60. Name the major categories of causes of short stature | 204 | ||
61. In a child with short stature, what rate of growth makes an endocrine abnormality unlikely? | 204 | ||
62. When evaluating a short child, why should you ask when the parents reached puberty? | 204 | ||
63. When does the pubertal growth spurt occur? | 204 | ||
64. Are upper to lower body ratios helpful for the diagnosis of growth problems? | 205 | ||
65. What laboratory studies should be obtained when evaluating short stature? | 205 | ||
66. In a very obese child, how does height measurement help determine whether an endocrinopathy might be the cause? | 205 | ||
67. How does a growth chart help determine the diagnosis of failure to thrive? | 205 | ||
68. How can one track growth in children who have spinal cord abnormalities or severe scoliosis? | 207 | ||
69. What is bone age? | 207 | ||
70. Why is a bone age determination helpful for evaluating short stature? | 207 | ||
71. What features suggest constitutional delay as a cause of short stature? | 207 | ||
72. How is constitutional delay managed? | 207 | ||
73. Should growth hormone therapy be given to the normal short child? | 207 | ||
74. What are the clinical manifestations of growth hormone excess? | 208 | ||
Hypoglycemia | 208 | ||
75. How is hypoglycemia defined? | 208 | ||
76. What are the clinical findings associated with hypoglycemia? | 208 | ||
77. What are the causes of childhood hypoglycemia? | 208 | ||
78. An unconscious 3-year-old girl is brought to the emergency department with a serum glucose concentration of 26mg/dL. ... | 209 | ||
79. In patients with acute hypoglycemia, what are the treatment options? | 209 | ||
Hypothalamic and pituitary disorders | 209 | ||
80. What clinical signs or symptoms suggest hypothalamic dysfunction? | 209 | ||
81. List the intracranial processes that can interfere with hypothalamic-pituitary function | 210 | ||
82. Why is it bad to have a ``Turkish saddle´´ that is too large? | 210 | ||
83. Which tests are useful for studying suspected hypothalamic and pituitary malfunction? | 210 | ||
Sexual differentiation and development | 210 | ||
84. An infant is born with ``ambiguous genitalia.´´ What features of the history and physical examination are key in the ... | 210 | ||
85. What are the causes of a DSD? | 211 | ||
86. Which studies are essential for the evaluation of a DSD? | 211 | ||
87. What major criteria are used to define a micropenis? | 212 | ||
88. What are the main concerns to be addressed during the initial evaluation of a 1-month-old infant with micropenis? | 212 | ||
89. Discuss the terms that denote aspects of precocious sexual development. | 212 | ||
90. Boys or girls: Who is more likely to have an identifiable cause for precocious puberty? | 212 | ||
91. A 7 -year-old girl develops breast buds and pubic hair. Is this normal or precocious? | 213 | ||
92. Breast buds are noted on a 2-year-old girl. Is this worrisome? | 213 | ||
93. Which aspects of the physical examination are particularly important when evaluating a patient with precocious puberty? | 213 | ||
94. Which radiologic and laboratory tests are indicated for the evaluation of precocious puberty? | 213 | ||
95. When does the male voice begin to crack? | 214 | ||
Thyroid disorders | 214 | ||
96. Which thyroid function tests are ``standard´´? | 214 | ||
97. What signs and symptoms in an infant suggest congenital hypothyroidism? | 214 | ||
98. What causes congenital hypothyroidism? | 214 | ||
99. How effective are screening programs for congenital hypothyroidism? | 215 | ||
100. Discuss the risks of delaying treatment for congenital hypothyroidism. | 215 | ||
101. A suspected goiter (diffuse enlargement of the thyroid gland) is noted during a routine examination of an asymptomat... | 215 | ||
102. What is the most common cause of acquired hypothyroidism in childhood? | 216 | ||
103. What is the most common clinical presentation of Hashimoto thyroiditis? | 216 | ||
104. What should a parent be told about the prognosis of a child who has euthyroid goiter caused by chronic lymphocytic t... | 216 | ||
105. What other autoimmune diseases are associated with chronic lymphocytic thyroiditis? | 216 | ||
106. What does a normal T4 and an elevated TSH suggest? | 216 | ||
107. What is the most common cause of hyperthyroidism in children? | 216 | ||
108. In addition to Graves disease, what conditions may cause hyperthyroidism? | 217 | ||
109. Describe the typical features of hyperthyroidism that occur as a result of Graves disease. | 217 | ||
110. What causes Graves disease? | 217 | ||
111. Why does exophthalmos occur in Graves disease? | 217 | ||
112. What treatment options are available for children with Graves disease? | 217 | ||
113. Describe the principal modes of actions and the side effects of medications used to treat Graves disease. | 218 | ||
114. Has radioactive iodide fallen into disfavor as a treatment option for Graves disease? | 218 | ||
115. During a routine physical examination, a solitary thyroid nodule is palpated on an asymptomatic 10-year-old child. C... | 219 | ||
116. How should this solitary thyroid nodule be investigated? | 219 | ||
117. How is the euthyroid sick syndrome diagnosed? | 219 | ||
118. How do antiepileptic medications affect thyroid function tests? | 219.e1 | ||
119. Of what value is the T3 resin uptake (T3RU) test? | 219.e1 | ||
120. How common is goiter (thyroid enlargement) in newborns with congenital hypothyroidism? | 219.e1 | ||
Chapter 7: Gastroenterology | 220 | ||
Clinical issues | 220 | ||
1. What is the definition of failure to thrive? | 220 | ||
2. What is the differential diagnosis of FTT? | 220 | ||
3. How is FTT evaluated? | 220 | ||
4. What features of history or on physical examination suggest a medical condition leading to FTT? | 220 | ||
5. How is the diagnosis of ``pinworms´´ made? | 220 | ||
6. What characterizes functional abdominal pain in children? | 221 | ||
7. In children with abdominal pain, what historical features suggest a possible organic or serious cause? | 221 | ||
8. What treatments are used for functional abdominal pain in children? | 221 | ||
9. What is intractable singultus? | 222 | ||
10. What is the most commonly ingested foreign body? | 222 | ||
11. Which is potentially more dangerous after ingestion: a penny made in 1977 or one made in 1987? | 222 | ||
12. What is the difference radiographically between a coin in the esophagus and a coin in the trachea? | 222 | ||
13. Why is ingestion of a button battery more dangerous than ingestion of a coin? | 222 | ||
14. Which is more dangerous, 2 magnets that are swallowed together or 2 magnets that are swallowed separately? | 223 | ||
15. What are the indications for emergent foreign body removal? | 223 | ||
16. What is the grim news about Rapunzel syndrome? | 223 | ||
17. What is the most common clinical presentation of juvenile polyps in children? | 223 | ||
18. What are the types of colonic polyps? | 223 | ||
19. Why is it important to confirm a diagnosis of juvenile polyposis? | 223 | ||
20. How is ascites diagnosed by physical examination? | 224 | ||
Constipation | 224 | ||
21. What constitutes constipation in childhood? | 224 | ||
22. What features suggest an organic etiology for constipation? | 224 | ||
23. What is the most important component of the physical examination when evaluating constipation? | 225 | ||
24. What are some common triggers of constipation in healthy infants and children? | 225 | ||
25. Which clinical features differentiate chronic retentive constipation from Hirschsprung disease? | 225 | ||
26. How is Hirschsprung disease diagnosed? | 225 | ||
27. What is the most common cause of encopresis? | 226 | ||
28. How should children with chronic constipation and encopresis be managed? | 226 | ||
Diarrhea and malabsorption | 227 | ||
29. What time frame distinguishes acute and chronic diarrhea? | 227 | ||
30. What is the most common cause worldwide of epidemic diarrhea? | 227 | ||
31. What are other common causes of acute diarrhea? | 227 | ||
32. Which historical questions are key when seeking the cause of diarrhea? | 227 | ||
33. In what settings can diarrhea be a severe, life-threatening illness? | 228 | ||
34. Why is true diarrhea during the first few days of life especially concerning? | 228 | ||
35. What are the most useful stool tests for diagnosing fat malabsorption? | 228 | ||
36. What stool test is most useful for helping diagnose GI protein loss? | 228 | ||
37. How do patterns of secretory or enterotoxigenic and inflammatory diarrhea vary? | 228 | ||
38. What is the primary pathophysiologic difference between secretory and osmotic diarrhea? | 228 | ||
39. How can osmotic diarrhea be distinguished from secretory diarrhea? | 228 | ||
40. How should children with secretory diarrhea be managed? | 229 | ||
41. What rare tumors can cause true secretory diarrhea? | 229 | ||
42. What features characterize ``toddler diarrhea´´? | 229 | ||
43. What is primary lactose intolerance? | 229 | ||
44. How does late-onset lactase deficiency vary by ethnicity? | 229 | ||
45. What conditions produce secondary lactose intolerance? | 230 | ||
46. How is lactose intolerance diagnosed? | 230 | ||
47. What is the role of stool elastase measurement? | 230 | ||
48. What three individual clinical features are the most accurate for predicting 5% dehydration? | 230 | ||
49. How accurate are urine specific gravity and blood urea nitrogen (BUN) measurements as means of assessing dehydration ... | 231 | ||
50. How do various oral rehydration solutions differ in composition from other liquids that are commonly used for rehydra... | 231 | ||
51. How can the World Health Organization (WHO) oral electrolyte (rehydration) solution be duplicated? | 231 | ||
52. What traditional approaches to feeding during diarrhea are no longer recommended and should be avoided? | 231 | ||
53. What is the role of antiemetic agents in children with gastroenteritis? | 231 | ||
54. What are non-antimicrobial drug therapies for diarrhea? | 232 | ||
55. What is the role of probiotic organisms in the treatment of antibiotic-associated diarrhea? | 232 | ||
56. Why is Salmonella enteritis so concerning in a child who is younger than 12 months? | 232 | ||
57. What are the clinical manifestations of typhoid fever? | 232 | ||
58. Who was Typhoid Mary? | 233 | ||
59. What is the most common cause of travelers´ diarrhea? | 233 | ||
60. How can travelers´ diarrhea be prevented? | 233 | ||
61. Which bacterial gastroenteritides may benefit from antimicrobial therapy? | 233 | ||
62. What strains of E. coli are associated with diarrhea? | 234 | ||
63. What clinical entity has been attributed to EHEC, specifically strain O157:H7? | 234 | ||
64. What is the most common cause of antibiotic-associated colitis? | 234 | ||
65. How is the diagnosis of C. difficile made? | 234 | ||
66. How common is asymptomatic C. difficile carriage? | 234 | ||
67. Why are alcohol-based sanitizers insufficient when examining patients with C. difficile? | 235 | ||
68. What are the three most common presenting symptoms of giardiasis? | 235 | ||
69. How reliable are the various diagnostic methods for detecting Giardia? | 235 | ||
70. What are the potential complications of amebiasis? | 235 | ||
71. What is gluten? | 236 | ||
72. What classic clinical features suggest celiac disease? | 236 | ||
73. What are possible nongastrointestinal manifestations of celiac disease? | 236 | ||
74. What is the appropriate screening test for celiac disease? | 236 | ||
75. What is the definitive way to diagnose celiac disease? | 237 | ||
76. What is the mainstay of treatment for celiac disease? | 237 | ||
Esophageal disorders | 237 | ||
77. What is the likely diagnosis for an infant with excessive secretions and choking episodes in whom a nasogastric tube ... | 237 | ||
78. What underlying diagnoses should be considered in a patient who presents with a meat impaction in the esophagus? | 237 | ||
79. What is the most common condition that might present as a food impaction in an adolescent? | 237 | ||
80. How is EoE diagnosed? | 237 | ||
81. What are common endoscopic findings in EoE? | 238 | ||
82. What causes esophageal eosinophilia in EoE? | 239 | ||
83. What are the symptoms of EoE? | 239 | ||
84. What are the therapies for EoE? | 239 | ||
Food allergies | 240 | ||
85. What are the most common food allergies in children? | 240 | ||
86. How are adverse food reactions characterized? | 240 | ||
87. What can be the acute manifestations of milk protein allergy in childhood? | 240 | ||
88. What is the most common chronic manifestation of milk protein allergy? | 240 | ||
89. What likely condition does a birch-allergic child have who develops tongue swelling when eating an apple? | 240 | ||
90. Can dietary manipulation in the first few months of life reduce the risk for atopic dermatitis and food allergies? | 240 | ||
91. What are the symptoms of allergic proctocolitis or milk protein intolerance in an infant? | 241 | ||
92. Does the diagnosis of allergic proctocolitis in infants usually require endoscopy? | 241 | ||
Gastrointestinal bleeding | 241 | ||
93. What features on physical examination can help identify an unknown cause of GI bleeding? | 241 | ||
94. In patients with acute GI bleeding, how may vital signs indicate the extent of volume depletion? | 242 | ||
95. What is the simplest way of differentiating upper GI from lower GI bleeding? | 242 | ||
96. How does the type of bloody stool help pinpoint the location of a GI bleed? | 242 | ||
97. What can cause false-negative and false-positive results when stool testing for blood? | 243 | ||
98. How do the causes of lower GI bleeding vary by age group? | 243 | ||
99. A previously asymptomatic 18-month-old child has large amounts of painless rectal bleeding (red but mixed with darker... | 243 | ||
100. Worldwide, what is the most common cause of GI blood loss in children? | 243 | ||
101. How do the causes of upper GI bleeding vary by age group? | 243 | ||
102. What is the most likely cause of hematemesis in a healthy term infant? | 244 | ||
103. What are the two most likely causes of visible blood in the stool of an otherwise healthy infant? | 244 | ||
104. What are the six most common causes of massive GI bleeding in children? | 244 | ||
Gastrointestinal dysmotility | 244 | ||
105. How rapidly do infants outgrow GER? | 244 | ||
106. When does GER become GERD (gastroesophageal reflux disease)? | 244 | ||
107. What are the diagnostic methods for GER? | 245 | ||
108. How effective are nonpharmacologic agents as treatments for suspected GER? | 245 | ||
109. How effective are H2 blockers and proton pump inhibitors (PPIs) in the treatment of GER? | 245 | ||
110. An infant with known GER who periodically arches his or her back may have what syndrome? | 245 | ||
111. What is a Nissen fundoplication? | 245 | ||
112. Which patients are candidates for fundoplication? | 246 | ||
113. A teenage girl has symptoms of swallowing difficulties improved by positional head and neck changes, nocturnal regur... | 246 | ||
114. What are the key tests to diagnose achalasia? | 246 | ||
115. What are treatment options for achalasia? | 246 | ||
116. What are the common symptoms of gastroparesis? | 247 | ||
117. In what clinical settings should gastroparesis be suspected? | 247 | ||
118. How is postinfectious gastroparesis diagnosed? | 247 | ||
119. How is gastroparesis treated? | 247 | ||
120. A 12-year-old who presents with weight loss and a history of effortlessly and involuntarily regurgitating many meals... | 247 | ||
Hepatic, biliary and pancreatic disease | 247 | ||
121. What laboratory tests are commonly used to evaluate liver disease? | 247 | ||
122. What conditions are associated with elevations of aminotransferases? | 248 | ||
123. What is the most frequent cause of chronically elevated aminotransferases among children and adolescents in the Unit... | 248 | ||
124. What is the main reason for the apparent increase in pediatric NAFLD? | 248 | ||
125. What is the best way to screen for NAFLD? | 249 | ||
126. Why is it important to determine whether an elevated bilirubin is conjugated or unconjugated? | 249 | ||
127. When are levels of conjugated bilirubin considered abnormal? | 249 | ||
128. What are the common causes of neonatal hepatitis and neonatal cholestasis? | 249 | ||
129. What is the likelihood of chronic hepatic disease developing after acute infections with hepatitis viruses A to G? | 250 | ||
130. Other than viral hepatitis, what are other common causes of acute and chronic hepatitis in children? | 250 | ||
131. How is α1-antitrypsin deficiency most likely to present in infants and children? | 250 | ||
132. Why is measuring the level serum level of α1-antitrypsin not enough to diagnose α1-antitrypsin deficiency? | 250 | ||
133. What is the metabolic defect in patients with Wilson disease? | 250 | ||
134. What are the treatments of choice for Wilson disease? | 251 | ||
135. A 3-year-old child who experiences mild fluctuating jaundice in times of illness ``just like his Uncle Kevin´´ is li... | 251 | ||
136. What are the clinical findings of portal hypertension? | 251 | ||
137. How does autoimmune hepatitis (AIH) typically present? | 251 | ||
138. A patient with liver failure develops confusion. Why worry? | 251 | ||
139. What is the most common indication for pediatric liver transplantation? | 251 | ||
140. Calculous and acalculous cholecystitis: what are the differences? | 251 | ||
141. Which patients are at risk for cholelithiasis? | 252 | ||
142. What are the possible causes of pancreatitis in children? | 252 | ||
143. What is the typical presentation of acute pancreatitis in children? | 252 | ||
144. Which enzyme is a more sensitive marker of pancreatic injury in children: amylase or lipase? | 253 | ||
145. What conditions may be associated with hyperamylasemia? | 253 | ||
Inflammatory bowel disease | 253 | ||
146. What is the epidemiology of pediatric inflammatory bowel disease (IBD)? | 253 | ||
147. How do ulcerative colitis and Crohn disease vary in intestinal distribution? | 253 | ||
148. What features differentiate ulcerative colitis from Crohn disease? | 253 | ||
149. What is the role of serologic panels in the diagnosis of IBD? | 254 | ||
150. What are the extraintestinal manifestations of pediatric IBD? | 255 | ||
151. What pharmacologic therapies are used in the treatment of ulcerative colitis and Crohn disease? | 255 | ||
152. How are therapies chosen for IBD? | 255 | ||
153. Is there a potential role for thalidomide in the treatment of Crohn disease? | 255 | ||
154. In a child who has been diagnosed with Crohn disease, what are potential long-term complications? | 256 | ||
155. Are children with IBD at increased risk for malignancy? | 256 | ||
156. When is surgery indicated for children with IBD? | 256 | ||
Nutrition | 256 | ||
157. What are various requirements for protein, fat, and carbohydrates? | 256 | ||
158. If recommended caloric intakes are maintained, what is normal daily weight gain of young children? | 257 | ||
159. What are the recommended bottle feedings by age? | 257 | ||
160. Why should whole cow milk not be introduced until 1 year of age? | 258 | ||
161. Why is honey not recommended for infants during the first year of life? | 258 | ||
162. How is nutritional status objectively assessed in children? | 258 | ||
163. What features on examination of the scalp, eyes, and mouth suggest problems of malnutrition? | 258 | ||
164. How do marasmus and kwashiorkor differ clinically? | 258 | ||
165. What vitamins and minerals are often deficient in strict vegans and some vegetarians? | 259 | ||
166. What two factors make vitamin D deficiency such a common problem? | 259 | ||
167. How much vitamin D should children receive on a daily basis? | 259 | ||
168. What are the cutoffs for vitamin D deficiency and sufficiency? | 260 | ||
Obesity and lipid disorders | 260 | ||
169. What are the weight status categories for children in terms of body mass index (BMI) percentile? | 260 | ||
170. What screening laboratory tests should be done for obese children? | 260 | ||
171. What are the different types of cholesterol? | 260 | ||
172. Why is the promotion of cardiovascular health and the identification of specific risk factors important in pediatric... | 260 | ||
173. What are the screening guidelines for lipids? | 261 | ||
174. What are the cutoffs for abnormal lipid levels? | 261 | ||
175. What are the American Heart Association dietary strategies for all children older than 2 years? | 261 | ||
176. How are the primary genetic hyperlipidemias classified? | 262 | ||
177. What is the most common hyperlipidemia in childhood? | 262 | ||
Surgical issues | 262 | ||
178. What is the natural history of an umbilical hernia? | 262 | ||
179. Which umbilical hernias warrant surgical repair? | 262 | ||
180. When should an infant with inguinal hernia have it electively repaired? | 263 | ||
181. Does surgical repair of one hernia warrant intraoperative exploration for another on the opposite side? | 263 | ||
182. How are incarcerated inguinal hernias reduced? | 263 | ||
183. Under what clinical settings should manual reduction of an inguinal hernia not be attempted? | 263 | ||
184. What is the significance of green vomiting during the first 72 hours of life? | 263 | ||
185. What are the clinical findings of malrotation of the intestine? | 264 | ||
186. What causes the intestinal obstruction in malrotation? | 264 | ||
187. In an asymptomatic child with an incidental finding of malrotation, is surgery indicated? | 264 | ||
188. What is the most common cause of intestinal obstruction in young children? | 265 | ||
189. In what settings should intussusception be suspected? | 265 | ||
190. How commonly does intussusception appear with the classic findings? | 265 | ||
191. What causes intussusception? | 265 | ||
192. What is the most common type of intussusception? | 265 | ||
193. How is intussusception diagnosed? | 266 | ||
194. How frequently does intussusception recur? | 266 | ||
195. Rotavirus vaccine and intussusception: how are they intertwined? | 266 | ||
196. Duodenal or jejunoileal atresia: which is associated with other embryonic abnormalities? | 266 | ||
197. What is the classic radiographic finding in duodenal atresia? | 266 | ||
198. How does the infant with biliary atresia classically present? | 266 | ||
199. What is the surgical procedure for biliary atresia? | 267 | ||
200. Which is accompanied by more complications: high or low imperforate anus? | 267 | ||
201. What is the classic presentation of pyloric stenosis? | 267 | ||
202. How is pyloric stenosis diagnosed? | 267 | ||
203. What is the mechanism of hyperbilirubinemia in babies with pyloric stenosis? | 267 | ||
204. In a patient with suspected pyloric stenosis, why is an acidic urine very worrisome? | 267 | ||
