Scabies and Fractures: Diagnosis and Treatment, Exams of Pediatrics

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Impetigo -correct answer Which of the following is contagious? A. Atopic Dermatitis B. Contact Dermatitis C. Impetigo D. Milia A fluid sac in the scrotal sac that usually resolves by 1 year is known as_______________ -correct answer hydrocele What is the next step if not resolved by 1 year of age? -correct answer Urology consult for surgical intervention phimosis -correct answer The inability to retract the foreskin in an uncircumcised male is

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paraphimosis -correct answer The inability to bring the foreskin back over penis and is a medical emergency is ________________ Testicular Torsion -correct answer A twisting of the spermatic cord that causes sudden severe pain and swelling. Most often occurs in males ages 12-16 and is a medical emergency. Young males may present with complaints of lower abdominal pain, belly pain. Prehn's Sign -correct answer Elevation of the testis may relieve the pain of epididymitis, but not epididymic torsion. You are examining Josh a 5 year old male. His mother states that he stayed at a friends house and now has a rash. When you examine Josh you note linear borroughs in the finger webs and wrists bilaterally. What do you suspect? A. Pediculosis Capitus B. Contact Dermatitis C. Scabies D. Bed Bugs -correct answer C. Scabies A. Pediculosis Capitus is Lice B. Contact Dermatitis is a rash D. Bed Bugs present as red marks in 3's (AKA breakfast, lunch and dinner bites) Scabies -correct answer Suggested by linear burrows about the wrists, ankles, finger webs, areolas, anterior axillary folds, genitalia, or face. Extremely pruritic. Treatment is Permetherin 5% applied as a single overnight dose and repeated in 7 days. David is 7 weeks old. His mother brought him to your office because of a reported high fever the morning of 104.2 rectally. The mother does not report any symptoms of cough,

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runny nose, congestion, vomiting or diarrhea. The baby is eating normally. On physical exam temp is 103F there are no abnormal findings. What is your next step? -correct answer Refer to ED for sepsis workup on any infant <3 months old with high grade fever. Brian, a 13 year old male, comes to the office with a cast for his right ankle fracture. Dad reports he is taking pain medication but continues to complain of pain and he noticed the toes are "white". What do you suspect? What needs to be done? -correct answer Compartment/compression syndrome Send to Emergency Department for immediate cast removal What are the 3 P's of compartment syndrome? -correct answer Pain Pallor Parathesias Children and adolescents with which of the following disorders can participate in sports UNRESTRICTED? A. anticoagulation therapy B. Marfan Syndrome C. Ehlers-Danlos Syndrome D. Coronary artery anomalies -correct answer B. Marfan Syndrome Marfan Syndrome -correct answer Aortic root dilation associated with mitral valve prolapse and regurgitation. Participation in sports with minimal physical demands. What is the criteria for clearance for sports physicals? -correct answer Read chapter 27 starting p How are acute sports injuries managed? -correct answer P-protect the injury from further damage (taping, splints, braces) R- rest the area I- ice C- compression of the injury E- elevation immediately Gender specific problems related to sports participation -correct answer Female triad: oligomenorrhea, sport where leanness is desired, high impact sport a risk for stress fracture (decreased calcium intake) What is the recommended management of an infant with undescended testicle? -correct answer Watchful waiting. If not resolved by 1 year of age, the refer for surgical intervention The following problems from Down Syndrome can develop in childhood -correct answer Thyroid dysfunction

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Visual disturbance Hearing loss Obstructive sleep apnea Celiac disease Atlanto-occipital instability- because of hypotonia and ligament laxity, usually at the C1,C2 level. Autism What is a fracture? -correct answer Complete separation of bone. When the force exerted on a bone is stronger than the bone itself. Transverse fracture -correct answer fracture perpendicular to the long axis of the bone Oblique fracture -correct answer fracture line runs at an obilque angle to long axis of bone Spiral Fracture -correct answer Fracture line curves in spiral fashion around the bone Communited Fracture -correct answer Fracture in which more than 2 fragments are present Impacted fracture -correct answer fracture in which ends are driven into each other Torus fracture -correct answer pediatric impact fracture in which cortex of a long bone buckles with no loss of cortical continuity Compression fracture -correct answer excessive axial load compresses the bone beyond its limits Depressed fracture -correct answer fracture of cortical bone caused by localized force that breaks and depresses 1 segment below level of surrounding bone. Stress fracture -correct answer caused by repetitive loading beyond bone tolerance Pathologic fracture -correct answer pre-existing condition weakens bone Avulsion Fracture -correct answer Forcible muscular contraction of ligamentous attachment to bone pulls attached bone away. Sprain -correct answer Stretching/tearing of the ligaments Strain -correct answer Stretching/tearing of tendons Dislocation -correct answer An injury where a joint is forced out of normal position