205. What is the connection between pyloric stenosis and macrolide antibiotics? | 268 | ||
206. What is the short bowel syndrome? | 268 | ||
207. Why are infants with short bowel syndrome prone to renal calculi? | 268 | ||
208. In extensive small bowel resection, how much is ``too much´´? | 268 | ||
209. Appendicitis in children: clinical, laboratory, or radiologic diagnosis? | 269 | ||
210. How specific is the diagnosis of appendicitis if an appendicolith is noted on radiograph? | 269 | ||
211. Should a digital rectal examination be performed on all children with possible appendicitis? | 269 | ||
212. In children taken to surgery for suspected appendicitis, how often is perforation of the appendix present? | 270 | ||
213. Should children with acute abdominal pain be given analgesia before a diagnosis? | 270 | ||
214. In what clinical settings is rectal prolapse most commonly seen? | 270.e1 | ||
215. List the indications for lower gastrointestinal colonoscopy or endoscopy in children. | 270.e1 | ||
216. How can you tell a coin from a button battery on x-ray? | 270.e1 | ||
217. What are the indications for nonemergent foreign body removal? | 270.e1 | ||
218. What are risk factors for the formation of phytobezoars? | 270.e1 | ||
219. What tests, in addition to those ruling out Hirschsprung disease, are commonly considered for refractory cases of co... | 270.e1 | ||
220. Which children should be seen for the medical evaluation of acute diarrhea? | 270.e2 | ||
221. What is the differential diagnosis of chronic diarrhea in different age groups? | 270.e2 | ||
222. What is the physiologic basis for oral rehydration therapy? | 270.e2 | ||
223. What are the basic principles guiding optimal treatment of children with diarrhea and mild dehydration? | 270.e2 | ||
224. What is the most common treatment for travelers´ diarrhea in children? | 270.e3 | ||
225. Which patients are particularly susceptible to giardiasis? | 270.e3 | ||
226. What common conditions are associated with an increased risk for celiac disease? | 270.e3 | ||
227. What is the management for massive upper GI bleeding in children? | 270.e3 | ||
228. Why is the buffering of gastric acid important for controlling upper GI bleeding? | 270.e3 | ||
229. What are the most common complications of fundoplication? | 270.e3 | ||
230. How does the presentation of achalasia differ with age? | 270.e4 | ||
231. Can hepatitis C virus (HCV) be acquired vertically at birth? | 270.e4 | ||
232. Is a decreased ceruloplasmin pathognomonic to Wilson disease? | 270.e4 | ||
233. An infant with cholestasis, triangular facies, and a pulmonic stenosis murmur is likely to have what syndrome? | 270.e4 | ||
234. What are the common side effects of the immunomodulators? | 270.e4 | ||
235. What is the difference between Infliximab and adalimumab? | 270.e4 | ||
236. What is the mechanism of enteral nutrition therapy for IBD? | 270.e4 | ||
237. What is the postoperative prognosis for Crohn disease and ulcerative colitis? | 270.e4 | ||
238. When and how should solids be introduced into an infants diet? | 270.e5 | ||
239. What are risk factors for low vitamin D levels? | 270.e5 | ||
240. What comorbidities are associated with obesity? | 270.e5 | ||
241. How do causes of intestinal obstruction vary by age? | 270.e5 | ||
242. When should a Kasai procedure be performed? | 270.e6 | ||
243. What conditions may mimic appendicitis? | 270.e6 | ||
Chapter 8: Genetics | 271 | ||
Clinical issues | 271 | ||
1. Which disorders with ethnic and racial predilections most commonly warrant maternal screening for carrier status? | 271 | ||
2. Why are mitochondrial disorders transmitted from generation to generation by the mother and not the father? | 271 | ||
3. What is genetic imprinting? | 271 | ||
4. What is uniparental disomy? | 272 | ||
5. What is the etiology of arthrogryposis congenita? | 272 | ||
6. How common are genetic causes of hearing loss in childhood? | 273 | ||
7. What is the most common genetic mutation in infants with prelingual hearing loss? | 273 | ||
8. What are the genetic causes of microcephaly? | 273 | ||
9. Are older fathers at increased risk of having a child with a genetic disease? | 273 | ||
10. What is the most common genetic lethal disease? | 273 | ||
11. What are the syndromes associated with macrosomia (large baby syndromes)? | 274 | ||
12. What is the ``H3O´´ of Prader-Willi syndrome? | 274 | ||
13. A child with supravalvular aortic stenosis, small and abnormally shaped primary teeth, low muscle tone with joint lax... | 274 | ||
14. What are the two most common forms of dwarfism that are recognizable at birth? | 274 | ||
15. What chromosomal abnormality is found in cri-du-chat syndrome? | 275 | ||
16. Is there a ``Catch-22´´ to the Catch-22 syndrome? | 275 | ||
17. For what condition are patients with isolated limb hypertrophy at risk? | 275 | ||
18. After Down syndrome, what are the next most common autosomal trisomies in live-born children? | 276 | ||
19. What are the reasons that a condition might be genetically determined but the family history would be negative? | 276 | ||
20. What online resources are available for a pediatrician who suspects a child has a genetic syndrome or would like addi... | 277 | ||
Down syndrome | 277 | ||
21. What are the common physical characteristics of children with Down syndrome? | 277 | ||
22. Are Brushfield spots pathognomonic for Down syndrome? | 278 | ||
23. What is the chance that a newborn with a simian crease has Down syndrome? | 278 | ||
24. Why is an extensive cardiac evaluation recommended for newborns with Down syndrome? | 279 | ||
25. What proportion of infants with Down syndrome has congenital hypothyroidism? | 279 | ||
26. Infants with Down syndrome are at increased risk for a number of conditions during early infancy. What are they? | 279 | ||
27. What is the most common malignancy in an infant with Down Syndrome? | 279 | ||
28. What is the genetic basis for Down syndrome? | 279 | ||
29. What chromosomal abnormalities are related to maternal age? | 279 | ||
30. How does the risk for having an infant with Down syndrome change with advancing maternal age? | 280 | ||
31. Who was Down of Down syndrome? | 280 | ||
Dysmorphology | 280 | ||
32. What is the clinical significance of a minor malformation? | 280 | ||
33. Do infants with the LEOPARD syndrome have spots? | 280 | ||
34. Which is correct: CHARGE syndrome or CHARGE association? | 281 | ||
35. What is the proper way to test for low-set ears? | 281 | ||
36. How is hypertelorism distinguished from telecanthus? | 281 | ||
37. What is the inheritance pattern of cleft lip and palate? | 282 | ||
38. Which syndromes are associated with colobomas of the iris? | 282 | ||
Genetic principles | 283 | ||
39. Identify the common symbols used in the construction of a pedigree chart | 283 | ||
40. How can the same genotype lead to different phenotypes? | 283 | ||
41. When a geneticist says they are going ``FISH´´ing, what does that mean? | 283 | ||
42. What is currently the best method for detecting small chromosome deletions and duplications? | 284 | ||
Inborn errors of metabolism | 284 | ||
43. What types of inherited metabolic conditions are routinely screened by most states? | 284 | ||
44. In what settings should inborn errors of metabolism be suspected? | 284 | ||
45. What are the main categories of specialized laboratory testing to detect an IEM? | 284 | ||
46. What are the main principles of treatment for IEM? | 285 | ||
47. What are the main features of phenylketonuria (PKU)? | 285 | ||
48. What are the main characteristics of a patient with glycogen storage disease type 1 (GSD 1)? | 285 | ||
49. What are the main features of a patient with mucopolysaccharidosis? | 285 | ||
50. An 8-month-old presents with vomiting, lethargy, hypoglycemia and no ketones on urinalysis. What condition is likely? | 287 | ||
51. What features should raise suspicion of mitochondrial disease? | 287 | ||
52. What is the most common presentation of childhood-onset mitochondrial disease? | 287 | ||
53. When you are rounding in the well newborn nursery, one of the infants has an unusual odor. What are the typical body ... | 287 | ||
54. Which inborn errors of metabolism can result in fetal hydrops? | 289 | ||
55. Which metabolic disorders can present as sudden unexpected death syndrome (SUDS)? | 289 | ||
56. One of the infants in your care dies from a suspected IEM. What postmortem investigations are key? | 289 | ||
Sex-chromosome abnormalities | 289 | ||
57. Does the Lyon hypothesis refer to the ``king of beasts´´? | 289 | ||
58. What are the features of the four most common sex-chromosome abnormalities? | 289 | ||
59. Of the four most common types of sex-chromosome abnormalities, which is identifiable at birth? | 291 | ||
60. What are the differences between Noonan syndrome and Turner syndrome? | 292 | ||
61. What is the second most common genetic form of mental retardation? | 292 | ||
62. What are the characteristic facial features of fragile X syndrome? | 292 | ||
63. What is the nature of the mutation in fragile X syndrome? | 292 | ||
64. What are the associated medical problems of fragile X syndrome in males? | 293 | ||
65. What is the outcome for girls with fragile X? | 293 | ||
Teratology | 293 | ||
66. Which drugs are known to be teratogenic? | 293 | ||
67. Describe the characteristic features of the fetal hydantoin syndrome | 294 | ||
68. A pregnant female sommelier asks you what amount of Chateauneuf Du Pape is safe to ingest during pregnancy. | 294 | ||
69. What are the frequent facial features of the fetal alcohol syndrome? | 294 | ||
70. What happens to children with fetal alcohol syndrome when they grow up? | 295 | ||
71. What syndromes with a genetic basis should be considered in a patient with ambiguous genitalia? | 295.e1 | ||
72. What is the genetic basis of Angelman syndrome? | 295.e1 | ||
73. Why are patients with Marfan syndrome at risk for sudden cardiac death? | 295.e1 | ||
74. List the syndromes and malformations associated with congenital limb hemihypertrophy | 295.e1 | ||
75. What are the most common chromosome deletion syndromes? | 295.e1 | ||
76. Which of the inborn errors of metabolism are associated with liver disease? | 295.e1 | ||
Chapter 9: Hematology | 296 | ||
Bone marrow failure | 296 | ||
1. What are the types of bone marrow failure? | 296 | ||
2. What are the causes of acquired aplastic anemia? | 296 | ||
3. What is the definition of severe aplastic anemia? | 296 | ||
4. What are the treatments and prognosis for children with aplastic anemia? | 296 | ||
5. What is the probable diagnosis of a 6-year-old child with pancytopenia, short stature, abnormal thumbs, and areas of h... | 297 | ||
6. How is the diagnosis of Fanconi anemia made? | 297 | ||
7. A 1-year-old child presents with pallor and lethargy and is found to have a normocytic anemia (hemoglobin 3.5 g/dL). T ... | 297 | ||
8. Why is distinguishing between the two conditions extremely important? | 297 | ||
9. How are the two conditions diagnosed? | 297 | ||
10. What is Kostmann syndrome? | 298 | ||
11. You are asked to evaluate a 9-month-old male with eczema and recurrent respiratory infections who was found to be thr... | 298 | ||
12. A 4-year-old with failure to thrive and chronic diarrhea has a normal sweat test but is noted to have neutropenia on ... | 298 | ||
Clinical issues | 298 | ||
13. What is the hemoglobin value below which children are considered to be anemic (lower limit of normal)? | 298 | ||
14. When does the physiologic anemia of infancy occur? | 298 | ||
15. Why does the physiologic anemia of infancy occur? | 298 | ||
16. In what settings of shortened RBC survival can the reticulocyte count be normal or decreased? | 299 | ||
17. How does the pathophysiology of anemia differ in chronic and acute infection? | 299 | ||
18. Describe the differential diagnosis for children with splenomegaly and anemia. | 299 | ||
19. What is the significance of a leukemoid reaction? | 299 | ||
20. Name the three most common causes of eosinophilia in children in the United States. | 299 | ||
21. What conditions are associated with extreme elevations of eosinophils in children? | 299 | ||
22. A 14-month-old child presents symptoms including marked cyanosis, lethargy, and normal oxygen saturation by pulse oxi... | 300 | ||
23. What is the treatment for methemoglobinemia? | 300 | ||
24. Why are infants at greater risk for the development of methemoglobinemia? | 300 | ||
25. What are the critical steps in planning for a teenager with a chronic hematologic condition to transition to adult-or... | 300 | ||
Coagulation disorders | 300 | ||
26. What features on history or physical examination help pinpoint the cause of a bleeding problem? | 300 | ||
27. What do the activated partial thromboplastin time (aPTT) and the prothrombin time (PT) measure in the basic clotting ... | 301 | ||
28. What are the possible causes of a prolonged aPTT and PT? | 301 | ||
29. What is the INR? | 301 | ||
30. What are the frequency and the inheritance patterns of common bleeding disorders? | 302 | ||
31. Why is the lack of a family history of bleeding problems only moderate evidence against the likelihood of hemophilia ... | 302 | ||
32. What are the clinical classifications for hemophilia A and B? | 302 | ||
33. What are the primary measures for achieving hemostasis in individuals with bleeding disorders? | 303 | ||
34. To what degree should factor levels be raised for patients with hemophilia with or without life-threatening hemorrhage? | 303 | ||
35. How are doses of replacement factors calculated? | 303 | ||
36. In patients with severe hemophilia, can prophylaxis with factor replacement prevent severe hemorrhage? | 303 | ||
37. What are the half-lives of exogenously administered factors VIII and IX? | 304 | ||
38. Are longer-acting factors VIII and IX available? | 304 | ||
39. What can cause an elevation of the PT when other coagulation testing is normal? | 304 | ||
40. Who gets hemophilia C? | 304 | ||
41. Why is factor IX deficiency also called ``Christmas disease´´? | 304 | ||
42. What is the von Willebrand factor (vWF)? | 305 | ||
43. What are the coagulation abnormalities in von Willebrand disease? | 305 | ||
44. What are initial diagnostic tests for suspected von Willebrand disease? | 305 | ||
45. What does the ristocetin cofactor assay measure? | 305 | ||
46. How is von Willebrand disease treated? | 305 | ||
47. In an adolescent with menorrhagia, how likely is a bleeding disorder? | 305 | ||
48. How does DDAVP work in the treatment of von Willebrand disease? | 305 | ||
49. Should children awaiting surgery undergo routine preoperative screening for potential abnormal bleeding? | 306 | ||
50. What is the role of vitamin K in coagulation? | 306 | ||
51. In what settings outside the newborn period can vitamin K abnormalities contribute to a bleeding diathesis? | 306 | ||
52. What is the best test for distinguishing coagulation disturbances that result from hepatic disease, DIC, and vitamin ... | 306 | ||
53. What is DIC? | 307 | ||
54. What tests are valuable for the diagnosis of suspected DIC? | 307 | ||
55. What is the treatment of choice for DIC? | 307 | ||
56. What are the common hereditary disorders that predispose a child to thrombosis? | 307 | ||
57. What are the inheritance patterns of the hypercoagulable states? | 307 | ||
58. In an adolescent with an unprovoked deep vein thrombosis (DVT), what risk factors need to be assessed? | 308 | ||
59. What anatomic variants will predispose individuals to venous thromboses? | 308 | ||
60. What are the mechanisms for low molecular weight heparin and pentasaccharide as antithrombotic agents? | 308 | ||
61. What are the direct thrombin inhibitors? | 308 | ||
Developmental physiology | 308 | ||
62. How do immunoglobulin (Ig) levels change during the first years of life? | 308 | ||
63. Why are antibodies not produced by the fetus in appreciable quantities? | 308 | ||
64. What is the role of the thymus? | 309 | ||
65. At what age does thymic function cease? | 309 | ||
66. How does neutrophil function in the neonate compare with that of adults? | 309 | ||
Hematology laboratory | 309 | ||
67. Of the seven red-cell parameters given by a Coulter counter, which are measured and which are calculated? | 309 | ||
68. How does the mean corpuscular volume help provide a quick screen of the possible causes of anemia? | 309 | ||
69. What is a quick rule of thumb for approximating MCV? | 309 | ||
70. In addition to an elevated reticulocyte count, what laboratory studies suggest increased destruction (rather than dec... | 309 | ||
71. Why must the reticulocyte count sometimes be corrected? | 310 | ||
72. What is the significance of targeting on an RBC smear? | 310 | ||
73. In what conditions are Howell-Jolly bodies found? | 310 | ||
74. What is the cause of Heinz bodies? | 310 | ||
75. What makes an ``atypical lymphocyte´´ atypical? | 311 | ||
76. A patient with oculocutaneous albinism has repeated Staphylococcus aureus infections and the peripheral smear shown i... | 311 | ||
Hemolytic anemia | 312 | ||
77. What clinical features are suspicious for hemolytic anemia? | 312 | ||
78. What two types of RBC forms are commonly seen on the peripheral smear in patients with hemolytic anemia? | 312 | ||
79. Name the two most common inherited disorders of red-cell membranes | 312 | ||
80. Which disorder is most commonly associated with an elevated MCHC? | 312 | ||
81. What is the osmotic fragility test? | 312 | ||
82. What is the difference between alloimmune and autoimmune hemolytic anemia? | 313 | ||
83. In which settings do alloimmune and AIHA most commonly appear? | 313 | ||
84. How does the cause of AIHA vary by age? | 313 | ||
85. What is the most important test to establish the diagnosis of AIHA? | 313 | ||
86. What are the differences between autoimmune hemolytic anemias caused by ``warm´´ and ``cold´´ erythrocyte autoantibodies? | 313 | ||
87. A 6-year-old presents with acute anemia, fatigue, jaundice, and dark urine after an early spring swim in a local quar... | 313 | ||
88. An 8-year-old black male developed jaundice and very dark urine 24 to 48 hours after beginning nitrofurantoin for a u... | 313 | ||
89. Why are ``bite cells´´ seen in patients with G6PD deficiency´´? | 314 | ||
90. In a patient with G6PD deficiency, why is the initial diagnosis often difficult in the acute setting? | 314 | ||
91. What is favism? | 314 | ||
Immunodeficiency | 314 | ||
92. How is neutropenia defined? | 314 | ||
93. How do children with neutrophil disorders present? | 315 | ||
94. What is the most common cause of transient neutropenia in children? | 315 | ||
95. Excluding intrinsic defects in myeloid stem cells, what conditions are associated with neutropenia in children? | 315 | ||
96. Which is the most common form of chronic childhood neutropenia? | 315 | ||
97. How common are primary immunodeficiencies? | 315 | ||
98. What are the typical clinical findings of the various primary immunodeficiencies? | 316 | ||
99. What is the single most important laboratory test if SCID is suspected? | 316 | ||
100. Why are male children more likely to suffer from a primary immunodeficiency? | 317 | ||
101. Which is the most common type of primary immunodeficiency? | 317 | ||
102. What are the diagnostic criteria for IgA deficiency? | 317 | ||
103. What is the association of autoimmune disorders and IgA deficiency? | 317 | ||
104. Why is immunoglobulin therapy not used as a treatment for selective IgA deficiency? | 317 | ||
105. In an infant with panhypogammaglobulinemia, how can the quantitation of B and T lymphocytes in peripheral blood help... | 317 | ||
106. What is the underlying disorder in an 8-year-old girl with atypical eczema, pneumatoceles, and bouts of severe furun... | 318 | ||
107. What are the proven indications for intravenous immunoglobulin (IVIG) therapy? | 318 | ||
108. What are the pharmacologic characteristics of IVIG? | 318 | ||
109. What are the adverse reactions to IVIG? | 318 | ||
110. Which viral infections can result in hypogammaglobulinemia in the immunocompetent individual? | 319 | ||
111. What is the classic triad of Wiskott-Aldrich syndrome? | 319 | ||
112. What is the likely diagnosis of a patient presenting with a progressive ataxia, conjunctival abnormalities, and recu... | 319 | ||
113. What disease did the ``bubble boy´´ have? | 320 | ||
114. Describe the molecular defect of chronic granulomatous disease (CGD) | 320 | ||
115. Which laboratory tests are used for the diagnosis of CGD? | 320 | ||
116. What types of infections are commonly seen in children with CGD? | 320 | ||
117. Which disorder has to be considered in a newborn patient with delayed separation of the umbilical cord? | 320 | ||
118. Which potential life-threatening disorder of the complement system is associated with nonpruritic swelling and occas... | 320 | ||
Immunology laboratory | 321 | ||
119. Which are the initial screening tests for a suspected immunodeficiency? | 321 | ||
120. Which laboratory tests allow for a broad evaluation of the humoral immune system? | 321 | ||
121. Which diagnostic tests allow for the specific evaluation of T-cell functions? | 321 | ||
122. What is the value of skin testing for the diagnosis of T-cell deficiencies? | 321 | ||
123. What is the importance of the CD4/CD8 ratio? | 321 | ||
124. Which laboratory tests appropriately evaluate the phagocytic system? | 322 | ||
125. How is the classic complement cascade evaluated? | 322 | ||
Iron-deficiency anemia | 322 | ||
126. What is the worlds most common single-nutrient deficiency? | 322 | ||
127. At what age do exclusively breast-fed infants become at risk for iron deficiency? | 322 | ||
128. Why are infants who begin consuming cow milk at an early age susceptible to iron-deficiency anemia? | 323 | ||
129. As iron becomes depleted from the body, what is the progression at which laboratory tests change? | 323 | ||
130. How might the reticulocyte hemoglobin content be helpful for the diagnosis of iron deficiency? | 323 | ||
131. Why are tests for iron stores more difficult to interpret during acute inflammatory states? | 324 | ||
132. What is the role of hepcidin in iron metabolism? | 324 | ||
133. What are the common causes of microcytic anemia in children? | 324 | ||
134. How is the RDW useful for distinguishing causes of microcytic anemia? | 324 | ||
135. What is the Mentzer index? | 324 | ||
136. In a child with suspected iron-deficiency anemia, is a therapeutic trial with iron an acceptable diagnostic approach? | 324 | ||
137. After iron therapy is initiated, how early can a response be detected? | 324 | ||
138. What foods affect the bioavailability of nonheme iron? | 324 | ||
139. What are the options for use of parenteral iron therapy? | 325 | ||
140. What are the differences between pica, geophagia, and pagophagia? | 325 | ||