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Subluxation -correct answer An incomplete or partial dislocation of a joint 2 month old Allie presents to your office for recurrent vomiting described as projectile. You notice an almond-shaped mass in the abdomen. What are you suspicious for? A. Intussusescption B. Pyloric Stenosis C. Foreign Body ingestion D. Appendicitis -correct answer B. Pyloric Stenosis. An almond-shape mass in the abdomen is a classic sign. . . Appendicitis -correct answer presents with fever and periumbilical abdominal pain that localizes to the right lower quadrant with signs of peritoneal irritation. May also have anorexia, vomiting, diarrhea and constipation. Foreign body ingestion: -correct answer presents with dysphagia, drooling, regurgitation and chest/abdominal pain Intussesception -correct answer present with abdominal pain with screaming and drawing up of the knees altered with lethargy in between paroxysms. upper mid abdomen, tender distended What are some of the reasons for delaying vaccines in a child? -correct answer Fever > 100.4, receiving immunoglobulins (must wait 6-9 months) Are there any specific reasons to delay live vaccines vs. inactive vaccines? -correct answer Do not give live vaccines in chemo and long-term steroid use. Name some differences between the presentations of anorexia nervosa and bulimia - correct answer Anorexia- Marked by weight loss and restriction of calories; common ritualized exercise; hypotension and bradycardia; risk of hypokalemia and arrythmia Bulimia- Binge/purge cycle; weight may be normal; binge eating; hypotension and bradycardia uncommon; risk of hypokalemia, arrhythmia, and esophageal rupture. In a patient with anorexia nervosa, name some indications for hospitalization -correct answer Body weight less than 25% of IBW Intractable weight loss despite treatment Refusal to eat Prolonged QT interval; other arrhythmias Bradycardia of 35-40 bpm

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Symptomatic hypotension Body temp < 96 What lab values would be concerning that medication may be missed or inadequately dosed in a child with hypothyroidism? A. decreasing TSH B. No change in TSH C. A decreasing T D. An increase in thyroglobin antibodies -correct answer B. No change in TSH. If medication has been missed or inadequately dosed, you should see an elevated TSH. You wouldn't be testing T4. When interviewing an adolescent, he admits that he does not like his school and doesn't have many friends. He has quit the soccer team because "it is boring". Mom adds that his grades are declining and all he does is sleep when he is home. What do you expect is happening? What questions would you want to ask him? What responses raise a red flag? -correct answer Hitting on access to modality such as access to a gun if part of a SI increases severity risk--- may need crisis. Do NOT allow parent to transport to hospital. Accessing safety is key and most important first line. A pregnant mother brings in her 5 year old complaining of a rash. You diagnose the child with Scarletina. What counseling do you provide? Are there any risks to mom? Are there any rashes that would cause concern given mother's condition? -correct answer No risk to mother. Rashes concerning include Rubella, Varicella and Fifth's Disease The FNP is caring for an adolescent with diabetes. The teen tells the nurse that he cannot join his friends at a local fast food restaurant because of his diet. Which of the following intervention is MOST appropriate for the FNP to use at this time? A. Reinforce the importance of dietary guidelines in diabetic care. B. Encourage him to bring food he can eat to the fast food restaurant. C. Help him to select restaurant fast foods that will fit into his diet plan. D. Refer him to a support group of teens with diabetes. -correct answer C. Help him to select restaurant fast foods that will fit into his diet plan. Elizabeth, age 4, comes for her preschool physical and you note that she has not gained much weight since her last visit. Mom tells you that she eats all the time and she goes to the bathroom frequently and can't seem to get enough to drink. After the exam and labs, you diagnose type I diabetes. You explain to Elizabeth and her mom:

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A. She will outgrow this when she is an adult B. This is a defect with the beta cells. in the pancreas and she cannot make her own insulin. C. She will only need shots until she is a teenager and then she can take the oral medication. D. She will not be able to participate in any sports. -correct answer B. This is a defect with the beta cells in the pancreas and she cannot make her own insulin. The NP prescribes iron supplementation for 3 year old Luke. When instructing his mother how to give the iron preparation it is important for the NP to stress that iron: A. Is best absorbed on an empty stomach B. Is best absorbed when given with milk C. Should not be given near bedtime D. Is best absorbed when given with meals. -correct answer A. Is best absorbed on an empty stomach. A father brings his 3 year old child to be assessed. The father states that his son doesn't enjoy playing with his toys, hasn't spoken his first word yet, and spins the tire of his toy constantly. The FNP determines that the client may have: A. Mental retardation B. Conduct disorder C. Autism D. Attention Deficit Hyperactivity Disorder (ADHD) -correct answer C. Autism Which statement demonstrates that the mother understands the diagnosis of attention deficit hyperactivity disorder? A. My son will never go to college B. My son's performance will improve in a structured setting that provides rewards for appropriate behavior. C. My son doesn't have anything wrong with him. He just has bad teachers. D. He is just going through a stage. -correct answer B. My son's performance till improve in a structured setting that provides rewards for appropriate behavior. John, a 10 year old boy, has type I diabetes. His late afternoon blood sugars over the past 2 weeks have ranged between 210 and 230. He is currently on 10 units of regular insulin and 25 units of NPH in the morning and 15 units of regular insulin and 10 units NPH insulin in the evening. Which of the following is the best treatment plan for this patient? A. Increase both types of the morning dose. B. Increase only the NPH in the morning C. Decrease the afternoon dose of NPH insulin

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D. Decrease both NPH and regular insulin doses in the morning. -correct answer B. Increase only the NPH morning dose. Insulin chart -correct answer What are the characteristics of Type I diabetes -correct answer Absolute insulin deficiency Has an abrupt onset Ketosis prone Generally not obese Insulin dependent Not responsive to oral agents Onset usually 18 years or younger What are the characteristics of Type II diabetes? -correct answer Insulin resistance Insidious onset Not prone to ketosis Usually obese Non-insulin dependent Responsive to oral hypoglycemic medications Onset usually in adults BUT SEEN IN OBESE CHILDREN AND ADOLESCENTS What is first line treatment for Type II diabetes? -correct answer Lifestyle management with diet and exercise = weight loss A 2 year old girl has a generalized tonic clonic seizure that lasts 1 minute while she is febrile. If the patient recovers and the source of the fever is identified, should she be placed on an antiepileptic or undergo further testing? -correct answer No The mother is 18 month old TW states that the child has been irritable and has not been sleeping will secondary to itching. During the physical exam, you note fine papular lesions in linear pattern worse along finger webs and inguinal area. What diagnosis is most likely? A. Atopic dermatitis B. Contact dermatitis C. Scabies D. Tinea Corporis -correct answer C. Scabies Having confirmed the diagnosis of scabies in TW, what is the treatment of choice? A. Permetherin 5% B. Lindane 1% C. Sulfur Ointment 6% D. Crotamiton 10% -correct answer A. Permetherin 5%

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A 14 year old adolescent has been diagnosed with mononucleosis. The FNP should teach the adolescent and the parents that which of the following should be avoided? A. Strenuous activity and any contact sports B. Weight-bearing activities until lab tests show resolution of the disease. C. Unnecessary activity until lymph nodes return to normal size. D. Stretching and reaching activities during the acute stage of illness. -correct answer A. Strenuous activity and any contact sports The mother of a toddler with a typical roseola-type rash and a history of high fever asks if there is any treatment available for the condition. The FNP tells the mother that: A. Topical corticosteroids are helpful to relieve itching B. Oral Diphenhydramine is helpful to decrease desquamation C. Aspirin should be used to treat the typical high fever. D. There is no medical treatment for roseola. -correct answer D. There is no treatment for roseola Which of the following vaccines is contraindicated for routine use in a 3 year old child who is receiving vin-cristine for maintenance treatment of acute lymphocytic leukemia? A. DPT B. Injectable influenza C. MMR D. Hepatitis B. -correct answer C. MMR Mrs. B. has brought 5 year old Julio to the clinic. She reports that he has been lethargic and has been running a low-grade fever for about 2 wees. Physical exam reveals no significant findings other than pallor and lymphadenopathy. A complete blood count reveals a decreased hematocrit, neutropenia, and thrombocytopenia. The practitioner's next action should be to: A. Prescribe a broad spectrum antibiotic and ferrous sulfate B. Instruct Mrs. B on the appropriate use of acetaminophen to treat Julio's fever C. Reassure Mrs. B that Julio's signs and symptoms are indicative of a viral infection D. Refer Julio to a pediatric hematologist/oncologist for further evaluation. -correct answer D. Refer Julio to a pediatric hematologist/oncologist for further evaluation. An abnormality of more than one formed element of the blood (RBC, WBC, or Platelets) may indicate aplastic anemia (bone marrow dysfunction) or cancer, and should be evaluated by a physician When lab results reveal a hypochromic, microcytic anemia in a 2 year old child, differential diagnosis must include