141. What is the derivation of the term pica? | 325 | ||
142. Discuss the relationship between iron deficiency and development in infants and toddlers. | 325 | ||
143. What are the risk factors for iron deficiency or iron-deficiency anemia in a 1-year-old? | 325 | ||
144. Why are iron-deficient children at increased risk for lead poisoning? | 325 | ||
145. How and when should younger children be screened for iron deficiency? | 326 | ||
Megaloblastic anemia | 326 | ||
146. What is megaloblastic anemia? | 326 | ||
147. Is megaloblastic anemia the most common cause of macrocytic anemia? | 326 | ||
148. What findings on a CBC are suggestive of megaloblastic anemia? | 326 | ||
149. What are the causes of vitamin B12 (cobalamin) deficiency in children? | 326 | ||
150. What are the best dietary sources of folate and B12? | 327 | ||
151. What is pernicious anemia? | 327 | ||
152. A 10-month-old child who was exclusively fed goat milk is likely to develop what type of anemia? | 327 | ||
Platelet disorders | 327 | ||
153. How can a platelet count be estimated from a peripheral smear? | 327 | ||
154. What are the main pathophysiologic processes that can result in thrombocytopenia? | 327 | ||
155. A previously healthy 3-year-old child develops mucosal petechiae, multiple ecchymoses, and a platelet count of 20,00... | 327 | ||
156. What microscopic features would suggest a diagnosis other than ITP in a patient with a platelet count of 20,000/mm3? | 327 | ||
157. What is the natural history of acute childhood ITP? | 327 | ||
158. In a toddler with suspected ITP, what is the significance of a palpable spleen on examination? | 328 | ||
159. In patients with suspected ITP, should a bone marrow evaluation be done? | 328 | ||
160. When should medical treatment be given for acute ITP without active bleeding? | 328 | ||
161. What are thrombocytopenic precautions in children? | 328 | ||
162. How do treatments for ITP compare? | 328 | ||
163. Which children with ITP are candidates for splenectomy? | 329 | ||
164. What evaluations should be considered in a patient with persistent refractory thrombocytopenia? | 329 | ||
165. How is neonatal alloimmune thrombocytopenia diagnosed and treated? | 329 | ||
166. In what conditions of children is thrombocytosis most commonly seen? | 329 | ||
167. What level of thrombocytosis requires treatment? | 329 | ||
Sickle cell disease | 330 | ||
168. What is the mutation that results in sickle cell disease? | 330 | ||
169. Why is sickle cell disease often asymptomatic during the first months of life? | 330 | ||
170. What are the various genotypes that can cause the clinical syndrome of sickle cell disease? | 330 | ||
171. What are the two major pathophysiologic mechanisms in sickle cell anemia that cause the morbidities associated with ... | 330 | ||
172. A 6-month-old black male has painful swelling of both hands. What is the most likely diagnosis? | 330 | ||
173. When does functional asplenia occur in children with sickle cell disease? | 331 | ||
174. What is the most common cause of death in children with sickle cell disease? | 331 | ||
175. What are the four main categories of acute events requiring intervention in patients with sickle cell disease? | 331 | ||
176. How should a child with a vasoocclusive (painful) event be managed? | 331 | ||
177. A 15-month-old with sickle cell disease presents with pallor and fatigue, but no jaundice. On exam, his spleen is pa... | 331 | ||
178. What is ``acute chest syndrome´´ in sickle cell patients? | 332 | ||
179. How should the acute chest syndrome in sickle cell patients be treated? | 332 | ||
180. How often is priapism a problem in children with sickle cell disease? | 332 | ||
181. What are some long-term morbidities associated with sickle cell disease? | 332 | ||
182. How can stroke be prevented in children with sickle cell disease? | 332 | ||
183. If initiated for either primary or secondary stroke prevention, when should blood transfusions be discontinued? | 333 | ||
184. What is the primary mechanism by which hydroxyurea is beneficial for sickle cell disease? | 333 | ||
185. Hydroxyurea treatment in young children: how early and how beneficial? | 333 | ||
186. How common is the sickle cell trait in the United States? | 334 | ||
187. Does sickle cell trait have any significant morbidity? | 334 | ||
188. What is the second most common worldwide hemoglobin variant? | 334 | ||
Thalassemia | 334 | ||
189. What are the thalassemias? | 334 | ||
190. Where was β-thalassemia first described? | 334 | ||
191. What accounts for the variability in the clinical expression of the thalassemias? | 334 | ||
192. How is the diagnosis of thalassemia made in most clinical laboratories? | 335 | ||
193. Describe the clinical features of the alpha-thalassemia syndromes | 335 | ||
194. What is hemoglobin Barts? | 335 | ||
195. What are the clinical features of the beta-thalassemia syndromes? | 335 | ||
196. How can coexistent iron deficiency increase the difficulty of diagnosing beta-thalassemia? | 335 | ||
197. What are the adverse effects of chronic transfusional iron overload in children with thalassemia? | 336 | ||
198. What are the two most common diseases that are associated with transfusion-related iron overload? | 336 | ||
199. How do you reduce iron accumulation in children who require repeated transfusions? | 336 | ||
200. In addition to iron loading, what are additional risks of chronic transfusion therapy? | 336 | ||
Transfusion issues | 336 | ||
201. What is the difference between the direct and indirect Coombs tests? | 336 | ||
202. What is the difference between forward and reverse blood typing? | 337 | ||
203. What can cause a patient to be ABO indeterminate? | 337 | ||
204. What is a naturally forming RBC antibody? | 337 | ||
205. What is the difference between a type and screen and a type and cross? | 337 | ||
206. What are the indications for the use of leukoreduced RBCs? | 337 | ||
207. What is the estimated total blood volume of children? | 337 | ||
208. What is the RBC transfusion threshold for infants <4 months of age? | 338 | ||
209. What is the packed red blood cell (PRBC) transfusion threshold for children >4 months of age? | 338 | ||
210. In patients with severe chronic anemia, how rapidly can transfusions be given? | 338 | ||
211. At typical doses, what are the expected increases and likely average survival of packed RBCs, platelets, and fresh f... | 338 | ||
212. What are the components of cryoprecipitate? | 339 | ||
213. What are the most common types of transfusion reactions? | 339 | ||
214. What is the most common cause of transfusion-related death in the United States? | 339 | ||
215. What is the difference between an acute hemolytic transfusion reaction and a delayed hemolytic transfusion reaction? | 339 | ||
216. Why do some blood products require irradiation? | 339 | ||
217. In what clinical settings is apheresis utilized? | 340 | ||
218. How are transfusion-transmitted diseases prevented? | 340 | ||
219. What role does molecular testing play in providing blood products to patients? | 340 | ||
220. Do socioeconomic factors affect the ability of pediatric patients to successfully transition health care? | 340.e1 | ||
221. Which are the characteristics of immunoglobulin transport across the placenta? | 340.e1 | ||
222. What are the allergies associated with IgA deficiency? | 340.e1 | ||
223. Is there a role for stimulating platelet production in ITP therapy? | 340.e1 | ||
224. In addition to stroke, what other sickle cell-related conditions benefit from chronic transfusion regimens? | 340.e1 | ||
225. What are the indications for platelet transfusion in neonates and children? | 340.e1 | ||
Chapter 10: Infectious Diseases | 341 | ||
Anti-infective therapy | 341 | ||
1. What are the main features of penicillins? | 341 | ||
2. What are the different classes and spectra of activity of penicillins? | 341 | ||
3. In patients for whom the history lists ``penicillin allergy,´´ how commonly is a true allergy present on testing? | 342 | ||
4. If a 16-year-old male develops a pruritic, maculopapular rash 1 week after starting treatment with amoxicillin for an ... | 342 | ||
5. What are the similarities between penicillins and cephalosporins? | 342 | ||
6. How do the ``generations´´ of cephalosporins differ from one another? | 342 | ||
7. What are the differences among first-, second-, third-, and fourth-generation cephalosporins? | 342 | ||
8. Can cephalosporins be safely given to patients who are allergic to penicillin? | 343 | ||
9. What are the two primary mechanisms of resistance to β-lactam antibiotics? | 343 | ||
10. What are the main features of carbapenems? | 343 | ||
11. What is the role of ``double antimicrobial coverage´´? | 343 | ||
12. What are the ``ESKAPE´´ organisms? | 344 | ||
13. How can the emergence of antibiotic-resistant pathogens be minimized? | 344 | ||
14. What is the distinction between community-associated methicillin-resistant S. aureus (CA-MRSA) and hospital acquired ... | 344 | ||
15. Why is the D-test done? | 344 | ||
16. Is mupirocin useful in the eradication of S. aureus in colonized children? | 345 | ||
17. What is the ``red man syndrome´´ and which antibiotic is it associated with? | 345 | ||
18. How should infections with vancomycin-resistant enterococci be managed? | 345 | ||
19. Is vancomycin still effective against all staphylococci? | 346 | ||
20. In what situations may treatment with vancomycin be considered appropriate? | 346 | ||
21. Are fluoroquinolones safe to use in children? | 346 | ||
22. What are the uses of ribavirin? | 347 | ||
23. Why is chicken soup so helpful for upper respiratory infections (URIs)? | 347 | ||
24. Is there any physiologic basis to the adage ``starve a fever, feed a cold´´? | 347 | ||
Clinical issues | 347 | ||
25. Name the three stages of pertussis infection (whooping cough) | 347 | ||
26. What is the most common cause of death in children with whooping cough? | 348 | ||
27. Is antibiotic therapy of value in pertussis infection? | 348 | ||
28. What are ways on physical exam to help distinguish swelling as a result of mumps from swelling caused by lymphadenitis? | 348 | ||
29. What is the empiric treatment of a skin and soft tissue infection (SSTI) in the setting of the increasing prevalence ... | 348 | ||
30. What are the distinguishing features of staphylococcal scalded skin syndrome, staphylococcal toxic shock syndrome, an... | 349 | ||
31. Can antiviral medications be used to prevent or treat oral herpes simplex virus (HSV) infections? | 350 | ||
32. What is the proper medical term for oral thrush? | 350 | ||
33. What is the most common specific etiology diagnosed in patients with systemic febrile illness after international travel? | 350 | ||
34. What is the classic triad of malaria? | 350 | ||
35. How is malaria diagnosed? | 351 | ||
36. Which illness is associated with the term ``breakbone fever´´? | 351 | ||
37. What causes leptospirosis? | 351 | ||
38. What are the phases of leptospirosis? | 351 | ||
39. Which organisms are particularly dangerous to clinical microbiology laboratory workers? | 352 | ||
Congenital infections | 352 | ||
40. Which congenital infections cause cerebral calcifications? | 352 | ||
41. What are the late sequelae of congenital infections? | 352 | ||
42. What is the most common congenital infection? | 353 | ||
43. How common is hearing loss from congenital CMV? | 353 | ||
44. How is CMV transmitted from mother to infant? | 353 | ||
45. How should congenital CMV be treated? | 353 | ||
46. What is the risk to the fetus if the mother is infected with parvovirus B19 during pregnancy? | 353 | ||
47. What are the consequences of primary varicella infection during the first trimester? | 353 | ||
48. What are the indications for postexposure prophylaxis for varicella in the newborn? | 353 | ||
49. Do urogenital mycoplasmas have a role in neonatal disease? | 354 | ||
50. What are the features of congenital rubella syndrome (CRS)? | 354 | ||
51. Should all pregnant women be screened for HSV infection during pregnancy? | 354 | ||
52. What are risk factors for the development of neonatal HSV disease? | 354 | ||
53. What are the three forms of neonatal HSV disease? | 355 | ||
54. When should HSV disease be suspected in newborn or infants? | 355 | ||
55. How should the neonate with suspected HSV disease be treated? | 355 | ||
56. In which groups of women is prenatal hepatitis B surface antigen (HBsAg) screening recommended? | 355 | ||
57. What is the risk to the fetus if the mother is infected with hepatitis B virus? | 356 | ||
58. How should infants born to mothers with hepatitis B infection be managed? | 356 | ||
59. How should infants born to mothers with hepatitis A infection be managed? | 356 | ||
60. How should infants born to mothers with hepatitis C infection be managed? | 356 | ||
61. How do the clinical features of early and late congenital syphilis differ? | 356 | ||
62. How is the diagnosis of congenital syphilis made? | 356 | ||
63. What are the pitfalls of RPR and VDRL testing? | 357 | ||
64. If a pregnant woman is found to have Chlamydia trachomatis in her birth canal, what is the most appropriate course of... | 358 | ||
65. Should newborns of mothers with untreated chlamydial infection receive prophylactic antibiotic therapy? | 358 | ||
66. What is the risk to a fetus after primary maternal Toxoplasma infection? | 358 | ||
67. What is the typical presentation of congenital toxoplasmosis? | 359 | ||
68. How can a woman minimize the chance of acquiring a Toxoplasma infection during pregnancy? | 359 | ||
Emerging infectious diseases | 359 | ||
69. Which mycobacterium may infect someone who has a home aquarium? | 359 | ||
70. What are possible sources for an anthrax infection in a 17-year-old who lives on a cattle farm, makes and plays drums... | 359 | ||
71. What are the novel coronaviruses? | 359 | ||
72. What viral etiology should be considered in a patient with acute, unexplained respiratory illness who is not febrile? | 360 | ||
73. What two diseases in particular should be in the differential diagnosis for a traveler returning from the Caribbean w... | 360 | ||
74. What is the most common viral intestinal infection you can get from eating at a salad bar? | 360 | ||
75. When was the Ebola virus first discovered? | 360 | ||
76. What are the clinical features of an Ebola infection? | 360 | ||
77. What is the natural reservoir host of the Ebola virus? | 361 | ||
The febrile child | 361 | ||
78. At what temperature does a child have fever? | 361 | ||
79. Where did the popular notion that a normal temperature is 98.6 °F originate? | 361 | ||
80. How does temperature vary among different body sites? | 361 | ||
81. How accurate is parental palpation for fever in infants? | 361 | ||
82. How should the temperature of young infants be taken? | 362 | ||
83. How do environmental factors affect an infant's temperature? | 362 | ||
84. What is occult bacteremia? | 362 | ||
85. How has the pneumococcal vaccine (PCV) affected the incidence of occult bacteremia? | 362 | ||
86. What is meant by ``serotype replacement´´? | 362 | ||
87. What is the proper way to evaluate and manage febrile illness in neonates 28 days? | 363 | ||
88. What is the evaluation and management of febrile illness in infants >28 days to 90 days? | 363 | ||
89. How should older infants and toddlers (3 to 36 months old) with fever and no apparent source be managed? | 363 | ||
90. When is a chest radiograph indicated for a febrile young infant? | 364 | ||
91. What is the approach for a 2-week-old, otherwise healthy, afebrile, full-term female who presents to the ED with mast... | 364 | ||
92. What is a CLABSI? | 364 | ||
93. How long should one wait before a blood culture is designated negative? | 364 | ||
94. What is the utility of so-called ``rapid´´ pathogen testing? | 365 | ||
95. When is a fever considered a fever of unknown origin (FUO)? | 365 | ||
96. What is the eventual etiology of fever in children with FUO? | 365 | ||
97. How should a child with FUO be evaluated? | 365 | ||
98. What is PFAPA? | 366 | ||
99. In addition to PFAPA, which syndromes are associated with periodic fevers? | 366 | ||
Human immunodeficiency virus infection | 366 | ||
100. How common is the maternal-to-infant transmission of HIV? | 366 | ||
101. What drugs are recommended for reducing the maternal-to-infant transmission of HIV? | 367 | ||
102. What are the risk factors for perinatal transmission of HIV? | 367 | ||
103. Should HIV-infected women breast-feed? | 367 | ||
104. How is an infection with HIV confirmed in the newborn infant? | 368 | ||
105. What are the earliest and most common manifestations of congenital HIV infection? | 368 | ||
106. When should Pneumocystis prophylaxis begin and end for an HIV-exposed infant? | 368 | ||
107. Among patients <13 years of age with HIV infection, how is the severity of HIV illness classified? | 369 | ||
108. What is the significance of the ``viral load´´? | 369 | ||
109. What are the classes of antiretroviral agents (ARTs) used to treat HIV? | 369 | ||
110. What are the common toxicities associated with antiretroviral therapy? | 369 | ||
111. How should nonadherence to HIV medication be addressed? | 371 | ||
112. Should a classroom teacher be told that a child is HIV positive? | 371 | ||
113. What are the risk factors for HIV transmission after a needlestick injury? | 371 | ||
Immunizations | 372 | ||
114. What is the derivation of the word ``vaccination´´? | 372 | ||
115. Why are the buttocks a poor location for intramuscular (IM) injections in infants? | 372 | ||
116. When administering an IM vaccination, is aspiration necessary before injection? | 372 | ||
117. Is there any risk associated with administering multiple vaccines simultaneously? | 372 | ||
118. Should premature babies receive immunization on the basis of postconception age or chronologic age? | 373 | ||
119. Which vaccines are egg-embryo-based vaccines? | 373 | ||
120. What is the difference between whole-cell and acellular pertussis vaccines? | 373 | ||
121. What are the absolute contraindications to pertussis immunization? | 373 | ||
122. How long does protection against pertussis last after immunization? | 374 | ||
123. What is cocooning? | 374 | ||
124. Which vaccines offer protection against cervical cancer? | 374 | ||
125. How effective is the pneumococcal conjugate vaccine? | 374 | ||
126. What is the ``grandparent effect´´ of vaccination? | 375 | ||
127. What serogroup capable of causing meningococcal infections is lacking in licensed polyvalent vaccines in the United ... | 375 | ||
128. How effective is the varicella vaccine if given after exposure to the illness? | 375 | ||
129. Is the MMR vaccine effective in preventing measles if given after exposure to the illness? | 376 | ||
130. Of the vaccines included in the routine schedule, which ones contain live viruses? | 376 | ||
131. What are the indications for palivizumab? | 376 | ||
132. What are the recommendations regarding the administration of live-virus vaccines to patients receiving corticosteroi... | 376 | ||
133. What is thimerosal? | 377 | ||
134. Does thimerosal or any vaccine or vaccine combination cause autism? | 377 | ||
135. How should parents who refuse vaccinations be handled? | 377 | ||
Infections with rash | 377 | ||
136. What is the traditional numbering of the ``original´´ six exanthemas of childhood, and when were they first described? | 377 | ||
137. What conditions are associated with fever and petechiae? | 378 | ||
138. What are the three Cs of measles? | 378 | ||
139. What do Koplik spots look like? | 378 | ||
140. What is ``atypical´´ about atypical measles? | 379 | ||
141. How is measles diagnosed? | 379 | ||
142. Why is postmeasles blindness so common in underdeveloped countries? | 379 | ||
143. How is measles treated? | 379 | ||
144. What are the most feared neurologic complications of measles? | 380 | ||
145. Which viruses comprise the human herpesviruses (HHV)? | 380 | ||
146. What is the derivation of the word herpes? | 380 | ||
147. What are the typical features of roseola (exanthema subitum)? | 380 | ||
148. What causes roseola? | 380 | ||
149. How common is human herpesvirus type-6 (HHV-6) infection in children? | 381 | ||
150. What is the spectrum of disease caused by parvovirus B19? | 381 | ||
151. Describe the characteristic rash of Rocky Mountain spotted fever (RMSF) from Rickettsia rickettsii. | 381 | ||
152. Why is doxycycline recommended for all ages in patients with suspected RMSF? | 381 | ||
153. How long after exposure to chickenpox (varicella) do symptoms develop? | 382 | ||
154. What is the risk for varicella-associated complications in normal children 1 to 14 years old? | 382 | ||
155. How common are second episodes of varicella after natural infection? | 382 | ||
156. What is herpes zoster? | 382 | ||
157. In children with herpes zoster, what is the distribution of the rash? | 382 | ||
158. Is it possible to get herpes zoster after the varicella vaccine? | 383 | ||
159. Should chickenpox be treated with an antiviral medication? | 383 | ||
160. Should healthy children with zoster be treated with antiviral medications? | 384 | ||
161. Who gets herpes gladiatorum? | 384 | ||
162. What is eczema herpeticum? | 384 | ||
163. What is hand-foot-and-mouth disease? | 384 | ||
164. What is the spectrum of disease caused by enterovirus? | 384 | ||
165. Why do real-time PCR positive test results indicate both ``rhinovirus/enterovirus´´? | 385 | ||
Influenza | 385 | ||
166. What is the difference between an epidemic, an outbreak, and a pandemic? | 385 | ||
167. What are the types of influenza viruses? | 385 | ||
168. What are the functions of hemagglutinin and neuraminidase? | 385 | ||
169. What clinical features typically distinguish an infection with an influenza virus from the common cold? | 385 | ||
170. What is the difference between ``antigenic shift´´ and ``antigenic drift´´? | 385 | ||
171. What made the influenza A H1N1 pandemic strain of 2009 so novel? | 385 | ||
172. Which patients should not receive the live-attenuated influenza vaccine? | 386 | ||
173. What are the main antiviral medications used as treatment for influenza? | 387 | ||
174. Does influenza display resistance to antiviral medications? | 387 | ||
175. What are the indications for antiviral medications for influenza in children? | 387 | ||
176. What complications can be associated with influenza infections? | 387 | ||
177. What bacterial coinfection is most commonly identified in influenza-associated pediatric deaths? | 388 | ||
Lymphadenitis and lymphadenopathy | 388 | ||
178. What are the most common causes of acute and chronic lymphadenitis in normal, otherwise healthy children? | 388 | ||
179. What infectious etiology should be considered in a toddler with an intensely erythematous but minimally tender subma... | 388 | ||