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A. Lead poisoning B. Pernicious anemia C. Hemophilia D. Folic acid deficiency -correct answer A. Lead poisoning.- Causes hypochromic, microcytic anemia. Pernicious anemia and folic acid deficiency are associated with macrocytosis The mother of an 11 year old boy is concerned that her son is developing secondary sexual characteristics too early. Your counseling for this family is based on the knowledge that puberty is considered precocious in boys if secondary sexual characteristics appear prior to age: A. 12 B. 11 C. 10 D. 9 -correct answer D. 9 The pathophysiology of type I diabetes: A. Autoimmune destruction of the pancreatic beta cells. B. Primary insuiln receptor resistance C. Increased hepatic glucose production D. Reduces glucose uptake by target tissue -correct answer A. Autoimmune destruction of the pancreatic beta cells. An 11 year old girl presents at a well-child visit with symptoms of polyuria and polydipsia. Which of the following diagnosis must be ruled out? A. Diabetes Mellitus B. Hyperthyroidism C. Adrenocortical Insufficiency D. Nephrotic syndrome -correct answer A. Diabetes Mellitus Amanda is a 6 month old infant recovering from a viral illness. At the peak of her illness ( 2 days ago), she spike a temp of 104 and experienced a febrile seizure. Amanda's mother is young and inexperienced, but is very open to teaching. She wants to know if the seizure will "do anything" to Amanda. While teaching this new mother about simple febrile seizures, it would be accurate to say that Amanda: A. Is at increased risk for epilepsy as an adult B. Would benefit from the phenytoin prophylaxis C. May experience repeated seizures. D. Would benefit from phenobarbital prophylaxis -correct answer C. May experience repeated seizures

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Children with a diagnosis of simple febrile seizures may experience repeated febrile seizures, particularly if the first seizure occurred before 1 year of age. They are not at increased risk for epilepsy as adults, phenytoin is not efficacious as a prophylactic drug, and phenobarbital is not routinely recommended. A 17 year old college freshman is seen in the student clinic with a complaint of migraine headaches. In collecting the history, you would expect him to say he experiences pain: A. Throughout the head without any localization B. Restricted to one side of his head during an episode C. Mostly in the Occipital area. D. Across his head from one temporal side to another. -correct answer B. Restricted to one side of the head during an episode Upon physical exam of a 4 year old boy, you note seven cafe au lait spots greater the 5mm in diameter. This finding may be indicative of: A. Tuberous sclerosis B. Sturge-Weber disease C. Duchenne's Dystrophy D. Neurofibromatosis -correct answer D. Neurofibromatosis. More than six caafe au lait spots (greater than 5mm in diameter) in prepubertal children is an essential part of the diagnosis of neurofibromatosis Which of the following signs is NOT characteristic of generalized seizures? A. Unilateral motor manifestations B. Disturbance of consciousness C. Tonic stiffening of the trunk D. Simultaneous and symmetrical cerebral hemisphere discharge -correct answer A. Unilateral motor manifestations Primary immunization is of paramount importance for preventing meningitis especially in young children that is caused by: A. Haemophilus influenzae type b B. Neisseria meningitidis C. Escherichia coli D. Klebsiella pneumonia -correct answer A. Recommended primary immunization schedules include vaccines licensed for use against H. influenzae type B (key- young children) 16 year old female, D.H., in for well child visit. Weight > 95th percentile, height 50th percentile. Physical exam shows acanthosis nigrans. She also complains of missing

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period for past 2 months. DH is not sexually active and HCG is negative. Lab work reveal HGB A1C 7.4. In counseling the patient and mom, you discuss: A. DH is at risk for developing diabetes but more importantly needs to have amenorrhea workup B. DH is currently diabetic and will require insulin to manage sugar. C. DH is currently diabetic and start on Metformin immediately to manage sugar D. DH is currently diabetic and will need to see dietician and begin regimen of diet and exercise initially to manage disease process -correct answer D. DH is currently diabetic and will need to see a dietician and begin regimen of diet and exercise initially to manage. Virginia comes to your office stating that there were abnormal results on her most recent ultrasound. She proceeds to tell you that the baby may have a cleft lip and/or palate. She asks why did this occur and how is this treated? You tell her... A. It can occur with genetic syndromes and is an incomplete fusion of fetal tissue. It can be treated with surgery but needs to await the baby's arrival for a definitive diagnosis and treatment plan. B. It can runin families and is the most common craniofacial malformation and treatment depends on the severity. C. You are on Dilantin which may be the cause and either a cheiloplasty and/or staphylorrhaphy is the treatment D. All of the above. -correct answer D. all of the above Clyde, an 8 year old male comes to the office for follow-up of abdominal pain. He has numerous visits to urgent care and the emergency department with negative CT scan, ultrasound, and lab work. His mother asks what the problem is and you tell her the greatest suspicion is for... A. Appendicitis B. Intussisception C. Cholecystitis D. Functional Abdominal Pain -correct answer D. Functional abdominal pain No organic disorder is identified and is now chronic Which of the following diagnostic tests or laboratory test results should cause the nurse to suspect that the child has appendicitis? A. Increased BUN levels on BMP B. Increased WBC on serum CBC C. Increased Bands on differential of CBC D. Barium enema testing positive for structural defects E. Abdominal Ultrasound -correct answer B. Increased WBC on serum CBC E. Abdominal Ultrasound

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A 2 year old child has a chronic history of constipation and stool holding behaviors is brought to the clinic for evaluation. The first step in the therapeutic plan initially includes: A.Bowel cleansing with oral or rectal laxatives B. Dietary Modification C. Structured toilet training D. Behavior modification -correct answer A. Bowel cleansing with oral or rectal laxatives would be the first step. The child has to get "cleaned out", then you could start with the other options A FNP should know that a child with intussusseption would present with the following symptoms? -correct answer Intermittent abdominal pain alternating with no pain Jelly stool Vomiting alternating with no vomiting Barium enema -correct answer Not only diagnostic but many times therapeutic A FNP who is assessing a child for Meckel's diverticulum would look for what clinical symptoms? -correct answer Painless bright red bleeding No pain DX: Nuclear scan to detect gastric tissue. An infant with pyloric stenosis is at risk for: (select all that apply) A. Dehydration B. Metabolic Acidosis C. Hyperbilirubinemia D. Metabolic Alkalosis -correct answer A. Dehydration D. Metabolic Alkalosis Pt. Presents with projectile vomiting. Bilious vomiting causes metabolic alkalosis The management of a 2 year old with nephrotic syndrome includes all of the interventions or treatments EXCEPT: A. Corticosteroids B. Albumin and Lasix C. Ribavirin D. Fluid Restrictions -correct answer C. Ribavirin Not viral but autoimmune Which of the following findings would the nurse expect to assess in a child with acute glomerulonephritis? A. Dysuria and azotemia B. OLiguria and hypertension

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C. Glycosuria and polyuria D. Nocturnal and proteinuria -correct answer B. Oliguria and hypertension A child with cryptorchidism who was discharged after an outpatient orchioplexy arrives in your clinic for follow-up. The FNP provides all of the following anticipatory guidance except: A. Monitor the surgical site for infection B. The adolescent child will have to be diligent in performing testicular exams. C. The child should prevent participating in any type of rough play or straddle toys for a week D. The child will be at risk for priapism in the future. -correct answer D. The child will be at risk for priapism in the future 12 month old female with sudden onset of intermittent "temper tantrums" , vomiting and pain. Having an increased number of bowel movements. VS: 99.4F, 130bpm, RR36, BP 102/60, 99% PMH: MRSA -correct answer Intussusseption 7 year old male comes on complaining of "tummy hurts" Has had right sided abdominal pain for the past couple of days, vomiting an fever to

PMH: Inflammatory linear verrucous epidermal nexus syndrome, granule (delta) storage pool deficiency, autism, developmental delay Med: dextroamphetamine, cyproheptadine, risperidone -correct answer Appendicitis 10 year old female with vomiting and diarrhea for 24 hour. Unresponsive initially but now more responsive. Temp 103.5, 130 bpm, RR 40, BP 110/70, 85% initially now 96%. Received 500ml fluid bolus, cap refill 5 seconds, No urination. PMH: All of the patient's family members had recently been sick but improved without treatement. -correct answer Severe gastroenteritis with dehydration GERD -correct answer Pathological alterations in protective mechanisms causing bothersome signs and symptoms and complications if not treated. May present with coughing and wheezing, worse when lying down, increased incidence of pna. Presenting signs and symptoms of GERD -correct answer Recurrent vomiting in infant Recurrent vomiting and poor weight gain in infant Recurrent vomiting and irritability in infant Recurrent vomiting in older child Heartburn in child/adolescent Esophagitis Dysphagia or feeding refusal Apnea Asthma Recurrent pna

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Upper airway symptoms Sandifer's syndrome Dental Erosion GERD red flags -correct answer Bilious or forceful vomiting Hematemesis, Hematochezia Dysphagia Abdominal tenderness or distinction Failure to thrive Fever, lethargy, HSM Macro or microcephalic, seizures Persistent or recurrent symptoms Management of GERD -correct answer Conservative therapy is first line: Positioning, thickened feeds Then pharmacotherapy if conservative failure Conservative treatment for infants with GERD -correct answer Normalize feeding volume and frequency Consider thickened formula Consider non-prone positioning during sleep Consider trial of hypoallergenic formula for 1 month before starting meds Conservative treatment for older children with GERD -correct answer Avoid large meals Do Not lie down immediately after eating Lose weight if obese Avoid caffeine, chocolate, and spicy foods that provoke symptoms Eliminate exposure to tobacco smoke Pharmacotherapy for GERD -correct answer Antacids- neutralize gastric acidity- can use short term, not long-term solution H2 Blocker- blocks acid production- Zantac, Pepcid PPI-Completely blocks the production of stomach acid by shutting down the proton pump- "azoles". Do not stop abruptly Reglan- Increases gastric emptying and intestinal transit without increasing GI secretions. Risk of high dose and long term use for Tardive Dyskinesia Surface Mucosal Protector- Carafate- A coating agent that adheres selectively to damaged mucosa. May cause aluminum toxicity When to refer the GERD patient to a GI specialist -correct answer GERD that is refractive to therapy Relapses off therapy Failure to thrive Stricture Barrett's Esophagus