180. How is the diagnosis of NTM disease made? | 388 | ||
181. How is NTM lymphadenitis treated? | 388 | ||
182. What infectious etiology should be considered in a child with swollen, tender axillary nodes? | 388 | ||
183. What is the typical course of the lymphadenitis in cat-scratch disease? | 388 | ||
184. What are other manifestations of cat-scratch disease in addition to lymphadenopathy? | 389 | ||
185. What are the presentations of Epstein-Barr virus (EBV) infection? | 389 | ||
186. How was the monospot test developed? | 389 | ||
187. What is the natural course of serologic responses to EBV infection? | 389 | ||
188. When are steroids indicated for children with EBV infection? | 389 | ||
189. What are the clinical presentations of acquired CMV infection? | 390 | ||
190. What is the most common form of tularemia? | 390 | ||
191. What vectors are commonly associated with tularemia? | 390 | ||
192. Which other organisms can cause a mononucleosis-like clinical picture? | 390 | ||
193. Why is it called ``mononucleosis´´? | 390 | ||
Meningitis | 391 | ||
194. What are the most common signs and symptoms of meningitis in infants <2 months? | 391 | ||
195. What percentage of neonates <30 days of age with bacterial sepsis and positive blood cultures have meningitis? | 391 | ||
196. What is the most common cause of viral meningitis? | 391 | ||
197. What is the diagnostic test of choice for enteroviral meningitis? | 391 | ||
198. What are common arthropod-borne viral causes of meningoencephalitis in the United States? | 391 | ||
199. Should computed tomography (CT) scans be performed before an LP during the evaluation of possible meningitis? | 391 | ||
200. What is the range of normal parameters for CSF in infants and children who do not have meningitis? | 392 | ||
201. If bloody CSF is collected during LP, how is CNS hemorrhage distinguished from a traumatic artifact? | 392 | ||
202. How is a traumatic LP interpreted? | 392 | ||
203. What is the best way to position the patient for an LP? | 392 | ||
204. How do the CSF findings vary in bacterial, viral, fungal, and tuberculous meningitis in children beyond the neonatal... | 393 | ||
205. What CSF indices help in the diagnosis of bacterial versus viral meningitis? | 393 | ||
206. When is the best time to obtain a serum glucose level in an infant with suspected meningitis? | 393 | ||
207. Does antibiotic therapy before LP affect CSF indices? | 393 | ||
208. How quickly is the CSF sterilized in children with meningitis? | 393 | ||
209. What are the most common organisms responsible for bacterial meningitis in the United States? | 394 | ||
210. What are the drugs of choice for the empiric treatment of bacterial meningitis in children >1 month? | 394 | ||
211. What is the role of corticosteroids in the treatment of bacterial meningitis? | 395 | ||
212. How long after treatment has been initiated must individuals with meningitis remain on droplet precautions? | 395 | ||
213. Should children receiving therapy for bacterial meningitis undergo repeat LP? | 395 | ||
214. What is the accepted duration of treatment for bacterial meningitis? | 395 | ||
215. In a patient with meningitis, what are the findings that suggest intracranial complications and provide indications ... | 396 | ||
216. What are the most common causes of prolonged fever in patients with meningitis? | 396 | ||
217. What should the parents of a child with bacterial meningitis be told about long-term outcomes? | 396 | ||
218. How should contacts of children with N. meningitidis disease be managed? | 397 | ||
219. What is the most common parasitic infection of the CNS? | 397 | ||
Ocular infections | 397 | ||
220. Among neonates with conjunctivitis, what is the timing for the various etiologies? | 397 | ||
221. What is the best method of prophylaxis for ophthalmia neonatorum? | 397 | ||
222. Can newborns with chlamydial conjunctivitis be treated with topical therapy alone? | 397 | ||
223. In children with conjunctivitis and otitis media, what are the most likely etiologic agents? | 398 | ||
224. Can bacterial conjunctivitis be distinguished from viral conjunctivitis on clinical grounds alone? | 398 | ||
225. What is keratoconjunctivitis? | 398 | ||
226. What are the most common causative organisms of acute bacterial conjunctivitis? | 398 | ||
227. How does the treatment vary by age for suspected acute bacterial conjunctivitis? | 398 | ||
228. What should be the specific treatment for a 5-year-old diagnosed with infectious conjunctivitis in an outpatient set... | 398 | ||
229. What is Parinaud oculoglandular syndrome? | 399 | ||
230. How is orbital cellulitis distinguished from periorbital (or preseptal) cellulitis? | 399 | ||
231. What is the pathogenesis of periorbital and orbital cellulitis? | 399 | ||
232. What are the most common organisms causing orbital cellulitis? | 400 | ||
233. What are treatment options for orbital cellulitis? | 400 | ||
234. What is the difference between a hordeolum, a stye, and a chalazion? | 400 | ||
235. Why is the ``ciliary flush´´ particularly worrisome when evaluating a patient with a pink or red eye? | 400 | ||
236. What organism should not be overlooked when treating ocular infections following penetrating trauma? | 400 | ||
Otitis media | 400 | ||
237. Is ear pulling a reliable sign of infection? | 400 | ||
238. What are the landmarks of the tympanic membrane? | 401 | ||
239. What are the most reliable ways, on physical examination, to accurately diagnosis AOM? | 401 | ||
240. What are the most common viral and bacterial agents that cause AOM? | 401 | ||
241. What is the ``watchful waiting´´ approach for otitis media? | 402 | ||
242. Should all children with AOM be treated with antibiotics? | 402 | ||
243. What is the recommended therapy for children for whom treatment for AOM is indicated? | 402 | ||
244. After an acute episode of otitis media (OM), how long does the middle ear effusion persist? | 402 | ||
245. What are the indications for tympanostomy tubes? | 402 | ||
246. Should a child with tympanostomy tubes be allowed to swim? | 403 | ||
247. A child with the acute onset of ear pain and double vision likely has what condition? | 403 | ||
248. What are differences between acute and chronic mastoiditis? | 403 | ||
249. What are the potential complications of mastoiditis? | 403 | ||
250. What famous playwright died of mastoiditis? | 403 | ||
Pharyngeal and laryngeal infections | 403 | ||
251. Can group A β-hemolytic streptococcal (GAS) pharyngitis reliably be distinguished from viral causes? | 403 | ||
252. What is the typical rash of scarlet fever? | 404 | ||
253. Why is a throat culture for GAS advised if a rapid antigen detection test is negative? | 404 | ||
254. What is the rationale for the treatment of GAS pharyngitis? | 404 | ||
255. What is the recommended treatment for GAS pharyngitis? | 404 | ||
256. Why do some clinicians use treatments other than penicillins for GAS pharyngitis? | 404 | ||
257. How does one differentiate a patient with a sore throat who is a streptococcal carrier with an intercurrent viral ph... | 405 | ||
258. When can children treated for positive streptococcal throat cultures return to school or day care? | 405 | ||
259. How commonly do children <3 years of age develop GAS pharyngitis? | 405 | ||
260. How long after the development of streptococcal pharyngitis can treatment be initiated and still effectively prevent... | 405 | ||
261. What diagnosis should be suspected in a teenager with pharyngitis followed by multifocal pneumonia and sepsis? | 406 | ||
262. What is the difference between herpangina and Ludwig angina? | 406 | ||
263. What is quinsy? | 406 | ||
264. How is a peritonsillar abscess distinguished from peritonsillar cellulitis? | 406 | ||
265. What radiographic features suggest the diagnosis of a retropharyngeal abscess? | 406 | ||
266. Which age group is most susceptible to retropharyngeal abscess? | 407 | ||
267. What are the indications for tonsillectomy in children 1 to 18 years old? | 407 | ||
268. How should children with epiglottitis be managed? | 407 | ||
269. What are the bacterial causes of epiglottitis? | 408 | ||
270. How is epiglottitis distinguished clinically from croup? | 408 | ||
271. What are the criteria for the admission of a child with viral croup? | 408 | ||
272. Are steroids efficacious for the treatment of croup? | 408 | ||
273. If a child has received racemic epinephrine as a treatment for croup, is hospitalization required? | 409 | ||
274. Is a cool-mist vaporizer truly of benefit for patients with croup? | 409 | ||
275. What are membranous croup and pseudomembranous croup? | 409 | ||
Sinusitis | 409 | ||
276. When do the sinuses develop during childhood? | 409 | ||
277. Does a thick, green nasal discharge on day 2 of a respiratory illness indicate a bacterial sinus infection? | 410 | ||
278. What is the typical presentation of sinusitis in children? | 410 | ||
279. What is the role of sinus imaging in the diagnosis of sinusitis? | 410 | ||
280. What should be suspected in an adolescent male with a very severe frontal headache in the setting of sinusitis? | 410 | ||
281. When should imaging be considered in cases of sinusitis? | 410 | ||
282. Which organisms are responsible for acute and chronic sinusitis in the pediatric age group? | 411 | ||
283. What is the management of acute sinusitis? | 411 | ||
284. List the predisposing factors for the development of chronic sinusitis | 411 | ||
Tuberculosis | 411 | ||
285. How effective is the Bacillus Calmette-Guerin (BCG) vaccination? | 411 | ||
286. When are the steps in screening for M. tuberculosis? | 411 | ||
287. How is the Mantoux test interpreted in the context of clinical signs and symptoms and epidemiologic risk factors, su... | 412 | ||
288. What are the reasons for a false-negative tuberculin skin test (TST)? | 412 | ||
289. How does BCG immunization influence TB skin testing? | 412 | ||
290. What is the role of interferon-γ release assays (IGRAs) in the diagnosis of TB in children? | 412 | ||
291. How are IGRA results interpreted? | 413 | ||
292. How should a patient with a positive TST or IGRA be evaluated? | 413 | ||
293. How common is HIV and TB coinfection? | 413 | ||
294. What is latent tuberculosis infection (LTBI) and why is it treated? | 413 | ||
295. In a younger child suspected of having TB disease, what is the utility of gastric aspirates? | 413 | ||
296. What is the role of nucleic acid amplification testing (NAAT) in the diagnosis of TB? | 413 | ||
297. How do the manifestations of active pulmonary TB on chest radiograph differ between adults and children? | 414 | ||
298. How are children with active pulmonary TB treated? | 414 | ||
299. Why are multiple antibiotics used for the treatment of TB disease? | 414 | ||
300. What are the signs of TB meningitis? | 414 | ||
301. What is the importance of DOT in the treatment of TB? | 414 | ||
302. Why is pyridoxine supplementation given to patients who are receiving isoniazid? | 415 | ||
303. Why do children with TB rarely infect other children? | 415 | ||
304. In addition to TB, what other airborne microbes can cause respiratory disease? | 415 | ||
305. Which famous U.S. First Lady died of TB? | 415 | ||
Chapter 11: Neonatology | 416 | ||
Clinical issues | 416 | ||
1. When does the ductus arteriosus (DA) close in well newborn infants? | 416 | ||
2. Why is it not always possible to auscultate a murmur in an infant with a ventricular septal defect (VSD) on the first ... | 416 | ||
3. What are the three main types of congenital heart disease, and how do they present in the newborn period? | 416 | ||
4. What is the chance that an extremely preterm infant will survive without significant impairment? | 416 | ||
5. What interventions are indicated in future pregnancies after a mother delivers a preterm infant? | 417 | ||
6. Which infants require ophthalmologic evaluation for retinopathy of prematurity (ROP)? | 417 | ||
7. What are the stages of ROP? | 418 | ||
8. What are the indications for treatment for ROP? | 418 | ||
9. When should hearing evaluations be repeated after neonatal intensive care unit (NICU) discharge? | 418 | ||
10. What are the manifestations of drug withdrawal in the neonate? | 418 | ||
11. What is the recommended pharmacologic treatment for neonatal abstinence syndrome (NAS) from opioid withdrawal? | 419 | ||
12. Should breastfeeding be initiated in infants with NAS? | 419 | ||
13. If maternal drug abuse is suspected, which specimen from the infant is most accurate for detecting exposure? | 419 | ||
14. Does in utero exposure to selective serotonin reuptake inhibitors (SSRIs) result in neonatal withdrawal? | 419 | ||
15. What is the difference between ``sudden unexpected infant death (SUID)´´ and ``sudden infant death syndrome (SIDS)´´? | 419 | ||
16. What is the ``Back to Sleep´´ program? | 420 | ||
17. What additional recommendations have been made regarding the most ideal sleep environment for infants? | 420 | ||
18. Do home apnea monitors help prevent sudden infant death syndrome (SIDS)? | 420 | ||
Delivery room issues | 420 | ||
19. When should the umbilical cord be clamped after birth? | 420 | ||
20. How long has meconium been present in the amniotic fluid if an infant has evidence of meconium staining? | 420 | ||
21. Is meconium staining a good marker for neonatal asphyxia? | 421 | ||
22. If meconium is noted before or during the time of delivery, what is the recommended course of action? | 421 | ||
23. During asphyxia, how is primary apnea distinguished from secondary apnea? | 421 | ||
24. How should apnea be managed in the delivery room? | 421 | ||
25. What are the clinical signs of adequate ventilation? | 421 | ||
26. What are the pros and cons of the T-piece resuscitator? | 422 | ||
27. How does one estimate the size of the endotracheal tube required for resuscitation? | 422 | ||
28. What is the ``7-8-9´´ rule? | 422 | ||
29. When should epinephrine be given during resuscitation in the delivery room? | 422 | ||
30. Should sodium bicarbonate be given during resuscitation in the delivery room? | 422 | ||
31. When should a laryngeal mask airway (LMA) be used in neonatal resuscitation? | 423 | ||
32. What is the role for CO2 detectors in neonatal resuscitation? | 423 | ||
33. What techniques are available to keep preterm infants warm in the delivery room? | 423 | ||
34. What amount of oxygen is recommended for neonatal resuscitation? | 424 | ||
35. After a ``traumatic´´ delivery, what are the possible injured systems? | 424 | ||
36. What bone is the most frequently fractured in the newborn? | 424 | ||
37. Who was Virginia Apgar, and how does one remember her score? | 425 | ||
38. Is a low Apgar score alone sufficient to diagnose a neonate as asphyxiated? | 425 | ||
39. When should neonatal resuscitation be stopped? | 425 | ||
Fetal issues | 425 | ||
40. What is the most accurate method of pregnancy dating? | 425 | ||
41. What features constitute the biophysical profile? | 426 | ||
42. What factors influence biophysical profile performance? | 426 | ||
43. What are the increased risks of twin pregnancies? | 426 | ||
44. Why are monozygotic twins considered higher risk than dizygotic twins? | 426 | ||
45. What are the known benefits of antenatal corticosteroids and when are they indicated? | 426 | ||
46. What are the potential fetal effects associated with diabetes during pregnancy? | 426 | ||
47. How is hypertension in pregnancy classified? | 427 | ||
48. What are the clinical consequences for the fetus from maternal preeclampsia? | 427 | ||
49. How does postmaturity differ from dysmaturity? | 427 | ||
50. What is the first bone in the human fetus to ossify? | 427 | ||
51. What external characteristics are useful for estimating gestational age? | 427 | ||
52. At what gestational age does pupillary reaction to light develop? | 428 | ||
53. At what gestational age does a sense of smell develop? | 428 | ||
54. When does the fetal heart begin to contract in utero? | 428 | ||
55. How does fetal circulation differ from neonatal circulation? | 428 | ||
56. What is the normal rate of head growth in the preterm infant? | 428 | ||
57. What morbidities (short-term and long-term) are known to occur more frequently in growth-restricted babies? | 429 | ||
58. When do premature infants ``catch up´´ on growth charts? | 429 | ||
Gastrointestinal issues | 429 | ||
59. When does the newborn infant´s stomach begin to secrete acid? | 429 | ||
60. When is meconium usually passed after birth? | 429 | ||
61. How is gastroschisis differentiated from omphalocele in the newborn infant? | 429 | ||
62. Which conditions are associated with intra-abdominal calcifications? | 430 | ||
63. What is necrotizing enterocolitis (NEC)? | 430 | ||
64. Is pneumatosis intestinalis pathognomonic for NEC? | 430 | ||
65. What are the most important risk factors for NEC in preterm infants? | 431 | ||
66. Is it safe to feed infants with umbilical catheters? | 431 | ||
67. How long should infants with NEC receive nothing by mouth? | 431 | ||
68. Does the feeding of immunoglobulin to infants as prophylaxis prevent NEC? | 431 | ||
69. Is there a role for probiotics in the prevention of NEC? | 431 | ||
70. Are trophic feedings beneficial to preterm infants? | 431 | ||
Hematologic issues | 432 | ||
71. When does the switch from fetal to adult hemoglobin synthesis occur in the neonate? | 432 | ||
72. Does the definition of anemia vary by gestational age? | 432 | ||
73. How does the hemoglobin concentration change during the first few days of life? | 432 | ||
74. When and at what dose should iron supplementation be initiated and for how long should it be maintained? | 432 | ||
75. Should erythropoietin be used in preterm infants? | 432 | ||
76. How can Rh disease be prevented? | 432 | ||
77. Why is the direct Coombs test frequently negative or weakly positive in infants with ABO incompatibility? | 432 | ||
78. If fetomaternal hemorrhage is suspected as a cause of neonatal anemia, how is this diagnosed? | 433 | ||
79. If a gastric aspirate contains blood shortly after birth, what test can determine whether the blood is swallowed mate... | 433 | ||
80. How is polycythemia defined? | 433 | ||
81. What are the clinical manifestations of polycythemia? | 433 | ||
82. Which infants with polycythemia should be treated? | 433 | ||
83. What is the definition of thrombocytopenia in the neonate? | 433 | ||
84. At what platelet count should platelet transfusion be considered? | 433 | ||
85. What features on physical examination suggest a specific cause of thrombocytopenia? | 434 | ||
86. What is the most common cause of severe thrombocytopenia in the first day of life? | 434 | ||
87. What treatment is available during subsequent pregnancies for mothers who have had a child affected with NAIT? | 434 | ||
88. When do the prothrombin time and partial thromboplastin time ``normalize´´ to adult values? | 434 | ||
89. How is disseminated intravascular coagulation (DIC) diagnosed in the neonate? | 435 | ||
90. How should newborn infants with DIC be managed? | 435 | ||
91. What causes hemorrhagic disease of the newborn? | 435 | ||
92. What are the risks and benefits of restrictive versus liberal transfusion criteria in preterm infants? | 435 | ||
Hyperbilirubinemia | 435 | ||
93. What are the normal changes in bilirubin levels in full-term healthy newborns? | 435 | ||
94. How should infants be assessed for jaundice before discharge? | 435 | ||
95. How soon should infants be evaluated after discharge? | 436 | ||
96. What is believed to be the fraction of bilirubin that is toxic to the CNS? | 436 | ||
97. Which infants are ``set-ups´´ for ABO incompatibility? | 436 | ||
98. What screening tests should pregnant women have to identify infants at risk for hyperbilirubinemia? | 436 | ||
99. What are the clinical features of bilirubin toxicity? | 437 | ||
100. When should phototherapy be instituted in infants who are at least 35 weeks of gestational age? | 437 | ||
101. What distinguishes breastfeeding jaundice from breast milk jaundice? | 437 | ||
102. Why should infants at risk for breastfeeding jaundice be fed more frequently? | 438 | ||
103. Where does bilirubin go when you turn on the lights? | 438 | ||
104. What are the factors that affect the efficacy of phototherapy? | 438 | ||
105. What are the contraindications to phototherapy? | 438 | ||
106. What are the common adverse effects of phototherapy? | 438 | ||
107. A newborn develops dark skin discoloration and dark urine after beginning phototherapy. What is the diagnosis? | 438 | ||
108. What are the complications of exchange transfusions in the newborn? | 439 | ||
109. What is the relationship between neonatal hyperbilirubinemia and urinary tract infection (UTI)? | 439 | ||
110. Can transcutaneous bilirubin measurements be used in place of serum levels? | 439 | ||
111. What is the role of metalloporphyrins in the treatment of hyperbilirubinemia? | 439 | ||
112. What is the role of IVIG use in the treatment of hyperbilirubinemia? | 439 | ||
Infectious disease issues | 440 | ||
113. What is the best method of umbilical cord care during the immediate neonatal period? | 440 | ||
114. Can sepsis be distinguished from other causes of respiratory distress in the neonate? | 440 | ||
115. What is the single most important factor in determining whether an infant should be evaluated and treated for possib... | 440 | ||
116. Should a lumbar puncture (LP) be performed on all newborns as part of the sepsis evaluation? | 440 | ||
117. List the contraindications to the performance of an LP. | 440 | ||
118. What are normal CSF values for healthy neonates? | 441 | ||
119. What is the preferred strategy for identifying women for intrapartum GBS prophylaxis? | 441 | ||
120. Which women should receive intrapartum antibiotic prophylaxis? | 441 | ||
121. What is the typical clinical presentation of early-onset GBS disease? | 441 | ||
122. Do intrapartum antibiotics change the clinical presentation of early-onset GBS sepsis? | 442 | ||
123. What are the most common pathogens that are responsible for late-onset sepsis in the newborn infant? | 442 | ||
124. What are the major risk factors for nosocomial sepsis? | 442 | ||
125. Is methicillin-resistant S. aureus (MRSA) a significant pathogen in the NICU? | 442 | ||
126. How is systemic candidiasis diagnosed in the neonate? | 442 | ||
127. Should preterm infants receive prophylaxis for the prevention of Candida infections? | 442 | ||
128. What is the risk for prenatal viral transmission in infants born to mothers with hepatitis B? | 443 | ||
129. Should preterm infants receive hepatitis B vaccine during their newborn stay in the hospital? | 443 | ||
130. What prophylactic medications should be given to infants born to HIV-positive mothers? | 443 | ||
131. When is treatment for congenital cytomegalovirus (CMV) infection indicated? | 443 | ||
Metabolic issues | 443 | ||
132. How frequently are the various metabolic disorders detected by newborn screening? | 443 | ||
133. In what settings should inborn errors of metabolism be suspected? | 444 | ||
134. What key urine odors are associated with inborn errors of metabolism? | 444 | ||
135. One of the key presenting features of inborn errors of metabolism is the presence or absence of metabolic acidosis. ... | 444 | ||
136. What is the definition and management of neonatal hypoglycemia? | 445 | ||
137. When is hypoglycemia most likely to occur in a neonate? | 445 | ||
138. What is the prognosis of infants with hypoglycemia? | 445 | ||
139. What features on physical examination suggest the etiology of hypoglycemia? | 446 | ||
140. What is the differential diagnosis for an infant with hypoglycemia? | 446 | ||
141. Should insulin be used to treat preterm infants with hyperglycemia? | 446 | ||
142. What are the manifestations of hypocalcemia in the neonate? | 446 | ||
143. Which neonates are at highest risk to develop hypocalcemia? | 446 | ||
144. When should hypocalcemia be treated in the neonate? | 446 | ||
145. How should symptomatic hypocalcemia be treated? | 447 | ||
146. What are the causes of neonatal hypomagnesemia? | 447 | ||
147. In which neonates should the serum magnesium concentration be measured? | 447 | ||
148. How is hypomagnesemia treated? | 447 | ||
Neurologic issues | 447 | ||
149. After a difficult delivery, what three major forms of extracranial hemorrhage can occur? | 447 | ||
150. If a cephalhematoma is suspected, should a skull radiograph be performed to evaluate for fracture? | 448 | ||
151. When screening for IVH, when is the best time to perform an ultrasound? | 448 | ||
152. What is the standard grading system for IVH? | 448 | ||
153. What is the cause of hydrocephalus after an intracranial hemorrhage? | 448 | ||
154. What factors predispose premature infants to the development of periventricular leukomalacia? | 448 | ||
155. What modalities should be used to detect periventricular leukomalacia? | 449 | ||
156. What is the most common brachial plexus palsy? | 449 | ||
157. What is Klumpke paralysis? | 449 | ||
158. In newborns with facial paralysis, how is peripheral nerve involvement distinguished from central nerve involvement? | 450 | ||
159. Is ankle clonus normal in the newborn infant? | 450 | ||
160. What is therapeutic hypothermia? | 450 | ||
161. Which infants should be treated with therapeutic hypothermia? | 450 | ||
162. How is neonatal encephalopathy evaluated and classified? | 450 | ||
163. What is the most common cause of a neonatal seizure? | 450 | ||
Nutrition | 451 | ||
164. How many calories are required daily for growth in a healthy, growing preterm infant? | 451 | ||
165. How should enteral feedings be started in the preterm infant? | 451 | ||
166. What are the medical benefits of breastfeeding? | 451 | ||
167. How does the composition of maternal breast milk differ for a full-term versus a premature baby? | 452 | ||
168. How does colostrum differ from mature human breast milk? | 452 | ||
169. How do fore milk and hind milk differ? | 452 | ||
170. What are contraindications to breastfeeding? | 452 | ||
171. What advice should be given to a mother who plans to express and save breast milk for later feedings? | 452 | ||
172. What are the advantages of a 60/40 whey-to-casein ratio in infant formulas? | 453 | ||
173. ``Low-iron´´ or ``regular iron-fortified´´ formulas: which are preferred for infants? | 453 | ||
174. Is vitamin supplementation necessary for exclusively breast-fed term infants? | 453 | ||
175. What is nonnutritive sucking? | 453 | ||
176. Which fatty acids are essential for the neonate? | 453 | ||
177. What are the proven advantages of supplementing formulas with long-chain polyunsaturated fatty acids? | 453 | ||
178. What are the manifestations of essential fatty acid deficiency? | 454 | ||
179. What are the manifestations of vitamin E deficiency in the neonate? | 454 | ||
Respiratory issues | 454 | ||
180. What causes infants to grunt? | 454 | ||
181. What do hyperpnea and tachypnea signify in the neonate? | 454 | ||
182. Until what age are infants obligate nose breathers? | 454 | ||
183. What conventional mechanical ventilator settings are likely to affect Po2 and Pco2? | 454 | ||
184. What factors determine the mean airway pressure on a conventional ventilator? | 454 | ||
185. What are the physiologic effects of PEEP? | 454 | ||
186. What are the effects of severe hypercarbia (Pco2100mm Hg) if there is no associated hypoxia? | 454 | ||
187. What are the most common causes of respiratory distress in term or late preterm infants? | 455 | ||
188. What are the risks and benefits of oxygen therapy in preterm infants? | 455 | ||
189. What is respiratory distress syndrome (RDS)? | 455 | ||
190. What is the composition and function of surfactant? | 456 | ||
191. When is treatment with exogenous surfactant indicated in newborn infants? | 456 | ||
192. What is persistent pulmonary hypertension of the newborn (PPHN)? | 456 | ||
193. Is there a role for sildenafil (Viagra) in the treatment of PPHN? | 456 | ||
194. What is the pathophysiology and typical course of transient tachypnea of the newborn (TTN)? | 456 | ||
195. Why are fetuses with anhydramnios or severe oligohydramnios at risk for respiratory problems after birth? | 457 | ||
196. Has nasal prong CPAP been proven to decrease the risk for BPD? | 457 | ||
197. What is the mechanism of action of inhaled nitric oxide (iNO) in the management of pulmonary hypertension? | 457 | ||
198. Which infants benefit most from extracorporeal membrane oxygenation (ECMO)? | 457 | ||
199. What is the most common type of congenital diaphragmatic hernia (CDH)? | 457 | ||
200. What is bronchopulmonary dysplasia (BPD)? | 458 | ||
201. In the current era of neonatal medicine, how is BPD or CLD (chronic lung disease) diagnosed? | 458 | ||
202. What are the respiratory benefits of caffeine therapy in preterm infants? | 459 | ||
Chapter 12: Nephrology | 460 | ||
Acid-base, fluids, and electrolytes | 460 | ||
1. How is the cause of hyponatremia established? | 460 | ||
2. What is the emergency treatment of symptomatic hyponatremia? | 460 | ||
3. How is the cause of hypernatremia established? | 461 | ||
4. Why can correcting hypernatremia too rapidly cause seizures? | 461 | ||
5. What is the differential diagnosis of nephrogenic diabetes insipidus (NDI)? | 461 | ||
6. An infant boy presents with severe dehydration, polyuria, and hypernatremia. What is the first renal diagnosis that sh... | 462 | ||
7. What are the clinical and physiologic consequences of progressive hypokalemia (low potassium)? | 462 | ||
8. What are the causes of hypokalemia? | 462 | ||
9. Which foods are high in potassium? | 462 | ||
10. List the causes of hyperkalemia in children. | 462 | ||
11. When are calcium infusions indicated in a patient with elevated serum potassium? | 463 | ||
12. What are key aspects in the treatment of hyperkalemia? | 463 | ||
13. What are the causes of periodic paralysis syndromes involving both high and low potassium levels? | 463 | ||
14. What is the undetermined serum anion gap? | 463 | ||
15. How is the serum anion gap helpful in the evaluation of a metabolic acidosis? | 464 | ||
16. What are the causes of an elevated serum anion gap acidosis? | 464 | ||
17. How limited is the respiratory response to metabolic alkalosis? | 464 | ||
18. What is the differential diagnosis in a child presenting with symptoms of primary metabolic alkalosis? | 464 | ||
19. Why is the urine pH often acidic (pH5.0 to 5.5) in a child with metabolic alkalosis from severe vomiting? | 464 | ||
Acute kidney injury | 465 | ||
20. Why has the term acute kidney injury replaced acute renal failure? | 465 | ||
21. What clinical and laboratory observations are useful for distinguishing prerenal oliguria (decreased effective circul... | 465 | ||
22. What is the most common cause of AKI in young children in the United States? | 465 | ||
23. What is the triad of clinical findings of HUS? | 466 | ||
24. What are the causes of HUS? | 466 | ||
25. Does the use of antibiotic therapy in children with diarrhea caused by E. coli OH157:H7 prevent HUS? | 467 | ||
26. Can anything be done to lessen the severity of the renal disease in children with HUS caused by E. coli OH157:H7? | 467 | ||
27. Why is Shiga toxin-associated HUS so terrifying for patients, family, and physicians? | 467 | ||
28. What is meant by atypical hemolytic uremic syndrome (aHUS)? | 467 | ||
29. What are indications for dialysis in AKI? | 468 | ||
Chronic kidney disease | 468 | ||
30. Based on GFR estimations and serum creatinine levels, how are AKI and chronic kidney disease (CKD) defined? | 468 | ||
31. What are the stages of CKD? | 468 | ||
32. What are the main causes of CKD in children that result in renal transplantation? | 468 | ||
33. Your nephrology attending likes to use the Socratic method of teaching. ``What are four major endocrine and cardiac m... | 469 | ||
34. What is the new term for renal osteodystrophy? | 469 | ||
35. What hormonal elevation is key in the pathogenesis of CKD-MBD? | 469 | ||
36. Why is it important to recognize CKD-MBD at an early stage? | 469 | ||
37. Why is FGF23 an important evolving concept in CKD-MBD? | 469 | ||
38. What are the ciliopathies? | 469 | ||
39. Nephronophthisis is difficult to pronounce and spell, but what is it? | 470 | ||
40. Which is more common in children: autosomal dominant polycystic kidney disease (ADPKD) or autosomal recessive polycys... | 470 | ||
41. What anatomic features characterize ADPKD? | 470 | ||
42. How is ADPKD diagnosed and managed? | 470 | ||
43. Why was the term infantile polycystic kidney disease replaced with ARPKD? | 470 | ||
Enuresis/dysfunctional voiding | 471 | ||
44. How common is nocturnal enuresis in older children? | 471 | ||
45. Why does nighttime bed-wetting persist in some children? | 471 | ||
46. What treatments are available for nocturnal enuresis? | 471 | ||
47. A 7-year-old presents with problems of intermittent daytime urinary incontinence with a normal urinalysis and a negat... | 471 | ||
48. What is the term for extraordinary daytime urinary frequency? | 472 | ||
49. Why is giggle incontinence not a laughing matter? | 472 | ||
50. What is the normal bladder capacity in children? | 472 | ||
Glomerular diseases | 472 | ||
51. What constellation of findings defines nephrotic syndrome? | 472 | ||
52. What differentiates nephrotic syndrome from nephritis? | 472 | ||
53. A 12-year-old girl complains of a sore throat and passes painless coke-colored urine for 2 days. When you see her a f... | 473 | ||
54. What is the long-term prognosis for patients with IgAN? | 473 | ||
55. During the evaluation of a patient with hematuria, what features suggest acute glomerulonephritis, chronic glomerulon... | 473 | ||
56. If glomerulonephritis is suspected, what laboratory tests should be considered? | 474 | ||
57. Which glomerulonephritides have a genetic basis? | 474 | ||
58. Which types of glomerulonephritis are associated with hypocomplementemia? | 474 | ||
59. Does the treatment of streptococcal skin or pharyngeal infections prevent ASPGN? | 474 | ||
60. What is the usual time course for ASPGN? | 474 | ||
61. What percentage of children with ASPGN have elevated levels of serum anti-streptolysin O titers? | 475 | ||
62. If pharyngitis and the brown urine occur on the same day or within 1 or 2 days, does this make ASPGN less likely? | 475 | ||
63. A 7-year-old girl has a typical presentation of poststreptococcal glomerulonephritis with positive ASO titers and low... | 475 | ||
64. You are on rounds and a know-it-all nephrology fellow asks you ``what are the renal complications of HIV infection?´´ | 475 | ||
Hematuria | 476 | ||
65. How common is hematuria in children? | 476 | ||
66. What is the most identifiable cause of microscopic hematuria? | 476 | ||
67. What distinguishes lower from upper tract bleeding? | 476 | ||
68. Why does recurrent macroscopic hematuria ``gross´´ us out? | 477 | ||
69. If a healthy 10-year-old boy has bright red blood at the end of a previously clear urine stream, what is the likely d... | 477 | ||
70. A concerned mother of infant twins brings in a diaper from each with one having pink urine stains and the other blue ... | 477 | ||
71. What evaluations should be considered during the evaluation of isolated hematuria? | 477 | ||
72. What condition should be suspected in a 9-year-old with a history of hearing loss and visual deficits who presents wi... | 478 | ||
Hypertension | 478 | ||
73. How is hypertension defined in children? | 478 | ||
74. Why are repeat visits necessary to diagnose hypertension? | 479 | ||
75. How do you determine the optimum cuff size for obtaining a blood pressure? | 479 | ||
76. Which Korotkoff sound best represents diastolic blood pressure? | 479 | ||
77. What is ambulatory blood pressure monitoring (ABPM)? | 479 | ||
78. What are the advantages and limitations of ABPM? | 479 | ||
79. In what settings is ABPM particularly useful? | 479 | ||
80. When should hypertension be treated in the neonate? | 480 | ||
81. What are the indications for the pharmacologic treatment of hypertension in children and in adolescents? | 480 | ||
82. During the evaluation of a child with elevated blood pressure, what risk factors should be considered for identificat... | 480 | ||
83. What historical information suggests a secondary cause of hypertension? | 481 | ||
84. What is the most common cause of renal artery stenosis in children in the United States? | 481 | ||
85. List the features on physical examination that suggest a secondary cause of hypertension | 481 | ||
86. What are the categories of antihypertensive medications used for outpatient management of hypertensive children? | 482 | ||
87. A 12-year-old girl is referred for evaluation of severe hypertension. She has hypernatremia, hypokalemia, and metabol... | 482 | ||
88. Why should patients with hypertension and/or those using diuretics avoid true licorice? | 483 | ||
Proteinuria/nephrotic syndrome | 483 | ||
89. How does the dipstick test for urine protein compare with the sulfosalicylic method? | 483 | ||
90. What is microalbuminuria? | 483 | ||
91. In what clinical setting is microalbuminuria a particularly important finding? | 483 | ||
92. What is the best spot method for determining the amount of proteinuria? | 483 | ||
93. An asymptomatic 11-year-old boy is found to have 2+ protein on dipstick testing during a routine checkup. How should ... | 484 | ||
94. How is the diagnosis of orthostatic proteinuria established? | 484 | ||
95. What additional evaluation should be done for a patient with persistent proteinuria? | 484 | ||
96. What is the natural history of orthostatic proteinuria? | 484 | ||
97. What level constitutes significant proteinuria? | 484 | ||
98. In a child with hematuria, can proteinuria be attributed to the protein that is contained in whole blood? | 484 | ||
99. Can proteinuria be caused by leukocytes or mucus in the urine? | 484 | ||
100. At what serum albumin concentration does edema develop? | 484 | ||
101. What is the most common form of nephrotic syndrome in childhood? | 485 | ||
102. What is the most important historical factor to consider when assessing a patient for possible MCNS? | 485 | ||
103. What are the typical clinical features and therapeutic responses seen in patients with MCNS? | 485 | ||
104. What are the indications for furosemide and albumin infusions in patients with nephrotic syndrome? | 485 | ||
105. Name two important complications of MCNS | 485 | ||
106. What are the prognostic factors in MCNS? | 485 | ||
107. A 5-year-old child presents with puffy eyes and the laboratory features of the nephrotic syndrome, but fails to resp... | 485 | ||
Renal function assessment and urinalysis | 486 | ||
108. What is the simplest way to estimate the glomerular filtration rate (eGFR) in the absence of a timed urine collection? | 486 | ||
109. How can you be confident that a 24-hour urine collection (for any determination) is complete? | 486 | ||
110. When should routine urinalyses (UA) be performed in the pediatric age group? | 486 | ||
111. What are the maximal and minimal renal dilutional and concentrating capabilities? | 487 | ||
112. What is the difference between urine specific gravity (SG) and urine osmolality? | 487 | ||
113. Which urinary crystals are always pathologic? | 487 | ||
Surgical issues | 488 | ||
114. What is the most common cause of urinary tract obstruction in the newborn? | 488 | ||
115. What is the most common renal abnormality detected on antenatal ultrasound? | 488 | ||
116. What are the possible causes of prenatal hydronephrosis? | 488 | ||
117. What is the most common cause of kidney disease of children worldwide? | 488 | ||
118. Is unilateral renal agenesis (URA) a benign condition? | 488 | ||
119. Should a child with a single kidney be allowed to play football? | 488 | ||
Tubular disorders | 489 | ||
120. In what settings should renal tubular acidosis (RTA) be considered? | 489 | ||
121. What are defects in each type of primary RTA? | 489 | ||
122. What are clinical and laboratory features of the primary RTAs? | 489 | ||
123. How is determining the urine anion gap helpful in the evaluation of metabolic acidosis? | 489 | ||
124. How is RTA diagnosed with utilizing a urine anion gap in a patient with a hyperchloremic metabolic acidosis and a no... | 490 | ||
125. What is the recommended alkali therapy for the treatment of various forms of RTA? | 490 | ||
126. What is most common cause of the renal Fanconi syndrome? | 490 | ||
127. A 2-year-old girl, generally healthy with height just below the 5th percentile, was noted to have blinking problems ... | 490 | ||
128. Glucosuria is detected on repeated urine dipstick testing in a 5-year-old boy, but the blood glucose is always norma... | 491 | ||
129. What is the clinical presentation of acute interstitial nephritis (AIN)? | 491 | ||
130. What medications are causes of AIN? | 491 | ||
131. What laboratory abnormalities are seen in patients with AIN? | 491 | ||
Urinary Tract infections | 491 | ||
132. What two features on the dipstick test are used to evaluate possible UTIs? | 491 | ||
133. How helpful are dipstick testing and microscopic analysis of urine as screening tests for UTIs? | 491 | ||
134. Can the diagnosis of UTI be made on the basis of urinalysis alone? | 492 | ||
135. What bacterial counts constitute a positive urine culture? | 492 | ||
136. A child has painful, frequent urination and a culture revealed a UTI, but the original urinalysis had a negative nit... | 492 | ||
137. What factors can cause a low colony count despite a definite urinary infection? | 492 | ||
138. Why should urine specimens be refrigerated if they cannot be immediately processed? | 493 | ||
139. What are the common presenting signs and symptoms of a UTI in an infant? | 493 | ||
140. How common are UTIs in young febrile infants? | 493 | ||
141. What pathogens are associated with UTIs in children? | 493 | ||
142. How is cystitis distinguished clinically from pyelonephritis? | 493 | ||
143. What is the diagnostic approach for a possible UTI for a female infant 3 to 24 months of age with no known urinary t... | 493 | ||
144. Which patients with UTIs require hospitalization and parenteral antibiotics? | 494 | ||
145. Should all pediatric patients with clinical pyelonephritis be hospitalized? | 495 | ||
146. What is the expected resolution of fever after a child is started on an antibiotic for a UTI? | 495 | ||
147. What is the duration of antibiotic therapy for a UTI? | 495 | ||
148. Are repeat cultures required at the end of therapy for a patient without symptoms? | 495 | ||
149. In what patients are prophylactic antibiotics indicated for UTIs? | 495 | ||
150. Is cranberry juice helpful in the management of recurrent UTIs in children? | 496 | ||
151. Do patients with an initial UTI require imaging studies? | 496 | ||
152. What imaging studies can be used for patients with UTIs who warrant evaluation? | 496 | ||
Urogenital issues | 497 | ||
153. What are risks associated with circumcision? | 497 | ||
154. Is circumcision now medically indicated? | 497 | ||
155. What distinguishes phimosis and paraphimosis? | 497 | ||
156. What is hypospadias? | 497 | ||
157. How common are undescended testicles at birth? | 497 | ||
158. When should undescended testicles be repaired? | 497 | ||
159. How do you treat labial adhesions? | 498 | ||
Urolithiasis | 498 | ||
160. Why are kidney stones increasing in frequency in children in the United States? | 498 | ||
161. What are the clinical findings in pediatric urolithiasis? | 498 | ||
162. What is the composition of kidney stones in children? | 498 | ||
163. What is the most common cause of pediatric urinary calculi? | 498 | ||
164. How is hypercalciuria defined in pediatrics? | 499 | ||
165. What are the appropriate laboratory studies for the initial evaluation of children with renal stones? | 499 | ||
166. When is lithotripsy or surgery indicated for children with kidney stones? | 499 | ||
Vesicoureteral reflux | 499 | ||
167. How is vesicoureteral reflux (VUR) graded? | 499 | ||
168. What is the natural history of VUR? | 500 | ||
169. How is VUR managed: medically or surgically? | 500 | ||
170. Are antibiotics effective to prevent recurrent UTIs in children with reflux? | 500 | ||
171. Should asymptomatic siblings of a patient with VUR have urologic imaging done as a screen for reflux? | 500 | ||
172. Why are some children with congestive heart failure (CHF) hyponatremic while others are not? | 500.e1 | ||
173. What treatment is available for NDI? | 500.e1 | ||
174. Which children with acute kidney injury are at the greatest risk for hyperkalemia? | 500.e1 | ||
175. In a child with HUS, does the presence of a low C3 level have any special significance? | 500.e1 | ||
176. What is urotherapy? | 500.e1 | ||
177. Why is constipation associated with daytime urinary symptoms? | 500.e1 | ||
178. What is vaginal reflux? | 500.e2 | ||
179. The mother consults Dr. Google when the hematuria recurs and requests an ear, nose, and throat (ENT) consult because... | 500.e2 | ||
180. A 15-year-old black girl with sickle cell trait has gross hematuria for the second time 1 day after playing in a lac... | 500.e2 | ||
181. What are the most possible causes of hypertension by age group? | 500.e2 | ||
182. Why doesnt eating more protein restore the serum albumin concentration to normal in individuals with the nephrotic s... | 500.e3 | ||
183. For which patients with MCNS should additional therapies be considered? | 500.e3 | ||
184. What are the alternative therapies for children with MCNS? | 500.e3 | ||
185. What must patients, family members, and prescribers be aware of when offering cyclophosphamide or tacrolimus? | 500.e3 | ||