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Adenocarcinoma Extra-esophageal presentations Summary of GERD -correct answer Most often presents with effortless vomiting Path logic GERD is often associated with malnutrition, respiratory disease, and esophagitis Diagnosis is frequently based on comprehensive history and physical exam CONSERVATIVE THERAPY IS CRITICAL FIRST STEP Empiric pharmacotherapy with antacids or H2 blockers is reasonable in the thriving infant. Pyloric Stenosis- What is it? -correct answer Hypertrophy and hyperplasia of the pyloric muscle What are the characteristic findings in pyloric stenosis? -correct answer Projectile vomiting and loss of gratis contents Dehydration Failure to thrive Visible left-to-right peristalsis Olive-shaped mass just right of the umbilicus Most commonly seen in the first born child, males > females, 1st few weeks of life. Meckel's Diverticulum -correct answer Is an out pocketing pouch containing gastric or pancreatic tissue that secretes HCl acid or pancreatic enzymes, causing irritation- ulceration- abscess MOST COMMON CAUSE OF GI BLEEDING IN CHILDREN Classic sign of Meckel's Diverticulum -correct answer Painless, bright red rectal bleeding The Rule of Twos in Meckel's Diverticulum -correct answer 1. Meckel's diverticulum is estimated to be present in 2% of the population 2 About 2% of the affected population presents with clinical findings typically before age 2 years 3 The condition is two times more common in males than females. Meckel's diverticulum Complications -correct answer Inflammation Obstruction (intussusseption or volvulus) Painless hematochezia (bright red bleeding suggests hemorrhage) Stools can be dark maroon (most common), bright red, or tarry Occasional infarction Intussusseption -correct answer Usually occurs in the first 24 months of life. Episodes of acute abdominal pain with intervals of no pain

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Vomiting Abdominal mass Later- Currant jelly stools, abdominal distinction Diagnostic/therapeutic treatment for intussesception -correct answer Barium enema Anticipatory guidance for Intussusception -correct answer Inform parents that it can recur. Foreign bodies -correct answer Infants and small children at greatest risk Generally classified as: Sharp or dull Pointed or blunt Toxic or nontoxic Small button batteries are the most common toxic foreign body ingested. Rubeola (Ordinary measles) -correct answer 3 C's: Conjunctivitis, Cough, Coryza (runny nose) Fever Koplik spots on buccaneers mucosa Rash appears at hairline and spreads cephalocaudally over 3 days. NOT PRURITIC Complications: Secondary bacterial infection encephalitis, subacute sclerosis grandson 5th Disease/Erythema Infectiosum (Parvovirus B19) -correct answer Rash: Slapped cheeks (raised uniform maculopapular). May appear on extensor surfaces. Usually NOT pruritic Flu-like illness 1-3 days riot to rash Complications: Arthritis (10%), vasculitis APLASTIC CRISIS reticulocytopenia During pregnancy: fetal hydrosphere/fetal loss Which of the following viral infections is associated with occasional abnormal forms of lymphocytes during an acute infection? A. Cytomegalovirus (CMV) B. Epstein-Barr Virus (EBV) C. Human Papilloma Virus (HPV) D. Coxsackie virus -correct answer B. Epstein-Barr virus (EBV) A test for an acute infection of the Epstein-Barr virus will show abnormal forms of lymphocytes EBV is the MOST common cause of neutropenia in children Rosella Infantum (Exanthum Subitum)(Human Herpes Virus 6) -correct answer Affects young children 6-36 months old Caused by human herpes virus 6 Abrupt high fever After fever subsides, a rash develops, starting on the neck and trunk and spreading to the face and extremities. NON-PRURITIC!