186. What are the risks associated with the infusion of albumin with furosemide? | 500.e3 | ||
187. What physical findings should prompt a search for an underlying renal abnormality? | 500.e3 | ||
188. A young girl diagnosed with AIN has developed a painful red eye. Could there be a connection? | 500.e3 | ||
189. Which patients with UTIs are at higher risk for having an abnormality? | 500.e4 | ||
190. How does altering the urine pH affect renal calculi? | 500.e4 | ||
191. In addition to reflux, what other pathologic bladder findings may be noted on a VCUG? | 500.e4 | ||
192. What are the pros and cons of a VCUG versus a radionuclide cystogram (RNC) for the evaluation of reflux? | 500.e4 | ||
Chapter 13: Neurology | 501 | ||
Antiepileptic drugs | 501 | ||
1. Should treatment with antiepileptic drugs (AEDs) be started after the first afebrile seizure in a child? | 501 | ||
2. What is the advantage of monotherapy chosen according to the epilepsy syndrome? | 501 | ||
3. Which AEDs are recommended for primary generalized tonic-clonic seizures in children over 1 month of age? | 501 | ||
4. What is the drug of choice for absence epilepsy? | 502 | ||
5. Can AEDs paradoxically cause a worsening of seizures? | 502 | ||
6. When should blood levels be obtained if seizures are poorly controlled, compliance is questionable, or drug toxicity s... | 502 | ||
7. What are the suggested therapeutic ranges of AEDs? | 502 | ||
8. What are the typical dose-related side effects of AEDs? | 503 | ||
9. What idiosyncratic drug reactions are associated with antiepileptic medications? | 503 | ||
10. Which children are most susceptible to valproic acid-induced acute hepatic failure? | 504 | ||
11. What are the warning signs and symptoms of hypersensitivity syndromes to AEDs? | 504 | ||
12. What is Diastat? | 504 | ||
13. Are there other options for outpatient treatment of severe recurrent and prolonged seizures in children? | 504 | ||
14. After what period can AEDs be safely discontinued? | 505 | ||
15. When the decision is made to discontinue AEDs, should the tapering period be long or short? | 505 | ||
Cerebral palsy | 505 | ||
16. What is cerebral palsy? | 505 | ||
17. What are the most common brain lesions seen on magnetic resonance imaging (MRI) in children with cerebral palsy? | 505 | ||
18. What are the Levine (POSTER) criteria for the diagnosis of CP? | 505 | ||
19. What are the types of cerebral palsy? | 506 | ||
20. What proportion of CP is related to birth asphyxia? | 506 | ||
21. How well do Apgar scores correlate with the development of CP? | 506 | ||
22. Why is CP difficult to diagnose clinically during the first year of life? | 507 | ||
23. What behavioral symptoms during the first year should arouse suspicion about the possibility of CP? | 507 | ||
24. What gross motor delays are diagnostically important in the infant with possible CP? | 507 | ||
25. What problems are commonly associated with CP? | 508 | ||
26. What features in an infant suggest a progressive central nervous system (CNS) disorder rather than CP as the cause of... | 508 | ||
27. What therapies are used to treat the spasticity and dystonia of cerebral palsy? | 508 | ||
Cerebrospinal fluid | 508 | ||
28. What is normal cerebrospinal fluid (CSF) pressure? | 508 | ||
29. What are the normal CSF volumes in an infant, child, and adolescent? | 509 | ||
30. What are the common causes of an elevated CSF protein? | 509 | ||
31. What CSF findings suggest metabolic disease as a cause of neurologic signs and symptoms? | 509 | ||
32. Why is a stylet used during a lumbar puncture? | 510 | ||
33. As tests of meningeal irritation, what constitutes a positive Kernig or Brudzinski sign? | 510 | ||
34. How do the manifestations of increased intracranial pressure (ICP) differ in an infant compared with an older child? | 510 | ||
35. What comprises the Cushing triad? | 510 | ||
36. How is hydrocephalus classified? | 511 | ||
37. What is the normal growth rate of head circumference during the first year of life? | 511 | ||
38. What are the complications of ventricular shunts? | 511 | ||
39. What are the characteristic features of idiopathic intracranial hypertension? | 511 | ||
40. What causes idiopathic intracranial hypertension? | 511 | ||
41. What treatment is recommended for severe cases of idiopathic intracranial hypertension? | 512 | ||
Clinical issues | 512 | ||
42. What are the key questions in a neurologic evaluation? | 512 | ||
43. What are general rules that govern localization of a potential neurologic problem? | 512 | ||
44. What distinguishes the pediatric neurologic examination? | 512 | ||
45. What are the advantages and disadvantages of various imaging procedures used in pediatric neurologic evaluation? | 512 | ||
46. A child presents with progressive left leg weakness and diplopia, especially when looking toward the left. Where is t... | 513 | ||
47. A dilated and unreactive pupil indicates the compression of what structure? | 513 | ||
48. Pinpoint pupils and respiratory changes indicate the compression of what structure? | 514 | ||
49. How does the presentation of stroke differ between infants and older children? | 514 | ||
50. What is the differential diagnosis of stroke in children? | 514 | ||
51. What is the derivation of ``moyamoya´´ in moyamoya disease? | 514 | ||
52. A child who develops weakness, incontinence, and ataxia 10 days after a bout of influenza likely has what diagnosis? | 515 | ||
53. In patients with acute injury to the brain, what two types of edema may occur? | 515 | ||
54. What are the treatments for increased ICP? | 515 | ||
55. How is brain death defined? | 515 | ||
56. How is the diagnosis of brain death in children made? | 516 | ||
57. Compare the persistent vegetative state with the minimally conscious state. | 516 | ||
58. What is the differential diagnosis of an intracranial bruit? | 516 | ||
59. In a previously normal child who develops acute ataxia, what are the two most common diagnoses? | 516 | ||
60. What are the causes of toe walking? | 517 | ||
61. What is the significance of a positive Babinski response? | 517 | ||
62. A 7-year-old child with progressive ataxia, kyphoscoliosis, nystagmus, pes cavus (high arch), and an abnormal electro... | 517 | ||
63. What clinical features help distinguish peripheral from central vertigo? | 517 | ||
64. In what settings is hyperacusis noted? | 517 | ||
65. What is the most common cause of neonatal asymmetric crying facies? | 518 | ||
66. What are the common causes of peripheral seventh-nerve palsy? | 518 | ||
67. How is peripheral seventh-nerve palsy distinguished from central seventh-nerve palsy? | 519 | ||
68. During recovery from Bell palsy, why do the eyes water at mealtime? | 519 | ||
69. When are ``dolls eyes´´ movements considered normal or abnormal? | 519 | ||
70. How are cold calorics done? | 519 | ||
71. What causes pinpoint pupils? | 519 | ||
72. What is the differential diagnosis of ptosis? | 519 | ||
73. What does the Marcus Gunn pupil detect? | 520 | ||
74. How is the swinging flashlight test done to detect a Marcus Gunn pupil? | 520 | ||
Epilepsy | 520 | ||
75. What is epilepsy? | 520 | ||
76. What is the long-term outcome for children with epilepsy? | 520 | ||
77. How often are EEGs abnormal in healthy children? | 520 | ||
78. Should an EEG be done on all children who have a first afebrile seizure? | 521 | ||
79. In a patient with a suspected seizure disorder, but a normal EEG, how can the sensitivity of the EEG be increased? | 521 | ||
80. Which types of epilepsy are characterized by specific EEG findings? | 521 | ||
81. Should all children with a new-onset afebrile, unprovoked generalized seizure have a CT or MRI evaluation? | 521 | ||
82. Which disorders commonly mimic epilepsy? | 521 | ||
83. What are ways to distinguish psychogenic nonepileptic seizures (PNES) from epileptic seizures? | 522 | ||
84. What are the categories of seizures in children? | 522 | ||
85. What are structural and metabolic causes of seizures? | 523 | ||
86. If a previously normal child has an afebrile, generalized tonic-clonic seizure, what should parents be told about the... | 523 | ||
87. What are the most common inherited seizure or epilepsy syndromes? | 524 | ||
88. What are the clinical features of rolandic epilepsy? | 524 | ||
89. What distinguishes typical and atypical absence seizures? | 524 | ||
90. In a child who is suspected of having absence seizures, how can a seizure be elicited during an examination? | 524 | ||
91. What percentage of patients with absence seizures also have occasional grand mal seizures? | 524 | ||
92. What is the prognosis for children with absence epilepsy? | 524 | ||
93. A teenager, like his father, develops brief, bilateral, intermittent jerking of his arms. What seizure disorder is he... | 525 | ||
94. What are myoclonic seizures? | 525 | ||
95. What distinguishes atonic and akinetic seizures? | 525 | ||
96. Which seizure types constitute the ``epileptic encephalopathies´´? | 525 | ||
97. What is the classic triad of epileptic (infantile) spasms? | 525 | ||
98. What characterizes hypsarrhythmia? | 525 | ||
99. How commonly is a cause identified in epileptic spasms? | 526 | ||
100. What is the prognosis for infants with epileptic spasms? | 526 | ||
101. What is the treatment of choice for epileptic spasms? | 526 | ||
102. What is the most likely diagnosis in a child of Ashkenazi descent with stimulus-sensitive seizures, cognitive deteri... | 526 | ||
103. A patient with seizures, microcephaly, and a low CSF glucose but a normal serum glucose has what likely condition? | 527 | ||
104. What is the clinical triad of the Lennox-Gastaut syndrome? | 527 | ||
105. A 5-year-old with a history of normal language development who develops seizures and inattention to speech with seve... | 527 | ||
106. How is status epilepticus defined? | 528 | ||
107. Why is status epilepticus so dangerous? | 528 | ||
108. What should be done in the first 10 minutes for a child who presents with an ongoing seizure? | 528 | ||
109. What is the most common cause of refractory seizures? | 528 | ||
110. What is the role of the ketogenic diet for the treatment of seizures? | 528 | ||
111. What is the role of the vagus nerve stimulator in seizure control? | 529 | ||
112. What should a teenager with epilepsy be told about the potential of obtaining a drivers license? | 529 | ||
113. What are some common seizure triggers about which families should be counseled? | 529 | ||
114. When should a child be referred for possible epilepsy surgery? | 529 | ||
Febrile seizures | 530 | ||
115. How are febrile seizures defined? | 530 | ||
116. What is the likelihood of recurrence of a febrile seizure? | 530 | ||
117. What features make a febrile seizure complex rather than simple? | 530 | ||
118. Why are complex febrile seizures more worrisome than simple febrile seizures? | 530 | ||
119. When should a lumbar puncture (LP) be performed as part of the evaluation of a child <12months of age with a simple ... | 530 | ||
120. Are EEG or neuroimaging studies indicated for a child with a simple febrile seizure? | 530 | ||
121. Do prolonged febrile seizures result in an increased peripheral white blood cell count? | 531 | ||
122. What ancillary testing should be considered in a patient with a complex febrile seizure? | 531 | ||
123. What is the risk for epilepsy after a simple febrile seizure? | 531 | ||
124. What is the long-term outcome for children with febrile seizures? | 531 | ||
125. After a febrile seizure, should a child be treated with prophylactic AEDs? | 532 | ||
126. Is the aggressive use of antipyretic therapy at the start of a febrile illness effective in reducing the likelihood ... | 532 | ||
Headache | 532 | ||
127. What are the emergency priorities when evaluating a child with a severe headache? | 532 | ||
128. When should neuroimaging be considered in a child with headache? | 532 | ||
129. What are the three primary headache disorders in children? | 533 | ||
130. What are the clinical features of migraine headaches in children? | 533 | ||
131. Which physical findings are important during the initial evaluation of possible migraine headache? | 533 | ||
132. When do children begin to have migraine headaches? | 534 | ||
133. Which foods have been associated with the development of migraine headaches? | 534 | ||
134. What is familial hemiplegic migraine? | 534 | ||
135. What is the likely diagnosis for a 10-year-old girl with a history of headaches and a family history of migraines wh... | 534 | ||
136. How do the triptans work to treat an acute migraine headache? | 534 | ||
137. What nonpharmacologic therapies are available for the prevention of migraine? | 534 | ||
138. What categories of medication are available for the prevention of migraine in children? | 535 | ||
139. Who should be started on prophylactic medication for migraine headaches? | 535 | ||
140. How long are the prophylactic medications continued? | 535 | ||
141. What distinguishes tension-type headaches from migraines? | 535 | ||
Movement disorders | 535 | ||
142. What are the various types of pathologic hyperkinetic movements? | 535 | ||
143. What techniques can be used to elicit abnormal movements (particularly chorea)? | 536 | ||
144. What disorders are commonly associated with the various hyperkinetic movements? | 536 | ||
145. What constitutes a tic? | 536 | ||
146. What is the range of clinical tics? | 536 | ||
147. What are the causes of a tic? | 536 | ||
148. How should simple tics be treated? | 536 | ||
149. What comorbidities occur in children with tics? | 537 | ||
150. When do tics warrant pharmacologic intervention? | 537 | ||
151. What are the diagnostic criteria for Tourette syndrome? | 537 | ||
152. What is coprolalia? | 537 | ||
153. What behavioral problems are associated with Tourette syndrome? | 537 | ||
154. Why is the diagnosis of Tourette syndrome commonly delayed? | 537 | ||
155. What is the cause of tardive dyskinesia? | 538 | ||
156. For a patient taking neuroleptic medication, how long must therapy last before symptoms of tardive dyskinesia can de... | 538 | ||
157. What is neuroleptic malignant syndrome? | 538 | ||
158. Which movement disorder in children presents with ``dancing eyes and dancing feet´´? | 538 | ||
Neonatal seizures | 538 | ||
159. How are neonatal seizures classified? | 538 | ||
160. Why are generalized seizures uncommon in newborns? | 538 | ||
161. What is the most common type of clinical seizure during the neonatal period? | 538 | ||
162. What are the causes of neonatal seizures? | 538 | ||
163. In premature and full-term infants, how do the causes of seizures vary with regard to relative frequency and time of... | 539 | ||
164. What is an acceptable workup in a newborn with seizures? | 539 | ||
165. In what settings should an inborn error of metabolism be suspected as a cause of neonatal seizures? | 539 | ||
166. How are seizures differentiated from tremors in the neonate? | 540 | ||
167. What are the treatment options for neonatal seizures? | 540 | ||
168. What is the treatment for refractory seizures in the neonate? | 540 | ||
169. Of what prognostic value is the interictal EEG in a neonate with seizures? | 540 | ||
170. After an infant has recovered from a seizure, how long should medication be continued? | 541 | ||
171. In patients with neonatal seizures, how does the cause affect the prognosis? | 541 | ||
Neurocutaneous syndromes | 541 | ||
172. What are the three most common neurocutaneous syndromes? | 541 | ||
173. What are the inheritance patterns of the various neurocutaneous syndromes? | 541 | ||
174. What are the diagnostic criteria for neurofibromatosis-1 (NF1)? | 542 | ||
175. How does NF1 differ from NF2? | 542 | ||
176. How common are café-au-lait spots at birth? | 542 | ||
177. If a 2-year-old child has seven café-au-lait spots that are larger than 5mm in diameter, what is the likelihood that... | 542 | ||
178. What are Lisch nodules? | 542 | ||
179. How common is a positive family history in cases of NF1? | 543 | ||
180. What are the primary diagnostic criteria for tuberous sclerosis complex (TSC)? | 543 | ||
181. What is the classic triad of TSC? | 543 | ||
182. What is the most common presenting symptom of TSC? | 544 | ||
183. What are skin findings in patients with tuberous sclerosis? | 544 | ||
184. Why is the term adenoma sebaceum a misnomer when used to describe patients with tuberous sclerosis? | 544 | ||
185. What is the ``tuber´´ of tuberous sclerosis? | 545 | ||
186. What is the tissue type of a shagreen patch? | 545 | ||
187. Which types of facial port-wine stains are most strongly associated with ophthalmic or CNS complications? | 545 | ||
188. What are the three stages of incontinentia pigmenti? | 545 | ||
189. What is the likely diagnosis for a 7-year-old who is noted to have recurrent nosebleeds, cutaneous telangiectasias o... | 545 | ||
Neuromuscular disorders | 546 | ||
190. How can the anatomic site responsible for muscle weakness be determined clinically? | 546 | ||
191. What are the causes of acute generalized weakness? | 546 | ||
192. If a child presents with weakness, what aspects of the history and physical examination suggest a myopathic process? | 547 | ||
193. What is the significance of a Gowers sign? | 547 | ||
194. How does electromyography help differentiate between myopathic and neurogenic disorders? | 547 | ||
195. How is pseudoparalysis distinguished from true neuromuscular disease? | 548 | ||
196. Why is it important to localize the cause of hypotonia? | 548 | ||
197. How can you detect myotonia clinically? | 548 | ||
198. How do the presentations of the two forms of myotonic dystrophy differ? | 548 | ||
199. In a newborn with weakness and hypotonia, what obstetric and delivery features suggest a diagnosis of congenital myo... | 548 | ||
200. How is myotonic dystrophy an example of the phenomenon of ``anticipation´´? | 548 | ||
201. How does the pathophysiology of infant botulism differ from that of food-borne and wound botulism? | 549 | ||
202. What is the earliest indication for intubation in an infant with botulism? | 549 | ||
203. In an infant with severe weakness and suspected botulism, why is the use of aminoglycosides relatively contraindicated? | 549 | ||
204. What are the two most common symptoms in children with juvenile myasthenia gravis? | 549 | ||
205. What are the risks to a neonate who is born to a mother with myasthenia gravis? | 549 | ||
206. How does the pathophysiology of juvenile versus congenital myasthenia gravis differ? | 549 | ||
207. How is the edrophonium (Tensilon) test done? | 550 | ||
208. Does a negative antibody test exclude the diagnosis of juvenile myasthenia gravis? | 550 | ||
209. What are the four characteristic features of damage to the anterior horn cells? | 550 | ||
210. What processes can damage the anterior horn cells? | 550 | ||
211. What is the primary genetic abnormality in infants and children with spinal muscular atrophy (SMA)? | 550 | ||
212. How are the inherited progressive spinal muscular atrophies distinguished? | 550 | ||
213. What are muscular dystrophies? | 550 | ||
214. What is the clinical importance of dystrophin? | 550 | ||
215. How are Duchenne and Becker muscular dystrophies distinguished? | 550 | ||
216. What causes the calf hypertrophy seen in Duchenne muscular dystrophy? | 552 | ||
217. Is corticosteroid therapy effective for the treatment of Duchenne muscular dystrophy? | 552 | ||
218. What is the most likely diagnosis in a child with progressive walking difficulties evolving over several days? | 552 | ||
219. What are subtypes of GBS? | 553 | ||
220. What CSF findings are characteristic of GBS? | 553 | ||
221. Outline the management of acute GBS. | 553 | ||
222. What is the prognosis for children with GBS? | 553 | ||
223. Does multiple sclerosis (MS) present during childhood? | 554 | ||
Spinal cord disorders | 554 | ||
224. Which sacral dimples and coccygeal pits in a newborn are concerning for an occult spinal dysraphism (OSD)? | 554 | ||
225. What are the two main features of the Chiari malformations? | 554 | ||
226. What are the types of Chiari malformations? | 554 | ||
227. What are types of spina bifida? | 555 | ||
228. How common are asymptomatic spinal anomalies in normal children? | 556 | ||
229. What is the full anatomic expression of myelomeningocele? | 556 | ||
230. What is the likelihood that a patient with myelomeningocele will have hydrocephalus? | 556 | ||
231. What is the usual cause of stridor in a child with myelomeningocele? | 556 | ||
232. What are the principal options for managing urinary incontinence in patients with myelomeningocele? | 557 | ||
233. How frequently is myelomeningocele associated with intellectual disability? | 557 | ||
234. In an infant born with myelomeningocele, how does the initial evaluation predict long-term ambulation potential? | 557 | ||
Chapter 14: Oncology | 558 | ||
Chemotherapy and radiation therapy | 558 | ||
1. What was the first cytotoxic chemotherapeutic agent used for the treatment of children with leukemia? | 558 | ||
2. Name the common cytotoxic chemotherapeutic drug classes. | 558 | ||
3. We can thank the guinea pig for a major (albeit serendipitous) breakthrough in the treatment of childhood acute lympho... | 558 | ||
4. Which chemotherapeutic agents are cell cycle dependent? In which phase are they most active? | 558 | ||
5. What is the difference between adjuvant and neoadjuvant chemotherapy? | 559 | ||
6. Why are most chemotherapeutic drug dosages based on body surface area (BSA)? | 559 | ||
7. What is the difference between pharmacokinetics and pharmacodynamics? | 559 | ||
8. What are the phases of clinical trials? | 559 | ||
9. What is the major dose-limiting toxicity for the alkylating agents? | 559 | ||
10. If one had to choose a single laboratory test to obtain before administering high-dose methotrexate, which one should... | 559 | ||
11. What factors are associated with an increased risk for developing anthracycline-induced cardiotoxicity? | 560 | ||
12. How did a periwinkle plant contribute to some longstanding chemotherapeutic agents? | 560 | ||
13. What is the mechanism of action of vincristine? | 560 | ||
14. What agent can limit the complication of hemorrhagic cystitis that occurs in some chemotherapeutic regimens? | 560 | ||
15. What is a vesicant? | 560 | ||
16. Which classes of chemotherapeutic agents have most commonly been implicated in causing secondary leukemias? | 561 | ||
17. Why is intrathecal chemotherapy dose based on patient age, whereas systemic (oral, intravenous) dosing is based on we... | 561 | ||
18. What antiemetic agents are most effective in the management of chemotherapy-induced nausea and vomiting? | 561 | ||
19. Who develops the ``somnolence syndrome´´? | 561 | ||
20. What is radiation recall? | 561 | ||
21. What is a ``fraction´´ of radiation? | 561 | ||