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Complications: Febrile seizures Chickenpox (Varicella Zoster) -correct answer Rash: Everywhere! Vesicles on macules (dewdrops on rose petals). VERY PRURITIC!!!!! 1-3 day pro drone of fever an respiratory symptoms Complications: Congenital varicella syndrome (1st or 2nd trimester) DDH (Developmental Dysplasia of the Hips) -correct answer Can mean many things: Laxity, subluxation, dislocation, acetabular dysplasia PAINLESS CONDITION Limited hip abduction of less than 60 degrees while the knee is in 90 degrees of fexion is believed to be the MOST sensitive sign for detecting dysplastic hip Galeazzi Sign: Positive Positive Ortaloni & Barlow signs Treatment: Pavlik harness, Spica cast, Closed/open reduction Salter-Harris fracture classifications -correct answer Mnemonic SALTR Type I: Slipped Fracture plane passes all the way through the growth plate, not involving bone Type II: Above Fracture passes across most of the growth plate and up through the metaphysics Type III: Lower Fracture plane passes some distance along the growth plate and down through the epiphysis Type IV: Through or Transverse or Together Fracture plane passes directly through the metaphysics, growth plate and down through the epiphysis Type V: Ruined or Rammed Crushing type injury does not displace the growth plate but damages it by direct compression Torus (Buckle) Fracture -correct answer Most common upper extremity fracture in kids (along with Salter Harris type I) Most commonly occur when kids fall with outstretched hands. Galeazzi sign -correct answer Elicited by placing the child supine with both hips and knees flexed. An inequality in the height of the knees is a positive Galeazzi sign and is usually caused by hip dislocation or congenital femoral shortening. Ortaloni Sign -correct answer Elicited by placing infant supine. The examiner's long finger is placed over the greater trochanter and the thumb over the inner side of the thigh. Both hips are flexed 90 degrees and then slowly abducted from the midline, one hip at a time. With gentle pressure, an attempt is made to lift the greater trochanter forward. A feeling of slipping as the head relocates is a sign of instability. A test of reducability

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Is positive only if a dislocated hip is reduced. Is negative if: a hip lies reduced OR: if a hip is dislocated and irreducible! Barlow Sign -correct answer When the joint is more stable, the deformity must be provoked by applying slight pressure with the thumb on the medial side of the thigh as the thigh is addicted, thus slipping the hip posteriorly and eliciting a palpable clunk as the hip dislocates. Trendelenburg sign -correct answer When the child stands on the affected leg, a dip of the pelvis will be evident on the opposite side, due to weakness of the gluteus mediums muscle. This accounts for the unusual swaying gait. Slipped Capital Femoral Epiphysis (SCFE) -correct answer Caused by displacement of the proximal femoral epiphysis due to disruption of the growth plate. Most commonly seen in Adolescent, obese males Risk factors: endocrine disorders, obesity, deep acetaular socket (coax profunda), and femoral or acetabular retroversion. Clinically, classified as stable or unstable Stable if able to bear weight Unstable if unable to bear weight- causes increased rate of avascular necrosis Acute SCFE occasionally occurs following a fall or direct trauma to hip Clinical presentation of SCFE -correct answer May or ma not have pain in the hip/groin region May or may not have knee pain (may only complain of knee pain) External rotation affected limb Limp Limited internal rotation Diagnostics for SCFE -correct answer AP and frog views of hips Treatment of SCFE -correct answer Non-weight bearing Refer immediately for surgery (through ED if necessary) How is Risser sign used to help determine classification of skeletal maturity when dealing with idiopathic scoliosis? -correct answer Risser's sign refers to the amount of calcification of the human pelvis as a measure of maturity. It is based on the observation of an X-ray image. The grade of 5 indicates that skeletal maturity has been reached. Physical Exam in determining Idiopathic scoliosis -correct answer Cutaneous findings: neurofibromatosis (characterized by cafe a lait spots) is closely associated with scoliosis Neurological status: if abnormal, consider presence of underlying spinal cord abnormality

• Reflexes, sensory, strength

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• Ability to heel walk, toe walk, balance Spinal balance
• Adam's Forward Bend Test: MOST specific test for scoliosis; often used during school screening for scoliosis.
• symmetry
• Trunkopelvic alignment Treatment of idiopathic scoliosis -correct answer Observation: Recommended for curvature <25 degrees on X-ray Bracing: if skeletally immature, recommended for curves 25-45 degrees. Most effective if worn between 18-20 hour/day, especially during the day when the child is upright. Surgery: for curves >45 degrees Goal: Spinal balance Overuse syndromes in young athletes -correct answer Tibial tubercle (Osgood- Schlatter) Patella (Sinding-Larson-Johansson) Calcaneus(Sever's) Epidemiology of overuse syndromes (Osteochondroses) -correct answer Areas of inflammation at the apophysis (ossification center) where tendon attaches; causes micro trauma and pain to the area of inflammation Affects teenage athlete during periods of growth Occurs typically unilaterally; but can occurjbilaterally 20-30% of the time in Osgood- Schlatter and Sever's Disese Osgood-Schlatter Disease -correct answer Common cause of ANTERIOR knee pain in children and adolescents Painful over tibial tuberosity- PMT- s at the tibial tuberosity Tender to palpating. With or without swelling Knee exam otherwise normal Cartilage overgrowth is responsible for the bump Treatment: Self-limiting process that responds well to activity modification and NSAIDS
• Quad stretching
• Relative rest if limping
• ICE, +/- NSAIDS Siding-Larson-Johansson Syndrome -correct answer Similar to Osgood-Schlatter, except that SLJ occurs at the inferior pole of the patella Most commonly seen in boys 10-12 involved in jumping sports Point tenderness is localized to the inferior pole of the patella Treatment is Quad stretching and relative rest.

Complete Solutions

Sever's Apophysitis -correct answer Sever's disease, or cal animal apophystitis (inflammation of the growth plate in the heel), is a common cause of heel pain in young athletes. Heel pain, unilateral or bilateral; typically seen in athletes 9-12 involved in running or jumping activities (with soccer being the most common) Once foot is done growing- diagnosis may progress from Sever's to Achillie's tendinitis Physical Exam: -Tenderness with heel compression; often with tight achilles tendon -Limp with acitivities or after activities an may limp first thing in the morning -Tight heel cords Treatment:

• gastrocnemius-Sousa (calf muscle) stretching
• shock absorbing insoles/heel lift (to take stress of heel)
• Soccer cleats can aggravate the symptoms; try to use regular shoes during practice and reserve wearing cleats during games or when field is muddy and additional traction is needed. Musculoskeletal infections in children -correct answer Septic arthritis Osteomyelitis Transient Synovitis Septic Arthritis -correct answer Acute bacterial infection of a joint (but may also present as chronic infection) May or may not be associated with trauma Onset of acute bony pain, limping, or refusal to walk Usually in long bones (tibia and fibula most common) Fever, warmth, edema, and erythema possible is an EMERGENCY CONDITION! Refer to ED for immediate treatment! Transient synovitis -correct answer Due to a viral condition Considered only after ruling out osteomyelitis and septic arthritis Usually limp or pain after minor illness (usually after URI) May have mildly decreased motion in the affect joint Non-toxic appearing, not usually febrile Relatively normal labs vs ESR and CRP in septic arthritis The following are risk factors for hypertension in children and teens: (choose all that apply) A. Being obese B. Drinking whole milk C. Being exposed to second-hand smoke D. Watching 2 or more hours of TV/day -correct answer A. Being obese C. Being exposed to second-hand smoke

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Fruit juice intake is acceptable in children 6 months and older per the following recommendation (choose all that apply): A. The juice is mixed in small amounts to flavor water B. Only 100% juice is used C. Juice replaces no more than one serving of milk D. The juice is consumed in the morning with breakfast. E. No more than 6oz (177 ml) per day is recommended for children 6 months to 5 years. -correct answer A. The juice is mixed in small amounts to flavor water B. Only 100% juice is used E. No more than 6 oz (177ml) per day is recommended for children 6 months to 5 years In evaluating a healthy 9 year old child with a healthy BMI during a well visit, a comprehensive cardiovascular evaluation should be conducted by the following methods (choose all that apply): A. Obtain fasting lipid profile B. Screen for type 2 DM by measuring HbA1c C. Assess for family history of thyroid disease D. Assess diet and physical activity -correct answer A. Obtain fasting lipid profile D. Assess diet and physical activity At what age is it appropriate to recommend dietary changes to parents if overweight or obesity is a concern? A. 12 months old B. 5 years old C. 10 years old D. 18 years old -correct answer A. 12 months old The following are risk factors for type 2 DM in children and teens (Choose all that apply): A. Hyperinsulinemia B. Abnormal weight-to-height ratio C. Onset of nonorganic failure to thrive in the toddler years D. Native American ancestry -correct answer A. Hyperinsulinemia B. Abnormal weight-to-height ratio D. Native American ancestry Screening children with a known risk factor for type 2 DM s recommended at age 10 or at onset of puberty, and should be repeated how often? A. Every other year B. Every year C. Every six months D. If child presents with a BMI in the 85th percentile or higher -correct answer A. Every other year Prediabetes in children is defined as (choose all that apply):

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A. Impaired fasting glucose (glucose level >= 100mg/dl or 6.2) but<= 125 mg/dl or 7.0 B. Impaired glucose tolerance (2-hour postprandial >= 140-199mg/dl or 7.8-11) C. Body mass index in the 85th percentile or higher D. Body mass index in the 60th percentile or higher -correct answer A. B. Risk factors for dyslipidemia in children include (choose all that apply): A. Blood pressure at the 70th to 80th percentile for age B. Breastfeeding into the toddler years C. Family history of lipid abnormalities D. Family history of Type II DM -correct answer C.Family history of lipid abnormalities D. Family history of Type II DM Screening cholesterol levels in children with one or more risk factors begins at what age? A. Birth B. 2 years C. 5 years D. 10 years -correct answer B. 2 years An acceptable level of total cholesterol in children and teens is: A. <170 B. <130 C. 110-130 D. 130-199 -correct answer A. <170