22. A 10-year-old girl is being treated for AML with a combination of high-dose cytarabine and daunorubicin. Five days af... | 561 | ||
23. What are the long-term sequelae of chemotherapy? | 562 | ||
24. Radiation therapy: what are its long-term effects? | 562 | ||
Clinical issues | 562 | ||
25. A patient has a central venous catheter and develops a fever. What should be done? | 562 | ||
26. Describe three different types of infection that are associated with central venous catheters, and how the treatment ... | 562 | ||
27. A patient undergoing chemotherapy is neutropenic and has a fever. What should be done? | 562 | ||
28. A patient remains febrile and neutropenic despite appropriate antibiotics for several days. Is there cause for concern? | 563 | ||
29. How should a patient who has oral candidiasis or esophageal candidiasis be treated? | 563 | ||
30. After receiving broad-spectrum antibiotic therapy for 4 days for fever and neutropenia, a patient develops a new feve... | 563 | ||
31. A 10-year-old in her second year of treatment for ALL has had all medications voluntarily stopped by her parents for ... | 563 | ||
32. What paraneoplastic syndromes can occur in childhood? | 563 | ||
33. What are the metabolic abnormalities in the tumor lysis syndrome? | 564 | ||
34. In what settings is tumor lysis syndrome more likely to occur? | 564 | ||
35. What are the current recommendations regarding management of tumor lysis syndrome? | 564 | ||
36. What two pharmacologic agents can be used to prevent or treat hyperuricemia caused by tumor lysis syndrome? | 564 | ||
37. A child with newly diagnosed leukemia experiences a rapid decline in hemoglobin soon after administration of rasburic... | 564 | ||
38. A child undergoing induction chemotherapy for leukemia develops right lower quadrant pain and tenderness. What diagno... | 564 | ||
39. What is the difference between a Broviac and a Port-A-Cath? | 564 | ||
40. What is the differential diagnosis of an anterior mediastinal mass? | 565 | ||
41. What is superior mediastinal syndrome? How is it managed? | 565 | ||
42. Which tumor is the most common cause of superior mediastinal syndrome in children? | 565 | ||
43. Why is a generous mediastinal shadow on a radiograph much more worrisome in a teenager than in an infant? | 565 | ||
44. Which neoplasms are associated with hemihyperplasia? | 565 | ||
45. Which cancers are often associated with splenomegaly? | 566 | ||
46. What are the predictors of malignancy in the pediatric patient with peripheral lymphadenopathy? | 566 | ||
47. What is the function of the Langerhans cells? | 566 | ||
48. What are the features of Langerhans cell histiocytosis (LCH)? | 566 | ||
49. What is an eosinophilic granuloma? | 566 | ||
50. What are the common indications for transfusion support for children with cancer? | 566 | ||
51. What are the most common symptoms experienced by oncology patients receiving end-of-life care? | 566 | ||
Epidemiology | 567 | ||
52. Although in psychic lore a ``seer´´ can look into the future, SEER has a different connotation for cancer researchers... | 567 | ||
53. How do the types of cancers differ between adults and children? | 567 | ||
54. What is the most frequently occurring childhood cancer? | 567 | ||
55. How do the types and frequency of childhood cancers vary by age? | 567 | ||
56. Where does cancer rank as a cause of death in younger children? | 567 | ||
57. Is cancer the leading cause of death in teenagers and young adults? | 567 | ||
58. What are the relative risks for children to develop leukemia? | 568 | ||
59. Does cell phone usage increase the risk of cancers, specifically brain tumors? | 568 | ||
60. Which cancers have a significant racial predilection? | 568 | ||
61. What cancers are most commonly associated with a second neoplasm? | 568 | ||
62. Are there any known transplacental carcinogens? | 569 | ||
63. Is prenatal ultrasound associated with a risk for leukemia later in childhood? | 569 | ||
64. Do children living near electrical power lines have an increased risk for developing cancer? | 569 | ||
Leukemia | 569 | ||
65. What are the most common clinical findings in the initial presentation of ALL? | 569 | ||
66. What are the typical hematologic findings noted during the presentation of ALL? | 570 | ||
67. What studies of tumor cells are useful for determining a patients prognosis? | 570 | ||
68. Which patients with ALL have a poorer prognosis: younger or older children? | 570 | ||
69. What is the significance of translocations of the MLL gene? | 570 | ||
70. Although many prognostic factors have come and gone for childhood ALL, which two have remained significant for the pa... | 571 | ||
71. Why do boys with ALL fare more poorly than girls? | 571 | ||
72. Are race and ethnicity related to treatment outcome in patients with acute leukemia? | 571 | ||
73. In the United States, what are the four most common types of pediatric leukemia, and about how many children are diag... | 571 | ||
74. What is MRD and how is it used? | 571 | ||
75. Is there a relationship between MRD and prognosis in children with ALL? | 571 | ||
76. What is the acute risk for a very elevated blast count noted at the time of the initial diagnosis of leukemia? | 572 | ||
77. What are the most common sites of extramedullary relapse of ALL? | 572 | ||
78. What are known risk factors for acute myeloid leukemia? | 572 | ||
79. What is a chloroma? | 572 | ||
80. What are the two major classes of lymphomas? | 572 | ||
81. What is the malignant cell of Hodgkin disease? | 572 | ||
82. How is Hodgkin disease staged? | 572 | ||
83. What is the difference between clinical and pathologic staging as it relates to Hodgkin disease? | 573 | ||
84. What is the histologic classification of Hodgkin disease? | 573 | ||
85. What is the prognosis for the various stages of Hodgkin disease? | 573 | ||
86. From what cells do non-Hodgkin lymphoma (NHL) derive? | 573 | ||
87. How is childhood NHL classified? | 573 | ||
88. Are there specific chromosomal abnormalities in Burkitt lymphoma? | 574 | ||
89. What is the role of geography in the classification of Burkitt lymphoma? | 574 | ||
90. Who was Burkitt? | 574 | ||
91. What differentiates B- and T-cell precursor leukemia from lymphoma? | 574 | ||
Nervous system tumors | 574 | ||
92. How are CNS tumors classified? | 574 | ||
93. Where is the most common area for each tumor to occur? | 574 | ||
94. What are the most common supratentorial brain tumors? What are their symptoms? | 575 | ||
95. What are the most common infratentorial tumors? What are their symptoms? | 575 | ||
96. Which common parameters should be closely monitored in a child after resection of a brain tumor? | 575 | ||
97. Which cranial nerve abnormality is most common in children showing signs of increased intracranial pressure as the re... | 575 | ||
98. What are the three ``Es´´ of the diencephalic syndrome? | 576 | ||
99. What is Parinaud syndrome? | 576 | ||
100. In addition to imaging studies, what should be included in the evaluation of a possible CNS germ cell tumor? | 576 | ||
101. What are the key evaluations for a child with a newly-diagnosed medulloblastoma? | 576 | ||
102. What is a ``dropped met´´? | 576 | ||
103. What are the differences among a glioma, an astrocytoma, and glioblastoma multiforme? | 576 | ||
104. What is the most common benign brain tumor found in children? | 576 | ||
105. Is resection curative for patients with juvenile pilocytic astrocytoma? | 576 | ||
106. Why is the prognosis for children with brainstem gliomas so poor? | 577 | ||
107. What is leukocoria? | 577 | ||
108. What is the heredity of retinoblastoma? | 577 | ||
109. What is the ``two-hit´´ hypothesis of cancer, particularly retinoblastoma? | 577 | ||
110. In what age group does retinoblastoma usually occur? | 577 | ||
111. Patients with retinoblastoma are at increased risk for other tumors. How significant a risk is this? | 577 | ||
112. What is the cell of origin of neuroblastoma? | 577 | ||
113. What is the most common cancer in younger children? | 577 | ||
114. What are the most common presentations of neuroblastoma? | 578 | ||
115. What is Horner syndrome? | 578 | ||
116. Where does neuroblastoma tend to metastasize? | 579 | ||
117. What is meant by ``dancing eyes, dancing feet´´? | 579 | ||
118. What urinary test aids in the diagnosis of neuroblastoma? | 579 | ||
119. Which molecular abnormality is associated with a more aggressive form of neuroblastoma? | 579 | ||
120. What does the S stand for in stage 4S neuroblastoma? | 579 | ||
121. How can the site of spinal cord compression be clinically localized? | 579 | ||
Solid non-nervous system tumors | 579 | ||
122. What are the peak ages of incidence of the most common solid tumors of childhood? | 579 | ||
123. What are ``blastemal´´ tumors? | 579 | ||
124. What is the average age of diagnosis for Wilms tumor? | 579 | ||
125. What are the three histologic components of a Wilms tumor? | 580 | ||
126. How is Wilms tumor distinguished radiographically from neuroblastoma? | 580 | ||
127. Where does Wilms tumor tend to metastasize? | 580 | ||
128. What is a stage V Wilms tumor? | 580 | ||
129. What factors influence the prognosis of a patient with Wilms tumor? | 580 | ||
130. ``Small, round, blue cell tumor´´ is often used in the description of which childhood tumors? | 580 | ||
131. Where are the most common locations of Ewing sarcoma? | 580 | ||
132. What molecular abnormality is commonly seen in Ewing sarcoma? | 580 | ||
133. What are the two most common sites of metastases for patients with Ewing sarcoma? | 580 | ||
134. What type of tumor is an osteosarcoma? | 580 | ||
135. Osteosarcoma generally arises in which part of the bone? | 580 | ||
136. Do all patients with osteosarcoma require surgical resection of the primary tumor? | 581 | ||
137. For patients with localized osteosarcoma, what factor is most predictive of a favorable outcome? | 581 | ||
138. What do Ewing sarcoma and osteosarcoma have in common? | 581 | ||
139. In what solid tumor has the surgical resection of pulmonary metastases been shown to result in long-term cure? | 581 | ||
140. What is a limb salvage procedure? | 582 | ||
141. What type of tumor is a rhabdomyosarcoma? | 582 | ||
142. Where do rhabdomyosarcomas usually arise? | 582 | ||
143. What sites of disease are associated with the best outcomes for children with rhabdomyosarcoma? | 582 | ||
144. What are the two major histologic subtypes of rhabdomyosarcoma? | 582 | ||
145. Which germ cell tumor is usually seen in young children? | 582 | ||
146. Why are tumor markers assessed before surgery for teratomas and other germ cell tumors? | 582 | ||
147. Virilization may be associated with which childhood cancer? | 582 | ||
148. How great is the risk for malignant transformation in undescended testes? | 582 | ||
149. What are the most common primary liver tumors of childhood? | 582 | ||
150. Which tumor marker is most likely to be elevated in children with hepatic tumors? | 583 | ||
151. Lance Armstrongs treatment for metastatic testicular germ cell tumor had an important modification from standard the... | 583 | ||
Stem cell transplantation | 583 | ||
152. What are the two main types of hematopoietic stem cell (HSC) transplant? | 583 | ||
153. What is the importance of HLA matching in HSC transplant recipients? | 583 | ||
154. What is the chance of siblings having the same human leukocyte antigen (HLA) type? | 583 | ||
155. What is the chance of finding an HLA-matched unrelated donor? | 583 | ||
156. What are the different sources of stem cells for transplantation? | 583 | ||
157. What are the advantages and disadvantages of umbilical cord blood as the source for a stem cell transplantation? | 584 | ||
158. How are stem cells collected? | 584 | ||
159. What is the rationale behind an autologous transplant? | 584 | ||
160. Are there nonmalignant indications for an HSC transplant? | 584 | ||
161. In transplant medicine, to what does the term ``conditioning´´ refer? | 584 | ||
162. What are the three most common categories of conditioning regimens? | 584 | ||
163. What are the major side effects from total-body irradiation used in conditioning? | 584 | ||
164. Which prophylactic measures should be taken after stem cell transplantation? | 585 | ||
165. What is the most common early complication seen in patients after HSC transplant? | 585 | ||
166. What are the major features of graft-versus-host disease (GVHD)? | 585 | ||
167. How is GVHD managed? | 585 | ||
168. What are the risk factors for GVHD? | 585 | ||
169. What is the most likely diagnosis for a patient who experiences weight gain, right upper quadrant pain, and hepatome... | 585 | ||
170. Which chemotherapeutic agents can be administered intrathecally to either treat or prevent meningeal malignancy? | 585.e1 | ||
171. What are the common side effects of methotrexate? | 585.e1 | ||
172. In what way do the side-effect profiles of cisplatin and carboplatin differ? | 585.e1 | ||
173. What are the common complications of vincristine? | 585.e1 | ||
174. What agent can limit the complication of hemorrhagic cystitis that occurs in some chemotherapeutic regimens? | 585.e1 | ||
175. What are the differences between conventional external radiation, intensity-modulated radiation therapy (IMRT), and ... | 585.e1 | ||
176. What treatment options exist for individuals who are allergic to sulfonamides and are unable to tolerate trimethopri... | 585.e1 | ||
177. What PJP prophylactic agent has been associated with methemoglobinemia? | 585.e2 | ||
178. Is it true that the PEG-asparaginase was affectionately named after its inventor? | 585.e2 | ||
179. Why are blood products irradiated and leukocyte depleted? | 585.e2 | ||
180. What is the most well-documented risk factor for hepatoblastoma? | 585.e2 | ||
181. Which distinct form of AML uses an analog of a common vitamin as a core component of its treatment? | 585.e2 | ||
182. What is the consensus regarding appropriate treatment for CML? | 585.e2 | ||
183. If you saw a car with the license plate, ``FLT3 ITD,´´ what would the most likely interest of its driver be? | 585.e2 | ||
184. What nuclear medicine agent has been useful in both the diagnosis and treatment of neuroblastoma? | 585.e3 | ||
185. Patients with high-risk neuroblastoma require treatment with virtually all known therapeutic modalities to maximize ... | 585.e3 | ||
186. Do all transplant patients require complete ablation of their recipient bone marrow? | 585.e3 | ||
187. What is graft-versus-leukemia (GVL)? | 585.e3 | ||
Chapter 15: Orthopedics | 586 | ||
Clinical issues | 586 | ||
1. What is torticollis? | 586 | ||
2. What is the differential diagnosis for torticollis? | 586 | ||
3. An x-ray of a 10-year-old boy taken to rule out an ankle fracture reveals a 4-mm, well-circumscribed lytic lesion in t... | 586 | ||
4. What are two other common types of benign bone tumors in children? | 586 | ||
5. How and why is it important to differentiate between an ABC and a UBC? | 586 | ||
6. What is rickets? | 586 | ||
7. What are the physical signs that are suggestive of rickets? | 586 | ||
8. Which bones are known to develop aseptic (also called avascular) necrosis? | 587 | ||
9. What are the inheritance patterns and clinical features of osteogenesis imperfecta? | 587 | ||
10. McCune-Albright syndrome is associated with what skeletal abnormalities? | 587 | ||
11. What are the causes of in-toeing gait (pigeon-toeing)? | 587 | ||
12. Is in-toeing a problem? | 588 | ||
13. When, if ever, does in-toeing need to be treated? | 588 | ||
14. A 15-year-old with tibial pain (worse at night and relieved by nonsteroidal anti-inflammatory drugs) has a small lyti... | 588 | ||
15. What is the clinical significance of limb-length discrepancy? | 588 | ||
16. What are the possible causes of a limb-length discrepancy? | 588 | ||
17. What are the general management principles for a limb-length discrepancy? | 588 | ||
18. What is a nursemaid elbow? | 589 | ||
19. How is a nursemaid elbow reduced? | 589 | ||
20. What signs and symptoms suggest a serious cause of back pain in a child that warrants further evaluation? | 590 | ||
21. What is the differential diagnosis of back pain in children? | 590 | ||
22. Do school backpacks contribute to back pain? | 590 | ||
23. What constitutes an orthopedic emergency? | 590 | ||
Foot disorders | 590 | ||
24. Do infants and children need shoes? | 590 | ||
25. What is the most common congenital foot abnormality? | 591 | ||
26. How is metatarsus adductus treated? | 591 | ||
27. How is clubfoot distinguished from severe metatarsus adductus? | 591 | ||
28. How are clubfeet treated? | 591 | ||
29. What is a calcaneovalgus foot? | 592 | ||
30. What should be suspected when pes cavus is noted on examination? | 592 | ||
31. Should children with flexible flat feet be given corrective shoes? | 592 | ||
32. When should I worry about a child with flat feet? | 592 | ||
33. How does the cause of foot pain vary by age? | 593 | ||
34. A 10-year-old boy with recurrent ankle sprains and painful flat feet should be evaluated for what possible diagnosis? | 593 | ||
Fractures | 593 | ||
35. What are the fractures patterns unique to children? | 593 | ||
36. What is a buckle fracture? | 593 | ||
37. What is a greenstick fracture? | 593 | ||
38. What does plastic deformation mean? | 593 | ||
39. Where are the most frequent sites of fractures among children? | 593 | ||
40. What is an open fracture? | 593 | ||
41. What is a toddler fracture? | 594 | ||
42. How are growth-plate fractures classified? | 594 | ||
43. In a patient with suspected fracture, what are the key points on physical examination? | 594 | ||
44. What are the signs of compartment syndrome? | 594 | ||
45. What is the treatment of compartment syndrome? | 595 | ||
46. How do you treat clavicle fractures? | 595 | ||
47. Is surgery ever indicated in clavicle fractures? | 595 | ||
48. A teenager who punches a wall in anger typically incurs what fracture? | 595 | ||
49. Children who fall on outstretched arms often suffer what type of fractures? | 596 | ||
50. What does the presence of the posterior fat pad on an elbow x-ray suggest? | 596 | ||
51. For a teenager with wrist trauma, why is palpation of the anatomic ``snuff box´´ a critical part of the physical exam? | 596 | ||
52. Name the eight carpal bones of the wrist. | 596 | ||
53. What is the difference between open and closed reductions? | 596 | ||
54. In pediatric fractures, what amount of angulation is acceptable before reduction is recommended? | 596 | ||
55. In which fractures will remodeling of bone not occur? | 597 | ||
56. How long should fractures be immobilized? | 597 | ||
57. How long do fractured clavicles and femurs take to heal? | 597 | ||
Hip disorders | 597 | ||
58. Why has DDH replaced CHD? | 597 | ||
59. What are the Ortolani and Barlow maneuvers? | 597 | ||
60. What is a positive Galeazzi sign? | 598 | ||
61. What is the significance of a ``hip click´´ in a newborn? | 598 | ||
62. What is the most reliable physical finding for a dislocated hip in the older child? | 598 | ||
63. What other diagnostic signs are suggestive of a dislocated hip? | 598 | ||
64. What radiographic studies are most valuable for diagnosing DDH during the newborn period? | 599 | ||
65. Should all infants be routinely screened by ultrasound for DDH? | 599 | ||
66. Who is at a higher risk for DDH? | 599 | ||
67. What is the recommended timing for ultrasound evaluation when screening is indicated? | 599 | ||
68. How is DDH treated? | 599 | ||
69. What is the natural history of untreated DDH? | 600 | ||
70. What is the significance of a Trendelenburg gait? | 600 | ||
71. What is the most common cause of a painful hip in a child <10years old? | 600 | ||
72. How can transient synovitis be differentiated from septic arthritis? | 600 | ||
73. What is LCP disease? | 601 | ||
74. What are the pathologic stages of LCP disease? | 601 | ||
75. What is the prognosis for children with LCP disease? | 602 | ||
76. What condition does the child in Figure15-9 have? | 602 | ||
77. How is the extent of femoral anteversion measured? | 602 | ||
78. Is sitting in the ``W´´ position harmful? | 602 | ||
79. Is there ever an indication to treat femoral anteversion? | 603 | ||
80. What symptoms do children with slipped capital femoral epiphysis (SCFE) have? | 603 | ||
81. What systemic conditions are associated with SCFE? | 603 | ||
82. What does FAI stand for? | 603 | ||
83. What new treatments are available for the treatment of hip pathology including DDH, FAI, and SCFE? | 603 | ||
Infectious diseases | 603 | ||
84. What percentage of septic arthritis is ``culture negative´´? | 604 | ||
85. Where does acute hematogenous osteomyelitis most commonly localize in children? | 604 | ||
86. What is the most common cause of acute hematogenous osteomyelitis? | 604 | ||
87. How often are blood cultures positive in patients with osteomyelitis? | 604 | ||
88. As osteomyelitis progresses, how soon do x-ray changes occur? | 604 | ||
89. What is the best way to confirm the diagnosis of osteomyelitis? | 604 | ||
90. How long should antibiotics be continued in patients with osteomyelitis and septic arthritis? | 605 | ||
91. Which marker, C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), is more sensitive to assess inflammat... | 605 | ||
92. When is open surgical drainage indicated in cases of osteomyelitis? | 605 | ||
93. Why are treatment failures more common in osteomyelitis than in septic arthritis? | 605 | ||
94. How is the diagnosis of discitis established? | 606 | ||
95. What is the most important variable that influences mortality in necrotizing fasciitis? | 606 | ||
96. What is the role of bone scintigraphy in children with obscure skeletal pain? | 606 | ||
97. What are the phases of a bone scan? | 606 | ||
Knee, tibia, and ankle disorders | 606 | ||
98. What is the difference between valgus and varus deformities? | 606 | ||
99. Are children normally knock-kneed or bowlegged? | 607 | ||
100. Which bowlegged infants or toddlers require evaluation? | 607 | ||
101. What are the causes of pathologic genu varum (bowleggedness) or genu valgus (knock knees)? | 607 | ||
102. Which children are more likely to develop Blount disease? | 607 | ||
103. How does tibial torsion change with age? | 608 | ||
104. How effective is the Denis Browne splint for the treatment of tibial torsion? | 608 | ||
105. Why are ligamentous injuries less common in children? | 608 | ||
106. How are ankle sprains graded? | 608 | ||
107. Which ankle sprains should be evaluated with an x-ray? | 608 | ||
108. Should ankle sprains be casted? | 608 | ||
109. What is the most significant mistake made during the evaluation of knee pain? | 608 | ||
110. In acute injury, what injuries typically cause bleeding into the knee joint? | 609 | ||
111. A 5-year-old boy with a painless swelling in the back of his knee has what likely condition? | 609 | ||
112. How does patellofemoral stress syndrome occur? | 609 | ||
113. What is the Q angle? | 609 | ||
Spinal disorders | 609 | ||
114. What are the different forms scoliosis? | 609 | ||
115. Is scoliosis more common in boys or girls? | 610 | ||
116. How likely is the progression of scoliosis? | 610 | ||
117. What are the risk factors for progression of idiopathic scoliosis? | 610 | ||
118. How is screening for spinal deformity performed? | 610 | ||
119. What constitutes an abnormal scoliometer measurement? | 610 | ||
120. How is scoliosis measured by the Cobb method? | 611 | ||
121. How valuable are school-based screening programs for scoliosis? | 612 | ||
122. What is the natural history of untreated severe idiopathic scoliosis? | 612 | ||
123. When should surgery be considered for idiopathic scoliosis? | 612 | ||
124. What type of surgery is typically performed for scoliosis correction? | 612 | ||
125. Are the spines of young children fused as well? | 612 | ||
126. So how are large curves in young children treated? | 612 | ||
127. Are casts still used to treat scoliosis? | 613 | ||
128. Is bracing an effective treatment for scoliosis? | 613 | ||
129. What diagnosis should you consider in a teenage male with very poor posture that is not flexible? | 613 | ||
130. What is the difference between spondylolysis and spondylolisthesis? | 613 | ||
Sports medicine | 614 | ||
131. A 12-year-old baseball player presents complaining of elbow pain. What diagnosis do you need to consider? | 614 | ||
132. Which is worse for a baseball pitchers elbow: throwing curveballs or fastballs? | 614 | ||
133. How can elbow and shoulder injuries be prevented in pitchers? | 614 | ||
134. Do meniscal tears occur in younger children? | 614 | ||
135. If a ninth-grade soccer player with knee swelling ``felt a pop´´ while scoring a goal, what are three possible diagn... | 614 | ||
136. How is meniscal integrity assessed on examination? | 614 | ||
137. What is the typical mechanism for an anterior cruciate ligament (ACL) tear? | 615 | ||
138. How is ACL stability tested on examination? | 615 | ||
139. Why are girls and young women more susceptible to ACL tears than their male counterparts? | 615 | ||
140. Are ACL tears treated differently in children, adolescents, and adults? | 616 | ||
141. Are there ways to prevent ACL tears? | 616 | ||
142. A teenager has chronic knee pain, swelling, and occasional ``locking´´ of the knee joint, and his x-ray reveals incr... | 616 | ||
143. What is the most likely diagnosis if a 12-year-old basketball player has painful swelling below both knees? | 617 | ||
144. What is the likely diagnosis in a fifth-grade football player with heel pain and a positive ``squeeze test´´? | 617 | ||
145. Which sports injuries are the most common in school-age children and adolescents? | 617 | ||
146. What are the definitions of concussion and postconcussion syndrome? | 617 | ||
147. What is the value of ``brain rest´´ in the treatment of concussion? | 618 | ||
148. When should an athlete who has suffered a concussion be allowed to return to play? | 618 | ||
149. Are stretching exercises helpful for congenital muscular torticollis? | 618.e1 | ||
150. What advice should be given to a parent about buying shoes for a toddler? | 618.e1 | ||
151. Which conditions are associated with coxa vara? | 618.e1 | ||
152. How do the features of osteomyelitis in the neonate differ from those seen in the older child and adult? | 618.e1 | ||
153. What predisposes a child or teenager to recurrent dislocation of the patella? | 618.e1 | ||
154. Is there a genetic test for scoliosis? | 618.e1 | ||
Chapter 16: Pulmonology | 619 | ||
Allergic rhinitis | 619 | ||
1. How common is allergic rhinitis? | 619 | ||
2. In addition to chronic or recurrent nasal congestion, what features on history and physical examination suggest allerg... | 619 | ||
3. What are three early-life risk factors for allergic rhinitis? | 619 | ||
4. How does the time of year help identify the potential cause of allergic rhinitis? | 620 | ||
5. When are allergy blood tests used? | 620 | ||
6. What is an antigen-specific IgE ImmunoCAP? | 620 | ||
7. Summarize the pros and cons of skin testing versus in vitro testing (e.g., IgE ImmunoCAP) for allergies | 620 | ||
8. What are the recommended treatments for children with allergic rhinitis? | 620 | ||
9. What are the major indoor (year-round) allergens? | 621 | ||
10. How can you decrease cat allergen in the home? | 621 | ||
11. Is there truly a dog breed that is ``hypoallergenic´´? | 621 | ||
12. Which children should be considered for immunotherapy? | 621 | ||
13. How common is exercise-induced bronchospasm in children with allergic rhinitis? | 621 | ||
Asthma | 622 | ||
14. If both parents are asthmatic, what is the risk that their child will have asthma? | 622 | ||
15. When does asthma usually have its onset of symptoms? | 622 | ||
16. Which children with wheezing at an early age are likely to develop chronic asthma? | 622 | ||
17. What historical points are suggestive of an allergic basis for asthma? | 622 | ||
18. What are other potential triggers for asthma? | 622 | ||
19. What distinguishes EIA from EIB? | 622 | ||
20. What is the time course of EIB? | 623 | ||
21. How is EIB diagnosed? | 623 | ||
22. A 15-year-old with repeated shortness of breath after track practice has suspected exercise-induced bronchospasm, but... | 623 | ||
23. What mechanisms lead to airway obstruction during an acute asthma attack? | 623 | ||
24. All that wheezes is not asthma. What are other noninfectious causes? | 623 | ||
25. How is the severity of an acute asthma attack estimated? | 624 | ||
26. Is a chest radiograph necessary for all children who wheeze for the first time? | 624 | ||
27. What are the usual findings on arterial blood gas sampling during acute asthma attacks? | 625 | ||
28. What are the indications for hospital admission in children with asthma? | 625 | ||
29. List the possible acute side effects of albuterol and other β-agonists | 625 | ||
30. What is the role of magnesium sulfate in acute asthma attacks? | 625 | ||
31. How is chronic asthma severity classified among children 5 to 11 years of age? | 625 | ||
32. What is the treatment of choice for patients with persistent asthma? | 625 | ||
33. Do inhaled steroids affect growth in children? | 627 | ||
34. What is anti-IgE treatment for asthma? | 627 | ||
35. Is there a role for complementary and alternative medicines in the treatment of asthma? | 627 | ||
36. How useful are pulmonary function tests when evaluating and following children with asthma? | 627 | ||
37. What proportion of asthmatic children ``outgrow´´ their symptoms? | 628 | ||
38. What diagnosis should be considered in a patient with poorly controlled asthma with recurrent infiltrates who has cen... | 628 | ||
Bronchiolitis | 628 | ||
39. What is the most important cause of lower respiratory tract disease among infants and young children? | 628 | ||
40. What other agents cause bronchiolitis? | 629 | ||
41. What are the best predictors of the severity of bronchiolitis? | 629 | ||
42. What are the typical findings on a chest radiograph in a child with bronchiolitis? | 629 | ||
43. Which patients with bronchiolitis are at risk for apnea? | 629 | ||
44. Is the use of steroids justified for bronchiolitis? | 629 | ||
45. Is inhalation therapy effective for bronchiolitis? | 630 | ||
46. Is there a vaccine to prevent RSV infection? | 630 | ||
47. Does infection with RSV confer lifelong protection? | 630 | ||
48. If a 5-month-old child is hospitalized as a result of RSV bronchiolitis, what should the parents be told about the li... | 630 | ||
Clinical issues | 630 | ||
49. How is hemoptysis differentiated from hematemesis? | 630 | ||
50. What are the indications for surgical repair of pectus excavatum? | 631 | ||
51. What are the most common causes of chronic cough? | 631 | ||
52. When should the diagnosis of psychogenic cough be considered? | 631 | ||
53. What medications are most effective for cold symptoms in children? | 632 | ||
54. Which is the more effective for cough in children: antihistamines, antitussives, mucolytics, decongestants, or honey? | 632 | ||
55. What constitutes passive cigarette smoke? | 632 | ||
56. What are the possible risks of passive cigarette smoke exposure? | 632 | ||
57. How is clubbing diagnosed? | 632 | ||
58. What are the causes of digital clubbing? | 633 | ||
59. What is the pathophysiology of clubbing? | 633 | ||
60. Nasal polyps are associated with which conditions? | 633 | ||
61. A patient with chronic sinusitis and recurrent pulmonary infections has a chest radiograph that demonstrates a right-... | 634 | ||
62. What percentage of children snore? | 634 | ||
63. In which children who snore should obstructive sleep apnea (OSA) be suspected? | 634 | ||
64. What evaluations should be performed on a child with suspected OSA? | 634 | ||
65. What are the potential long-term consequences of OSA? | 635 | ||
66. What is the most common cause of infantile stridor? | 635 | ||
67. How can you clinically distinguish bilateral from unilateral vocal cord paralysis in an infant? | 635 | ||
68. What is the most common cause of chronic hoarseness in children? | 636 | ||
69. What are the most common symptoms and signs in children with suspected foreign body aspiration? | 636 | ||
70. Which other clinical features are suggestive of foreign-body aspiration? | 636 | ||
71. Are chest radiographs useful for evaluating a foreign-body aspiration? | 636 | ||
72. On which side of the chest are foreign-body aspirations and aspiration pneumonias more common? | 637 | ||
73. What are the possible mechanisms for the development of lung abscesses in children? | 637 | ||
74. What are the typical clinical findings in patients with bronchiectasis? | 637 | ||
75. A novice teenage mountain-climber develops headache, marked cough, and orthopnea at the end of a rapid 2-day climb. W... | 637 | ||
76. What is the likely diagnosis of a child with diffuse lung disease, microcytic anemia, and sputum that contains hemosi... | 637 | ||
77. How should a child with a spontaneous pneumothorax be managed? | 638 | ||
78. Describe the clinical and radiographic features of a tension pneumothorax | 638 | ||
79. What physical examination features suggest a pleural effusion? | 638 | ||
80. In children with pleural effusions, how are exudates distinguished from transudates? | 638 | ||
81. What pediatric diseases are associated with exudative and transudative pleural effusions? | 639 | ||
82. What are possible treatments for infected parapneumonic effusions? | 639 | ||
83. What is the value of chest physiotherapy (CPT) in patients with pediatric pulmonary disease? | 640 | ||
84. Who was Ondine, and what was her curse? | 640 | ||
Cystic fibrosis | 640 | ||
85. What is the basic defect in patients with cystic fibrosis (CF)? | 640 | ||
86. What is the incidence of CF in various ethnic groups? | 640 | ||
87. What are the presenting signs and symptoms of CF? | 641 | ||
88. How is the diagnosis of CF made? | 641 | ||
89. What constitutes an abnormal sweat test? | 641 | ||
90. How are newborns screened for CF? | 641 | ||
91. When and why should children with cystic fibrosis be screened for possible CF-related diabetes mellitus? | 641 | ||
92. What are the mainstays of pulmonary therapy for children with CF? | 641 | ||
93. What is the role of Ivacaftor in the treatment of CF patients? | 642 | ||
94. Which features of CF have prognostic significance? | 642 | ||
Pneumonia | 642 | ||
95. What agents cause pneumonia in children? | 642 | ||
96. What are important trends in the etiology of pneumonia in the United States? | 643 | ||
97. Are throat or nasopharyngeal cultures helpful for the diagnosis of pneumonia? | 643 | ||
98. How often are blood cultures positive in children with suspected bacterial pneumonia? | 643 | ||
99. How often are pleural fluid cultures positive in children with suspected bacterial pneumonia? | 644 | ||
100. Can a chest radiograph reliably distinguish between viral and bacterial pneumonia? | 644 | ||
101. What are indications for hospital admission in children with pneumonia? | 644 | ||
102. What clinical clues suggest atypical pneumonia? | 645 | ||
103. What are the causes of ``afebrile infant pneumonia´´ syndrome? | 645 | ||
104. What are the clinical characteristics of chlamydial pneumonia in infants? | 645 | ||
105. How helpful are cold agglutinins in the diagnosis of M. pneumoniae infections? | 645 | ||
106. When do the radiologic findings of pneumonia resolve? | 645 | ||
107. Do children with pneumonia need follow-up radiographs to verify resolution? | 645 | ||
108. What are the causes of recurrent pneumonia? | 646 | ||
109. How does the pH of a substance affect the severity of disease in aspiration pneumonia? | 646 | ||
110. How should children with aspiration pneumonia be managed? | 646 | ||
Pulmonary principles | 646 | ||
111. In addition to underlying immunologic immaturity, why are infants more susceptible to an increased severity of respi... | 646 | ||
112. At what age do alveoli stop increasing in number? | 646 | ||
113. What is the normal respiratory rate in otherwise healthy children? | 647 | ||
114. What is the significance of grunting respirations? | 647 | ||
115. What is normal oxygen saturation in healthy infants who are <6months? | 647 | ||
116. What is the difference among Kussmaul, Cheyne-Stokes, and Biot types of breathing patterns? | 647 | ||
117. Why a sigh? | 647 | ||
118. Is there a respiratory basis for yawning? | 647 | ||
119. At what concentration is inspired oxygen toxic? | 647 | ||
120. Why is a child who is receiving 100% oxygen more likely to develop atelectasis than one who is breathing room air? | 648 | ||
121. At what Pao2 does cyanosis develop? | 648 | ||
122. What are the causes of a reduced Pao2 associated with an increased A-aDo2 (alveolar-arterial oxygen tension differen... | 648 | ||
123. How does the pulse oximeter work? | 648 | ||
124. What are the disadvantages or limitations of pulse oximetry? | 648 | ||
125. In infants with unilateral lung disease, should the good lung be up or down? | 648 | ||
126. How can house dust mite (HDM) concentrations be minimized? | 649.e1 | ||
127. Is a nebulizer more effective than a metered-dose inhaler (MDI) with a spacer for the treatment of asthma? | 649.e1 | ||
Chapter 17: Rheumatology | 650 | ||
Clinical issues | 650 | ||
1. What is an ANA? | 650 | ||
2. What is an ANA profile? | 650 | ||
3. Should I order a profile instead of an ANA because it has more specificity? | 650 | ||
4. What is the significance of the various antibodies included in the ANA profile? | 650 | ||
5. A 6-year-old girl with a 2-month history of joint pain (onset after a viral illness) has a normal physical examination... | 650 | ||
6. Is Raynaud phenomenon a disease? | 650 | ||
7. When is a child considered to have hypermobile joints? | 651 | ||
8. Which children can demonstrate a Gorlin sign? | 651 | ||
9. In what settings can reactive arthritis occur? | 651 | ||
10. What conditions are associated with gastrointestinal symptoms and arthritis? | 651 | ||
11. One week after mild trauma, an 8-year-old girl has pain and tenderness in the right foot and leg, both of which are c... | 652 | ||
12. How is complex regional pain syndrome managed? | 652 | ||
13. Do children develop fibromyalgia? | 652 | ||
Dermatomyositis and polymyositis | 653 | ||
14. What are the criteria used for the diagnosis of juvenile dermatomyositis and polymyositis? | 653 | ||
15. What skin changes are pathognomonic for dermatomyositis? | 653 | ||
16. What are the other classic cutaneous findings of dermatomyositis among children? | 654 | ||
17. Which infectious agents are known to cause myositis? | 654 | ||
Juvenile idiopathic arthritis | 654 | ||
18. Why is JRA becoming juvenile idiopathic arthritis (JIA)? | 654 | ||
19. What is synovitis, and at what point is it considered chronic? | 654 | ||
20. What is the most common chronic arthritis seen in children? | 654 | ||
21. What are the diagnostic criteria for the classification of JIA? | 654 | ||
22. What are the characteristics of the seven main subsets of JIA? | 655 | ||
23. What percent of pediatric JIA presents as systemic JIA? | 655 | ||
24. What is the pattern of fever and characteristic rash of the systemic-onset subset of JIA? | 655 | ||
25. In addition to different clinical features, how is systemic JIA distinguished from other subgroups of JIA? | 656 | ||
26. Why is it sometimes difficult to distinguish systemic JIA (sJIA) from leukemia? | 656 | ||
27. In a patient with suspected rheumatic disease, what clinical features are more suggestive of malignancy? | 656 | ||
28. What is the value of measuring ANA and rheumatoid factor (RF) in patients with JIA? | 656 | ||
29. Are radiographs helpful for diagnosing JIA? | 656 | ||
30. A patient with JIA who becomes ill with thrombocytopenia, profound anemia, and markedly elevated transaminases probab... | 657 | ||
31. What are the main features of the macrophage activation syndrome? | 657 | ||
32. What is the traditional first-line approach to JIA medical management? | 657 | ||
33. What second-line agents have been used in the treatment of JIA? | 657 | ||
34. When are corticosteroids indicated for children with JIA? | 658 | ||
35. What are the most common side effects of prolonged corticosteroid therapy? | 658 | ||
36. What are biologic agents? | 658 | ||
37. Which children with JIA require the most frequent monitoring for uveitis? | 658 | ||
38. What is the earliest sign of uveitis among patients with JIA? | 659 | ||
39. What are the juvenile spondyloarthropathies under the revised classification system? | 659 | ||
40. What are the characteristic clinical features of the juvenile spondyloarthropathies? | 660 | ||
41. How is enthesitis diagnosed clinically? | 660 | ||
42. Why is the diagnosis of ankylosing spondylitis difficult to make in children? | 660 | ||
43. Where are the dimples of Venus? | 661 | ||
Lyme disease | 661 | ||
44. What criteria are used to diagnose Lyme disease? | 661 | ||
45. What is the typical rash seen in Lyme disease? | 661 | ||
46. How long after a tick bite does the rash of Lyme disease appear? | 662 | ||
47. How is Lyme disease confirmed in the laboratory? | 662 | ||
48. If infection ensues after a tick bite, how does Lyme disease progress? | 662 | ||
49. How is the diagnosis of Lyme meningitis established? | 662 | ||
50. How are Lyme disease and viral meningitis clinically differentiated? | 662 | ||
51. Should lumbar punctures be done for patients with facial palsy and suspected Lyme disease? | 663 | ||
52. How is Lyme arthritis differentiated from septic arthritis? | 663 | ||
53. What is the prognosis for children diagnosed with Lyme arthritis? | 663 | ||
54. What should be suspected if a patient with Lyme disease develops fever and chills after starting antibiotic treatment? | 663 | ||
55. Should we follow Lyme disease course and response to therapy with titers? | 663 | ||
56. Is antibiotic prophylaxis indicated for all tick bites? | 663 | ||
57. What are other means of preventing Lyme disease? | 664 | ||
Rheumatic fever | 664 | ||
58. What is acute rheumatic fever? | 664 | ||
59. What are the major Jones criteria for rheumatic fever? | 664 | ||
60. What is acceptable proof of antecedent streptococcal pharyngitis when diagnosing acute rheumatic fever? | 664 | ||
61. Which antistreptococcal antibodies are most commonly measured? | 664 | ||
62. What are the common manifestations of carditis in patients with ARF? | 665 | ||
63. How quickly can valvular lesions occur in children with ARF? | 665 | ||
64. What are the typical characteristics of arthritis in patients with ARF? | 665 | ||
65. What is the effect of aspirin therapy on the arthritis of rheumatic fever? | 665 | ||
66. What is the rash of rheumatic fever? | 665 | ||
67. What is Sydenham chorea? | 666 | ||
68. Who was Saint Vitus? | 666 | ||
69. Are corticosteroids of benefit for the treatment of ARF? | 666 | ||
70. Can antibiotic prophylaxis for rheumatic fever ever be discontinued? | 666 | ||
71. Where do PANDAS live in the world of pediatric rheumatology? | 666 | ||
Systemic lupus erythematosus | 667 | ||
72. What is systemic lupus erythematosus (SLE)? | 667 | ||
73. What laboratory tests should be ordered in a child who is suspected of having SLE? | 667 | ||
74. What are the most common manifestations of SLE in children? | 667 | ||
75. What are the neurologic manifestations of SLE? | 668 | ||
76. Which diseases should be considered in the differential diagnosis of children with a butterfly rash? | 668 | ||
77. Should children with SLE undergo a renal biopsy? | 668 | ||
78. How can the result of renal biopsy affect treatment of SLE? | 669 | ||
79. When should high-dose corticosteroid therapy be considered for SLE management? | 669 | ||
80. What is the association of antiphospholipid antibodies and lupus? | 669 | ||
81. Which laboratory tests are useful for monitoring the effectiveness of therapy in patients with SLE? | 669 | ||
82. What are the most common manifestations of neonatal lupus erythematosus? | 670 | ||
83. What is the pathophysiology of the CCHB of NLE? | 670 | ||
84. What are the common features of drug-induced lupus? | 670 | ||
85. What are the most common causes of drug-induced lupus in children? | 670 | ||
Vasculitis | 671 | ||
86. What clinical features suggest a vasculitic syndrome? | 671 | ||
87. How are the primary systemic vasculitides classified? | 671 | ||
88. What are the two most common pediatric vasculitides? | 671 | ||
89. Which infectious agents are associated with vasculitis? | 671 | ||
90. What are the conditions that are grouped under the term pulmonary-renal syndromes? | 671 | ||
91. What is the clinical triad of Behçet disease? | 672 | ||
92. Should it be ``Henoch-Schönlein purpura´´ or ``Schönlein-Henoch purpura´´? | 672 | ||
93. What are the characteristic laboratory findings of patients with Henoch-Schönlein purpura (HSP)? | 672 | ||
94. What kinds of skin lesions are noted in patients with HSP? | 672 | ||
95. In addition to the skin, what other organ systems are typically involved in HSP? | 673 | ||
96. How often does chronic renal disease develop in children with HSP? | 673 | ||
97. Why is the diagnosis of intussusception often difficult in patients with HSP? | 673 | ||
98. When are corticosteroids indicated for the treatment of HSP? | 673 | ||
99. What is acute hemorrhagic edema of infancy (AHEI)? | 674 | ||
100. In which rheumatic diseases can ``cauliflower ears´´ be seen? | 674 | ||
101. What is the difference between autoinflammatory and autoimmune diseases? | 674 | ||
102. Are all autoinflammatory diseases characterized by periodic fever and genetic mutations? | 674 | ||
Index | 676 |